After reviewing the Logic Model Development Guide from the readings, create a logic model for a new program you would like to fund to address this impact on the health delivery system. Discuss how the program can be applied to reduce the impact on the health delivery system.

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Instructions

There are many forces that impact health delivery systems. Choose one aspect that influences how health delivery systems are challenged, and describe the issue. Examples include, but are not limited to, access to care, quality health care improvement, lack of coordinated care, continuity of care (medical home), etc.

After reviewing the Logic Model Development Guide from the readings, create a logic model for a new program you would like to fund to address this impact on the health delivery system. Discuss how the program can be applied to reduce the impact on the health delivery system.

Requirements

The paper and included logic model should be at least 975 words in length.
Include a list of references in APA format, including the information used from the modules.

Evaluate the information technology and tools needed in each step of the decision-making process.

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Read the following case study regarding an adverse trend in a health care setting.

An elderly patient has been admitted to the medical/surgical unit from the local nursing care facility. The new lab results in her electronic health record (EHR) indicate that she has methicillin-resistant Staphylococcus aureus (MRSA) in her urine. She is placed on contact precautions per the hospital guidelines.

The health care provider arrives to examine her new patient and inquires about the need for contact precautions. The nurse explains the lab results reveal the patient has MRSA in her urine. The health care provider states that she reviewed the patient’s lab results in the emergency room and the urine results were normal. The unit coordinator reveals to the staff nurse and nurse manager that this is the third incident this month of lab results being uploaded to the wrong patient’s EHR when admitted from the emergency department.

Write a 1,050 to 1,400-word paper based on the case study in which you:

Analyze the adverse trend, including how it affects patient care.

Evaluate the data that needs to be collected, reviewed, and applied in the decision-making process to address the adverse trend.

Evaluate the information system methods that will be used to collect the data needed in the decision-making process, including the source(s) of the data.

Evaluate the information technology and tools needed in each step of the decision-making process.

Evaluate any regulatory, legal, ethical, political, sociocultural, and financial issues related to the data and information technologies that will be used in the decision-making process.

Analyze at least two strategies used to advocate and access social justice in health care design and delivery.

How could a refresh of materialised view be done? Discuss the advantages and disadvantages of your chosen method of refresh over the other techniques.

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PART ONE, Entity Relationship diagram PART ONE, All DDL commands, test data [use SELECT * FROM…] per table
PART TWO, All query SQL syntax [and SQL*PLUS syntax] and results- evidence of the statements running in the Oracle DBMS. [Use SPOOL command to demonstrate]
PART THREE, All SQL Syntax and results pertaining to the view, triggers – evidence of the statements running in the Oracle DBMS [Use SPOOL command to demonstrate]
PART THREE, 150 word answer to part 3 (c)

PART ONE

Use a simple Entity Relationship Diagram (ERD) to show the Hampton Medical Practice database design.  The diagram should use the type of labels and notation taught in Computing Modules in your undergraduate course.  You may use a simple drawing package or word processor software or Oracle Modeller, or a hand drawn diagram or another suitable tool.  Appropriate relational database rules for cardinality and suitable constraints should be included.  INCLUDE ALL YOUR ASSUMPTIONS.

PART TWO

Basing your answer on your ERD in part one and using appropriate attribute types to create these tables using Oracle’s SQL*Plus. Your answer must include all primary keys, foreign keys and any additional constraints that are applicable.

Answer the following queries in Oralce SQL ONLY. If your implementation does not match your design, this will be penalised in the marking process. [WARNING : Do NOT auto-generate your SQL DDL/code- marks will be deducted if you fail to follow this instruction].

Complete the following:

  1. Create the tables in the Oracle DBMS using SQL create table statements. For all data relating to names or addresses set up uppercase constraints in your tables (e.g. patient surname, address of the practice).
  1. Enter representative test data into the tables. Enter the first record in the patient table using your own name. Ensure you have at least 12-15 rows of data to yield at least a few rows of data per query, as appropriate.  Take care with data, specific datasets are required to satisfy the query-based
  2. c) Produce answers to the following queries in SQL:
  1. Create a query that will display the total number of doctors (gps) and of that total the number who were hired in 1994, 1996, 1998, and 2000. Give appropriate column headings. [hint: you will need to use the Oracle DECODE function and remember to format the output].
  2. Give a list of patients seen from a given G.P. practice showing the

practice name, practice address, patient number, surname, initials, and G.P. number surname and initials. The list should be ordered first on G.P. surname and initials and then patient surname and initials.

  1. List the name and address of the patients who have been diagnosed as having “Asthma”. Each patient should occur only once in the result even though they may have been given that diagnosis a number of times (e.g. through a recurring illness).
  2. List the names and addresses of all GPs who work in the same city (i.e. you choose the city for example ’BIRMINGHAM’). Show the results of a number of different cities.
  3. Find out how many patients are seen by certain GP (i.e. you choose which GP)
  4. Use the MINUS construct as you have covered in the module, to find practices which do not employ a GP (include the city where they are located).
  5. Repeat the previous query (query 6) using the NOT EXISTS construct.

8      Write a query to display gps who have one or more colleagues in their practice with later hiredates but higher salaries.

PART THREE

  1. Develop a view that shows details of all patients on record and their details of diagnosis.  Display the contents of the view.
  2. Carry out separate updates on each individual column within the view.   Carry out INSERTS of new rows into the view .Deletes of rows from the view.  Ensure that patients based in Wolverhampton cannot book a routine appointment on a Sunday

Create triggers that enforce the following business rules:

  1. Ensure that appointments cannot be made for a Sunday.
  1. If a patient makes a greater than FOUR appointments in one month (patient_id, patient_name, practice_name) must be placed in an audit table.

Hint: You will need to construct an audit table with the appropriate columns of correct datatype.

  1. Ensure that patient appointments cannot be deleted if the date of the appointment is not later than the current date.

An essential part of this question is that having successfully compiled the triggers, you must construct a set of SQL statements and use them to test out the workings of your triggers.

For instance, if you have created an UPDATE trigger you will need to execute at least two UPDATE statements on the table on which the trigger is based – one that fires the trigger (and probably generates any error message from the trigger), and one that does not. In your testing, you must test all of your triggers, show their code and the output that they generate.

d.) Write upto 150 words to answer  “ How would you use a materialised view that can be used to enhance performance and undergo query re-write?”  Include the following in your answer:-

  • Use an external source of reference from your reading
  • Use an example to show how ‘Query Rewrite’  can be confirmed
  • How updates on materialised view’s base tables can affect query rewrite
  • How could a refresh of materialised view be done? Discuss the advantages and disadvantages of your chosen method of refresh over the other techniques.

Elaborate on minimum standards identified in provider manual on procedures for seclusion and restraint and how staff will receive initial and ongoing training on the use of restraints

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Diadem Hearts INC,

The Department of State Health Services is seeking more information from your organization to verify you meet the requirements specified in the Home and Community Based Services-Adult Mental Health Open Enrollment (OE).
Our findings indicate your application remains incomplete. Applicant needs to ensure that they have both a policy and procedure in place for all the items notated in the Open Enrollment.

Below you will find some useful information to help you format the content of your policies and procedures. Also, please see attached template for an example of how to format your policies and procedures.

Policies are your rules and guidelines that ensure consistency and compliance with the HCBS-AMH program

– Your HCBS-AMH Policies should address:
· what the Policy is
· who is responsible for the execution and enforcement of the Policy, and
· why the Policy is required.

Procedures define the specific instructions necessary to perform a task or part of a Process.

– Your HCBS-AMH Procedures should detail:
· who performs the Procedure,
· what steps are performed,
· when the steps are performed, and
· how the Procedure is performed.

*DSHS has provided feedback and questions below outlining some of the deficits in your application:

Update on the HCBS-AMH program: The 84th Legislature directed DSHS to expand HCBS-AMH to divert populations with serious mental illness (SMI) from jails and emergency departments (ED) into community treatment programs. Providers that contract with DSHS are now able to choose which population(s) they serve.
} Long-term psychiatric hospitalization
} Jail Diversion
} Emergency Department Diversion

For an individual to qualify to receive a referral into the program they must meet 1 of the 3 criteria below:
1. For Jail Diversion:
– During the three years prior to their referral, an individual must have:
o two or more psychiatric crises (i.e., inpatient psychiatric hospitalizations and/or crisis episodes requiring outpatient mental health treatment), and
o repeated discharges from correctional facilities (i.e., three or more).
2. For Emergency Department Diversion:
– During the three years prior to their referral, an individual must have:
o a history of inpatient psychiatric hospitalizations or outpatient mental health crisis episodes, and
o a pattern of frequent utilization of the emergency department (ED) (i.e., fifteen or more total ED visits)
3. For Long-term Hospitalization
– During the five years prior to their referral, an individual must have:
o Spent three or more cumulative or consecutive years in an inpatient psychiatric setting

Questions for your response:
– Please identify the population(s) you intend on serving? (Extended tenure, Frequent arrests, Frequent ED visits)
– How long have you been a provider of mental health services?—-THIS IS MY FIRST CONTRACT, i HAVE NEVER BEEN A PROVIDER BUT HAVE WORKED IN MENTAL HOSPITAL
– What types of services do you currently provide?
– Tell me about your experience working with individuals with mental healthcare needs?
– Capacity to serve – How many individuals do you anticipate being able to serve? This can be determined based on the number of staff you employ or intend to employ for each service area, broken down by direct employees and sub-contractors.

This is the Link to the Provider Manual: provider manual

Please submit the following items:

– Please submit policy and procedures as outlined in the provider manual (Form L) for provision of services, utilization management, housing and placement
– Please submit detailed job descriptions for each position with required qualifications. Refer to the Provider Manual sections 9200 and 9300 Job descriptions should be provided for every service type included in our program services
– Please submit an updated organizational chart that includes direct care staff, contractors and subcontractors
– Please submit policy and procedures on provision of services/ coordination of care including routine and emergency availability, assurance that all services will be provided and notification to DSHS if services are unavailable
– Please expand on policy and procedures to include credentialing and staff training for both direct staff and subcontractors verification of staff licensure, qualifications, training requirements and certification records
– Provide policy for Personnel Recordkeeping Policy and Procedure needs to outline the applications/tools you will use to verify the following:
§ Review of Medicare/Medicaid Sanctions for staff members
§ Maintaining documentation verifying malpractice or liability insurance for professional staff.
§ Verify license of staff members
§ Review of state regulation sanctions of staff members (i.e. Employee Misconduct or Office of Inspector General)
§ Review disciplinary actions against staff members (i.e. State Board or other agency)
§ How you ensure criminal history and background checks are completed for all staff involved in the administration of HCBS-AMH services
§ Need to include your credentialing procedure including applications used to verify credentials.
– Provide policy and procedures for documenting training on policy and procedures for all staff and subcontractors
o Need to identify how you will document and monitor training to ensure all employees are trained according to HCBS-AMH standards.
– Provide Policy and Procedures that outline how you will document staff training is in compliance with HCBS-AMH requirements (see Appendix A in Provider Manual for an outline of required HCBS-AMH trainings)
o Need to identify in the document which trainings each service provider will need to receive.
o Identify how you will monitor that all staff trainings are up to date.
– Provide policy and procedures for maintaining client record keeping practices including the retention of records, updated and signed IRP, updated and signed progress notes (Provider Manual section 13400)
– Expand on and include in policy and procedures on confidentiality of client records and progress notes
o Expand your procedures for ensuring confidentiality of client records and progress notes.
§ More details needed so any employee reading the policy understands the specifics of HIPPA policy.
– Please provide policy and procedures for medication safety
– Provide policy and procedure on how to inform clients of rights and responsibilities and organizational grievance procedures
o Consumer grievances–Please clarify this section.
o Client complaints – how does your facility gather and address client complaints?
– Provide policy and procedures for Medicaid fair hearing
– Provide policy and procedures for personnel and client safety (examples include PMAB or CIT)
– Expand on critical incident reporting and reporting procedures for reporting abuse neglect and exploitation based on information in provider manual (Provider Manual section 13500)
– Provide separate contraband policy and procedures that outlines how discoveries of illicit drugs or weapons will be handled
– Elaborate on minimum standards identified in provider manual on procedures for seclusion and restraint and how staff will receive initial and ongoing training on the use of restraints
– Provide policy and procedures on how employees and subcontractors will receive payment for services rendered
o Payment of employees and subcontractors – A payroll policy defines the responsibilities and accountabilities of payroll staff and managers. Since payroll involves confidential information, the policy must specify access and security levels. The payroll procedures detail the process from when the employee is hired. They include payroll activities and forms required for processing new hires, employment changes, information updates, special payments, deductions, time reporting and termination
§ Payroll department responsibilities
§ Title of position that is in charge of managing payroll
§ Time Reporting – how do employees document time
§ How employees receive paychecks
§ Payroll schedules and deadlines for submission of payroll documents
– Provide policy and procedures for the transfer of individuals to another HCBS-AMH provider (Provider Manual section 10300)
– Provide policy and procedures for the discharge of individuals from HCBS-AMH (Provider Manual section 10000)
– Provide policy and procedures for a quality management plan including the formal process to diagnose problems and tracking resolution and monitoring for improvement
o Quality Management Plan
§ Formal procedures for diagnosis of problems – Note: This procedure should exist to help diagnose problems that exist within providing HCBS-AMH services, not diagnosing individual client problems.
§ Tracking resolution; and
§ Monitoring for improvement
– Provide policy and procedures for utilization management (Provider Manual section 12000)
– Provide policy and procedure for monitoring and tracking placement, expansion of community housing relationship plan. Reference form H of the OE
– Provide policy and procedures verifying provider owned and operated settings meet setting requirements. Policy should outline procedures for Form H (Provider Manual section 11000)