The Intermountain Care Process Model recently developed the Pediatric Traumatic Stress Screening Tool to assess traumatic stress in children in the primary care setting and to help identify diagnostic criteria for PTSD. 0000060798 00000 n xref 0000129815 00000 n 0000033569 00000 n 0000023933 00000 n 0000006375 00000 n 0000015322 00000 n 0000036090 00000 n by Amy Bowen | Kaye Coholan For children 6 18 years who report a potentially traumatic experience on the Pediatric Traumatic Stress Screening Tool (more information on this screening tool available in full CPM), the process of responding effectively to child traumatic stress involves three steps: Based on screening tool results, a brief in-office intervention targeting their most prominent symptom(s) has been shown to make a big difference for many children. 0000079241 00000 n ALL RIGHTS RESERVED. 0000007639 00000 n Of all the approaches leaders can leverage to address these issues, reducing unwarranted clinical variance is receiving increased attention. 0000036974 00000 n 0000018484 00000 n | Dr Chris Streather 0000006007 00000 n 0000005795 00000 n 0000022254 00000 n 0000008067 00000 n 0000069209 00000 n A child who is about 10 or older can complete the screener. Dr James was hired by Intermountain in 1986 as the director of medical research and continuing medical education. CPM020 - 01/21 3 COPD CPM JANUARY 2021 TABLES TABLE 1. 0000060023 00000 n 1425 82 0000063674 00000 n 0000002281 00000 n Intermountain has created care process models (CPMs) within each clinical programme that use a combination of existing evidence-based practice guidelines and historical EHR data. There are aspects of Royal Free care that Intermountain can learn from, said Dr Chris Wood, vice president, Cerner and medical executive for iCentra development at Intermountain Healthcare. 0000004060 00000 n 0000041140 00000 n 0000006219 00000 n 0000075636 00000 n The Royal Free Hospital provides the only high-level isolation unit of its kind for the care of patients with the Ebola virus and other infectious diseases. Cerner Corp. and Intermountain Healthcare announced recently the implementation of iCentra, a model electronic health record (EHR), practice management and revenue cycle system, at two Intermountain hospitals and 24 clinics across northern Utah. 0000225797 00000 n 0000076158 00000 n Care Process Model JUNE 2019 2019 Update GOALS & MEASUREMENTS The goal of this CPM is to improve the . 1425 0 obj <> endobj 0000042757 00000 n 0000063087 00000 n Children in the severe and moderate traumatic stress symptom range will typically benefit from an intervention based on their symptoms, but clinicians may also choose to use a brief 0000005742 00000 n The programme has evolved over the years, but the core philosophy is still the same the science of process management and change leadership is applied to healthcare leading to better quality, safety, cost and services outcomes. It is not a prescription for every physician or every patient, nor does it replace clinical judgment. 0000013703 00000 n /}>8N{oN9sw @P|&AM. 0000005907 00000 n 0000017396 00000 n We are already on our way to digitising 20 of those 44 pathways and will eventually have all 44 in the EHR.. 0000179330 00000 n 0000132101 00000 n 0000045478 00000 n 0000015005 00000 n The Child Traumatic Stress Care Process Model (CPM) was developed through a collaboration of the Department of Pediatrics at the University of Utah and the Center for Safe and Healthy Families at Intermountain Healthcares Primary Childrens Hospital. <]/Prev 276186/XRefStm 2368>> 1846 0 obj <>stream hSYPW>G&$B% i}(!IA|C;N3mJd1 @EbBBDQ(+ 0000012798 00000 n Seeing their institutional processes adapted by other health systems is a validation of the approach. 0000001979 00000 n Mild range scores (0 10) protective approach, Moderate range (11 20) resilient approach, Severe range (21 or higher) restorative approach. Intermountain monitors use of the Information Systems resources. 0000021074 00000 n 0000005602 00000 n 0000023429 00000 n 0000002388 00000 n 0000021696 00000 n 0000081803 00000 n WARNING: Intermountain Healthcare's Information Systems resources are for Intermountain approved purposes only. 0000000016 00000 n 0000005233 00000 n Prnom. 0000004772 00000 n They then work to continually refine and improve each care process. 0000177828 00000 n Critical to the relationships success is that Intermountain leaders visit RFL and can provide guidance and feedback in real time and on-site. 0000058232 00000 n 0000043417 00000 n 0000008994 00000 n For many children, belly breathing or mindfulness training (teens) will be able to slow down a racing heart or mind at bedtime to fall asleep easier or reduce the intensity of anxious / fearful or angry feelings. 0000013288 00000 n 0000008313 00000 n 0000019646 00000 n 0000007049 00000 n 0000018223 00000 n 0000025382 00000 n 0000004300 00000 n 0000044299 00000 n 0000066617 00000 n 0000180800 00000 n 0000012415 00000 n Treesa Carter and James Hitter share their experiences of working on the transformation of health and social care integration at Suffolk County Council. 0000023486 00000 n 0000007337 00000 n Members of each clinical programme regularly review the core care processes within it using evidence from literature and data from Intermountains own EHR. 0000073493 00000 n 0000006531 00000 n 0000009309 00000 n 0000005756 00000 n 0000066218 00000 n 0000176282 00000 n 0000006077 00000 n 0000118945 00000 n (2) removing Intermountain data from any Intermountain information system; or 0000010474 00000 n 0000051498 00000 n %%EOF Published on 8 March 2019. 0000052164 00000 n 0000087726 00000 n Intermountain used this philosophy to organise its most common care processes under the direction of an operations structure called clinical programmes. 0000179289 00000 n 0000004208 00000 n The PIPS team can help you identify resources in your area. 0000006937 00000 n (3) duplicating any Intermountain data or placing a copy of any Intermountain data on any non-Intermountain asset. 0000005534 00000 n h1 01!\Ax'MF[!!z 1- 0000066391 00000 n Partnering with and adapting the methodology of an internationally recognised leader like Intermountain signalled to staff that RFL was serious about improving care and has helped create buy in, Dr Streather believes. This care process model (CPM) was created by a multidisciplinary team of physicians, registered dietitians, mental health specialists, and other healthcare providers at Intermountain Healthcare. 0000005695 00000 n 0000011615 00000 n 30 June 2022 The approach focuses management attention not only on the facilities where care takes place but also on physician decision making and the care process itself, with the aim of boosting physician productivity and improving care quality, while saving money. 0000005441 00000 n We recommend that child or caregiver complete the child traumatic stress screener while in the waiting room, prior to their appointment. 0 Screen for child traumatic stress. 0000079777 00000 n The partnership has provided value to RFL on many levels. 0000005131 00000 n 0000011770 00000 n %PDF-1.7 % 0000054116 00000 n 0000020129 00000 n 1660 60 0000049258 00000 n 0000008686 00000 n 0000071811 00000 n 0000177145 00000 n under the leadership of Intermountain Healthcare's Behavioral Health Clinical Program. 0000170561 00000 n 0000011030 00000 n 0000023593 00000 n endstream endobj 207 0 obj <>>>/Metadata 204 0 R/Names 209 0 R/OpenAction 208 0 R/Outlines 197 0 R/PageLayout/TwoPageRight/Pages 203 0 R/Type/Catalog/ViewerPreferences<>>> endobj 208 0 obj <> endobj 209 0 obj <> endobj 210 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/Properties<>/XObject<>>>/Rotate 0/Tabs/W/Thumb 198 0 R/TrimBox[0.0 0.0 792.0 612.0]/Type/Page>> endobj 211 0 obj [212 0 R 213 0 R 214 0 R] endobj 212 0 obj <>/Border[0 0 0]/H/N/Rect[647.403 349.775 697.152 339.065]/Subtype/Link/Type/Annot>> endobj 213 0 obj <>/Border[0 0 0]/H/N/Rect[647.905 312.2 690.6 301.535]/Subtype/Link/Type/Annot>> endobj 214 0 obj <>/Border[0 0 0]/H/N/Rect[32.9 392.516 116.959 379.171]/Subtype/Link/Type/Annot>> endobj 215 0 obj <> endobj 216 0 obj <> endobj 217 0 obj <> endobj 218 0 obj <> endobj 219 0 obj [/ICCBased 246 0 R] endobj 220 0 obj <> endobj 221 0 obj <> endobj 222 0 obj <> endobj 223 0 obj <> endobj 224 0 obj <>stream Intermountain Healthcare in Salt Lake City, Utah, recognised the link between variance, quality and cost early on thanks in part to Dr Brent James. 0000063119 00000 n trailer 0000004309 00000 n Each visit is centred around a single theme to allow for a focused deep dive into that specialty. 0000014338 00000 n 0000045545 00000 n Provides patient education as directed (content reflects specific MA training, guidelines, care process models, protocols). 0000002368 00000 n 0000012722 00000 n Intermountain has also noted value in the partnership. 0000027605 00000 n Mary Ann Baily, Ph.D. 0000009144 00000 n 0000179788 00000 n 0000022567 00000 n 0000056318 00000 n 1 Resources for Parents and Caregivers 0000006881 00000 n 0000071068 00000 n 0000165371 00000 n The back page summarizes antibiotic recommendations and notes . . Alongside clinical perspective and evidence-based literature, incorporating the viewpoints and experiences of patients who are living with conditions into the care pathway design process is resulting in what Dr Streather calls idealised pathways that will help improve both quality and operational efficiency. 0000068805 00000 n 0000051827 00000 n 0000084852 00000 n 0000020531 00000 n 0000010167 00000 n In primary care settings, you can evaluate the response to services using the Pediatric Traumatic Stress Screening Tool at follow up visits. 0000004401 00000 n 6346 0 obj <> endobj 0000086396 00000 n Behaviors, Attention-Deficit/Hyperactivity Disorder (ADHD) & Mood Disorders, Fetal Alcohol Spectrum Disorder Distinguished from Autism, Mucopolysaccharidosis Type I & Motor Development, Mucopolysaccharidosis Type I (MPS 1) Genetics, Mucopolysaccharidosis Type I (MPS 1) Hematopoietic Stem Cell Transplantation & 1736 0 obj <> endobj We looked at a number of places known for their international best practice, and the most advanced version of what we were trying to do was happening at Intermountain.. *(N}L{{./ +A C C9p:nY)-({ ~U 4|VfI)3%N>K, L7 See the Intermountain care process model Non-surgical Management of Ectopic Pregnancy DEVELOPMENT AND DESIGN OF Care Process Models Care Process Model MONTH 2015 2015 Update 0000050231 00000 n Fortunately Intermountain Healthcare (among others) publishes their Care. 0000025573 00000 n 0000065867 00000 n Together, these components have allowed Intermountain to create integrated CPMs to manage practice guidelines and digital workflows that actively guide doctors toward the clinical decisions that will improve outcomes for patients. 0000000016 00000 n 0000015259 00000 n 0000011492 00000 n Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery. It is extremely important to screen patients until there are no further limitations on testing capacity. Addressing unwarranted variance in care protocols and embedding those processes in the electronic health record (EHR) can be an effective way for healthcare leaders to impact both quality outcomes and their bottom lines. As a founding member of the Together 2 Goal program, Intermountain's Medical Group Diabetes Care Process Model serves as the primary source material for much of the initiative. We are also working with the Point of Care Foundation, which facilitates us working with patients and families in the design phase of all our clinical pathways.. 0000086035 00000 n 0000086222 00000 n * This CPM presents a model of best care based on the best available scientific evidence at the time of publication. 0000226944 00000 n CPMs are meant to provide an evidence-based and standardised way to address the core clinical processes that matter most to their patients and clinicians. 0000017626 00000 n 0000059703 00000 n H\@. Salt Lake City, UT/Broomfield, CO (April 5, 2022) - Intermountain Healthcare and SCL Health, two leading nonprofit healthcare organizations, have completed their merger, creating a model health system that provides high-quality, accessible, and affordable healthcare to more patients and . 0000011835 00000 n 0000004039 00000 n 0000170459 00000 n All rights reserved. P.O. With the help and facilitation of Cerner, the two organisations entered into a formal partnership in 2016 to bring the philosophies and practices behind Intermountains clinical programmes and CPMs to RFL in a transatlantic knowledge sharing endeavour. 0000078906 00000 n 0000066508 00000 n 0000128388 00000 n Choose a state from the dropdown to add local service providers. 0000019314 00000 n 0000007186 00000 n 0000085699 00000 n 0000001556 00000 n 0000006553 00000 n 0000226257 00000 n 0000065800 00000 n 0000006220 00000 n We want to make it easy to do the right thing and take new measurements from doing the right thing so that its even better the next time.. It has three main hospitals the Royal Free Hospital (founded in 1828 with the direct mission of providing free, quality care to patients with little or no means), Barnet Hospital and Chase Farm Hospital. Learning some of these differences has provided insight for Intermountain into what may be possible in the future. In the 5 phase III alvimopan efficacy trials, a simple standardized accelerated postoperative care pathway was used rather than a comprehensive, multidisciplinary colon surgery care process model that is used by Intermountain Healthcare. 3 September 2021 Nope. 0000005681 00000 n 0000002571 00000 n In addition to teaching them a useful coping skill, the child often feels an increased sense of support from parent(s) / guardian(s) who can help them practice the skill at home and remind them to use it when needed. Choose a skill that you are comfortable teaching and share your knowledge with the families you see in clinic. If different clinicians in the same health system are using widely varying protocols to treat the same conditions, the result will be poorer patient outcomes and a less-than-clear picture of what it truly costs to treat the condition. Administers screening tests to . The clinical practice groups are changing the way we provide care in a profound way, said Streather. Each of the eight stages of change has a corresponding pitfall. 0000045671 00000 n 0000003820 00000 n 0000015816 00000 n 0000065975 00000 n 0000064797 00000 n hb``0f``d`e` l,x70y7Yc[%Lq|cO 'rX)!2[HQ(WVE 0khhDGG; J@(}=bw&5_R 0000087649 00000 n This CPM includes two processes to address child traumatic stress across the pediatric lifespan. 0000024023 00000 n by Dr Todd Allen 0000005387 00000 n The multidisciplinary team is tasked with asking how they can improve the care processes within the programme. 0000198367 00000 n 0000050145 00000 n Its purpose is to summarize and promote evidencebased approaches to lifestyle and weight management, and to facilitate implementation in routine . 0000062870 00000 n 0000057819 00000 n 0000004619 00000 n 0000016722 00000 n Copyright 2003-2020. Intermountain Health Care (IHC), an integrated delivery system based in Utah, has adopted a new strategy for managing health care delivery. During development of the care process model, the authors found many aspects of ICU care that required substantial change. With healthcare costs continuing to rise and clinical outcomes increasingly linked to reimbursement, optimising care and lowering costs are critical factors in determining the competitiveness and effectiveness of hospitals and health systems. P , s &v. 0000178724 00000 n 0000076267 00000 n 0000044620 00000 n 0000012208 00000 n 9-FCr-+| E+dJgx!Ck 0000003264 00000 n 0000177977 00000 n 0000071186 00000 n If symptom severity remains unchanged or worsens, consider alternatives such as providing a new brief in-office intervention, reinforcing the need to follow through with treatment for those who have not, or changing the treatment stratification and therapy referral to a more intensive approach. startxref It was created by general pediatricians at the University of Utah in collaboration with Intermountain Health pediatric . 0000132863 00000 n There is quite a lot of admiration in the United Kingdom for some of the system-wide approaches for improving quality in the United States, said Dr Streather. Based on national guidelines and emerging evidence and shaped by local expert opinion, this CPM provides practical strategies . 0000072266 00000 n 0000039302 00000 n Within a health system, unwarranted clinical variance is understood as the difference in clinical practices and services that do not derive from unique patient needs and that may involve the overuse, underuse or misuse of medical services. 0000039661 00000 n 0000128347 00000 n 0000072821 00000 n 0000031441 00000 n We apologize that the page you are looking for is not available on our site. 0000044721 00000 n bPatients who had at least 1 outpatient visit with a primary care physician (family medicine, internal medicine, geriatric, or pediatric specialty) during the period of 2003-2005 and a continuous service encounter from an Intermountain delivery location (either acute, ambulatory, radiologic, or laboratory services) at least once a year for each D dL :G=%C>[wgG5wvorb$j9u>~U'/795}[ucCwOxEQ\hzAR>9d)oHH,YIPxM. 0000048189 00000 n 0000001530 00000 n 0000007562 00000 n 0000072898 00000 n 0000010857 00000 n 0000043331 00000 n 0000004256 00000 n We didnt want to take a standardised cookbook approach to medicine, but we wanted to ensure that care was more predictable and evidence-based so that we could deliver it in a more cost-effective way.. This care process model (CPM) is maintained by Intermountain Healthcare's Lower Respiratory Tract Infection Team, . 0000003400 00000 n There can be reticence to learn from others and there can sometimes be the resistance to adopting something that was someone elses idea. 0000079537 00000 n Intermountain Healthcare and Royal Free London are working toward a common goal of reduced clinical variance. %2O92qx`x@7l* eLBX&4*p*x 9`%jX,/p*x2 aWbL dTK`rX/i-'bT Df`9D3hA9@@!N Hg1pfM_:+.y- iM=5{*g2msZ:G3Lrtwsut e5b1L & E-mail. 0000081734 00000 n 0000005079 00000 n 0000015124 00000 n 0000031920 00000 n Organising care in this way facilitates a broader, more longitudinal view of whats necessary to treat a condition. 0000045214 00000 n 0000013048 00000 n 0000056444 00000 n 0 0000193542 00000 n It doesnt make sense to imagine that you can do a fundamental change programme without working with other people., Dr Wood agrees that creating partnerships is key to future growth. 0000048275 00000 n When should the child or caregiver complete the traumatic stress screener? 0000011817 00000 n This is not like an IQ test or psychological testing where the results could be skewed. 0000079428 00000 n Special attention is also paid to who attends each visit to ensure all stakeholders are involved. Second, primary care providers and care teams can intervene with children (6 18 years) who have experienced a potentially traumatic experience through the use of the Pediatric Traumatic Stress Screening Tool and Road Map of Care for Pediatric Traumatic Stress (see image below). Users are prohibited from doing any of the Key Points All pregnant patients at 20 weeks of gestation require a Labor and . The report also estimated that approximately 75,000 deaths might have been prevented in 2005 if every U.S. state had provided care at a quality level on par with the best performing state. 0000179023 00000 n 0000026552 00000 n A 2012 report from the Institute of Medicine found that inefficiencies in the U.S. healthcare system resulted in up to $750 billion of wasted spending in 2009, roughly 30 percent of total healthcare spending in that year. hSiPSW>#BBX-"m6 EM;b;N:N+D(n." * 0000005227 00000 n RFL provides specialist services in liver and kidney transplantation, rare cancers, haemophilia, HIV, infectious diseases, plastic surgery, immunology, neurology, Parkinsons disease, vascular surgery, cardiology, amyloidosis and scleroderma. 0000004293 00000 n <<099953D8ECDC4449BF4B89817F7FC266>]/Prev 820759/XRefStm 5250>> 0000041187 00000 n Ive rarely seen in the NHS such buy-in from the clinical community, he said. 6440 0 obj <>stream 0000006822 00000 n 0000055034 00000 n 0000059943 00000 n 0000023004 00000 n By integrating our care process models into the EHR, we make sure that not only is the information where clinicians need it, when they need it, but its also baked into the soul of the organisation, Dr Allen said. 0000003817 00000 n As RFL leaders began to search for established models and methods to reduce variance in care, they were introduced to Intermountains clinical programme and CPM approach. 0000009576 00000 n Attempts to publish pathway development in the peer-reviewed literature are limited by lack of scientific rigor. 0000065716 00000 n 0000063196 00000 n 0000063228 00000 n 0000008918 00000 n Treatments, Prader-Willi Syndrome & Cognitive & Psychiatric Issues, Prader-Willi Syndrome and Complications from Obesity, Premature Infant and Retinopathy of Prematurity, Attention-Deficit/Hyperactivity Disorder (ADHD), Charcot-Marie-Tooth Disease (Hereditary Motor Sensory Neuropathy), Intellectual Disability & Global Developmental Delay, Postural Orthostatic Tachycardia Syndrome (POTS), Duchenne & Becker Muscular Dystrophy: Cardiomyopathy, MCADD (Medium-Chain Acyl-CoA Dehydrogenase), Somatic Symptom Disorder & Functional Neurologic Disorders, Carnitine Palmitoyltransferase 1A (CPT 1) Deficiency, Citrullinemia Type II & Citrin Deficiency, Guanidinoacetate Methyltransferase (GAMT) Deficiency, Holocarboxylase/Multiple Carboxylase Deficiency, Medium-Chain Acyl-CoA Dehydrogenase Deficiency (MCADD), Short/Branched Chain Acyl-CoA Dehydrogenase (SBCAD) Deficiency, Short-Chain Acyl-CoA Dehydrogenase Deficiency (SCADD), Very Long-Chain Acyl-CoA Dehydrogenase Deficiency (VLCADD), Screening Tests and the Diagnostic Process, After a Diagnosis or Problem is Identified, A New (or Old) Diagnosis - 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