Make this into a power point. The paper was a failure due to tight deadline. I need the presentation in this format. I was stating why elderly people were missing their appointments and the solution w

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UCLA Medical Center

Solution To Elderly Patient No Shows

Rodney Chew

HSM 520

October 1, 2021

Table of Contents

1. Executive Summary …………………………………………….…………………………3

2. Introduction………………………………………………………………………………...4

3. Mission, Vision, Values……………………………………………………………………5

4. Problem Statement…………………………………………………………………………5

5. Research Purpose…………….……………………………………………………………5

6. Research Questions………………………………………………………………………..6

• What is causing the no show rate of elderly patients

• What needs to be improved to increase pt. attendance

• Can changes be cost beneficial for patients and provider

1. Findings……………………………………………………………………………………6

2. Models of Analysis………………………………………………………………………..9

   1. External Analysis………………………………………………………………………...9

   2. SWOT Analysis…..…………………………………………………………………….10

3. Recommendation……………………………………………………………………….12

4. Summary and Conclusion………………………………………………………………13

5. References …………………………………………………………………………….15

Executive Summary

Patients over the age of 65 are often missing appointments across the UCLA Medical Center. Patients that do not keep or cancel their scheduled appointments are considered no-shows. The increasingly aging has resulted in a significant increase in the prevalence and consequences of chronic diseases, necessitating additional care and welfare. In prior primary care studies, it was discovered that in the US, missed appointment rates ranged from 5% to 55% (Ullah & Rajan).

It was decided to conduct an external analysis to discover external/environmental issues or developments in the industry that could have an impact on the organization's operations both externally and internally. The findings concluded that providers are not trying to persuade the patients nor adapting to this technological help. Majority of elderly patients are still working full time and maintain a household; therefore, afraid to miss work. UCLA is using telehealth medicine to help its elderly patients, but there was no through implementation or strategy to decrease no shows and make more it accessible. Telehealth allows patients to get health and social care from a distance allowing them to keep their independence and improve their quality of life. Telecare thus has made the elderly one of their key target populations. The current program being used from EPIC system “I/CHART” is too complicated for elderly patients on a time crunch.

The solution is an upgraded or corrected us of telehealth needs to be implemented . A SWOT analysis was then implemented to show the benefits and room for improvements using telehealth. Providers should also be trained based on the findings and commitment to the hospitals mission, values and vision.

Introduction

Many observations have been carried out to discover the root causes of elderly missed appointments at UCLA Medical Center and devise solutions to the problem. Considering the problem's enormity and persistence, there is a pressing need for additional research on the subject. Patient "no-shows" have been criticized for their financial toll on the healthcare system. Health care no-shows cost the United States more than 150 billion dollars annually, with individual doctors losing on average $200 for each unused appointment slot. Regardless of whether patients show up, healthcare organizations and medical practices must still pay their employees and cover expenses such as rent and equipment costs.

No-shows have a negative impact on people's health in addition to the financial costs. Patients who fail to show up for scheduled appointments disrupt the flow of care. It's impossible to keep tabs on medication efficacy on a regular basis. It's impossible to provide timely preventive services and screenings. Older patients are more likely than younger ones to miss a single appointment with their doctors, which puts them at greater risk of their illnesses becoming chronic. In addition, the research examined closely the effects on the sickest patients of missed appointments. Patients with diabetes, asthma, rheumatoid arthritis, cancer, and other diseases are particularly vulnerable to complications. In many cases, continuity of care and close coordination of primary care providers with specialists are the best ways to treat these illnesses. With just one missed appointment, the attrition rate for these patients doubled. Simply put, failing to keep a scheduled appointment can have serious consequences for one's health. According to the findings of one study, missed appointments are caused by three types of barriers: personal, structural/organizational, and monetary. Personal barriers can include beliefs about healthcare, education, and other aspects of a person's background.

The following are UCLA Medical Centers’ existing Mission, Vision and Values. UCLA prides itself on being if not the best, one of the best in southern California.

Mission Statement

Deliver quality customer-oriented services and programs that provide the strong foundation for UCLA to excel in education, research, and public service.

Vision Statement

Be the leader among higher education organizations by delivering innovative, high-value programs and services.

UCLA True Bruin Values

As a Bruin, I commit myself to the highest ethical standards.

• Respect
  I will value others by fostering an inclusive, collaborative and positive environment.

• Accountability
  I will be proactive and take personal responsibility to follow through on commitments and be a good steward of university resources.

• Integrity
  I will conduct myself as an ethical and honest representative of the University.

• Service
  I will provide a positive customer experience within a safe environment.

• Excellence
  I will always do my best and pursue continuous improvement.

Problem Statement

Elderly patients are currently missing their appointments and follow ups in many clinical departments.

Research purpose

Purchase of this research is to determine the cause of the no show rate of elderly patients. Changes needed to be made to uphold UCLAs’ Mission, Vision and Values.

Research Questions

• What is causing the no show rate of elderly patients

• What needs to be improved to increase pt. attendance

• Can changes be cost beneficial for patients and clinics

Findings

What is causing the no show rate of elderly patients

Interviews conducted with UCLA nurses revealed that elderly patients with a history of no-shows had low incomes, were the primary financial support in their families, and couldn't miss work because of it. Travel can be a hindrance, so telehealth is the main viable solution to bridge services from UCLA. Missed appointments can be caused by structural or organizational issues such as overbooking, appointment system difficulties, clinic hours, and inconvenient working hours. Convenience is what majority of elderly patients want. There are some patients who do not have the flexibility to call off work. Low-income families still depend on their elder relatives to contribute for survival.

This has led to their life's deterioration, and most do succumb. In this age bracket, people are known to be more forgetful and maybe cannot cope with the long distances to get treatment due to their less energetic nature. Some are clotted with poverty confining their chances of being admitted to hospitals due to the high fees, thus narrowing their lives to pain and death.

What needs to be improved to increase pt. attendance

UCLAs’ Telehealth system needs be further used by the oncoming flux of elderly patients. The current system is too complex for elderly patients and doctors. No thought was given to ensuring that elderly patients and doctors were comfortable enough using handheld devices for a video visit. The current I/CHART system is available only on a phone and I-pad.

Can changes be cost beneficial for patients and providers

Using the literature review method and analysis used, I found that truly Telehealth is a cost beneficial and effective activity (JJMoffat, 2011). It was found that patients can save more than 100 dollars by opting for telehealth sessions, as the average telehealth appointment only costs between 30 to 50 dollars compared to almost 170 dollars for in-person therapy. On individuals diagnosed with preterm delivery, the overall cost of gestation for those who use telehealth services was estimated to be around 7,000 dollars compared to almost 21,000 dollars for those who attended in-person consultations. It was further found that patients who used Telehealth saved an average of roughly 14,000 dollars (Bardsley and Steventon, 2013). Those frequently on elevated plans and footing the majority of the medical bill themselves would greatly benefit from those reductions. This excellent saving plan can help the patients, especially the elderly, remain with enough funds to fine-tune their eating diets and invest in their children instead of medical services alone. The telehealth costs also lighten the challenging economic situations slapping most individuals globally, especially those with the duty to provide to their kinships.

Doctors and clinics with telehealth programs were found to receiving general cost savings. According to the Geisinger Health plan study (Keck and Doarn, 2014), it was found that the telehealth program saved roughly 10% in cost throughout the study period, resulting in a return on investment of $3.30 in cost reductions for every $1 spent on telehealth program implementation. These advantages are directly significant to doctors and hospitals serving rural patients in remote places. According to the University of California, it was further found that the rural emergency sector saved almost $ 4600 on average when patients used pediatric telehealth consultations compared to physical talks (Illove, 2016). Further, according to Davis's study, it was highlighted that telehealth consultations reduce the number of patients being transferred or airlifted to other better hospitals by roughly 31%, thus rendering significant savings to the hospitals from costly air ambulance charges.

The cost reduction from fewer hospitalization was found to be another significant financial gain. From a study of nursing homes that applied Telehealth to provide off-hour care to patients, the nursing homes witnessed their hospitalization drop from 11% to 9% for the institutions under telehealth activities (Shaw, 2009). From another study, the Veterans Health Administration post-cardiac care program used Telehealth to reduce clinic readmissions by almost 50% for heart failure and 45% for other conditions (Novak, 2012). These are considerable reductions in costly hospital readmissions, which save a lot of money in the long run. These benefits were also not restricted to the patients and health care providers but the patients' employers and insurance companies.

Both its treatment and control groups saw a decrease in hospitalization per 100 resident days during the pre-and post-intervention periods. The control group witnessed a 5.5 percent decrease in hospitalization rate, while the treatment group saw roughly a 10 percent decrease. As a result, the treatment group pre-post disparity in hospitalization was almost 4.5 percent lower than the control group pre-post difference. This effect was most noticeable in the most engaged nursing homes, where hospitalization rates dropped by roughly 15 percent. Even with this great witness in the hospitalization of the patients, it was also found that some patients get into critical condition when not admitted. This was found to rise due to poor consultation between the patient and their doctor. Some patients were found to give an inadequate description of their health status as their physical strengths sometimes clotted their faces. The disease could build itself slowly within their bodies without their knowledge, something that could have been detected in case of an in-person visit to the doctor. Overall, it was voted in by almost 85% that Telehealth has genuinely reduced unnecessary hospitalization, giving those patients who do not like the hospital's environs a shiny face.

Models of Analysis used

Step 1 is “Organizing the External Analysis Process”, which further explains how much each nested system within an environment can affect other environments.

• Service area is the area of a health care provider encompassing the geographic location from which most of its customers and patients are recruited.

Step 2 is “Scanning the General Environment, Health Care System, and Service Area” This is being able eliminate predictable surprises. Strategic managers can avoid disasters by identifying and documenting a number of external organizations. By having an understanding and operation of external systems, they can anticipate and respond to shifts in general environments and health care systems

Step 3 is Monitoring and Confirming External Issues. This step ties closely with Step 2 but it monitors the issues in “scanning”. The four key functions in monitoring are identifying additional sources of information for each issue in the scanning process. It adds to the external issue data base. When it comes to trends, developments, dilemmas, and possible situations, it is very important to confirm or disprove it. Lastly its function is to determine the level of change within the issues.

Step 4 is Forecasting External Issues; integrating both monitoring and scanning. It is further extending trends and changes to predict future events. Forecasting looks for hidden trends that can possibly change the direction of an organization, extending the observed trends, developments, difficulties, and challenges the company is keeping an eye on to project the future condition (Ginter et al., 2018). When an organization is aware of the possible effects that situations beyond its control could have on it and the industry, it has the ability to predict and identify the advantages and disadvantages of this external impact.

Step 5 is Assessing External Issues is tying all the steps together. A strategic manager needs to able to interpret the information they receive. It’s a method to rate the importance and impact of unquantifiable factors on an organization where making judgements is the norm (Ginter et al., 2018). A number of strategic thinking frameworks can be employed for evaluating decision-making choices, including: Issue Impact and Probability Prioritization, Delphi Method, Nominal Group Technique, Brainstorming, Focus Groups, Dialectic Inquiry, Stakeholder Analysis, and Scenario Writing.

In business rivalry or project planning, a SWOT analysis can assist a person or organization determine their strengths, weaknesses, opportunities, and threats. For pre-decisional stages, this technique works by 'peeling back layers of the corporation.' It can be used to assess an organization's strategic position. Its goal is to establish the venture's goals and identify the internal and external elements that are helpful and hindering in reaching those goals, as well as possible solutions. A SWOT analysis is commonly used to provide meaningful information for each category and determine a company's competitive advantage by asking and answering questions. The name is an acronym for the four parameters the technique examines:

• Strengths: characteristics of the business or project that give it an advantage over others.

• Weaknesses: characteristics that place the business or project at a disadvantage relative to others.

• Opportunities: elements in the environment that the business or project could exploit to its advantage.

• Threats: elements in the environment that could cause trouble for the business or project

With Telehealth being an emerging issue in the health sector, it carries many advantages and some flaws. The benefits associated with Telehealth include: it reduces the rural barrier to care. This is actually among the most significant advantages of Telehealth as patients can be attended to wherever they are. It decreases strain on the healthcare system as patients no longer stress themselves from limited personal appointments and long traveling time. It supports independence, especially the elderlies, as they don't rely on others for institutionalization. It further delivers costs savings, as shall be seen from the findings as patients save on appointment fees and traveling expenses. It offers extensive telehealth technology options ranging from mobile phones to emails and computers. Lastly, Telehealth expedites timely care. It strives to quickly direct patients to their right health care providers, thus preventing them from much time in queues or clinic visits.

Even with those many strengths associated with Telehealth, it too has the following weaknesses. It is not practical to conduct every form of a visit from a distance. Patients still need to visit the doctor for imaging tests and blood testing, and diagnoses that require more hands-on treatment. The safety of electronic transmissions of personal health information is an issue. During the COVID-19 epidemic, insurance companies are gradually covering the costs of telehealth visits; however, some services may not be fully covered, resulting in out-of-pocket payments.

Furthermore, some of the patients are highly illiterate, thus confining them from effective digital electronic technologies. Lastly, Telehealth is not that readily available in many countries; therefore, patients cannot always depend on it. It may sometimes be interrupted with power or network problems, something that could not have happened in the case of in-person patients' treatment.

Recommendations for Action

UCLA should further develop a more convenient Telehealth system to benefit elderly patients. is cost beneficial and effective. With the findings depicting this for us, it still cannot be entirely argued that no more actions can be done to fine-tune it—some flaws associated with this need to be acted upon for Telehealth to be highly cost-effective. The health care providers from respective clinics and hospitals or the department of health agency should recommend less expensive technologies to be used by the patients for easier purchase by the less wealthy individuals (Marengoni, 2011). According to Massachusetts General hospital data (Wotton and Batch, 2005), it was found that Telehealth is currently considered as a driver of patients' satisfaction, meeting their expectations for convenient care access and quality. Scholars have long praised Telehealth as a valuable tool for connecting patients to care when they might otherwise encounter significant barriers to care. Patients who live long distances from the hospitals, having busy job schedules, or having a large family do heavily benefit from telehealth care. From the vast anticipated visits on the elderly patients, it is not a surprise that most of them found virtual meetings more convenient and impressed that they could still get quality care and communication better than the ancient and familiar in-person visits. It was easier to book a convenient appointment time for telehealth follow-up than for clinic visits, according to 80% of study participants. Patients also claimed that telehealth sessions were of good quality and their happiness with the scheduling process. Some patients thought telehealth services were just as good as in-person visits, while others argued that telehealth appointments are higher quality than in-person visits.

Even when using video visits, patients experienced meaningful ties with their doctors. 70% of the patients who used Telehealth stated that they had a good personal connection with their doctors. Patient's satisfaction with Telehealth was thus generally high, and on a ten-point scale, 72% of the patients gave their Telehealth a nine out of the possible ten. Some of the low ratings were due to minor technical issues associated with poor networking in some areas. Physicians, on the other hand, still place great importance on in-person appointments. Although almost 60% of telehealth practitioners believed that the technology was accepted for their respective patients' needs and of comparable quality to in-person sessions, some still expressed misgivings. A third of the doctors still vote that in-person visits provide better care than Telehealth. Furthermore, roughly 45% of the doctors felt that in-office visits allowed more patient-provider interaction than telehealth appointments.

The charges associated with these online consultations and diagnoses should also be halved after finding out that some providers value telehealth patients as wealthy persons bumping huge charges for their treatments to them. Since the activity is encouraged across every individual, the costs should be standardized relative to the patient's disease. With these changes made instantly in most counties, if not all, Telehealth will surely be the song in the future health sector.

Summary and Conclusion

Telehealth-based care is increasing in popularity. The elderly population has become increasingly involved in the momentum, and innovative telecare solutions are increasingly finding their ally. Technology advancements have made it possible to execute solutions commonly thought to a distant vision in the future. Aside from the fast-developing technology for education, protection, assessment, treatment, and rehabilitation, there are several other advantages. Telehealth opens up new possibilities for chronic disease patients. It improves the quality of life for older patients by reducing socioeconomic inequalities in access to treatment and providing equal opportunities for patients from both urban and rural areas. There has been a substantial shift in well-developed countries from passive monitoring to more active monitoring and having a decent fiscal future in recent years.

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