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News Article | February 15, 2017
Site: www.prweb.com

Sepsis Alliance and the High Reliability Organization Counsel (HROC) are joining forces to raise awareness of “superbugs,” or bacteria that are immune to drugs such as antibiotics. This partnership comes on the heels of a recent report by the Centers for Disease Control and Prevention (CDC) of a Nevada patient who recently died from a bacteria that could not be stopped by any antibiotic available in the U.S. The case in Nevada was not the first detection in the past year. In April, 2016, the Military identified a patient in Pennsylvania with a germ impervious to the antibiotic of last resort. Today, there is new evidence that these bacteria are circulating more widely than reported, and even among people with no signs of infection. The potential risks to patients and their loved ones cannot be overstated, and historic outbreaks have demonstrated the incredible toll such superbugs can take. For example, the nation's first large scale pandemic, the 1918 Spanish flu outbreak, was estimated to have killed up to 5% of the world's population. To put this in perspective, a mortality rate of 5% using current population numbers would equate to 350 million people globally. In the U.S., a 5% mortality rate would equal more than six times the number of people that died from all causes last year. Concerns of a pandemic were also just elevated by the CDC’s report in January, 2017 that death rates from influenza and pneumonia are now above epidemic thresholds. Flu and pneumonia are common precursors to sepsis, the body’s overwhelming response to infection that can lead to patient injury, limb amputation, or death. Consequently, treating infection early – and properly -- with effective antibiotics must be a primary mission for healthcare providers. Currently, the CDC notes drug-resistant bacteria cause 2 million illnesses and 23,000 deaths annually. Given the increase in infections in the past decade, more antibiotic use will be necessary and should be expected. Appropriate antimicrobial use and stewardship in healthcare will be critical, along with the reduced use of antibiotics in farming and the encouragement of new antibiotic development. Given the risks posed by these superbugs to national security, the United States Army commissioned a new research arm in 2009 to address the global threat of antibiotic overuse and preventable drug-resistant infections. The Multidrug-Resistant Organism Repository and Surveillance Network (MRSN) was designed to improve biosurveillance, and tied to about 100 military facilities around the world. Pandemic-level diseases such as the flu, Ebola, and other pathogens can spawn epidemics that can then result in sepsis -- the most dangerous of all complications from infection. Antibiotic-resistant bacteria are considered by experts to be the result of the overuse of antibiotics. To prevent possible infections from worsening, more people are using antibiotics with greater frequency and in stronger doses, given the threat to the elderly and the goal of avoiding severe infections and sepsis (currently a major focus nationwide). The paradox many healthcare providers are finding is that more resistant bacteria can emerge from this increased usage that, in turn, will not be able to be stopped by these antibiotics. To battle this crisis, one measure currently advocated by the CDC is "antimicrobial stewardship" (AMS). Studies have shown stewardship programs, involving increased monitoring, education within clinical settings, and improvements to antibiotic use, may lower the use of antibiotics by almost 20 percent. Such programs have also been linked to declining infection rates, especially from resistant microbes in a hospital. Given the presumed “limiting” associated with any stewardship program, a misconception exists that antimicrobial stewardship could make it even harder to fight sepsis, such as by delaying needed antibiotics. Research into another Military-led contribution against the pandemic threat, called the Military Acuity Model (MAM), suggests otherwise. Balancing the "not too little, not too much" in antibiotic use was key to the research conducted for MAM being applied to antimicrobial stewardship. "We have been doing research into how MAM can help reduce the threat to patients, and the ways reducing task saturation can help with this looming healthcare crisis," said Lieutenant Colonel Jared Mort, an expert on MAM and its implementation. "This strategy relies on people reacting precisely the right way at the right time. This was the reason for HROC's research into ensuring reliability in the proper timing and execution of care tasks." A study showing how MAM tackles this threat to patients and the public is expected to be published shortly. However, it is not the only research that seems to suggest more attention be focused on improving the means by which healthcare is delivered. A 2007 New Yorker article written by Atul Gawande quoted patient safety expert Peter Pronovost, M.D., who suggested the fundamental problem with the quality of American medicine is the failure to also view the delivery of health care as a science. Dr. Pronovost noted that the tasks of medical science fall into three buckets: 1. Understanding disease biology; 2. Finding effective therapies; 3. Ensuring those therapies are delivered effectively. "That third bucket has been almost totally ignored by research funders, government, and academia,” Dr. Pronovost said in the article. “It’s viewed as the art of medicine. That’s a mistake, a huge mistake. And from a taxpayer’s perspective, it’s outrageous." This “Delivery Science" is where HROC and Sepsis Alliance are focusing their joint efforts and research. In fact, the Bill & Melinda Gates Foundation estimated that $4.5 billion per year is required to protect against pandemic threats -- a key reason HROC and Sepsis Alliance joined the research to halt the rise of these pandemic risks that often lead to sepsis. The financial impact that health systems may suffer during possible pandemics is also a significant concern. The hospital that had the nation's first Ebola incident in 2014 was criticized for poor adherence to safety protocols, and suffered negative media attention after its mishandling of the Ebola patient. The financial impact of this superbug protocol failure was dramatic. The hospital's revenue dropped 25.6% in the month following the negative press, and continued to be running below normal even months later. Hospitals also have other expenses to consider, including losses from liability to patients and care workers, and costs from extra efforts to prevent the next disaster. Such expenses are so significant that they may force smaller, community-based hospitals to close, which will only exacerbate the issue of preventable fatalities in the event of an epidemic. "Hospitals that get overwhelmed by patients during a pandemic or superbug outbreak will have too much to do in too little time," notes Terry Rajasenan, HROC's chief scientist for MAM projects. "If teams become more reliable, they don't wait for high acuity patients to reach riskier late stages of infection that consume more staff time and costlier care, such as intensive care units. An example of too urgent is septic shock -- often too late to save patients. Earlier treatment means less fatalities, but it also means more patients to review to properly catch actual infections sooner -- or else it would lead to giving patients antibiotics that weren't needed. Staff with enough 'time to think' can choose this ideal time to treat. In short, timing is critical, and it's adversely impacted by task saturation." “Combating task saturation brings increased reliability and preparedness to our battle against pandemic risks, which in turn can help stop sepsis in its tracks,” said Tom Heymann, Executive Director of Sepsis Alliance. "All of us stand to benefit in improving antimicrobial stewardship.” For those interested in learning more about improving antimicrobial stewardship and preventing infections from reaching sepsis in any setting, HROC encourages people to access a special webinar on high reliability organizations, which is free for those qualifying as serving the public interest, such as those helping the Military and VA. More details are online at: For more information on identifying sepsis, or coping with its aftermath, visit the Sepsis Alliance website at: HROC (http://www.thinkhro.org) is a registered non-profit committed to scientific study and public safety, and serves as a platform for education and collaboration, supporting and assisting in the implementation of High Reliability Organizations (HRO) in healthcare, government, and nonprofit entities. It arose from over 2 years of pro bono work by ProcessProxy Corp. with the U.S. Air Force in a Cooperative Research And Development Agreement. HROC members are clinicians, researchers, veterans, and HRO practitioners on the frontline of educating the public on the need for healthcare to adopt HRO principles in the interest of significantly improving both patient and public safety. Sepsis Alliance is the nation’s leading sepsis advocacy organization, dedicated to saving lives by raising awareness of sepsis as a medical emergency. A 501(c)(3) organization, Sepsis Alliance was founded by Dr. Carl Flatley after the sudden, unnecessary death of his daughter Erin to a disease he had never even heard of. Sepsis Alliance produces and distributes educational materials for patients, families and health providers on sepsis prevention, early recognition and treatment. The organization also offers support to patients, sepsis survivors, and family members through its sepsis.org website which receives more than 1 million visits each year. The organization founded Sepsis Awareness Month in 2011, and works with partners to host community outreach events across North America. Since Sepsis Alliance began its mission, sepsis awareness has increased almost threefold, from 19% to 55%. For more information on Sepsis Alliance, a GuideStar Gold-rated charity, please visit http://www.sepsis.org. http://www.pbs.org/newshour/rundown/superbug-resistant-every-available-antibiotic-u-s-kills-nevada-woman/ https://www.washingtonpost.com/national/health-science/how-these-biomedical-detectives-identified-the-dreaded-new-superbug-in-us/2016/06/06/96ac8922-2bda-11e6-9de3-6e6e7a14000c_story.html?utm_term=.84a74125006d http://www.wsj.com/articles/new-study-raises-specter-of-more-bacteria-resistant-to-last-line-antibiotics-1484596800 https://wwwnc.cdc.gov/eid/article/12/1/05-0979_article. Also see: https://www.cdc.gov/flu/about/qa/1918flupandemic.htm http://news.nationalgeographic.com/news/2014/01/140123-spanish-flu-1918-china-origins-pandemic-science-health/ http://ocp.hul.harvard.edu/contagion/influenza.html http://cid.oxfordjournals.org/content/47/5/668.full https://www.cdc.gov/nchs/data/databriefs/db88.pdf https://www.thoracic.org/patients/patient-resources/resources/top-pneumonia-facts.pdf https://www.cdc.gov/drugresistance/ https://www.washingtonpost.com/national/health-science/how-these-biomedical-detectives-identified-the-dreaded-new-superbug-in-us/2016/06/06/96ac8922-2bda-11e6-9de3-6e6e7a14000c_story.html?utm_term=.84a74125006d https://www.thoracic.org/patients/patient-resources/resources/top-pneumonia-facts.pdf http://www.sepsis.org/sepsis-and/ebola/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124618/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/ https://www.cdc.gov/drugresistance/about.html https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783672/ http://www.forbes.com/sites/peterubel/2014/09/30/could-pay-for-performance-lead-to-overuse-of-antibiotics/#17872bbb53ed http://www.beckershospitalreview.com/quality/cms-proposed-rule-for-hospitals-reduce-antibiotic-use-or-exit-medicare.html http://paidpost.nytimes.com/gates-foundation/preparing-for-pandemics.html http://www.dailymail.co.uk/health/article-4076364/The-world-NOT-prepared-flu-epidemic-Bill-Gates-warns-amid-recent-surge-antibiotic-resistant-bugs.html http://abcnews.go.com/Health/dallas-nurses-hospital-sloppy-ebola-protocols-union/story?id=26205956 "Texas Health reports lower margin, higher expenses", Beth Kutscher, April 1, 2015 http://www.modernhealthcare.com/article/20150401/NEWS/150409983 "Texas Health Resources works to rebuild image after Ebola", Steven Ross Johnson, October 18, 2014 http://www.modernhealthcare.com/article/20141018/MAGAZINE/310189988 https://www.washingtonpost.com/news/to-your-health/wp/2015/09/04/failures-of-dallas-hospital-during-ebola-crisis-detailed-in-new-report/ https://www.washingtonpost.com/national/health-science/dallas-hospital-tries-to-repair-its-reputation/2014/10/17/dfb62dc4-55fa-11e4-809b-8cc0a295c773_story.html?tid=a_inl


News Article | December 12, 2016
Site: www.businesswire.com

CERRITOS, Calif.--(BUSINESS WIRE)--CareMore Health System has announced a new chief medical officer of new markets and business development, Dr. Vivek Garg. In this new role, Dr. Garg will oversee clinical operations in the organization’s new business markets, including Iowa and Tennessee. As the company continues to expand its model of care to new populations, Dr. Garg will work closely with the executive team to pursue and develop high-impact clinical business models for these expansion areas. “Dr. Garg brings a long-standing career of clinical leadership to CareMore,” said Dr. Sachin H. Jain, president of CareMore. “Passionate about health care innovation, Dr. Garg will serve as a conduit for advancing CareMore’s mission to transform the American health care delivery system.” Before coming to CareMore, Dr. Garg held the position of director of medical operations for Oscar Insurance and worked as the medical director of One Medical Group, a health care corporation specializing in primary care. Earlier in his career, Dr. Garg served as clinical assistant professor of medicine at Weill Cornell Medicine in New York, and acted as an assistant attending physician at New York-Presbyterian Hospital. He is a former editor of Health Care: The Journal of Delivery Science and Innovation. Dr. Garg received his medical degree and master’s in business administration from Harvard University. “I’m honored to join CareMore given its continually evolving model of care and commitment to patients and families,” said Dr. Garg. “CareMore’s reputation as a leader in health care innovation and its commitment to providing excellent care align with areas that I am passionate about. I am excited to collaborate with the team to ensure CareMore remains on the cutting edge in healthcare and continues to improve the quality of life for patients and families.” The company continues its nationwide search to fill the role of a system-wide chief medical officer, the position formerly held by the current president Dr. Sachin H. Jain. CareMore is a physician-founded, physician-led care delivery system and health plan that harnesses the power of teamwork to treat the whole person. Through a focus on prevention and highly coordinated care, its clinical model and designed-for-purpose approach to managing chronic disease proactively address the medical, social and personal health needs of its patients, resulting in clinical outcomes above the national average and ultimately, healthier people and communities. Over the past seven years, the CareMore Care Centers have expanded from one state to seven. And today, the CareMore delivery system provides care for enrollees in Medicare Advantage and Medicaid health plans in California, Nevada, Arizona, Virginia, Tennessee, Iowa, and Georgia. CareMore also is participating in a dual demonstration project in parts of Los Angeles County in conjunction with state and federal regulators to coordinate care for people eligible for both Medicare and Medicaid. For more information about CareMore, go to www.caremorehealthsystem.com.


Social and political factors influence physician and nurse workforce supply world-wide; there is more to positive patient outcomes than organizational resources and infrastructure A key component to achieving good patient outcomes in the healthcare world is having the right number and type of healthcare professionals with the right resources. While this may seem like a simple, obvious concept, it is still a large problem for many countries throughout the world. Social and political determinants impact how healthcare resources such as direct funding, national educational priorities, societal normative gender role assignment, and other factors all contribute to patient outcomes in varying degrees. A recent study in the BioMed Central journal Human Resources for Health, led by New York University Rory Meyers College of Nursing (NYU Meyers) Associate Professor Allison Squires, PhD RN, FAAN examines if country-level contextual factors have an impact on Human Resources for Health (HRH) and to what extent. Dr. Squires and her team define "country-level contextual factors" as those broader social and political institutional structures that affect, directly or indirectly, the healthcare system, population health, and health worker supply and demand. They limited the focus of the study to physicians and nurses/midwives because these are the two most consistently identifiable healthcare professions across the world. As such, the data is measuring the Nurse/Midwife per Population Ratio (NMPR) and the Physician per Population Ratio (PPR). "This exploratory observational study is grounded in complexity theory as a guiding framework," said Simon Jones, PhD, MSc, Research Professor in the Department of Population Health, Division of Healthcare Delivery Science, NYU Langone Medical Center (NYULMC), "Variables were selected through a process that attempted to choose macro-level indicators identified by the interdisciplinary literature as known or likely to affect the number of healthcare workers in a country." For the researchers, the combination of these variables attempts to account for the gender- and class-sensitive identities of physicians and nurses. The analysis consisted of one (1) year of publicly available data, using the most recently available year for each country. "The significance of the economic and inequality variables in the model suggests that systematic national policies aimed at reducing social, gender, and economic equality could positively affect health workforce production," said Dr. Squires. "For example, we discovered a strong, positive correlation between the average years spent in school and a population/ health workforce ratio. More schooling equals a better NMPR and PPR." "Another positive factor came from the increase in education, said Jennifer Uyei, PhD, MPH, Research Scientist in the Division of Comparative Effectiveness and Decision Science, NYULMC, "which correlates with a reduction of gender inequality in these professions." The researchers found evidence that gender inequality in nursing/midwives is a larger potentially more systemic problem because of its inherent female gender dominance. "Our results indicate that nurse/midwife production may be more sensitive to broader gender inequality issues than physicians," said Dr. Squires. "In some ways, this may seem like a 'common sense findings', but the prevailing research had not previously quantified it." The team also concluded the finding about the relationship between NMPR and migration rates may also be gender sensitive since men are more likely to migrate than women and with few exceptions, low and middle income country women are more likely to follow their migrating husband than initiate it themselves. The significant physician findings about migration rates may confirm this dynamic. "This analysis is the first of its kind in a multitude of ways," said Hiram Beltrán-Sánchez,MS, MA, PhD, assistant professor, Department of Community Health Sciences, UCLA. "Only a few studies have looked at the context of HRH production at a macro-level, but none in this way. It also is one of few to look at gender inequality issues among health professions beyond pay disparities, and among the first of its kind to highlight how political regimes and governance issues influence health workforce production." Dr. Squires and her team notes that the limitations of the study come from the known data quality possibly having inconsistencies in reporting across countries and data coordination failures known to affect cross-national datasets. They also mention that future studies may want to test other variables in the categories they identified to see if these enhance the model's precision. The research team's hope is this data will encourage and assist in further research about these issues; laying the foundation for the addition of a new facet of information about healthcare professionals and worker production. They also are hopeful it will propel the efforts to get policy changes supportive of all cadres of health workers on these issues and as a result, improve healthcare and health outcomes worldwide. The authors would like to thank Karina Schless, BSN, RN, and Lismarys Arjona, BSN, RN, for their countless hours pulling and cleaning data to help create the dataset for this study. This study was funded by a New York University Global Health Challenge grant and the Pauline Goddard Junior Faculty Fellowship. Funds were used to pay for research assistant services. AS conceived the idea for the study, obtained funding for the project, participated in data analysis, wrote initial paper drafts, and finalized the manuscript for submission. JU contributed to the study design, conducted analyses in STATA, and participated in writing the paper. HBS contributed to the study design, conducted analyses in STATA including supplemental regression models, and participated in writing the paper. SJ addressed statistical methods issues in the study, completed the analyses in R, and contributed to writing the paper. All authors read and approved the final manuscript. 1 Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, United States of America. 2 Research on Medical Education Outcomes (ROMEO) Division, School of Medicine, New York University, 433 First Avenue, New York, NY 10010, United States of America. 3Division of Comparative Effectiveness and Decision Science, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, United States of America. 4 Department of Community Health Sciences, California Center for Population Research, University of California, Los Angeles, 650 Charles E. Young Drive South, Room 41-257 CHS, Los Angeles, CA 53706-1393, United States of America. 5 Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY 10016, United States of America. NYU Rory Meyers College of Nursing is a global leader in nursing education, research, and practice. It offers a Bachelor of Science with a major in Nursing, a Master of Science and Post-Master's Certificate Programs, a Doctor of Nursing Practice degree and a Doctor of Philosophy in nursing research and theory development.


A key component to achieving good patient outcomes in the healthcare world is having the right number and type of healthcare professionals with the right resources. While this may seem like a simple, obvious concept, it is still a large problem for many countries throughout the world. Social and political determinants impact how healthcare resources such as direct funding, national educational priorities, societal normative gender role assignment, and other factors all contribute to patient outcomes in varying degrees. A recent study in the BioMed Central journal "Human Resources for Health," led by New York University Rory Meyers College of Nursing (NYU Meyers) Associate Professor Allison Squires, PhD RN, FAAN examines if country-level contextual factors have an impact on Human Resources for Health (HRH) and to what extent. Dr. Squires and her team define "country-level contextual factors" as those broader social and political institutional structures that affect, directly or indirectly, the healthcare system, population health, and health worker supply and demand. They limited the focus of the study to physicians and nurses/midwives because these are the two most consistently identifiable healthcare professions across the world. As such, the data is measuring the Nurse/Midwife per Population Ratio (NMPR) and the Physician per Population Ratio (PPR). "This exploratory observational study is grounded in complexity theory as a guiding framework," said Simon Jones, PhD, MSc, Research Professor in the Department of Population Health, Division of Healthcare Delivery Science, NYU Langone Medical Center (NYULMC), "Variables were selected through a process that attempted to choose macro-level indicators identified by the interdisciplinary literature as known or likely to affect the number of healthcare workers in a country." For the researchers, the combination of these variables attempts to account for the gender- and class-sensitive identities of physicians and nurses. The analysis consisted of one (1) year of publicly available data, using the most recently available year for each country. "The significance of the economic and inequality variables in the model suggests that systematic national policies aimed at reducing social, gender, and economic equality could positively affect health workforce production," said Dr. Squires. "For example, we discovered a strong, positive correlation between the average years spent in school and a population/ health workforce ratio. More schooling equals a better NMPR and PPR." "Another positive factor came from the increase in education, said Jennifer Uyei, PhD, MPH, Research Scientist in the Division of Comparative Effectiveness and Decision Science, NYULMC, "which correlates with a reduction of gender inequality in these professions." The researchers found evidence that gender inequality in nursing/midwives is a larger potentially more systemic problem because of its inherent female gender dominance. "Our results indicate that nurse/midwife production may be more sensitive to broader gender inequality issues than physicians," said Dr. Squires. "In some ways, this may seem like a 'common sense findings', but the prevailing research had not previously quantified it." The team also concluded the finding about the relationship between NMPR and migration rates may also be gender sensitive since men are more likely to migrate than women and with few exceptions, low and middle income country women are more likely to follow their migrating husband than initiate it themselves. The significant physician findings about migration rates may confirm this dynamic. "This analysis is the first of its kind in a multitude of ways," said Hiram Beltrán-Sánchez, MS, MA, PhD, assistant professor, Department of Community Health Sciences, UCLA. "Only a few studies have looked at the context of HRH production at a macro-level, but none in this way. It also is one of few to look at gender inequality issues among health professions beyond pay disparities, and among the first of its kind to highlight how political regimes and governance issues influence health workforce production." Dr. Squires and her team notes that the limitations of the study come from the known data quality possibly having inconsistencies in reporting across countries and data coordination failures known to affect cross-national datasets. They also mention that future studies may want to test other variables in the categories they identified to see if these enhance the model's precision. The research team's hope is this data will encourage and assist in further research about these issues; laying the foundation for the addition of a new facet of information about healthcare professionals and worker production. They also are hopeful it will propel the efforts to get policy changes supportive of all cadres of health workers on these issues and as a result, improve healthcare and health outcomes worldwide.


News Article | July 6, 2015
Site: techcabal.com

In a rather exciting development in the software as a service (SaaS) scene in Nigeria that could revolutionize the way Nigerian businesses manage their payrolls, the developers of PayrollPlus, are looking for Beta Testers to try out their web app, and provide feedback. PayrollPlus.co is a SaaS application that helps Nigerian businesses administer payroll for their teams. The platform’s features accommodate taxes, benefits, pension deductions, and more. PayrollPlus comes from the team behind Delivery Science, a Nigerian logistics tracking, and analytics startup. “We built it to scratch our itch, and are looking for other people to get value from it and give us feedback”, says Delivery Science CEO, Lanre Oyetodun. PayrollPlus currently offers two service plans; The free Pilot plan  allows HR managers to access most of the platform’s functionality, including exporting employee payroll data to spreadsheets, benefits, and deductions. The Pro plan costs ₦20,000 every six months, and ₦200 per transaction, and unlocks automated electronic salary payments via NIBSS instant payments.

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