An advance health care directive, also known as living will, personal directive, advance directive, or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity. In the U.S. it has a legal status in itself, whereas in some countries it is legally persuasive without being a legal document.A living will is one form of advance directive, leaving instructions for treatment. Another form is a specific type of power of attorney or health care proxy, in which the person authorizes someone to make decisions on their behalf when they are incapacitated. People are often encouraged to complete both documents to provide comprehensive guidance regarding their care. An example of combination documents includes the Five Wishes in the United States. The term living will is also the commonly recognised vernacular in many countries, especially the U.K. Wikipedia.
Veredas F.,University of Malaga |
Mesa H.,Advance Health |
Morente L.,Area de Enfermeria Comunitaria
IEEE Transactions on Medical Imaging | Year: 2010
A pressure ulcer is a clinical pathology of localized damage to the skin and underlying tissue caused by pressure, shear, or friction. Diagnosis, treatment, and care of pressure ulcers are costly for health services. Accurate wound evaluation is a critical task for optimizing the efficacy of treatment and care. Clinicians usually evaluate each pressure ulcer by visual inspection of the damaged tissues, which is an imprecise manner of assessing the wound state. Current computer vision approaches do not offer a global solution to this particular problem. In this paper, a hybrid approach based on neural networks and Bayesian classifiers is used in the design of a computational system for automatic tissue identification in wound images. A mean shift procedure and a region-growing strategy are implemented for effective region segmentation. Color and texture features are extracted from these segmented regions. A set of κ multilayer perceptrons is trained with inputs consisting of color and texture patterns, and outputs consisting of categorical tissue classes which are determined by clinical experts. This training procedure is driven by a κ-fold cross-validation method. Finally, a Bayesian committee machine is formed by training a Bayesian classifier to combine the classifications of the κ neural networks. Specific heuristics based on the wound topology are designed to significantly improve the results of the classification. We obtain high efficiency rates from a binary cascade approach for tissue identification. Results are compared with other similar machine-learning approaches, including multiclass Bayesian committee machine classifiers and support vector machines. The different techniques analyzed in this paper show high global classification accuracy rates. Our binary cascade approach gives high global performance rates (average sensitivity =78.7\%, specificity =94.7\%, and accuracy =91.5\%) and shows the highest average sensitivity score (=86.3%) when detecting necrotic tissue in the wound. © 2010 IEEE.
McManus M.A.,Advance Health |
Pollack L.R.,Advance Health |
Cooley W.C.,National Health Care Transition Center |
McAllister J.W.,National Health Care Transition Center |
And 3 more authors.
Pediatrics | Year: 2013
OBJECTIVE: To examine current US performance on transition from pediatric to adult health care and discuss strategies for improvement. METHODS: The 2009-2010 National Survey of Children with Special Health Care Needs is a nationally representative sample with 17 114 parent respondents who have youth with special health care needs (YSHCN) ages 12 and 18. They are asked about transition to an adult provider, changing health care needs, increasing responsibility for health care needs, and maintaining insurance coverage. We analyzed the association of selected characteristics with successful transition preparation. RESULTS: Overall, 40% of YSHCN meet the national transition core outcome. Several factors are associated with transition preparation, including female gender; younger age; white race; non-Hispanic ethnicity; income ≥400% of poverty; little or no impact of condition on activities; having a condition other than an emotional, behavioral, or developmental condition; having a medical home; and being privately insured. CONCLUSIONS: Most YSHCN are not receiving needed transition preparation. Although most providers are encouraging YSHCN to assume responsibility for their own health, far fewer are discussing transfer to an adult provider and insurance continuity. Although changes in sample design limit trend analysis, there have been no discernible improvements since this transition outcome was measured in the 2005-2006 National Survey of Children with Special Health Care Needs. The 2011 release of the American Academy of Pediatrics/American Academy of Family Physicians/American College of Physicians clinical recommendations on transition, new transition tools, and the spread of medical home should stimulate future improvements in transition performance.
Hopp F.P.,Wayne State University |
Martin L.,Wayne State University |
Zalenski R.,Advance Health
Social Work in Health Care | Year: 2012
This study addresses the need for more information about how urban African-American elders experience advanced heart failure. Participants included 35 African Americans aged 60 and over with advanced heart failure, identified through records from a community hospital in Detroit, Michigan. Four focus groups (n = 13) and 22 individual interviews were conducted. We used thematic analysis to examine qualitative focus groups and interviews. Themes identified included life disruption, which encompassed the sub-themes of living scared, making sense of heart failure, and limiting activities. Resuming life was a contrasting theme involving culturally relevant coping strategies, and included the sub-themes of resiliency, spirituality, and self-care that helped patients regain and maintain a sense of self amid serious illness. Participants faced numerous challenges and invoked a variety of strategies to cope with their illness, and their stories of struggles, hardship, and resilience can serve as a model for others struggling with advanced illness. © 2012 Copyright Taylor and Francis Group, LLC.
Rivera V.M.,Baylor College of Medicine |
Jeffery D.R.,Advance Health |
Weinstock-Guttman B.,State University of New York at Buffalo |
Bock D.,EMD Serono, Inc. |
Dangond F.,EMD Serono, Inc.
BMC Neurology | Year: 2013
Background: Registry to Evaluate Novantrone Effects in Worsening Multiple Sclerosis (RENEW) was a 5-year, phase IV study in which the safety of Mitoxantrone was monitored in a patient cohort from the United States (US). The objective of the study was to evaluate the long-term safety profile of Mitoxantrone in patients with secondary progressive multiple sclerosis (SPMS), progressive relapsing multiple sclerosis (PRMS), and worsening relapsing-remitting multiple sclerosis (RRMS).Methods: Overall, 509 patients (395 SPMS, 81 worsening RRMS, 33 PRMS) were enrolled and treated at 46 multiple sclerosis (MS) treatment centers located in the US. Patients received Mitoxantrone in accordance with the package insert every 3 months. During the treatment phase, patients received laboratory workups and cardiac monitoring every 3 months and then annually for a total of 5 years.Results: Five hundred and nine subjects were enrolled in this trial and received at least one infusion of Mitoxantrone. Overall, 172 (33.8%) completed the 5-year trial (i.e., participated for 5 years ± 3 months [treatment + follow-up]); 337 (66.2%) did not complete the 5-year trial. Annual follow-up data were available for 250 of 509 enrolled patients. Left ventricular ejection fraction reduction under 50% was reported in 27 (5.3%) patients during the treatment phase (n = 509) and 14 (5.6%) patients during the annual follow-up phase (n = 250). Signs and symptoms of congestive heart failure were observed in 10 (2.0%) patients (six during treatment phase and four during the annual follow-up phase). Post-hoc analyses of the risk for cardiotoxicity outcomes revealed that cumulative dose exposure is the primary risk factor associated with the risk of cardiac toxicity with Mitoxantrone. Therapy-related leukemia was reported in three (0.6%) patients who received total cumulative Mitoxantrone doses of 73.5 mg/m2, 107.3 mg/m2, and 97.1 mg/m2 respectively. During the treatment phase, persistent amenorrhea developed in 22% (28/128) of women with regular menses and 51% (25/49) of women with irregular menses at baseline. During the annual follow-up phase, persistent amenorrhea developed in 5% (4/73) of women with regular menses at baseline.Conclusion: RENEW results are consistent with the known safety profile of Mitoxantrone, and provide additional long-term safety data for Mitoxantrone in MS patients. © 2013 Rivera et al.; licensee BioMed Central Ltd.
Jeffery D.R.,Advance Health
Therapeutic Advances in Chronic Disease | Year: 2013
The development of new pharmacologic agents for the treatment of multiple sclerosis (MS) and advances in testing for exposure to the JC virus have led to changes in the treatment of MS. In addition several new agents are in late stage development for MS and their entry onto the market will provide additional treatment options. In 2012 and in early 2013, it is likely that both terifunomide and BG-12 will be approved by the United States Food and Drug Administration (FDA) for the treatment of relapsing forms of MS. The therapeutic environment has already changed and is likely to change rapidly over the next several years. Fingolimod was the first oral agent approved for the treatment of MS and this agent is now widely used in patients intolerant of injections and the side effects associated with the older platform therapies. In many settings it is also used a first-line agent. Owing to the risk of progressive multifocal leukoencephalopathy, natalizumab had previously been reserved for patients with active disease who were intolerant of first-line agents or patients who were worsening despite standard therapy. With the availability of JC virus antibody testing, natalizumab is now being used as a first-line agent in patients negative for JC virus antibodies. Teriflunomide and BG-12 will become available in the next year. Both agents have suitable efficacy and a favorable safety and tolerability profile. There are advantages and disadvantages associated with all of the oral agents. In this article we summarize the clinical trial results regarding the efficacy and safety of the oral agents and discuss the changes that are already taking place in the therapeutic landscape for MS. © The Author(s), 2012.
Lloyd T.,Advance Health
Orthopaedic Nursing | Year: 2011
Prevention of falls is an issue of concern for all hospitalized patients. Certain units, however, may be at higher risk for falls due to patient diagnosis, comorbidities, and other intrinsic factors. Creation of a unit-specific fall-prevention program may be more effective at reducing incidence of falls in the adult orthopaedic inpatient setting. It may also be better valued by staff according to a critical analysis of the literature and staff survey of perceptions. This information was used as a starting point to create a template for a unit-based fall program specifically for high-risk units. The evidence from this analysis could be used to identify high-risk units and adapt existing generic fall-prevention programs to this higher risk population. Copyright © 2011 National Association of Orthopaedic Nurses.
Advance Health | Date: 2013-12-30
A medical screening system includes: a mobile device including: a user interface embodied in an input/output system; a processor; and a memory in communication with the processor, including stored instructions that, when executed by the processor, cause the processor to: provide a medical screening intake system that receives objective medical data, subjective medical data, and medical test results for a person as input through the user interface; receive the objective medical data, subjective medical data, and medical test results for the person as input through the user interface; automatically process the objective medical data, subjective medical data, and medical test results to generate one or more plans of care specifically adapted for the person; and communicate the one or more plans of care specifically adapted for the person to the person as a report embodied in a structured data output.
Prior M.,Advance Health |
Prior M.,Georgetown University |
McManus M.,Advance Health |
White P.,Advance Health |
Davidson L.,Georgetown University
Pediatrics | Year: 2014
BACKGROUND AND OBJECTIVES: Without adequate support, adolescents transitioning from the pediatric to the adult health care system are at increased risk for poor health outcomes. Numerous interventions attempt to improve this transition, yet few comprehensively evaluate efficacy. To advance evaluation methods and ultimately the quality of transition services, it is necessary to understand the current state of health care transition measurement. This study examines and categorizes transition measures by using the "Triple Aim" framework of experience of care, population health, and cost of care. METHODS: Ovid Medline and the Cumulative Index to Nursing and Allied Health Literature were searched for articles published between 1995 and 2013. Two reviewers independently screened studies and included those that evaluated the impact of a health care transition intervention. Measures were subsequently classified according to population health, experience of care, and costs of care. RESULTS: Of the 2282 studies initially identified, 33 met inclusion criteria. Population health measures were used in 27 studies, with disease-specific measures collected most frequently. Fifteen studies measured cost, most often service utilization. Eight studies measured experience of care, with satisfaction assessed most commonly. Only 3 studies examined all 3 domains of the " Triple Aim." Transition interventions described in the gray literature were not reviewed. CONCLUSIONS: Transition programs are inconsistently evaluated in terms of their impact on population health, patient experience, and cost. To demonstrate improvement in the transition from pediatric to adult health care, a more robust and consistent set of measures is needed. Copyright © 2014 by the American Academy of Pediatrics.
News Article | January 27, 2015
Chantilly, Virginia-based Advance Health, a health risk assessments provider, has secured $40 million in funding. Summit Partners led the round with participation from Noro-Moseley Partners. Choate Hall & Stewart LLP advised Summit Partners on the transaction while Bass, Berry & Sims PLC advised Advance Health. In conjunction with the funding, Mark deLaar of Summit Partners has been added to Advance Health’s board of directors. Chantilly, VA and Boston, MA – January 27, 2015 – Advance Health, a leading provider of managed care prospective health assessments and care management solutions, announced that it received a $40 million minority growth equity investment led by Summit Partners, with participation from Noro-Moseley Partners. Advance Health will use the funding to continue product innovation, broaden market awareness, and expand its sales and services capabilities. Advance Health provides in-home health risk assessments and chronic care management services through its extensive provider network. The company’s combination of proprietary mobile workflow technology and highly experienced, dedicated care providers yields outstanding program results and better outcomes for clients and their health plan members. “Summit’s deep experience in the healthcare sector will help our team accelerate Advance Health’s long-term business plans, enabling us to capitalize on new market opportunities,” said Brian Wise, CEO of Advance Health. “Our goal is to meet the demands of the fast-moving healthcare marketplace by providing clients with innovative health assessment and care management services.” “Advance Health is a clear leader in the managed care market,” added Mark deLaar of Summit Partners, who has joined the Advance Health Board of Directors. “With its broad geographic reach, exceptional team and innovative technology, Advance Health is delivering the highest level of services available in the marketplace today. We are honored to partner with Brian, Marc and the rest of the management team to support the company’s continued growth.” Allen Moseley, a General Partner with Noro-Moseley Partners, added, “Advance Health is the first provider to offer complete electronic assessment capture at the point of care through its proprietary iOS iPad and HTML5 application. We’re delighted to partner with Advance Health as they move on to the next generation of quality and care.” “With our new equity partners, we are even more excited about the future of Advance Health. Our innovative technology and differentiated solution will continue to set us apart in the managed care marketplace,” said Marc Wise, the President of Advance Health. Advance Health’s clients include many of the country’s largest managed care companies. These entities rely on Advance Health to provide outstanding care and service to their patients. Advance Health was advised by Bass, Berry & Sims PLC. Summit Partners was advised by Choate Hall & Stewart LLP. About Advance Health Founded in 2010 and headquartered in Chantilly, VA, Advance Health is the leading healthcare provider of prospective health risk assessments (“HRAs”). Advance Health offers in-home and facility-based HRAs and chronic care management services for health plans. Advance Health employs a network of full-time Nurse Practitioners to provide its services. The company has developed a proprietary technology platform that providers use at the point of care. To date, the company has completed thousands of assessments for many of the largest Medicare Advantage programs in the United States. Visit Advance Health at www.advancehlth.com to learn more. About Summit Partners Founded in 1984, Summit Partners is a growth equity firm that has raised more than $16 billion in capital. Summit has invested in more than 400 companies in healthcare, technology and other growth sectors. These companies have completed more than 135 public offerings, and more than 150 have been acquired through strategic mergers and sales. Notable healthcare companies financed by Summit Partners include CareCentrix, HealthCare Partners, Heart to Heart Hospice, Lincare, MDVIP, Mednax and OB Hospitalist Group. Summit maintains offices in North America and Europe, and invests in companies around the world. For more information, visit www.summitpartners.com or follow on Twitter at @SummitPartners. About Noro-Moseley Partners Noro-Moseley Partners, based in Atlanta, is a venture capital firm focused on early growth stage companies in the healthcare IT and services sectors and information technology sectors. Since 1983, NMP has been a leader in its market, investing more than $650 million in over 175 companies. The managers of NMP’s current fund, Noro-Moseley Partners VII, have more than 60 years collectively of direct venture investing experience and bring a diverse set of skills to assist entrepreneurs in growing their companies. For more information, visit www.noro-moseley.com.