Presentation Outline ICHP Annual Meeting September 13-15

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Allocation of Health Care Resources and Workforce Allocation of Healthcare Resources and Workforce …. in comparison to Population w/chronic disease Patients with Chronic Disease Patients with Advanced Stage Disease Patients who are dying Life Course Perspective –Current Delivery System Trajectory for Chronic Disease • Diabetes •HTN, Lipids •Obesity • Smoking w/o Primary Prevention w/o Secondary Prevention • Vasculopathy •CV and Renal damage • Mild Disability •ESRD, MI, CVA •Heart, Kidney Failure • Severe Disability • Mild Disability Severe Disability End Stage Care ‐ Death Life Course Perspective –NewDelivery System Trajectory for Chronic Disease • Diabetes •HTN, Lipids •Obesity • Smoking Primary Prevention w/o Secondary Prevention • Vasculopathy •CV and Renal damage • Mild Disability •ESRD, MI, CVA •Heart, Kidney Failure • Severe Disability • Mild Disability Severe Disability • Minimal vascular disease •Preserved Heart, Kidney Function End Stage Care ‐ Death End Stage Care ‐ Death Epidemiology • Chronic disease = highly prevalent • Uncontrolled chronic conditions = highly prevalent • Epidemic id i of f uncontrolled ll d chronic h i conditions di i Life Course Perspective –Current Delivery System Trajectory for Chronic Disease • Diabetes •HTN, Lipids •Obesity • Smoking w/o Primary Prevention w/o Secondary Prevention • Vasculopathy •CV and Renal damage • Mild Disability •ESRD, MI, CVA •Heart, Kidney Failure • Severe Disability • Mild Disability Severe Disability End Stage Care ‐ Death What do patients need to do to get our attention? What does it take to get our best care? Health Care Resources, Workforce and Population Many Patients with Uncontrolled Chronic Disease Many Patients with Controlled Chronic Disease More Patients with Advanced Stage Disease Patients dying younger and sicker Less Patients with Advanced Stage Disease Patients still die, but later and “better” 8/30/2012 2
Highly Effective Healthcare • What does “world class” care look like? • Examples – Historical – CContemporary • Opportunity How Reliable is our Care? A function of System and Culture Autonomy Teamwork Highly Reliable Organizations Chaos Error 1:10 1:100 1:10,000 1:1 million Custom‐ Standard Standard crafted training, process, processes ttry hard h d hbit habits and d patterns Each Doctor writes individual orders Each staff member has his/her own way Multi‐ disciplinary rounds Deference to expertise, “ “safety f t culture” Blood banking, Approval for high risk orders Loss of individual id identity tit Yes but, it’s like herding cats What we say What doctors hear • Performance improvement ‐ You doubt my judgment • Accountability ‐Insult my integrity • Collaborative practice ‐ Losing control • Electronic Records ‐ OMG! • Guidelines ‐ Cookbooks Achieving the Triple AIM 14 Integrated CPS Health Status Adverse Drug Events Anesthesia safety, airline industry Engaging Physicians in Performance Improvement Understanding the frustration • Satisfaction with practice has decreased for many physicians. • The “psychological contract” has been changed changed, without informed consent consent. • Professional ethos that got them here is no longer working. 8/30/2012 3
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ACTIVITY DESCRIPTION Target Audienc
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Current Challenges • Expansion of
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Examples of Medication Consideratio
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Etiology (Dana Point, 2008) 1’. P
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PAH Therapy Targets Schulze-Neick I
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Chronic Adjuvant Therapies in PAH D
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Cummulative suurvival Survival in I
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ACCF/AHA Consensus PAH Treatment Al
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Study Name Drug SUPER-1 Oral silden
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IV Epoprostenol in PAH Due to Scler
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70 60 50 40 30 20 10 Inhaled Ilopro
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Conclusions • PAH therapy improve
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ESC/ERS Guidelines Galie N, et al.
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FUTURE DIRECTIONS WHICH MAY IMPACT
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Rationale for “Front-Loaded” Ap
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Addressing gthe Challenges g in PAH
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Considerations • Central vs. peri
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Pulmonary Hypertension • Approxim
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Example Cassette Calculations • V
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Assessment Question 1 Which of the
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Illinois Council of Health‐System
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Patient Activity ‐ 1 Patients in
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Hospitalists National Trends • Ja
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Pharmacy Landscape • PGY‐2: So
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Primary Care Physicians by Field, F
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Health Systems Pharmacy and TATAI
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Readings The 21 Irrefutable Laws of
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What is a “Practice Model”? •
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Completing the Self Assessment •
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Residency trained (B23p) Illinois N
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Solving the PPMI Puzzle ‐ Here Ar
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Overview of Value Based Purchasing
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Implementation of Medication‐ rel
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Question #1 Within which programs a
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Solving the PPMI Puzzle‐ Here are
Page 71 and 72: Discharge Education/Med Rec • New
Page 73 and 74: Media‐Worthy Trials? Making Sense
Page 75 and 76: Prevention of Recurrent VTE • Unp
Page 77 and 78: VTE recurrence during study period
Page 79 and 80: Which patient might be a candidate
Page 81 and 82: Azithromycin and CV Death • Endpo
Page 83 and 84: Azithromycin and CV Death Azithromy
Page 85 and 86: Hormonal Contraception and VTE •
Page 87 and 88: • Age • Calendar year • Educa
Page 89 and 90: ARR=2.20, 2.28 for stroke, MI when
Page 91 and 92: Which of the following combinations
Page 93 and 94: 3 Months of Treatment for Latent TB
Page 95 and 96: 3 Months of Treatment for Latent TB
Page 97 and 98: T/F: Rifapentine in combination wit
Page 99 and 100: 2. Which of the following statement
Page 101 and 102: Fitting the Counseling Piece into M
Page 103 and 104: Current Evidence: Implementing Bund
Page 105 and 106: Teach Back Process • Step 1 Expla
Page 107 and 108: Questions for Consideration and Dis
Page 109 and 110: Why do we care about ADE? • Adver
Page 111 and 112: True or False • Medication errors
Page 113 and 114: Check Point Which of the following
Page 115 and 116: Proactive Screening Process Patient
Page 117 and 118: MTI Pilot at NAH PharmD Students tr
Page 119 and 120: ASHP PPMI Case Study Adding Value:
Page 121: Interdisciplinary Teamwork: How Phy
Page 125 and 126: Inter‐Professional Teams ‐ Chan
Page 127 and 128: Meeting the PPMI Goals for Technolo
Page 129 and 130: Drug‐Bug Mismatch Example Con’t
Page 131 and 132: Drug‐Bug Mismatch Build Rules •
Page 135 and 136: Patient Scanning Compliance Sample
Page 139 and 140: Global Immunizations 3 • Jan 2012
Page 141 and 142: Mobile Devices: Beyond Angry Birds
Page 143 and 144: Google Play • Google Play - Inter
Page 145 and 146: Other Useful Productivity Apps •
Page 147 and 148: Mobile Devices: Beyond Angry Birds
Page 149 and 150: Net Activations by Industry Source:
Page 151 and 152: News Readers/Aggregators Features S
Page 153 and 154: Contact Information • E‐mail: -
Page 155 and 156: Early‐Onset Sepsis • Sign and s
Page 157 and 158: • BR is on day 2 of cefotaxime wi
Page 159 and 160: Immunizations: The Superheroes to P
Page 161 and 162: Current ACIP Recommendations Influe
Page 163 and 164: Herpes Zoster Vaccine Recommendatio
Page 165 and 166: Assessment Questions 1. What are th
Page 167 and 168: HIV Linkage and Retention in Care T
Page 169 and 170: DHHS Guidelines, March 2012: When t
Page 171 and 172: Protease Inhibitors • Require “
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Mean Change (mg/ /dL) STARTMRK: Lip
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RAL Drug Interactions • Does not
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Instructions for Credit In order to
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Staging Stage Criteria (Durie‐Sal
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Salvage Therapy Partial List Regime
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Bortezomib-Thalidomide-Dexamethason
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Case 2 ST is a 76 y/o African Ameri
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Thalidomide and Lenalidomide • Ad
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Fixed Low-Dose Warfarin Study Thera
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New Drugs 2012 Anna Nowobilski‐Va
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Pulmonology » Cystic Fibrosis •
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Oncology » MTX Toxicity • MTX 1o
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NEW DRUGS AND BIOLOGICALS 2012 RESO
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Disease State Reviews for Pharmacy
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Chronic Obstructive Pulmonary Disea
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Green Zone • Patient is not havin
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• A hormone produced by the pancr
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Unraveling Unraveling The The Puzzl
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The Reward Center In time, serious
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So what makes addicted pharmacists
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How to find a treatment center Onli
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Internet Drug Abuse Study conducted
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NIAAA = best resource for alcohol d
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Impact of Postoperative Pain • Pi
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Safety Profile • Amar et al confi
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References 1. Rømsing J, Møiniche
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Society of Regional Anesthesia Meet
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A New Approach IV Acetaminophen •
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References • Schechter, Leslie N.
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Bupivacaine liposome injectable sus
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Error Potential • Inadvertent IV
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Decolonization Methods • Anti-sep
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Evidence: Inpatient ICU MRSA Coloni
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Residency Project Pearls Adherence
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650 subjects id identified tifi d R
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Overtreatment versus Appropriate Tr
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Adherence to and Outcomes Associate
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Background • Lack of comprehensiv
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Results Results‐User User Audits
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Special thanks to: • Carol Heunis
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Antibiotic Prophylaxis American Hea
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Study Limitations • Dependent on
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Study Background • Observation of
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A patient has a CrCl of 25 mL/min.
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• Cysteine hydrochloride: antioxi
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Sample Preparation • Intravenous
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Questions? Residency Project Pearls
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The Interview: Your Preparation •
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PGY1 Residency Options Carol Heunis
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RESIDENCY PROGRAM BASICS • Progra
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CV: The key to a top curriculum vit
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Tips for a Top Notch CV • Focus o
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What is PhORCAS? • PhORCAS is the
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Piecing together the new CHEST guid
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Initiating therapy CHEST 2012 2.1.8
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What is “Consistently Stable?”
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Puzzle # 2A: patient has just compl
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What would you do for JJ? • A. Ho
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Considerations for SB • Bleeding
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Presentation Outline ICHP Annual Meeting September 13-15

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