Brand New Day HMO: August 2017

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Parent Document
01_Assignment_COPD_17070801_Gibbs BND 6.2.1

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James J Krueger MD for Brand New Day by Keith E Torkelson MS

We like: Brand New Day
Chest Pathology & Cost Containment Class

Session-6 Namesake = COPD Course

COPD Risk Management

BND Pulmonary Cost Containment

Special Event Workshop Quality Measurement

Abstract – In The End

Tomorrow August 16, 2017 from 11am – Noon is class number six of MSG’s and our consumer peers COPD adventure. This will mark the end of the six-session one hour courses. We hope that the administrators will offer up a Satisfaction Survey as is customary with their contemporaries. We have included two controls: An individual whose behaviors are well known to us and a control hour the STEPS program. One day attending a STEPS presentation far outweighed attending any day of the BND course of study. Using our Quick Score Method (QSM) we scored the one hour value for each an A. Applying our rubrics the results are quite different. Using our event satisfaction rubric this course earned from 64.1% to 85.0%. For our one day with STEPS we awarded them a 100.0%. The process values we award as follows: COPD (52.3% - 75.7%) and STEPS (86.4%). Finally, the product values we award as follows: COPD (40.9% - 77.3%) and STEPS (81.8%). The COPD course failed to clearly define and provide for any product definition.

Last Up Front Method (Session 6/6 Graduation Day)

The Health Instructor Laura Davis-Loschiavo delivered a strong finish. She prepare and provided health foods for us to eat (free food), a book on nutrition that she had authored: Simply Eating Healthy (By Laura Davis-Loschiavo, 2015) and two helpful handouts. She also gave each student a gift pack that she designed. Yet the most important thing she offered up is a COPD Course Satisfaction Survey (CCSS). We filled out and submitted our CCSS. Guided by the survey question constraints with gave the course relatively good marks. We gave them a Quick Score of 4.0 and a Calculated Score of 4.4 (See table that follows).

Buster Keith is Stage 1.5

If We Were To Submit

In general we submit about one-quarter of our papers. If we were to submit this paper we have no idea of whom at Brand New Day to share it with. This paper is our delivery on assignment. For now it will be shared via Blog using our dedicated Brand New Day Blog. It is too out of score for sharing with anyone we associate with at the Orange County Health Care Agency (OCHCA). Why did we make the effort? Answer: We would like to reduce our COPD risk and possibly quit smoking.

COPD Course Satisfaction Survey (Content Assessment)

“From a scale from 1-5 1 being the least interesting and 5 being the most interesting topics. How would you rate the following topics I this course.”

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Item #	Element (Class Number)	20170816-W CRC	Comment
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1	Knowledge of COPD and the lungs work (1)	4
2	Medication and the use of spacer (2)	5
3	Techniques to manage stress and anxiety	4	Track with Anxiety Assessment
4	Breathing and Conditioning Exercises	5
5	Proper diet and learning a few new recipes (6)	4

6	How would you rate this course?	QSM = 4 CALC = 4.4

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Last Reviewed: 20170818-F:

Comments - How could this course be improved?

MSG Response - Utilize more assessments and outcome measures. Deliver to us some pertinent numbers from our Electronic Health Records. An example would be our Spirometry results over time.

Name (Optional) – Keith T

CRC = Consumer Rates Course

QSM = Quick Score Method

CALC = Calculated Value from Prior Items
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Usual and Customary Turnaround

When you take a college course the typical turnaround rate for course related figures is one week or less. Thus we would like to see the summary results from the Satisfaction Survey posted at Brand New Day (BND) by next Wednesday the 23^rd of August 2017.
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Star Equivalents CC Overall CMS Stars

We gave this course a calculated Star Equivalent Value (SEV) of 4.4. Brand New Day is rated by the Centers for Medicare & Medicaid Services (CMS) for 2017 as a 3.0 Star program. Thus using 3.0 as a benchmark this COPD program exceeded our expectations.
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Names for Course

With no agendas offered from the start we have had a hard time deciding what the course is called: The following is our name elimination list based on what the presenters and the titles they have mentioned. In the sixth and final meeting the course was identified in writing as COPD Course.

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Description	Source	Detail

COPD Class	Jeff Gibbs
COPD Course (6)	Laura Davis-Loschiavo	Name on final assessment
COPD Special Event	Jeff Gibbs	In sales pitch phone call
Cost Containment Class	Krueger James J MD	Implied
Heavy (High) Utilizer Class	Krueger James J MD	Implied
Pulmonary Rehabilitation	Unknown presenter (Wally?)	Voiced and in PowerPoint
Special Event	Jeff Gibbs
Training	Carley?
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Last Reviewed: 20170818-F:
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We like: Brand New Day – Chest Pathology – Cost Containment Class

We had really hoped that Doctor Krueger would have brought a handout with some pertinent numbers including the costs sustained by BND for COPD.
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Paperwork

Once again we figure that five pages of key Intel should be provided per class.
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Standardization – EBR

In the face of the fact that we are the first class enticed into this study we now know better why there seemed to be little if any standardization. In a manner of speaking our cohort of members is an experimental group for this COPD course.
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FYI – Experimental Bunny Rabbit (EBR) Vignette

We just can’t restrain ourselves. Here is the EBR vignette. When we were attending for our freshman year the UC Davis School of Veterinary Medicine we were offered an Experimental Bunny Rabbit (EBR). At the end of the study the cohort of some one-hundred (100) rabbits should have all been euthanized as per protocol. A researcher gave us an adult male Norwegian White who had a history of living in a cage and experimented upon. Just call him Norge. Norge weighed in at about eleven (11) pounds. He was vicious. The most vicious rabbit we ever handled. If we needed to catch him up for any reason in the backyard we could only safely do so with a dogcatcher catch loop. After about six (6) months we thought it best just to let Norge go be free in the park.
[INSERT PICTURE OF NORGE RELEASE POINT]

Oxford Park Davis California

TimeSpent

We most likely spent more time preparing for each lecture than did the instructors. There is an exception: Laura Davis-Loschiavo provided evidence of considerable preparation.
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Underrepresenting Yoga

At the end of each class they instrumented a brief practical. At times our practical exercises were sold as yoga. Briefly, yes there is relaxation yoga yet the yoga that transforms is very intense and rigorous. We will take this opportunity to say one of the best things that Brand New Day (BND) provides for us in our 24-hour Fitness membership. We go to yoga as much as possible. Our yoga class is partially associated with our current weight reduction to 151 pounds (5’8”) from January 2017 at about 160 pounds. This is measurable progress. For us a correlation between yoga and weight change is high.
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Name of Assignment – COPD Special Event (Gibbs)

A Brand New Day Rep Jeff Gibbs assigned us via a phone call this course of study. We assumed that the course was about what we needed Tobacco Cessation. We had hoped that by attending it would increase our chances for controlling our cigarette smoking habit. We also hoped that the material presented would qualify for us: A promising practice.

Actual – Cost Containment Centered About Pulmonary (Chest) Disorders

We assign responsibility and accountability to the most qualified instructor. This would be Doctor Krueger. It appears in Mentalations Solution Group’s (MSG) external quality review efforts that giving credit to people is a more promising approach than giving credit to processes.

Outline of Lectures (Agendas)

We here at Mentalation Solutions Group (MSG) are familiar with both the UC course format and the Public Health format for offering courses, workshops, etc. Both offer up a list of items to be discussed. The list may include some or all of the following: Schedule, assessments, plans or to-do lists. We know that when Doctor Krueger James J MD went to Med School his professors offered up hardcopy lesson materials. In the UC system the product is student performance and anything it takes to deliver high performers. In grade 9-12 science the instructor offers up an assessment on the first or second meeting to gauge the prior knowledge for each student. In (public) health now more than ever instructors need help Proving their Concept in a quest towards maturing a Promising Practice. Proof of Concept should best be measured and amalgamated with quantitative results.

Assessments and Indicators

Fortunately our Assessment Base (MSGAssBase) has come a long way since our intensive public health investigation began back in 2009. Many of our derived assessment tools have reached the mature phase. We pulled a few to apply to this study. This course has yet to offer up any quizzes or exams the demonstrate student learning. What follows is MSG’s assessment elimination list. We place Spirometry Results highest on the list. We have Spirometry in the Central City Community Health Center (CCCHC) database going back to 2012. Spirometry is a focal indicator for Chest Health. In addition individualized reports would demonstrate that administration knows how to leverage the PCP’s (CCCHC) Electronic Health Record.

Goal

Doctor Krueger identified his goal: Decrease emergency room (ER) and hospital visits for pulmonary disorders and decrease avoidable costs.
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Assessments and Indicators (Consumer Evaluates Self)

Assessments as Products – Quick Score Method (QSM)

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Track with	Before-After Classes Trend	Is Class Correlated?
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1-Spirometry Results	“m=0”	NO
20170726-W: Stress & Anxiety - Beck Anxiety Inventory (Added)	“m=0”	NO
Chronic Fatigue Syndrome	“m=0”	NO
Performance Challenge such as staying away from the ER or admit as an Inpatient	“m=0”	NO
Performance Challenge such as endurance in Yoga	“m=0”	NO
Performance Challenge such as jogging	“m=0”	Minor
Performance Earned Value	“m=0”	NO
Quality Of Life (BND)	“m” Positive	Minor
Satisfaction with Life	“m” Positive	Minor
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Last Reviewed: 20170811-F:

“m” is the slope

Assessments Supplied and Prescribed by Administration

Brand New Day has a few prescribed assessments in their library. We selected their version for a Quality Of Life (QOL). The course really did not impact our QOL. A better assessment would have been Satisfaction With Self (SWS) to track the impact of the course. Of course improvement in Spirometry results would be one of the best indicators that the course had real time impact.

Correlation & Impact

Non rigorous correlation pinging is a fickle beast. Unless you specifically and intensely address an area of health such as anxiety you really do not get strong associations between a method and what a method is intended to change. The impact for us was getting to hang out in a classroom environment with more than one BND staffers at a time. And the BND director said more in one hour that we heard her say in a whole year.

Defining a Product

For us the product is this report. As far as what taking the course was supposed to produce we are still at a bit of a loss.

Controls – Individual - Speedy

Our individual control is a BND Member “Speedy”. For 2017 Speedy would be classified as a high utilizer for chest problems. About two months ago he was admitted to the hospital for breathing problems. After the hospital released him he came back home. For about ten (10) days he was gifted with home nurse visits, care, and advice. We just knew if this course could help Speedy it might help us. Speedy walked out of session one (1): At the middle of Doctor Krueger’s lecture and sales pitch. We caught up with Speedy later in the day over a cigarette we inquired of him: What would have enticed you to stay for the whole lecture? We will address his response(s) later one.
[INSERT SPEEDY PICTURE]
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Speedy Our Control Subject - After Session-1

Controls – Session - STEPS (Established 2011)

For our alternate hour Program Control we picked a Public Health related presentation. We visited the Telecare STEPS program in Santa Ana. The agency Telecare has higher standards to meet than does Universal Care Brand New Day. Telecare has to demonstrate fidelity to the Mental Health Services Act (MHSA). Telecare delivers a spectrum of services they call Striving Towards Enhanced Partnerships or STEPS. In their mission they have to demonstrate measured outcomes. We will address more about STEPS later. Just a couple of notes: STEPS promotes injectable long acting medications. STEPS has a package for stable housing. Both these things we here at MSG have found issues about. FAQ - How is it that the PharmCos don’t have a once a month injectable to address COPD or cigarette withdrawal?

FYI – Metadata – Adherence

[XENONET & MDOC Daniels]

Injections - Almost the worst-case scenario

10_BMB_Invega_Experiment_17011603_Notes

TimeSpent
We might have better spent the time (some four hours) learning and working on our plan to increase our chances to quit smoking. Our goal here is to help Brand New Day and Network deliver a better product if they even deem it useful to upgrade and repeat this. We get the feeling that Doctor Krueger sized his students up during the first lesson and said it wasn’t worth his time. Doctor Krueger did not return for the second, fifth, and sixth lesson. Over six (6) weeks the student attrition rate was substantial. That is the consumers way of saying for them this is non-sense. 20170815-TU: This report in its current incarnation is about thirty (30) pages. That equates to processing about six (6) pages per lesson session. Our rigor exceeds that of the instruction staff.

Some Standards Up Front (SUFs)

MHSA In General (Compare) – Tenants of the MHSA

Mental Health Services Act (MHSA)

http://www.dhcs.ca.gov/services/mh/Pages/MH_Prop63.aspx

Mental Health

Accuracy and Timeliness of MHSA Reporting by Counties 6/30/2010.

http://mhsoac.ca.gov/

FYI - The Mental Health Services Oversight and Accountability Commission

Our Mission (MHSOAC)
“Provide vision and leadership, in collaboration with clients, their family members, and underserved communities, to ensure Californians understand mental health is essential to overall health. Hold public mental health systems accountable. Provide oversight for eliminating disparities; promote wellness, recovery and resiliency; and ensure positive outcomes for individuals living with serious mental illness and their families.”

Positive Outcomes

The material above may address mental health yet in general everything can be tweaked to apply to all health in general. We would like to help BND ensure measured and measurable positive outcomes. Oh! And our mission: We would like to help BND improve its’ CMS Stars Scores. The quote above is just good language to get familiar with.

Summary of BND Classes

https://bndhmo.com/

https://bndhmo.com/special-programs/

Special Programs
Brand New Day Program for Individuals with

Chronic Mental Illness

CHF and Stage A CHF Hypertension
Diabetic Program

Dementia Program

Medicare & Medi-Cal Program

Possible Addition

COPD (Course)
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BND - Our programs follow the Brand New Day “Seven Fundamentals of Chronic Care Management”, which include: https://bndhmo.com/about-2/

Lived Experience

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	Element	SLB 20170818-F	SLA 20170818-F
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1	Education about the member’s chronic or ongoing medical conditions and avoidable risks	Weak (1)	Strong (5)
2	Nutrition	Moderate (3)	Strong (5)
3	Exercise	Weak (1)	Weak (1)
4	Self-Testing and Monitoring	Weak (1)	Moderate (3)
5	Medication Adherence to doctor orders	Strong (5)	Strong (5)
6	Preventive Care planning	Weak (1)	Moderate (3)
7	Linkage to community support programs	Weak (1)	Weak (1)
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	Value Added Score (VAS) = 35 MAX	13/35 37%	23/35 66%
		1.9 Stars	3.3 Stars

Date Scored and Last Reviewed: 20170818-F:

SLB = Strength Level Before

SLA = Strength Level After

Value Added Score (VAS)

This class improved our association with Brand New Day and select Network Professionals.

Teach To The Test- Consumer Evaluates Units


Track with		CSG 20170819-SAT

Performance Earned Value (PEV)		Neutral
Satisfaction with unit and pedagogy		Disagree
Satisfaction with reasonable compensation		Disagree
Teaching to the test		Disagree

Last Reviewed: 20170811-F: Findings for Keith T.

CSG = Consumer Self Grade

20170731-M – Prior Expectations

Data: As a minimum we expected our individualized Spirometry data sets as maintained by PCP offices

Presentations with data

Data driven presentations

Orientation: First meeting provided a hard copy overview of this unit

Resource Leveling
For better or worse Brand New Day and a few of its’ network professionals really do not think we consumers do anything of value with our time. This becomes most obvious with scheduling. We engage in substantial volunteer work. This report is our way of volunteering for BND. In order to suit up and show up for as many COPD Course classes as possible we had to address our limited resources and reframe our time commitments.

Commercial-Off-The-Shelf Tool

As you can see with the Metadata below we have been using our Event Assessment Tools (EATs) since 2011. Over multiple events including job fairs we handed them out to all participants: Staff, funder, and consumer alike. The purpose was to sustain funding for each subsequent or following event. Even though we are not administering these events anymore we set a foundation in measurement. The events we help create continue annually.

MSG’s Quality Assurance System for Events

Associated Forms

Metadata for Assessing Events >

PostEventEval_11050401_CCNC_Frmtd V2016

Systems_Eval_11111602_Engage_Value V2016

01_Assess_Post-Event-Eval_17070803_BND-COPD

Summary of Class Themes

Chronic Obstructive Pulmonary Disease (COPD)

Coughing Techniques

Bronchitis

Destroying Alveoli (Irreversible)

Heavy Utilizers

Nutrition

Pulmonary Rehabilitation

Relaxation & Breathing

Yoga

And More!

Controls

Individual: Speedy – High Utilizer

Program: MHSA – Telecare - STEPS Substitution

The Assignment – Jeff Gibbs

Jeff Gibbs assigned this six week commitment once per week on Wednesday from 11am-12am to us over the phone. Now a couple of weeks into the “COPD Course” we know this in not Jeff’s project. Thus we will not include much if anything about Jeff Gibbs in this evaluation report.

FYI - 20170801 Here Is The News (HITN) – Oswaldo Escalante is back.

Outline of Lecture & Practical – Unit Plan – COPD Course - Six Lessons

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Mtg# AFS	TimeStamp	Nature	Sat QSM	Paperwork	N

1 – AFS	20170712	Orientation Krueger James J MD	A-	1 Page – Pulmonary Pathology	25
2 – AFS	20170719	S2D2 Practical Using Support Devices	A-	PowerPoint on Meds Different teacher	20
3 – AFS	20170726	Stress & Anxiety Carley	A-		15

4 – AFS	20170802	Swap time for STEPS	A	Poor quality marketing collateral WRAP Outline	30
5 - AFS	20170809	Anxiety – Stress – Acute Suffocation Wally	A-	Sign in sheet	7
6 – AFS	20170816	Nutrition & Behaviors that facilitates breathing – Primary Instructor – Laura Davis-Loschiavo	A	Exercise Band Workout COPD Health Eating Habits Simply Healthy Eating COPD Course Satisfaction Survey	12

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Lecture Schedule – BND COPD Course - Table Designed: 20170716-SUN: Last Update: 20170818-F:
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AFS = Apply Form Set
SatQSM = Satisfaction Quick Score Method

Satisfaction

Results – Event Evaluation – Success & Satisfaction

Program Evaluation: Post Event Evaluation

Measure of Satisfaction

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Wk	Day of Event	Items	Scored Items	Raw	Satisfying & Successful (%)

1	20170716-W	12	11 (12)	8.5	70.8%
2	20170719-W	12	11 (12)	8.8	79.5%
3	20170726-W	12	11 (12)	6.8	64.1%

4A	20170731-M-CAAC	12	11 (12)	11.0	100.0%
4B	20170802-W-Skip
5	20170809-W	12	11 (12)	7.3	65.9%
6	20170816-W	12	11 (12)	94	85.0%

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Satisfaction (MSG) - Last Reviewed: 20170817-F: BND COPD Course (Pilot Episode).
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CAAC = MHSA Consumer Action Advisory Committee

CAAC Going Rate

The going rate for a CAAC member is a $20.00 gift card for each meeting
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Process

Results – Event Value Evaluation

Performance Earned Value (Indicator for Satisfaction)

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Wk	Day of Event	Items	Scored Items	Raw	% Successful
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1	20170716-W	11	11	7.0	63.6
2	20170719-W	11	11	5.8	52.3
3	20170726-W	11	11	6.3	56.8

4A	20170731-M-CAAC	11	11	9.5	86.4
4B	20170802-W-Skip
5	20170809-W	11	11	7.0	63.6
6	20170816-W	11	11	8.3	75.7

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Process - Last Reviewed: 20170817-F: BND COPD Course (Pilot Episode).

Product

Results – Event Value Evaluation

Performance Earned Value (Indicator for Satisfaction)

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Wk	Day of Event	Items	Scored Items	Raw	% Successful
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1	20170716-W	11	11	5.0	45.5
2	20170719-W-NPD Attended	X	X	X	X
3	20170726-W	11	11	4.5	40.9

4A	20170731-M-CAAC	11	11	9.0	81.8
4B	20170802-W-Skip
5	20170809-W	11	11	6.0	54.5
6	20170816-W	11	11	8.5	77.3

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Product - Last Reviewed: 20170817-F: BND COPD Course (Pilot Episode).
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20170719-W: NPD = Need Product Definition

We had to pause for one week to try to figure what the COPD Course was to deliver. One of the reasons we tabulated is that have a side job with Public Health Technology and Recovery. We are trying to define standard for data tables.
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Facilities

Probably the most significant shortfall in facilities is that there is no free Wi-Fi.

Marketing & Sales

What we Need?
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20$ gift card for each class per person

Collect some good images (a record of good memories)

Truthful recognition in the BND Newsletter in both text and photographs

Marketing – Record for Comparing 2017 COPD w 2017 MHSA STEPS

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Medium	20170712-W	20170731-M
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On Calendar	Unknown	Karla via mass Email
By Phone	July 6, 2017 (TH) 714 867-6462 (335PM)	Unnecessary
Collateral	None	Karla sent agenda
Online	Not	No
Other	Word of mouth Especially Speedy	Network conversation
Pass It On	I did to Speedy 20170708	No we kept it secret
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Last Reviewed: 20170819-SAT

Penetration

The marketing and sales prior to the event were sufficient to attract a significant number of BND consumers. During the course of the COPD Course sales fell of quite a bit.

Measureable - Sample Tracking Assessment

Quality Of Life (QOL) Choice

Quality Of Life Assessment Results for Keith Torkelson, M.Sci.

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	Date	% Normalized (Items Scored) A(P)L	Comment

	20150623	71 (15)	Prep for Helper #4 – Jeff Gibbs
	20151219	62 (15)
	2015 – Yearly Average - Retro	62 (15)
	2015 – Yearly Average - Calculated	67 (15)
	20160309	66 (15) Baseline	Submitted with new service plan Another Baseline for Eye Crisis
	20160612-SUN	70 (15)

	201706-1^st Half Retro	79 (15)	Before retina issue
	20170627-TU		Date of detached retina diagnosis
	20170702-SUN-RT	52 (15)
	201706 Retroactive For 1^st half of June	79 (15)	Baseline for Eye Crisis
	20170702-SUN-RT	52 (15)	Retina Crisis Significant
	20170818-F-RT	88 (15)	Close of COPD Course
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High Resolution Longitudinal Process Measures for Quality of Life (QOL-15) – Last Update: 20170718-F: For Consumer – Keith T.

RT = Real Time
A(P)L = Actualization (Purpose) Level (%)

Metadata > Quality of Life (QOL)

Introduced in Chapter-03B

BND_0.0_Assessement_17062503_History

Interpretation

This is really interesting for us because our Quality of Life improved over the COPD Course timeframe. Yet the improvement has little or nothing to do with participating in said course.

Included Below

Included below is a sample of the Brand New Day prescribed Quality of Life (QOL) Assessment. Even though we have submitted several we have yet to receive our scores or interpretations back.

[INSERT QOL]

Lesson-1: 20170712-W

The lead speaker identified himself as James J. Krueger, MD (JJK). He did not hand out an agenda of any sort. Doctor Krueger did have a handout on chest pathology. He focused a bit on this handout. In our opinion he underemphasized normal anatomy in favor of pathology. He indicated on more than one occasion that alveolar pathology in not reversible. This is a real inspiration killer. JJK did little to address variations in COPD presentation given similar stimulus. For example both my mother and her sister began smoking cigarettes in their teens. My mother died from complications of smoking in 1998 (Age 73). My aunt JMB as of 2017 still smokes and just turned 92.

20170712-W: Our Control Subject

Our Control subject Speedy left the meeting before the half way point. Since this year beginning April 2017 Speedy suffered breathing issues so intense that he: Went to the Emergency Room, was admitted, and upon release was assigned home visiting nurses. In the beginning of this course we had 3 controls. Two of them also smokers didn’t even show for the first lesson. The reason we select Speedy as our control is that if the program can reduce the severity of his COPD and possibly get him to stop smoking cigarettes the process the program uses might work for us. We asked Speedy what would have kept him in the room. The offer of cash seemed to perk him up a bit. See later about CAAC and reasonable compensation.

20170712-W: Key Event Tracking

Doctor Krueger (SPELLED) presented for about an hour. A videotape was taken of the first fifteen minutes or so. In 2012 we agreed to everything in the Brand New Day enrollment package except to a permanent release for our photos and videos. About twenty minutes into the lecture one of his highest COPD utilizers this year walked out on him. This individual for pulmonary disorders went to the ER, was admitted, and had daily home nursing when he went home. This individual is quite exceptional on how many COPD symptoms he will tolerate before he surrenders and goes to the hospital. Going to the hospital really doesn’t help him much.

Shortfalls

The teaching staff did not collect any student baseline data. There were no condition assessment. They did not describe any indicators for success. The product they were trying to sell was not well defined. We still have the question: What is/are the intended products?

Why Kill?

Metadata > PM_17072601_When_Kill Partnership-COPD

You might ask why we didn’t drop this COPD Course or kill the partnership(s). For the most part this class passed our standard Project Management for when to kill a project. Three of the reasons we have stuck it out are:

We are serious about controlling our chest issues

We get to apply some of our legacy assessments and tests

We may get to influence in a positive manner future course offerings

Organization & Materials

Any instructor that engages in contemporary pedagogy knows you “teach to the test” and provide hardcopy materials for students to take each lesson home. This exercise (workshop - module) employed no Agendas or any content Assessments. The PowerPoint’s were below average. Actually now that we have time to reflect this venture may just be so administration can check something off on a checklist.

The Army Man Story

Twice Doctor JJK addressed toxicities: One about cigarette additives inhaled and exhausted. The other toxicity was about VAPEs. He indicated that VAPE exhaust contained some major toxic elements. The older generation pulmonary specialist missed the boat regulating tobacco additives. Now the new generation whines about VAPE toxicity when they were positioned to regulate VAPE juice additives.

Special Topic – Who is Krueger anyhow?

Professor Krueger’s Bios

James J. Krueger, MD - Memorial Care Health System - Orange County...

https://www.memorialcare.org/find-providers/physician/james-j-krueger-md

James J. Krueger, MD. "Chest medicine is a complex and diverse practice of clinical medicine. In order to be a good clinician of chest medicine one requires a working knowledge of the interaction between the lungs, heart, and great vessels.”

A Promise of Performance

We basically no – we were promised nothing if we stayed out of the ER or hospital. He did promise that are alveoli would not regenerate.

Objective - Stars Summary for Doctor James J Krueger - Pulmonologist

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TimeStamp Date Found	Online Utility	AVG Stars 5.0 Best	Number Of Reviews	UWD
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20170726-W	WebMD	5.0	1	5.0
20170726-W	Healthgrades	4.8	18	86.4
20170726-W	Yelp	3.5	5	17.5
20170726-W	Vitals	4.2	13	54.6
	-
20170816-W	SUM Reviews =		46
				163.5
20170816-W	AVG Stars =		3.6
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Last Reviewed: 20170816-W: Online Star Search Rating for How You Rate Your Doctor – Krueger MD.

UWD – Unweight Discombobulate

Interpretation & Error Rate

We all know everyone makes mistakes. What doctor can honestly say that they had 100% on all university related exams. What doctor can say they scored in the 99 percentile on all MCAT elements. What doctor can say they never lost one and I couldn’t practice much better.

28 %

We here at MSG calculated an error rate figure for Doctor Krueger of twenty-eight percent. Due to lack of transparency we do not know his actual error rate. Yet based on consumer online reporting there are indications that he made a mistake here and there. If indeed the average Stars of 3.6 have any meaning he is performing about Brand New Days 3.0 Stars threshold. Because he is in the middle he does not qualify as a Person Of Interest (POI). We focus our efforts on high performers and low performers. One again we do not rate our doctors online because it messes with its’ objective value.

Online Stars (Search) Research for Doctor James J Krueger

We hope we don’t have to see Doctor Krueger in his MD capacity so we are withholding the details about our Star Search. As you could see he does pretty well.

Session-1 Krueger Handout

Necrotic Alveolus (?)

Chance Doctor Was Paid by Astra

Lesson-2: Professor Drops Class (S2:D2) – Pulmonary Rehab with Wally

20170719-W

Lesson-2 was about Medications that target the pulmonary system. Medication Management is one of the primary realms for MDs. Doctor Krueger was a no show for lesson-2. What we wanted out of lesson-2 was a report with our yearly Spirometry results for 2014-2016. We also wished to take a COPD status paper test or better yet an online COPD assessment. COPD Rx: Dilators and Anti-inflammatories > Albuterol (Generic) > Theophylline (LiveX).

FYI - Side Story About Human Lung Evolution

“Buddy We Have A Hypothesis”

Have you ever wondered why human being lungs can even handle something as toxic as tobacco smoke in the first place? Apparently mammals have been around some odd 150 plus million years. Over the course of millions of years the atmosphere changed substantially. There were periods that mammals survived through when Earth “air” was downright poisonous and toxic. Without adaptation tobacco smoke should be self-limiting with the hacking it could produce. In addition the tobacco mixer possibly include one or more numbing agents.

Lesson-3 (Training) - Stress and Anxiety

20170726-W

The presenter was a new BND staffer for us. We believe her name is Carley. Since she addressed COPD and anxiety we suggest adding a good anxiety assessment such as the Beck Anxiety Inventory (BAI) to the COPD Course arsenal. Carey also discussed: Advanced Health Care Directives and “End of Life Wishes”. At this point not having agenda’s is annoying.

Beck Anxiety Inventory Metadata
[INSERT]

Lesson-4 – Alternative – COPD Value

20170731-M

Swap HRE time for OCHCA STEPS site tour 20170731-M:

Orange County, California - STEPS - OC Health Care Agency

http://www.ochealthinfo.com/bhs/about/pi/mhsa/fsp/adult/steps

“Telecare STEPS (Striving Towards Enhanced Partnerships) is a Full Service Partnership (FSP). Services are “wrapped around” clients to help them gain the skills and confidence to live successfully in the community. STEPS offers outreach and engagement, intensive case management, 24/7 availability, housing and medication support. They also offer dual diagnosis treatment, vocational and educational services and linkage to financial benefits.”

20111027

In 2011 we were invited to participate on the OCHCA – MHSA – Innovation’s Component – Innovations (project) Advisory Committee. With our acquired Intel we helped the Mental Health Services Oversight and Accountability Commission (MHSOAC) inventory Innovations Project related assessment tools for Orange County. In doing so we manually had to contact about ten (10) program analysts by phone and email. We are still just waiting for a really good list of links into the county silos and databases.

FYI - COPD Related Data Table Hunt

[PDF] - Trends in COPD (Chronic Bronchitis and Emphysema): Morbidity and Mortality (23 Pages).

http://www.lung.org/assets/documents/research/copd-trend-report.pdf

American Lung Association - Epidemiology and Statistics Unit - Research and Health Education Division - March 2013

Features of MHSA STEPS – From STEPS Perspective

Presentation Parity Assessment (PPA)

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Item #	Criteria	DS-20170808 BND COPD	DS-20170808 MHSA STEPS

01	Associated with a Housing Program	N/A	YES
	Compensation for Time	No	YES Member about $13.33/hour
	Data Analyst on Hand	No	YES
	Data Driven Presentation(s)	No	YES
05	Director Presents	MD Weak	YES
	Leveraged Measurement	No	YES
	One-hour Commitment	Weak	YES
	Proficiency at Outcome Measures	No	YES
09	Treated all in Room as Peers (Team Members)	No	YES

	Normal Percent =	0.0%	100.0%
	Star Equivalents =	0.0	5.0
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Last Reviewed: 20170818-F:

Presentation Parity Assessment (PPA) – Interpretation

We derived the table above based on the higher performer between BND and STEPS. Thus the table above illustrates STEPS derived items.

California Institute for Behavioral Health Solutions – Standards

Many of MSG’s standards come from the California Institute for Behavioral Health Solutions (CIBHS). We take much of our data management material from CIBHS material as presented online and by attending the yearly conference they host.

Lesson-4 – TimeSpent Alternative – Data Driven Program (Control)

20170731-M

One Hour with STEPS

STEPS Summary - Location

Telecare STEPS Orange County (Striving Towards Enhanced Partnerships)

Time of Meeting

20170731-M-CAAC - Approximately 930am – 1030am

Instead of 20170802-W

Notes From STEPS Meeting

About the STEPS program success is partially measured by how long the graduates they live in one place. Karaoke is a favorite activity. Report with data for 6/16 – 6/17 pending. Their presentation was data rich and data-driven. Proof Of Concept (POC) satisfied. Telecare STEPS serves two populations. The first population is transitioning out of long-term care. The second population is those desiring the court to expunge their legal concerns. Judge Kreeber apparently replaced Judge Lindley as Orange County’s Behavioral Health Judge. By referral the Health Care Agency (HCA) handles any therapy. STEPS had its’ inception back in 2011. Members served per year approximately ninety (90). The transitional consumers are often graduated into a Board and Care environment else reunited with their families. Paperwork was available to create your Wellness Recovery Action Plan (WRAP). Program collateral was handed out. The collateral included a testimony of success. STEPS encourages graduation. Some consumers drop out. Telecare has a housing specialist. So what are their products: Satisfied consumers and clients demonstrating improvements that are measurable.

STEPS and Legal Status

There is no indication that STEPS assists consumers in need and capable for terminating their LPS status. The non court related population has a history of being institutionalized for upwards of ten (10) years. Telecare manages a Representative Payee Program (RRP). Staff is available 24/7 by phone. In the face of adherence they promote long acting injectable medications. The court ordered population is subject to a “Flash Incarceration”. A Flash Incarceration may be defined as: When the consumer strays Judge Kreeber remands them to custody for twenty-four (24) hours. This usually leaves and impression and the consumer returns to track. The program director identified unmet need in the community: Housing that is comfortable, clean, and affordable.

FYI - 20170815-TU: 3.0 Stars - 1 Google review

Address: 2100 N Broadway, Santa Ana, CA 92706

Hours: Open today · 8:30AM–5PM > Phone: (714) 245-6881

Consumer Action Advisory Committee (CAAC) Compensation

We attended the STEPS presentation for several reasons. One we are in the email distribution for CAAC events. Two we were a compensated member of CAAC and thus maintain loyalty. Three it gave us the opportunity to compare TimeSpent about the Brand New Day COPD Course. The Orange County Health Care Agency (OCHCA) supports the Consumer Action Advisory Committee (CAAC). The CAAC is composed of behavioral health consumers and family members. The OCHCA indicates that they value consumers’ time with reasonable accommodation in rewarding them with a twenty dollar ($20.00) food card for their roughly monthly contribution of 1.5 hours per member. Returning the case of Speedy. Speedy indicated that the only thing that would have prevented him from dropping the course the first day is cold hard cash!

Lesson-5 – Alternatives to Suffocation – COPD Value

20170809-W

Because there are no handouts we really do not know for sure who the presenters were. The primary presenter this day identified as a Pulmonary Rehabilitation Specialist. The presenter addressed the following topics: Suffocation and Anxiety, Flu and Pneumonia Vaccines, Cough Techniques and Stress Management. For the practical component we were drilled by what we think is a Yoga-Plus instructor. She taught: Breathing Exercises and Stress Management. Only seven (7) or so consumers attended. At least two BND Reps showed up.

Lesson-6 (Final) – COPD Value – Satisfaction Survey

20170816-W

At this final meeting our teacher indicated that we were the charter class for this COPD course. For lesson-6 the final episode as we discussed earlier we expect to take at least one assessment. The best candidate would be a how satisfied with this course evaluation. If MSG administered this event we would apply our Event Satisfaction Survey (ESS) to all in the room at this final class meeting. We were happily surprised that yes indeed they had a 5-6 item quantifiable Satisfaction Survey. The assessment is called: COPD Course Satisfaction Survey. The approximate number of people that showed for the last session was twelve (12). The teacher for this session was Laura Davis-Loschiavo (LD-L). She addressed: “COPD Health Eating”, weight management, methods of chewing, “Exercise Band Workout”, and more breathing exercises. A side note about breathing in adults: Uninformed breathing, music teacher informed breathing, and acupuncturist informed breathing. Based on a whole bunch of practice the acupuncturist makes the best argument. The acupuncturist teaches consumers to breath so low and deep that your pubic bone moves up and down (in and out). Our acupuncturist has an incredible test to prove that you are really getting and applying the pubic recommendation. We will not discuss breathing for now because we intend on writing a report on smoking cessation.

Lesson-6: Wrapping it All Up – Strong Finish

20170816-W

The COPD Course team gained a lot of lost ground at this last meeting. They gifted free food: Apples, greens, red bell peppers, roasted chicken, salad dressing, and shaved carrots. BND also gave each of us a gift. Included was a book LD-L authored for BND about nutrition. Actually LD-L or her equivalent might best be identified in the first class as the course’s principal. Last LD-L had that yoga teacher therapeutic tone and talk going on. We usually do not fill out and submit assessments because we need a copy for our reports. In closing you can tell that Laura works at least from time to time with very disabled consumers. On multiple occasions we as group demonstrated far more physical strength than she expected. Our goal is to have our report finished before next Wednesday. Since we submitted assessments it would be nice to see the COPD Course satisfaction summary results posted by next Wednesday.

Session-6

Session-6 Gift From Brand New Day

Aside – Gibbs on SMART Goal

“A S.M.A.R.T. goal is defined as one that is specific, measurable, achievable, results-focused, and time-bound. Below is a definition of each of the S.M.A.R.T. goal criteria. Goals should be simplistically written and clearly define what you are going to do.”

We came a bit early to session-6. Jeff Gibbs was leading a group. At one point he mentioned the SMART method. So let us see how our COPD measures up. The course really did not clearly define what we were going to do or how it was to be measured.

	-
	-	20170818-F	20170818-F	Comment
	-
S	Specific	Moderate	3
M	Measurable	Weak	1
A	Achievable	Moderate	3
R	Results-focused	Weak	1
T	Time-bound	Strong	5
	-
			13/25 * 100 = 52%

	Star Equivalents		2.6

Last Reviewed: 20170818-F:

Appendix – Charter Information (20170818 -20170823)

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Specification	Note	Detail
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Assigned By	Jeff Gibbs - Life Coach	On 20170706 by Phone
Principal Instructor	James J Krueger MD	Chest Medicine
Google Plus Sharing	[BELOW]
Blog	Brand New Day
Name of Post	James J Krueger MD for Brand New Day COPD by Keith E Torkelson, MS
Post Charter Date	20170820-SUN
Post Close Date	20170822-TU
Images (Count)	20 (or so)
Image Key Words	Keith Torkelson for Brand New Day HMO_
Link to Related Study
Related Study/Studies	Tobacco Cessation COPD Risk
Name of Class
-