Implementation of a non-emergent medical transportation programme at an integrated health system.

OBJECTIVES: To implement a unified non-emergency medical transportation (NEMT) service across a large integrated healthcare delivery network. METHODS: We assessed needs among key organisational stakeholders, then reviewed proposals. We selected a single NEMT vendor best aligned with organisational priorities and implemented this solution system-wide. RESULTS: Our vendor's hybrid approach combined rideshares with contracted vehicles able to serve patients with equipment and other needs. After 6195 rides in the first year, we observed shorter wait times and lower costs compared with our prior state. DISCUSSION: Essential lessons included (1) understanding user and patient needs, (2) obtaining complete, accurate and comprehensive baseline data and (3) adapting existing workflows-rather than designing de novo-whenever possible. CONCLUSIONS: Our implementation of a single-vendor NEMT solution validates the need for NEMT at large healthcare organisations, geographical challenges to establishing NEMT organisation-wide, and the importance of baseline data and stakeholder engagement.

The diabetes disease state management exemplar.

One relatively new method of providing care to patients with chronic disease is disease state management (DSM). Diabetes is particularly interesting to study because it is not only one of the most prevalent chronic diseases, but it is also a disease for which DSM is highly cost effective. Similarly, registered nurses represent the group of practitioners most likely to provide a comprehensive set of DSM activities. This experiment was conducted in fall 2005 at a nationally recognized diabetes center which is affiliated with a large, full service medical center. The results suggest at least three forms of content delivery--in-class, at-home study packets, and online modules--are all equally effective at enhancing diabetes DSM knowledge.