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Dan X, He YL, Tian YL, Huang Y, Ren JH. Summary of evidence on comprehensive healthcare for chemotherapy-induced peripheral neuropathy in cancer patients. Support Care Cancer 2024; 32:264. [PMID: 38564034 DOI: 10.1007/s00520-024-08466-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE This paper aims to provide an evidence-based summary of the most effective strategies for comprehensive healthcare of chemotherapy-induced peripheral neuropathy (CIPN) in cancer patients. METHOD Following the "6S" model, relevant evidence on CIPN management was collected from reputable evidence-based resource websites and databases nationally and internationally. The included articles were evaluated for methodological quality, and evidence was extracted using the Australian JBI Evidence-based Health Care Center's literature evaluation standard (2016 edition). RESULTS A total of 60 articles were included in this study, comprising 2 guidelines, 5 expert consensus statements, and 53 systematic reviews. The findings of these articles were summarized across 7 dimensions, including risk factor screening, assessment, diagnosis, prevention, treatment, management, and health education, resulting in the identification of 42 relevant pieces of evidence. CONCLUSIONS This study provides a comprehensive synthesis of evidence-based recommendations for managing CIPN in cancer patients, offering guidance for healthcare professionals engaged in clinical practice. However, when implementing these recommendations, it is crucial to consider the individual patient's clinical circumstances, preferences, and expert judgment, ensuring feasibility and applicability in real-world clinical settings.
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Affiliation(s)
- Xin Dan
- Department of Radiation Therapy and Chemotherapy for Cancer Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Ya-Lin He
- Department of Radiation Therapy and Chemotherapy for Cancer Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Ya-Lin Tian
- Department of Radiation Therapy and Chemotherapy for Cancer Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Yan Huang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China.
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Jian-Hua Ren
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China.
- Department of Obstetrics and Gynecology Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
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Liang Y, Chi L, Wang J. A study on the effectiveness of comprehensive nursing care for patients with depression and suicidal behavior. Minerva Surg 2024; 79:268-270. [PMID: 37851018 DOI: 10.23736/s2724-5691.23.10066-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Affiliation(s)
- Yun Liang
- School of Mental Health and The Affiliated Wenzhou Kangning Hospital, Department of Psychiatry, Zhejiang Provincial Clinical Research Center for Mental Disorders, Wenzhou Medical University, Wenzhou, China
| | - Lisi Chi
- School of Mental Health and The Affiliated Wenzhou Kangning Hospital, Department of Psychiatry, Zhejiang Provincial Clinical Research Center for Mental Disorders, Wenzhou Medical University, Wenzhou, China
| | - Jieqiong Wang
- School of Mental Health and The Affiliated Wenzhou Kangning Hospital, Department of Psychiatry, Zhejiang Provincial Clinical Research Center for Mental Disorders, Wenzhou Medical University, Wenzhou, China - wangjieqiong0508 @163.com
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Santos T, Bergman A, Smith-McLallen A. Access to Mental Health and Substance Use Treatment in Comprehensive Primary Care Plus. JAMA Netw Open 2024; 7:e248519. [PMID: 38669019 PMCID: PMC11053373 DOI: 10.1001/jamanetworkopen.2024.8519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/28/2024] [Indexed: 04/29/2024] Open
Abstract
Importance To meet increasing demand for mental health and substance use services, the Centers for Medicare & Medicaid Services launched the 5-year Comprehensive Primary Care Plus (CPC+) demonstration in 2017, requiring primary care practices to integrate behavioral health services. Objective To examine the association of CPC+ with access to mental health and substance use treatment before and during the COVID-19 pandemic. Design, Setting, and Participants Using difference-in-differences analyses, this retrospective cohort study compared adults attributed to CPC+ and non-CPC+ practices, from January 1, 2018, to June 30, 2022. The study included adults aged 19 to 64 years who had depression, anxiety, or opioid use disorder (OUD) and were enrolled with a private health insurer in Pennsylvania. Data were analyzed from January to June 2023. Exposure Receipt of care at a practice participating in CPC+. Main Outcomes and Measures Total cost of care and the number of primary care visits for evaluation and management, community mental health center visits, psychiatric hospitalizations, substance use treatment visits (residential and nonresidential), and prescriptions filled for antidepressants, anxiolytics, buprenorphine, naltrexone, or methadone. Results The 188 770 individuals in the sample included 102 733 adults (mean [SD] age, 49.5 [5.6] years; 57 531 women [56.4%]) attributed to 152 CPC+ practices and 86 037 adults (mean [SD] age, 51.6 [6.6] years; 47 321 women [54.9%]) attributed to 317 non-CPC+ practices. Among patients diagnosed with OUD, compared with patients attributed to non-CPC+ practices, attribution to a CPC+ practice was associated with filling more prescriptions for buprenorphine (0.117 [95% CI, 0.037 to 0.196] prescriptions per patient per quarter) and anxiolytics (0.162 [95% CI, 0.005 to 0.319] prescriptions per patient per quarter). Among patients diagnosed with depression or anxiety, attribution to a CPC+ practice was associated with more prescriptions for buprenorphine (0.024 [95% CI, 0.006 to 0.041] prescriptions per patient per quarter). Conclusions and Relevance Findings of this cohort study suggest that individuals with an OUD who received care at a CPC+ practice filled more buprenorphine and anxiolytics prescriptions compared with patients who received care at a non-CPC+ practice. As the Centers for Medicare & Medicaid Innovation invests in advanced primary care demonstrations, it is critical to understand whether these models are associated with indicators of high-quality primary care.
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Affiliation(s)
- Tatiane Santos
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Alon Bergman
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Health Care Management Department, The Wharton School, University of Pennsylvania, Philadelphia
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Mota CS, Lira ADS, Queiroz MCAD, Santos MPAD. Àgô Sankofa: an overview of the progression of sickle cell disease in Brazil in the past two decades. Cien Saude Colet 2024; 29:e06772023. [PMID: 38451649 DOI: 10.1590/1413-81232024293.06772023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/19/2024] [Indexed: 03/08/2024] Open
Abstract
Sickle cell disease (SCD) is an emblematic case of historical health neglect in Brazil and reflects how institutional racism produces health inequalities. This article engaged in a historical journey of this disease, showing the delayed implementation of health policies for people with sickle cell disease, often concealed in Public Power's (in)actions and omissions. The lack of commitment to implement the recommendations of the Brazilian Ministry of Health, such as neonatal screening, and the difficulty in incorporating technologies for health care result from this modus operandi. The advances and setbacks in programmatic actions and the constant pressure on several governmental entities have characterized the reported saga in the last twenty years. The present text discusses the policies for people with SCD, appropriating the Sankofa symbol, meaning that building the present is only possible by remembering past mistakes. Thus, we recognize this trajectory and this historical moment in which there is a concrete possibility of moving forward and achieving the longed-for comprehensive care for people with SCD. There is an invitation to glance at a new perspective, one in which hope is the trigger for the movements needed to guarantee the rights of people with SCD.
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Affiliation(s)
- Clarice Santos Mota
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. R. Basílio da Gama s/n, Canela. 40110-040 Salvador BA Brasil.
- GT Racismo e Saúde, Associação Brasileira de Saúde Coletiva (Abrasco). Rio de Janeiro RJ Brasil
| | | | | | - Márcia Pereira Alves Dos Santos
- GT Racismo e Saúde, Associação Brasileira de Saúde Coletiva (Abrasco). Rio de Janeiro RJ Brasil
- Faculdade de Odontologia, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil
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Buckey TM, Bosso JV. A stepwise approach to the adult immunodeficiency evaluation for the rhinologist. Curr Opin Otolaryngol Head Neck Surg 2024; 32:50-54. [PMID: 38193520 DOI: 10.1097/moo.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW Patients with an immunodeficiency may present to their Rhinologist with a history of recurrent, severe, and chronic infections. Therefore, it is essential for the Rhinologist to have a basic understanding of clinically relevant immune deficiencies. RECENT FINDINGS After describing different types of immunodeficiencies, their presentations, and management strategies, an evaluation algorithm is described. SUMMARY Through a collaborative approach, Rhinologists and Clinical Immunologists can provide comprehensive medical care to patients with immunodeficiencies.
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Affiliation(s)
- Timothy M Buckey
- Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine
| | - John V Bosso
- Division of Rhinology, Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Lee SY. [Sleep Strategies for Shift Work Nurses]. Hu Li Za Zhi 2024; 71:22-28. [PMID: 38253850 DOI: 10.6224/jn.202402_71(1).04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
To meet the demands of a 24/7 society, shift work is necessary. Shift work is outside the traditional regular 9-to-5 work schedule, is characterized by irregular working hours, and exists in various industries. However, this abnormal working time can disrupt the natural day and night rhythm, and if poorly adjusted, it can lead to shift work sleep disorder (SWSD). SWSD is associated with multiple health risks, including impaired cognitive function, increased risk of accidents, and various metabolic and cardiovascular diseases. The frontline nurses typically work shifts to provide comprehensive patient care. This article aims to discuss sleep physiology, apply existing literature to discuss the impact on nurses resulting from shift work, and further offer strategies to regulate sleep to promote physical and mental health. These strategies range from organizational interventions (e.g., optimizing shift schedules) to individual interventions (e.g., lifestyle changes) and the use of chronobiological techniques (e.g., light therapy) to promote the adjustment of circadian rhythms, etc.
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Affiliation(s)
- Shih-Yu Lee
- PhD, Professor, Department of Nursing, Hungkuang University, Taiwan, ROC.
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Burton W, Salsbury SA, Goertz CM. Healthcare provider perspectives on integrating a comprehensive spine care model in an academic health system: a cross-sectional survey. BMC Health Serv Res 2024; 24:125. [PMID: 38263013 PMCID: PMC10804504 DOI: 10.1186/s12913-024-10578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Healthcare systems (HCS) are challenged in adopting and sustaining comprehensive approaches to spine care that require coordination and collaboration among multiple service units. The integration of clinicians who provide first line, evidence-based, non-pharmacological therapies further complicates adoption of these care pathways. This cross-sectional study explored clinician perceptions about the integration of guideline-concordant care and optimal spine care workforce requirements within an academic HCS. METHODS Spine care clinicians from Duke University Health System (DUHS) completed a 26-item online survey via Qualtrics on barriers and facilitators to delivering guideline concordant care for low back pain patients. Data analysis included descriptive statistics and qualitative content analysis. RESULTS A total of 27 clinicians (57% response) responded to one or more items on the questionnaire, with 23 completing the majority of questions. Respondents reported that guidelines were implementable within DUHS, but no spine care guideline was used consistently across provider types. Guideline access and integration with electronic records were barriers to use. Respondents (81%) agreed most patients would benefit from non-pharmacological therapies such as physical therapy or chiropractic before receiving specialty referrals. Providers perceived spine patients expected diagnostic imaging (81%) and medication (70%) over non-pharmacological therapies. Providers agreed that receiving imaging (63%) and opioids (59%) benchmarks could be helpful but might not change their ordering practice, even if nudged by best practice advisories. Participants felt that an optimal spine care workforce would require more chiropractors and primary care providers and fewer neurosurgeons and orthopedists. In qualitative responses, respondents emphasized the following barriers to guideline-concordant care implementation: patient expectations, provider confidence with referral pathways, timely access, and the appropriate role of spine surgery. CONCLUSIONS Spine care clinicians had positive support for current tenets of guideline-concordant spine care for low back pain patients. However, significant barriers to implementation were identified, including mixed opinions about integration of non-pharmacological therapies, referral pathways, and best practices for imaging and opioid use.
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Affiliation(s)
- Wren Burton
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Osher Center for Integrative Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Christine M Goertz
- Implementation of Spine Health Innovations, Department of Orthopaedic Surgery, School of Medicine, 300 W. Morgan Street, Durham, NC, 27701, USA.
- Duke Clinical Research Institute, Musculoskeletal Research, Duke University, 300 W. Morgan Street, Durham, NC, 27701, USA.
- Duke-Margolis Center for Health Policy, Duke University, 300 W. Morgan Street, Durham, NC, 27701, USA.
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Torreggiani M, Maselli D, Costi S, Guberti M. Models of Care in Providing Comprehensive Healthcare on Cancer Survivors: A Scoping Review with a TIDieR Checklist Analysis. Int J Environ Res Public Health 2024; 21:122. [PMID: 38397613 PMCID: PMC10888265 DOI: 10.3390/ijerph21020122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND The study's aim is to identify the models of care used to provide survivorship care plans (SCPs) to cancer survivors in healthcare services, describing what kind of professionals are involved, in which settings and timings, and their feasibility. METHODS The Joanna Briggs Institute methodology for scoping reviews is followed. Studies that considered the SCPs applying different models of care, in any healthcare setting on any adult cancer survivors who completed oncological treatments, have been included. Pubmed, Embase, Cochrane Library, Scopus, and Cinahal were searched from 2013 to 2023 with these keywords: "Survivorship Care Plan", "Oncology", and "Program". The study selection process was reported with the PRISMA-ScR. A total of 325 records were identified, 42 were screened, and, ultimately, 23 articles were included. RESULTS The models of care include: SCP standardization in hospitals; self-support oriented; consultation-based; primary or specialist direct referral; shared care; a multimodal approach. Multidisciplinary teams were involved in the SCP models of care. The settings were private clinics or cancer centers. One-hour SCP interventions were most frequently delivered through in-person visits, by telephone, or online. CONCLUSIONS Implementing SCPs is feasible in healthcare contexts, but with challenges, like time and resource management. Patient-centered programs promoting coordinated care are promising models of care.
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Affiliation(s)
- Martina Torreggiani
- Health Professions Department, Azienda USL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Deborah Maselli
- International Doctorate School in Clinical and Experimental Medicine, Università degli Studi di Modena e Reggio Emilia, 41125 Reggio Emilia, Italy
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Monica Guberti
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy
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Trigiani BE, Polek C. Standard of Care for Psychological Assessment of Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation. Clin J Oncol Nurs 2024; 28:71-78. [PMID: 38252855 DOI: 10.1188/24.cjon.71-78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Comprehensive care prior to allogeneic hematopoietic stem cell transplantation (alloHSCT) can improve patient outcomes, yet psychological assessment prior to transplantation has been overlooked as a standard of care. OBJECTIVES This review summarizes the evidence on psychological assessment for patients undergoing alloHSCT and explores the impact of psychological distress and/or psychological disorders on clinical outcomes and overall survival. METHODS A literature search was conducted using PubMed®, CINAHL®, Embase®, and PsycINFO® for studies focused on psychological screening of patients in the alloHSCT population. FINDINGS alloHSCT is associated with patient psychological distress and disorders, which can result in negative outcomes such as poorer quality of life and overall survival. Future studies implementing a validated instrument for psychological assessment may allow for early identification of vulnerable patients undergoing alloHSCT and interventions, which may improve overall outcomes.
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Wood A, Pereira A, Araújo E, Ferigatto J, Buexm L, Barroso E, Vazquez F. Evaluation of the Impact of Oral Health on the Daily Activities of Users of the National Health System. Int J Environ Res Public Health 2024; 21:92. [PMID: 38248555 PMCID: PMC10815908 DOI: 10.3390/ijerph21010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND the integration of dentistry services in the Unified Health System in Brazil (SUS) is essential in primary care assistance. OBJECTIVE we aimed to develop a tool for improving demand flowby evaluating the impact of oral health on the daily activities of users of the Family Health Unitusing the Oral Impacts of Daily Performance (OIDP)tool. METHODS In Barretos, Brazil, a cross-sectional study was conducted at a Family Health Unit (FHU)including patients over 12 years old. Oral health impact was assessed using the Oral Impacts of Daily Performance (OIDP) tool, and family risk was measured with the Coelho-Savassi scale. RESULTS 430 participants, including 411 adults and 19 young people, were recruited. Of the adults, 31% had an average OIDP score of 16.61. For young people, 53% reported an impact (average OIDP score: 28.61). Family risk (R1) was prevalent in 57.9% of young people and 53.3% of adults. Among adults, different activities were affected by risk: smiling without embarrassment (risk level 2), enjoying contact with people (risk level 3), and performing one's job or social role (risk level 1). Emotional state (R3) had the lowest OIDP score (p = 0.029). CONCLUSION implementation of the OIDP scale in clinical practice enhances healthcare planning and ensures better-quality and equitable services, thus emphasizing comprehensive oral healthcare within the SUS.
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Affiliation(s)
- Adriane Wood
- Institute of Education and Research (IEP), Barretos Cancer Hospital, Barretos 14784-400, Brazil; (A.W.); (J.F.); (L.B.)
| | - Antonio Pereira
- Department of Health Sciences and Children’s Dentistry, Faculty of Dentistry of Piracicaba (FOP), State University of Campinas (UNICAMP), Piracicaba 13414-903, Brazil or (A.P.); or (E.A.)
| | - Enoque Araújo
- Department of Health Sciences and Children’s Dentistry, Faculty of Dentistry of Piracicaba (FOP), State University of Campinas (UNICAMP), Piracicaba 13414-903, Brazil or (A.P.); or (E.A.)
| | - Júlia Ferigatto
- Institute of Education and Research (IEP), Barretos Cancer Hospital, Barretos 14784-400, Brazil; (A.W.); (J.F.); (L.B.)
| | - Luisa Buexm
- Institute of Education and Research (IEP), Barretos Cancer Hospital, Barretos 14784-400, Brazil; (A.W.); (J.F.); (L.B.)
| | - Eliane Barroso
- Department of Dentistry, Faculty of Dentistry, University Center of the Barretos Educational Foundation (UNIFEB), Barretos 14783-226, Brazil;
| | - Fabiana Vazquez
- Center for Research and Prevention in Molecular Oncology (CPOM), Barretos Cancer Hospital, Barretos 14784-400, Brazil
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Singh P, Fu N, Dale S, Orzol S, Laird J, Markovitz A, Shin E, O’Malley AS, McCall N, Day TJ. The Comprehensive Primary Care Plus Model and Health Care Spending, Service Use, and Quality. JAMA 2024; 331:132-146. [PMID: 38100460 PMCID: PMC10777250 DOI: 10.1001/jama.2023.24712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/07/2023] [Indexed: 12/17/2023]
Abstract
Importance Implemented in 18 regions, Comprehensive Primary Care Plus (CPC+) was the largest US primary care delivery model ever tested. Understanding its association with health outcomes is critical in designing future transformation models. Objective To test whether CPC+ was associated with lower health care spending and utilization and improved quality of care. Design, Setting, and Participants Difference-in-differences regression models compared changes in outcomes between the year before CPC+ and 5 intervention years for Medicare fee-for-service beneficiaries attributed to CPC+ and comparison practices. Participants included 1373 track 1 (1 549 585 beneficiaries) and 1515 track 2 (5 347 499 beneficiaries) primary care practices that applied to start CPC+ in 2017 and met minimum care delivery and other eligibility requirements. Comparison groups included 5243 track 1 (5 347 499 beneficiaries) and 3783 track 2 (4 507 499 beneficiaries) practices, matched, and weighted to have similar beneficiary-, practice-, and market-level characteristics as CPC+ practices. Interventions Two-track design involving enhanced (higher for track 2) and alternative payments (track 2 only), care delivery requirements (greater for track 2), data feedback, learning, and health information technology support. Main Outcomes and Measures The prespecified primary outcome was annualized Medicare Part A and B expenditures per beneficiary per month (PBPM). Secondary outcomes included expenditure categories, utilization (eg, hospitalizations), and claims-based quality-of-care process and outcome measures (eg, recommended tests for patients with diabetes and unplanned readmissions). Results Among the CPC+ patients, 5% were Black, 3% were Hispanic, 87% were White, and 5% were of other races (including Asian/Other Pacific Islander and American Indian); 85% of CPC+ patients were older than 65 years and 58% were female. CPC+ was associated with no discernible changes in the total expenditures (track 1: $1.1 PBPM [90% CI, -$4.3 to $6.6], P = .74; track 2: $1.3 [90% CI, -$5 to $7.7], P = .73), and with increases in expenditures including enhanced payments (track 1: $13 [90% CI, $7 to $18], P < .001; track 2: $24 [90% CI, $18 to $31], P < .001). Among secondary outcomes, CPC+ was associated with decreases in emergency department visits starting in year 1, and in acute hospitalizations and acute inpatient expenditures in later years. Associations were more favorable for practices also participating in the Medicare Shared Savings Program and independent practices. CPC+ was not associated with meaningful changes in claims-based quality-of-care measures. Conclusions and Relevance Although the timing of the associations of CPC+ with reduced utilization and acute inpatient expenditures was consistent with the theory of change and early focus on episodic care management of CPC+, CPC+ was not associated with a reduction in total expenditures over 5 years. Positive interaction between CPC+ and the Shared Savings Program suggests transformation models might be more successful when provider cost-reduction incentives are aligned across specialties. Further adaptations and testing of primary care transformation models, as well as consideration of the larger context in which they operate, are needed.
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Affiliation(s)
| | - Ning Fu
- Mathematica, Princeton, New Jersey
| | | | | | | | | | | | | | | | - Timothy J. Day
- Centers for Medicare & Medicaid Innovation, Baltimore, Maryland
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Javanparast S, Roeger L, Reed RL. General practice staff and patient experiences of a multicomponent intervention for people at high risk of poor health outcomes: a qualitative study. BMC Prim Care 2024; 25:18. [PMID: 38191349 PMCID: PMC10775450 DOI: 10.1186/s12875-023-02256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND This study reports the experiences of general practice staff and patients at high risk of poor health outcomes who took part in a clustered randomised controlled trial of a multicomponent general practice intervention. The intervention comprised patient enrolment to a preferred General Practitioner (GP) to promote continuity of care, access to longer GP appointments, and timely general practice follow-up after hospital care episodes. The aims of the study were to better understand participant's (practice staff and patients) perspectives of the intervention, their views on whether the intervention had improved general practice services, reduced hospital admissions and finally whether they believed the intervention would be sustainable after the trial had completed. METHODS A qualitative study design with semi-structured interviews was employed. The practice staff sample was drawn from both the control and intervention groups. The patient sample was drawn from those who had expressed an interest in taking part in an interview during the trial and who had also experienced a recent hospital care episode. RESULTS Interviews were conducted with 41 practice staff and 45 patients. Practice staff and patients expressed support for the value of appointments with a regular GP and having sufficient time in appointments for the provision of comprehensive care. There were mixed views with respect to the extent to which the intervention had improved services. The positive changes reported were related to services being provided in a more proactive, thorough, and systematic manner with a greater emphasis on team based care involving the Practice Nurse. Patients nominated after hours care and financial considerations as the key reasons for seeking hospital care. Practice staff noted that the intervention would be difficult to sustain financially in the absence of additional funding. CONCLUSIONS The multicomponent intervention was supported by practice staff and patients and some patients perceived that it had led to improvements in care.
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Affiliation(s)
- Sara Javanparast
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Leigh Roeger
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Richard L Reed
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
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Lima AFS, Santos CEB, Alves NR, Lima MCF, Jorge JS, Tigre HWA, de Almeida AVA, Santos TDS, Costa LDMC. Nursing care for the Warao people: an experience report based on transcultural theory. Rev Esc Enferm USP 2024; 57:e20230035. [PMID: 38194513 PMCID: PMC10776090 DOI: 10.1590/1980-220x-reeusp-2023-0035en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 11/01/2023] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVE To report on the experience of nurses from the Street Clinic in caring for the Indigenous Venezuelan population of the Warao ethnic group in Maceió/AL based on Madeleine Leininger's Transcultural Theory. METODOLOGY A descriptive study, of the experience report type, based on the care of the Warao Indigenous population in the light of Madeleine Leininger's Transcultural Theory, carried out during the year 2022. RESULTS Light technologies were used to form bonds and understand the cultural universe of the Warao people. The concepts of preservation, accommodation and cultural restructuring of care from Leininger's transcultural theory helped to elucidate the practice. Comprehensive care was offered in accordance with the programs recommended by the Ministry of Health, with transcultural care, including respect for refusal of care. The language barrier and health beliefs represented challenges in the context of singular care. FINAL CONSIDERATIONS The experience of nurses from the Street Clinic in caring for the Indigenous population favored significant social interaction and expanded the possibilities for achieving comprehensive health care. The application of Transcultural Theory proved to be an effective and congruent device for health care.
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Yu T, Wang N, Li A, Xu Y. Clinical evaluation of targeted sedation nursing combined with comprehensive nursing in children with severe pneumonia. Medicine (Baltimore) 2024; 103:e36317. [PMID: 38181270 PMCID: PMC10766319 DOI: 10.1097/md.0000000000036317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/03/2023] [Indexed: 01/07/2024] Open
Abstract
The severity of severe pneumonia in children depends on the degree of local inflammation, spread of lung inflammation and systemic inflammatory response. Appropriate care can effectively reduce the mortality of children with severe pneumonia. This study was designed to explore the nursing effect of targeted sedation nursing and comprehensive nursing intervention in children with severe pneumonia. Eighty children with severe pneumonia who complained of the main complaint were selected, and they were evenly distributed to receive comprehensive care (control group) and targeted sedation care and comprehensive care (observation group). In each group, different degrees of sedation, pain scores, and changes in adverse reactions were evaluated. Before nursing, the sedation and pain scores of the 2 groups of children were not statistically significant; after nursing, the sedation and pain scores of the 2 groups of children improved with time, and the sedation effect of the observation group was significantly lower than that of the control. In the group, the pain score was lower than that of the control group, indicating improvement. The SAS and SDS of the observation group were lower than those of the control group, while the social support score was significantly higher than that of the control group. The difference was statistically significant (P < .05). The accidental extubation, delirium, respiratory depression, and laryngospasm of the 2 groups of children were significantly improved, and the observation group was significantly less than the control group. This difference was statistically significant (P < .05). Targeted sedation nursing and comprehensive nursing intervention can effectively reduce the incidence of adverse reactions in children with severe pneumonia, reduce the pain and discomfort of children with severe pneumonia, and significantly improve the degree of sedation, which has certain reference value for the care of children with severe pneumonia.
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Affiliation(s)
- Tao Yu
- Department of Paediatrics, Chengyang District People’s Hospital, Qingdao, China
| | - Ni Wang
- Department of Paediatrics, Chengyang District People’s Hospital, Qingdao, China
| | - Aiwei Li
- Department of Obstetrics, Chengyang District People’s Hospital, Qingdao, China
| | - Yeling Xu
- Department of Health Management Center, People’s Hospital of Dongxihu District, Wuhan, China
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Moraes SDQ, Paiva Neto FTD, Loch MR, Fermino RC, Rech CR. Characteristics and counseling strategies for physical activity used by primary health care professionals. Cien Saude Colet 2024; 29:e00692023. [PMID: 38198320 DOI: 10.1590/1413-81232024291.00692023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/17/2023] [Indexed: 01/12/2024] Open
Abstract
This study aim to describe the characteristics and strategies of counseling for physical activity used by Primary Health Care (PHC) professionals. A survey was carried out with 587 (85.4% women) health professionals who work in PHC in Florianopolis, in the state of Santa Catarina, southern Brazil. Counseling carried out in the last 12 months was considered. Operational aspects related to counseling practices and strategies used for counseling were evaluated. The frequency of physical activity guidance was 86.2% (95%CI = 83.2-88.8%). Counseling was characterized as a brief practice, carried out in individual consultations, aimed at adults and the older adults and people with morbidities. The most used strategy was to guide users to participate in physical activity groups at the Health Center (89.5%) and in relation to the 5As method, giving some "advice" was the most used strategy (99.0%) and the least used. used was to follow strategies (22.6%). Counseling for physical activity has been based on a brief practice, carried out in individual consultations and focused on people with morbidities and on adults and the elderly. The strategies used do not seem to cover the full care of the advised users.
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Affiliation(s)
- Sheylane de Queiroz Moraes
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Santa Catarina. Campus Universitário, Prédio Administrativo do Centro de Desportos, Trindade. 88040-900 Florianópolis SC Brasil.
| | | | - Mathias Roberto Loch
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Estadual de Londrina. Londrina PR Brasil
| | - Rogério César Fermino
- Programa de Pós-Graduação em Educação Física, Universidade Federal Tecnológica do Paraná. Curitiba PR Brasil
| | - Cassiano Ricardo Rech
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Santa Catarina. Campus Universitário, Prédio Administrativo do Centro de Desportos, Trindade. 88040-900 Florianópolis SC Brasil.
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Grubb LK. Where are the Adolescent Advocates in Ensuring Adolescent Access to Comprehensive Health Care? A State Study. J Adolesc Health 2024; 74:7-8. [PMID: 38103923 DOI: 10.1016/j.jadohealth.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Laura K Grubb
- Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
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17
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Cohen G, Lake T, Hossain M, O'Malley AS, Geonnotti K. Incorporating health IT into primary care transformation. Am J Manag Care 2024; 30:e26-e31. [PMID: 38271571 DOI: 10.37765/ajmc.2024.89491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVES To understand the role of health information technology (IT) vendors and health IT functionality in supporting advanced primary care. STUDY DESIGN We synthesized multiple rounds of surveys and interviews (2017-2022) from a mixed-methods evaluation of Comprehensive Primary Care Plus (CPC+), a multipayer model developed by CMS. CPC+ was the first federal advanced primary care reform effort that formalized health IT vendors' roles in supporting health IT implementation and specified detailed health IT requirements for practices. METHODS We conducted content analysis to identify cross-cutting themes related to health IT for both practices and vendors, comparing similarities and differences across participants and (when possible) over time. RESULTS Vendors and practices reported advances in registries and dashboards for improved information management within the practice as well as strengthened relationships between vendors and practices that supported health IT implementation. However, CPC+ practices noted several gaps or challenges using existing functionalities, and both vendors and practices reported broader challenges for more transformative health IT change, particularly the lack of interoperable health information exchange needed to support care management and care coordination. Key factors constraining vendors' investment in further advances included long product development schedules, making it difficult to respond to rapidly evolving model requirements. Vendors also shared that CPC+ practices represented a small fraction of their client base, so investing in developing new functionality was not strategic unless it was more broadly relevant outside CPC+. CONCLUSIONS Continued collaboration among health IT vendors, practices, policy makers, and payers could support continued technological improvements, particularly related to information exchange and communication. Aligning requirements more closely with other federal and private models could also help mitigate the risk for vendors.
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Affiliation(s)
- Genna Cohen
- Mathematica, 1100 1st St NE, 12th Floor, Washington, DC 20002-4221.
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18
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Premji K, Green ME, Glazier RH, Khan S, Schultz SE, Mathews M, Nastos S, Frymire E, Ryan BL. Characteristics of patients attached to near-retirement family physicians: a population-based serial cross-sectional study in Ontario, Canada. BMJ Open 2023; 13:e074120. [PMID: 38149429 PMCID: PMC10711930 DOI: 10.1136/bmjopen-2023-074120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/15/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVES Population ageing is a global phenomenon. Resultant healthcare workforce shortages are anticipated. To ensure access to comprehensive primary care, which correlates with improved health outcomes, equity and costs, data to inform workforce planning are urgently needed. We examined the medical and social characteristics of patients attached to near-retirement comprehensive primary care physicians over time and explored the early-career and mid-career workforce's capacity to absorb these patients. DESIGN A serial cross-sectional population-based analysis using health administrative data. SETTING Ontario, Canada, where most comprehensive primary care is delivered by family physicians (FPs) under universal insurance. PARTICIPANTS All insured Ontario residents at three time points: 2008 (12 936 360), 2013 (13 447 365) and 2019 (14 388 566) and all Ontario physicians who billed primary care services (2008: 11 566; 2013: 12 693; 2019: 15 054). OUTCOME MEASURES The number, proportion and health and social characteristics of patients attached to near-retirement age comprehensive FPs over time; the number, proportion and characteristics of near-retirement age comprehensive FPs over time. SECONDARY OUTCOME MEASURES The characteristics of patients and their early-career and mid-career comprehensive FPs. RESULTS Patient attachment to comprehensive FPs increased over time. The overall FP workforce grew, but the proportion practicing comprehensiveness declined (2008: 77.2%, 2019: 70.7%). Over time, an increasing proportion of the comprehensive FP workforce was near retirement age. Correspondingly, an increasing proportion of patients were attached to near-retirement physicians. By 2019, 13.9% of comprehensive FPs were 65 years or older, corresponding to 1 695 126 (14.8%) patients. Mean patient age increased, and all physicians served markedly increasing numbers of medically and socially complex patients. CONCLUSIONS The primary care sector faces capacity challenges as both patients and physicians age and fewer physicians practice comprehensiveness. Nearly 15% (1.7 million) of Ontarians may lose their comprehensive FP to retirement between 2019 and 2025. To serve a growing, increasingly complex population, innovative solutions are needed.
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Affiliation(s)
- Kamila Premji
- Department of Family Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael E Green
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
- Health Services and Policy Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Richard H Glazier
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Shahriar Khan
- Health Services and Policy Research Institute, Queen's University, Kingston, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Kingston, Ontario, Canada
| | - Susan E Schultz
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Maria Mathews
- Department of Family Medicine, University of Western Ontario, London, Ontario, Canada
| | - Steve Nastos
- Economics, Policy & Research, Ontario Medical Association, Toronto, Ontario, Canada
| | - Eliot Frymire
- Health Services and Policy Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Bridget L Ryan
- Department of Family Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
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19
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He F, Gasdaska A, White L, Tang Y, Beadles C. Participation in a Medicare advanced primary care model and the delivery of high-value services. Health Serv Res 2023; 58:1266-1291. [PMID: 37557935 PMCID: PMC10622300 DOI: 10.1111/1475-6773.14213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To evaluate whether primary care providers' participation in the Comprehensive Primary Care Plus Initiative (CPC+) was associated with changes in their delivery of high-value services. DATA SOURCES Medicare Physician & Other Practitioners public use files from 2013 to 2019, 2017 to 2019 Medicare Part B claims for a 5% random sample of Medicare Fee-for-Service (FFS) beneficiaries, the Area Health Resources File, the National Plan & Provider Enumeration System files, and public use datasets from the Centers for Medicare & Medicaid Services Physician Compare. STUDY DESIGN We used a difference-in-difference approach with a propensity score-matched comparison group to estimate the association of CPC+ participation with the delivery of annual wellness visits (AWVs), advance care planning (ACP), flu shots, counseling to prevent tobacco use, and depression screening. These services are prominent examples of high-value services, providing benefits to patients at a reasonable cost. We examined both the likelihood of delivering these services within a year and the count of services delivered per 1000 Medicare FFS beneficiaries per year. DATA COLLECTION/EXTRACTION METHODS Secondary data are linked at the provider level. PRINCIPAL FINDINGS We find that CPC+ participation was associated with increases in the likelihood of delivering AWVs (13.03 percentage points by CPC+'s third year, p < 0.001) and the number of AWVs per 1000 Medicare FFS beneficiaries (44 more AWVs by CPC+'s third year, p < 0.001). We also find that CPC+ participation was associated with more flu shots per 1000 beneficiaries (52 more shots by CPC+'s third year, p < 0.001) but not with the likelihood of delivering flu shots. We did not find consistent evidence for the association between CPC+ participation and ACP services, counseling to prevent tobacco use, or depression screening. CONCLUSIONS CPC+ participation was associated with increases in the delivery of AWVs and flu shots, but not other high-value services.
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Affiliation(s)
- Fang He
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Angela Gasdaska
- Institute for Advanced Analytics, North Carolina State UniversityRaleighNorth CarolinaUSA
| | - Lindsay White
- Department of Medical Ethics & Health PolicyPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Yan Tang
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Chris Beadles
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
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20
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Rubio K, Fraze TK, Bibi S, Rodriguez HP. Racial-Ethnic Composition of Primary Care Practices and Comprehensive Primary Care Plus Initiative Participation. J Gen Intern Med 2023; 38:2945-2952. [PMID: 36941423 PMCID: PMC10593678 DOI: 10.1007/s11606-023-08160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND It remains unclear whether the racial-ethnic composition or the socioeconomic profiles of eligible primary care practices better explain practice participation in the Centers for Medicare and Medicaid Services' (CMS) Comprehensive Primary Care Plus (CPC+) program. OBJECTIVE To examine whether practices serving high proportions of Black or Latino Medicare fee-for-service (FFS) beneficiaries were less likely to participate in CPC+ in 2021 compared to practices serving lower proportions of these populations. DESIGN 2019 IQVIA OneKey data on practice characteristics was linked with 2018 CMS claims data and 2021 CMS CPC+ participation data. Medicare FFS beneficiaries were attributed to practices using CMS's primary care attribution method. PARTICIPANTS 11,718 primary care practices and 7,264,812 attributed Medicare FFS beneficiaries across 18 eligible regions. METHODS Multivariable logistic regression models examined whether eligible practices with relatively high shares of Black or Latino Medicare FFS beneficiaries were less likely to participate in CPC+ in 2021, controlling for the clinical and socioeconomic profiles of practices. MAIN MEASURES Proportion of Medicare FFS beneficiaries attributed to each practice that are (1) Latino and (2) Black. KEY RESULTS Of the eligible practices, 26.9% were CPC+ participants. In adjusted analyses, practices with relatively high shares of Black (adjusted odds ratio, aOR = 0.62, p < 0.05) and Latino (aOR = 0.32, p < 0.01) beneficiaries were less likely to participate in CPC+ compared to practices with lower shares of these beneficiary groups. State differences in CPC+ participation rates partially explained participation disparities for practices with relatively high shares of Black beneficiaries, but did not explain participation disparities for practices with relatively high shares of Latino beneficiaries. CONCLUSIONS The racial-ethnic composition of eligible primary care practices is more strongly associated with CPC+ participation than census tract-level poverty. Practice eligibility requirements for CMS-sponsored initiatives should be reconsidered so that Black and Latino beneficiaries are not left out of the benefits of practice transformation.
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Affiliation(s)
- Karl Rubio
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Taressa K Fraze
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Salma Bibi
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Hector P Rodriguez
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
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21
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Esperto F, Pietropaolo A, Emiliani E, DE Coninck V, Tailly T, Keller EX, Talso M, Tonyali S, Sener ET, Zeesha Nhameed BM, Tzelves L, Ventimiglia E, Juliebø-Jones P, Faiella E, Mykoniatis I, Tsaturyan A, Scarpa RM. Unveiling the impact of stone disease: enhancing quality of life through comprehensive care. Minerva Urol Nephrol 2023; 75:658-660. [PMID: 37728501 DOI: 10.23736/s2724-6051.23.05537-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Esteban Emiliani
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Thomas Tailly
- Department of Urology, Gent University Hospital, Gent, Belgium
| | - Etienne X Keller
- Department of Urology, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Michele Talso
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Senol Tonyali
- Department of Urology, Istanbul School of Medicine, Istanbul University, Istanbul, Türkiye
| | - Emre T Sener
- Department of Urology, Marmara University School of Medicine, Istanbul, Türkiye
| | | | - Lazaros Tzelves
- Department of Urology, University College of London Hospital, London, UK
| | - Eugenio Ventimiglia
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS, San Raffaele Hospital, Milan, Italy
| | | | - Eliodoro Faiella
- Department of Radiology, Campus Bio-Medico University, Rome, Italy
| | | | - Arman Tsaturyan
- Department of Urology, Erebouni Medical Center, Yerevan, Armenia
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
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Ding Y, Jiang X, Li L, Dai Q, Tao L, Liu J, Li Z, Wang J, Liao C, Gao X. Effects of comprehensive functional nursing on functional recovery and quality of life in patients with spinal cord injury. Medicine (Baltimore) 2023; 102:e35102. [PMID: 37747020 PMCID: PMC10519484 DOI: 10.1097/md.0000000000035102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/17/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023] Open
Abstract
This study evaluated the effects of comprehensive functional nursing on functional recovery and quality of life in patients with spinal cord injuries (SCIs). A total of 214 patients with SCIs treated in our hospital from October 2019 to October 2021 were included in the retrospective analysis and divided into a general care group (n = 107) and a comprehensive care group (n = 107), based on the care that they received. Patients in the general care group received general functional nursing, whereas those in the comprehensive care group received a comprehensive functional nursing intervention. The Rivermead Mobility Index (RMI), Barthel Index (BI), and Berg Balance Score (BBS) were used to evaluate patient neurobehavioral ability before and after nursing. Changes in cardiopulmonary function indexes, left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), vital capacity (VC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, and maximal voluntary ventilation (MVV) were measured before and after nursing. The number of micturition, maximum micturition volume, bladder volume, residual urine volume, and lower urinary tract symptom (LUTS) score were recorded, and the improvement in bladder function were measured before and after nursing. The Hamilton Anxiety Scale (HAMA) and Beck Depression Inventory (BDI) scores were used to evaluate patients' emotional state. After nursing, the RMI, BI, BBS score, FEV1, FEV1/FVC, MVV, maximum micturition volume, bladder volume, and SF-36 scores of the comprehensive care group were significantly higher than those of the general care group, and the LVEDD, LVESD, micturition time, residual urine volume, and LUTS, HAMA, and BDI scores of the comprehensive care group were significantly lower than those of the general care group. In patients with SCIs, comprehensive functional nursing can promote the recovery of neurocognition, bladder function, and cardiorespiratory function, and improve their quality of life. Comprehensive functional nursing is worthy of clinical application.
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Affiliation(s)
- Yang Ding
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xixuan Jiang
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lunlan Li
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qing Dai
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lei Tao
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jing Liu
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhen Li
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jing Wang
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chenxia Liao
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xin Gao
- Anhui Medical University, Hefei, Anhui, China
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23
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Gausman J, Pingray V, Adanu R, Bandoh DAB, Berrueta M, Blossom J, Chakraborty S, Dotse-Gborgbortsi W, Kenu E, Khan N, Langer A, Nigri C, Odikro MA, Ramesh S, Saggurti N, Vázquez P, Williams CR, Jolivet RR. Validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (EmoNC) facilities: A study triangulating health system, facility, and geospatial data. PLoS One 2023; 18:e0287904. [PMID: 37708180 PMCID: PMC10501555 DOI: 10.1371/journal.pone.0287904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/15/2023] [Indexed: 09/16/2023] Open
Abstract
Availability of emergency obstetric and newborn care (EmONC) is a strong supply side measure of essential health system capacity that is closely and causally linked to maternal mortality reduction and fundamentally to achieving universal health coverage. The World Health Organization's indicator "Availability of EmONC facilities" was prioritized as a core indicator to prevent maternal death. The indicator focuses on whether there are sufficient emergency care facilities to meet the population need, but not all facilities designated as providing EmONC function as such. This study seeks to validate "Availability of EmONC" by comparing the value of the indicator after accounting for key aspects of facility functionality and an alternative measure of geographic distribution. This study takes place in four subnational geographic areas in Argentina, Ghana, and India using a census of all birthing facilities. Performance of EmONC in the 90 days prior to data collection was assessed by examining facility records. Data were collected on facility operating hours, staffing, and availability of essential medications. Population estimates were generated using ArcGIS software using WorldPop to estimate the total population, and the number of women of reproductive age (WRA), pregnancies and births in the study areas. In addition, we estimated the population within two-hours travel time of an EmONC facility by incorporating data on terrain from Open Street Map. Using these data sources, we calculated and compared the value of the indicator after incorporating data on facility performance and functionality while varying the reference population used. Further, we compared its value to the proportion of the population within two-hours travel time of an EmONC facility. Included in our study were 34 birthing facilities in Argentina, 51 in Ghana, and 282 in India. Facility performance of basic EmONC (BEmONC) and comprehensive EmONC (CEmONC) signal functions varied considerably. One facility (4.8%) in Ghana and no facility in India designated as BEmONC had performed all seven BEmONC signal functions. In Argentina, three (8.8%) CEmONC-designated facilities performed all nine CEmONC signal functions, all located in Buenos Aires Region V. Four CEmONC-designated facilities in Ghana (57.1%) and the three CEmONC-designated facilities in India (23.1%) evidenced full CEmONC performance. No sub-national study area in Argentina or India reached the target of 5 BEmONC-level facilities per 20,000 births after incorporating facility functionality yet 100% did in Argentina and 50% did in India when considering only facility designation. Demographic differences also accounted for important variation in the indicator's value. In Ghana, the total population in Tolon within 2 hours travel time of a designated EmONC facility was estimated at 99.6%; however, only 91.1% of women of reproductive age were within 2 hours travel time. Comparing the value of the indicator when calculated using different definitions reveals important inconsistencies, resulting in conflicting information about whether the threshold for sufficient coverage is met. This raises important questions related to the indicator's validity. To provide a valid measure of effective coverage of EmONC, the construct for measurement should extend beyond the most narrow definition of availability and account for functionality and geographic accessibility.
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Affiliation(s)
- Jewel Gausman
- Department of Global Health and Population, Women and Health Initiative, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Verónica Pingray
- Institute for Clinical Effectiveness and Health Policy (Instituto de Efectividad Clínica y Sanitaria (IECS)), Buenos Aires, Argentina
| | - Richard Adanu
- Department of Population, Family, and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Delia A. B. Bandoh
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | - Mabel Berrueta
- Institute for Clinical Effectiveness and Health Policy (Instituto de Efectividad Clínica y Sanitaria (IECS)), Buenos Aires, Argentina
| | - Jeff Blossom
- Center for Geographic Analysis, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Winfred Dotse-Gborgbortsi
- School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Ernest Kenu
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | | | - Ana Langer
- Department of Global Health and Population, Women and Health Initiative, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Carolina Nigri
- Institute for Clinical Effectiveness and Health Policy (Instituto de Efectividad Clínica y Sanitaria (IECS)), Buenos Aires, Argentina
| | - Magdalene A. Odikro
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Accra, Ghana
| | | | | | - Paula Vázquez
- Institute for Clinical Effectiveness and Health Policy (Instituto de Efectividad Clínica y Sanitaria (IECS)), Buenos Aires, Argentina
- Department of Health Science, Kinesiology, and Rehabilitation, Universidad Nacional de La Matanza, Buenos Aires, Argentina
| | - Caitlin R. Williams
- Institute for Clinical Effectiveness and Health Policy (Instituto de Efectividad Clínica y Sanitaria (IECS)), Buenos Aires, Argentina
- Department of Maternal & and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - R. Rima Jolivet
- Department of Global Health and Population, Women and Health Initiative, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Vardhan A, Rajendran VK, Joseph S, Pooludaiyar L, Datta D, Fletcher AE, Ravilla TD. Methods for a population-based Comprehensive Eye care Workload Assessment (CEWA) study in Southern India. Indian J Ophthalmol 2023; 71:3246-3254. [PMID: 37602616 PMCID: PMC10565924 DOI: 10.4103/ijo.ijo_3228_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 08/22/2023] Open
Abstract
Eye care programs, in developing countries, are often planned using the prevalence of blindness and visual impairment, often estimated from Rapid Assessment of Avoidable Blindness (RAAB) surveys. A limitation of this planning approach is that it ignores the annual overall eye care requirements for a given population. Moreover, targets set are arbitrary, often influenced by capacity rather than need. To address this lacunae, we implemented a novel study design to estimate the annual need for comprehensive eye care in a 1.2 million populations. We conducted a population-based longitudinal study in Theni district, Tamil Nadu, India. All permanent residents of all ages were included. We conducted the study in three phases, (i) household-level enumeration and enrollment, (ii) basic eye examination (BEE) at household one-year post-enrollment, and (iii) assessment of eye care utilization and full eye examination (FEE) at central locations. All people aged 40 years and above were invited to the FEE. Those aged <40 years were invited to the FEE if indicated. In the main study, we enrolled 24,327 subjects (58% aged below 40 years and 42% aged 40 years and above). Of those less than 40 years, 72% completed the BEE, of whom 20% were referred for FEE at central location. Of the people aged ≥40 years, 70% underwent FEE. Our study design provides insights for appropriate long-term public health intervention planning, resource allocation, effective service delivery, and designing of eye care services for resource-limited settings.
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Affiliation(s)
- Ashok Vardhan
- Department of Glaucoma, S V Aravind Eye Hospital, Tirupati, Andhra Pradesh, India
| | - Vinoth Kumar Rajendran
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Sanil Joseph
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, Tamil Nadu, India
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Lakshmanan Pooludaiyar
- Department of Biostatistics, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Dipankar Datta
- Cataract and IOL services and General Ophthalmology, Aravind Eye Hospital, Theni, Tamil Nadu, India
| | - Astrid E Fletcher
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Thulasiraj D Ravilla
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, Tamil Nadu, India
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Galbraith AA, Price J, Abraham C, Giardino AP. Principles of Child Health Care Financing. Pediatrics 2023; 152:e2023063283. [PMID: 37635688 DOI: 10.1542/peds.2023-063283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
The American Academy of Pediatrics believes that the United States can and should ensure that all children, adolescents, and young adults from birth through the age of 26 years who reside within its borders have affordable access to high-quality comprehensive health care. Comprehensive, high-quality care addresses issues, challenges, and opportunities unique to children and young adults and addresses the effects of historic and present inequities. All families should have equitable access to professionals and facilities with expertise in the care of children within a reasonable distance of their residence. Payment methodologies should be structured to guarantee the economic viability of the pediatric medical home and of pediatric specialty and subspecialty practices. The recent increase in child uninsurance over the last several years is a threat to the well-being of children and families in the short- and long-term. Deficiencies in plans currently covering insured children pose similar threats. The AAP believes that the United States must not sacrifice recent hard-won gains for our children and that child health care financing should be based on the following guiding principles: (1) coverage with quality, affordable health insurance should be universal; (2) comprehensive pediatric services should be covered; (3) cost sharing should be affordable and should not negatively affect care; (4) payment should be adequate to strengthen family- and patient-centered medical homes; (5) child health financing policy should promote equity and address longstanding health and health care disparities; and (6) the unique characteristics and needs of children should be reflected.
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Affiliation(s)
- Alison A Galbraith
- Department of Pediatrics, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Jonathan Price
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Claire Abraham
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Angelo P Giardino
- Department of Pediatrics, University of Utah School of Medicine, Intermountain Primary Children's Hospital, Salt Lake City, Utah
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Tapper CX. Geriatric Palliative Care: Providing Excellent Care to Lesbian, Gay, Bisexual, Transgender, Queer Older Adults. Clin Geriatr Med 2023; 39:359-368. [PMID: 37385688 DOI: 10.1016/j.cger.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
LGBTQ+ patients encounter discrimination and bias in health care settings. They experience worse health outcomes than their cisgender and heterosexual counterparts. There are numerous ways to provide equitable and comprehensive palliative care to seriously ill LGBTQ+ individuals. These strategies include communication techniques, encouragement to complete advance directives, implicit bias training, and interdisciplinary collaboration.
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Affiliation(s)
- Corey X Tapper
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 8021, Baltimore, MD 21205, USA.
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Chen DQ, Parvataneni HK, Miley EN, Deen JT, Pulido LF, Prieto HA, Gray CF. Lessons Learned From the Comprehensive Care for Joint Replacement Model at an Academic Tertiary Center: The Good, the Bad, and the Ugly. J Arthroplasty 2023; 38:S54-S62. [PMID: 36781061 PMCID: PMC10839807 DOI: 10.1016/j.arth.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Our institution participated in the Comprehensive Care for Joint Replacement (CJR) model from 2016 to 2020. Here we review lessons learned from a total joint arthroplasty (TJA) care redesign at a tertiary academic center amid changing: (1) CJR rules; (2) inpatient only rules; and (3) outpatient trends. METHODS Quality, financial, and patient demographic data from the years prior to and during participation in CJR were obtained from institutional and Medicare reconciled CJR performance data. RESULTS Despite an increase in true outpatients and new challenges that arose from changing inpatient-only rules, there was significant improvement in quality metrics: decreased length of stay (3.48-1.52 days, P < .001), increased home discharge rate (70.2-85.5%, P < .001), decreased readmission rate (17.7%-5.1%, P < .001), decreased complication rate (6.5%-2.0%, P < .001), and the Centers for Medicare and Medicaid Services (CMS) Composite Quality Score increased from 4.4 to 17.6. Over the five year period, CMS saved an estimated $8.3 million on 1,486 CJR cases, $7.5 million on 1,351 non-CJR cases, and $600,000 from the voluntary classification of 371 short-stay inpatients as outpatient-a total savings of $16.4 million. Despite major physician time and effort leading to marked improvements in efficiency, quality, and large cost savings for CMS, CJR participation resulted in a net penalty of $304,456 to our institution, leading to zero physician gainsharing opportunities. CONCLUSION The benefits of CJR were tempered by malalignment of incentives among payer, hospital, and physician as well as a lack of transparency. Future payment models should be refined based on the successes and challenges of CJR.
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Affiliation(s)
- Dennis Q Chen
- Department of Orthopaedic Surgery, College of Medicine, University of Florida, Gainesville, Florida
| | - Hari K Parvataneni
- Department of Orthopaedic Surgery, College of Medicine, University of Florida, Gainesville, Florida
| | - Emilie N Miley
- Department of Orthopaedic Surgery, College of Medicine, University of Florida, Gainesville, Florida
| | - Justin T Deen
- Department of Orthopaedic Surgery, College of Medicine, University of Florida, Gainesville, Florida
| | - Luis F Pulido
- Department of Orthopaedic Surgery, College of Medicine, University of Florida, Gainesville, Florida
| | - Hernan A Prieto
- Department of Orthopaedic Surgery, College of Medicine, University of Florida, Gainesville, Florida
| | - Chancellor F Gray
- Department of Orthopaedic Surgery, College of Medicine, University of Florida, Gainesville, Florida
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Sorum PC, Stein C, Moore DL. "Comprehensive Healthcare for America": Using the Insights of Behavioral Economics to Transform the U. S. Healthcare System. J Law Med Ethics 2023; 51:153-171. [PMID: 37226742 PMCID: PMC10209990 DOI: 10.1017/jme.2023.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
"Comprehensive Healthcare for America" is a largely single-payer reform proposal that, by applying the insights of behavioral economics, may be able to rally patients and clinicians sufficiently to overcome the opposition of politicians and vested interests to providing all Americans with less complicated and less costly access to needed healthcare.
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Oshman L, Othman A, Furst W, Heisler M, Kraftson A, Zouani Y, Hershey C, Cho TC, Guetterman T, Piatt G, Griauzde DH. Primary care providers' perceived barriers to obesity treatment and opportunities for improvement: A mixed methods study. PLoS One 2023; 18:e0284474. [PMID: 37071660 PMCID: PMC10112804 DOI: 10.1371/journal.pone.0284474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/31/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Primary care patients with obesity seldom receive effective weight management treatment in primary care settings. This study aims to understand PCPs' perspectives on obesity treatment barriers and opportunities to overcome them. STUDY DESIGN This is an explanatory sequential mixed methods study in which survey data was collected and used to inform subsequent qualitative interviews. SETTINGS AND PARTICIPANTS PCPs who provide care to adult patients in an academic medical center in the Midwestern US. METHODOLOGY PCPs (n = 350) were invited by email to participate in an online survey. PCPs were subsequently invited to participate in semi-structured interviews to further explore survey domains. ANALYTIC APPROACH Survey data were analyzed using descriptive statistics. Interviews were analyzed using directed content analysis. RESULTS Among 107 survey respondents, less than 10% (n = 8) used evidence-based guidelines to inform obesity treatment decisions. PCPs' identified opportunities to improve obesity treatment including (1) education on local obesity treatment resources (n = 78, 73%), evidence-based dietary counseling strategies (n = 67, 63%), and effective self-help resources (n = 75, 70%) and (2) enhanced team-based care with support from clinic staff (n = 53, 46%), peers trained in obesity medicine (n = 47, 44%), and dietitians (n = 58, 54%). PCPs also desired increased reimbursement for obesity treatment. While 40% (n = 39) of survey respondents expressed interest in obesity medicine training and certification through the American Board of Obesity Medicine, qualitative interviewees felt that pursuing training would require dedicated time (i.e., reduced clinical effort) and financial support. CONCLUSIONS Opportunities to improve obesity treatment in primary care settings include educational initiatives, use of team-based care models, and policy changes to incentivize obesity treatment. Primary care clinics or health systems should be encouraged to identify PCPs with specific interests in obesity medicine and support their training and certification through ABOM by reimbursing training costs and reducing clinical effort to allow for study and board examination.
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Affiliation(s)
- Lauren Oshman
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Amal Othman
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Wendy Furst
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, United States of America
| | - Andrew Kraftson
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Yousra Zouani
- College of Engineering, Wayne State University, Detroit, Michigan, United States of America
| | - Cheryl Hershey
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Tsai-Chin Cho
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Timothy Guetterman
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Gretchen Piatt
- Department of Learning Health Sciences, Ann Arbor, Michigan, United States of America
| | - Dina H. Griauzde
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, United States of America
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Mullen E. Radiation-Induced Carotid Artery Stenosis: What Nurses Need to Know. Clin J Oncol Nurs 2023; 27:173-180. [PMID: 37677829 DOI: 10.1188/23.cjon.173-180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Radiation therapy (RT) to the neck is used to treat malignancies such as cancers of the head and neck and lymphomas. Although RT improves survival rates and health outcomes in patients with cancer, it can contribute to late effects, including radiation-induced carotid artery stenosis (RI-CAS). Comprehensive cancer survivorship care includes detection, surveillance, and management of RI-CAS. OBJECTIVES This article provides an overview of the incidence, risk factors, detection, surveillance, and management of RI-CAS in cancer survivors. METHODS A literature search was conducted using PubMed®, Embase®, and Web of Science for articles published from January 2008 through June 2022. Search terms included carotid stenosis, radiation therapy, and cancer survivors. This updated review includes content from older references, which serve as a literature-based foundation for the clinical care of cancer survivors at risk for or diagnosed with RI-CAS. FINDINGS CAS is a long-term sequela of RT to the neck and can lead to serious complications. As part of a cancer survivorship plan of care, nurses monitor patients for RI-CAS so that survival rates and patients' quality of life improve.
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Kubielas G, Diakowska D, Czapla M, Uchmanowicz B, Berezowski J, Uchmanowicz I. Comprehensive Cardiac Care: How Much Does It Cost? Int J Environ Res Public Health 2023; 20:4980. [PMID: 36981889 PMCID: PMC10049416 DOI: 10.3390/ijerph20064980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
UNLABELLED The benefits of coordinating care between healthcare professionals and institutions are the main drivers behind reforms to the payment and delivery system for healthcare services. The purpose of this study was to analyse the costs incurred by the National Health Fund in Poland related to the comprehensive care model for patients after myocardial infarction (CCMI, in Polish: KOS-Zawał). METHODS The analysis involved data from 1 October 2017 to 31 March 2020 for 263,619 patients who received treatment after a diagnosis of first or recurrent myocardial infarction as well as data for 26,457 patients treated during that period under the CCMI programme. RESULTS The average costs of treating patients covered by the full scope of comprehensive care and cardiac rehabilitation under the programme (EUR 3113.74/person) were higher than the costs of treating patients outside of that programme (EUR 2238.08/person). At the same time, a survival analysis revealed a statistically significantly lower probability of death (p < 0.0001) in the group of patients covered by CCMI compared to the group not covered by the programme. CONCLUSIONS The coordinated care programme introduced for patients after myocardial infarction is more expensive than the care for patients who do not participate in the programme. Patients covered by the programme were more often hospitalised, which might have been due to the good coordination between specialists and responses to sudden changes in patients' conditions.
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Affiliation(s)
- Grzegorz Kubielas
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland
- Department of Health Care Services, Polish National Health Fund, Central Office in Warsaw, 02-528 Warsaw, Poland
| | - Dorota Diakowska
- Department of Basic Sciences, Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Michał Czapla
- Department of Emergency Medical Service, Faculty of Health Sciences, Wroclaw Medical University, 51-616 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
- Group of Research in Care (GRUPAC), Faculty of Health Science, University of La Rioja, 26006 Logrono, Spain
| | - Bartosz Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland
| | | | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
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Yoshimasu K, Inoue M, Harada S, Fujieda M, Ikeda K, Kojima K, Yamada H. [Actual condition and problems to be solved regarding construction of comprehensive community care system dealing with mental disorders]. Nihon Koshu Eisei Zasshi 2023; 70:225-234. [PMID: 36908151 DOI: 10.11236/jph.22-114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
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de Abreu MDSN, Galdino MCP, Matos SDDO, Cavalcanti CCDLPB, Trigueiro DRSG. Construction of an Ophthalmological Calendar for the Therapeutic Follow-Up of Glaucoma in the Elderly. Int J Environ Res Public Health 2023; 20:1237. [PMID: 36674014 PMCID: PMC9859579 DOI: 10.3390/ijerph20021237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/31/2022] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
Health teams in primary care play a key role in the eye health of users as they understand that early identification of any visual change can result in satisfactory outcomes and better prognoses, preventing damage that is often irreversible to health. Building an ophthalmological calendar for the therapeutic follow-up of glaucoma in the elderly, this is a methodological study, as the process of constructing the calendar's content followed the Raymundo theoretical framework. The calendar was built in the following steps: bibliographic survey, content development, transformation of the language of scientific information into easy-to-understand expressions, creation and production of illustrations of the first draft, evaluation of the first draft made by the examining board, diagramming and presentation of the product. The construction of the calendar covers a specific theme for the elderly with glaucoma, which emphasizes the need to invest more in the inclusion of new technologies that will provide greater effectiveness and adherence of the user and the health team for the management of comprehensive care. The implementation of the produced calendar will allow for a better understanding and bond between the team professionals and the user and, consequently, a better monitoring of the therapeutic process of the patient involved.
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Affiliation(s)
| | - Maria Clara Palitot Galdino
- Programa de Pós Graduação de Mestrado em Saúde da Família da, Faculdades de Enfermagem e Medicina Nova Esperança, João Pessoa 58067-698, PB, Brazil
| | - Suellen Duarte de Oliveira Matos
- Programa de Pós Graduação de Mestrado em Saúde da Família da, Faculdades de Enfermagem e Medicina Nova Esperança, João Pessoa 58067-698, PB, Brazil
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Shin E, Fleming C, Ghosh A, Javadi A, Powell R, Rich E. Assessing patient, physician, and practice characteristics predicting the use of low-value services. Health Serv Res 2022; 57:1261-1273. [PMID: 36054345 PMCID: PMC9643094 DOI: 10.1111/1475-6773.14053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To examine characteristics of beneficiaries, physicians, and their practice sites associated with greater use of low-value services (LVS) using LVS measures that reflect current care practices. DATA SOURCES This study was conducted in the context of a large, nationwide primary care redesign initiative (Comprehensive Primary Care Plus), using Medicare claims data in 2018. STUDY DESIGN We examined beneficiary-level total counts of LVS based on the existing 31 claims-based measures updated by excluding three services provided with diminishing frequency to Medicare beneficiaries and by replacing these with more recently identified LVS. We estimated hierarchical linear models with an extensive list of beneficiary, physician, and practice site characteristics to examine the contribution of characteristics at each level in predicting greater use of LVS. We also examined the proportion of variation in LVS use attributable to the set of characteristics at each level. DATA COLLECTION/EXTRACTION METHODS The study included 5,074,642 Medicare fee-for-service beneficiaries attributed to 32,406 primary care physicians in 11,009 primary care practice sites. PRINCIPAL FINDINGS Patients with disabilities, end-stage renal disease, and those in regions with higher poverty rates receive 10 (standard error [SE] = 3.0), 80 (SE = 14.0), and 10 (SE = 1.0) more LVS per 1000 beneficiaries across all 31 measures combined than patients without such attributes, respectively. Greater physician comprehensiveness and an increase in the number of primary care practitioners at a practice were associated with 40 (SE = 20.0) and 20 (SE = 6.0) fewer LVS per 1000 beneficiaries, respectively. Yet, the explanatory variables we examined only account for 11 percent of the variation in LVS use, with most of the variation (87 percent) being due to unobserved differences at the beneficiary level. CONCLUSIONS Unexplained residual variation, from underlying patient preferences and behavior of non-primary care providers, could be important determinants of LVS use.
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Nambiar V, Raj M, Vasudevan D, Bhaskaran R, Sudevan R. One-year mortality after acute stroke: a prospective cohort study from a comprehensive stroke care centre, Kerala, India. BMJ Open 2022; 12:e061258. [PMID: 36442894 PMCID: PMC9710353 DOI: 10.1136/bmjopen-2022-061258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The primary objective was to report the 1-year all-cause mortality among patients with stroke. The secondary objectives were (1) to report the mortality stratified by type of stroke and sex and (2) to report predictors of 1-year mortality among patients with stroke. DESIGN A prospective cohort study. SETTING Institutional-stroke care unit of a tertiary care hospital PARTICIPANTS: Patients who were treated in the study institution during 2016-2020 for acute stroke and were followed up for a period of 1 year after stroke in the same institution. MAIN OUTCOME MEASURES The main outcome measures were the mortality proportion of any stroke and first ever stroke cohorts at select time points, including in-hospital stay, along with 2 weeks, 2 months, 6 months and 1 year after index stroke. The secondary outcomes were (1) mortality proportions stratified by sex and type of stroke and (2) predictors of 1-year mortality for any stroke and first ever stroke. RESULTS We recruited a total of 1336 patients. The mean age of participants was 61.6 years (13.5 years). The mortality figures for 2 weeks, 2 months, 6 months and 12 months after discharge were 79 (5.9%), 88 (6.7%), 101 (7.6%) and 114 (8.5%), respectively, in the full cohort. The in-hospital mortality was 45 (3.4%). The adjusted analysis revealed 3 predictors for 1-year mortality after first ever stroke-age, pre-treatment National Institutes of Health Stroke Scale (NIHSS) score and Modified Rankin Scale (mRS) score at baseline. The same for the full cohort had only two predictors-age and pre-treatment NIHSS score. CONCLUSION Mortality of stroke at 1-year follow-up in the study population is low in comparison to several studies published earlier. The predictors of 1-year mortality after stroke included age, NIHSS score at baseline and mRS score at baseline.
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Affiliation(s)
- Vivek Nambiar
- Division of Stroke, Department of Neurology, Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | - Manu Raj
- Department of Pediatrics and Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | - Damodaran Vasudevan
- Department of Health Sciences Research, Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | - Renjitha Bhaskaran
- Department of Biostatistics, Amrita Institute of Medical Sciences, Cochin, India
| | - Remya Sudevan
- Department of Health Sciences Research, Amrita Institute of Medical Sciences, Amrita viswa vidyapeetham, Cochin, India
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Muñoz-Bermejo L, González-Becerra MJ, Barrios-Fernández S, Postigo-Mota S, Jerez-Barroso MDR, Martínez JAF, Suárez-Lantarón B, Marín DM, Martín-Bermúdez N, Ortés-Gómez R, Gómez-Ullate-García de León M, Martínez-Acevedo M, Rocha-Gómez L, Espejo-Antúnez S, Fraile-Bravo M, Galán MGS, Chato-Gonzalo I, Muñoz FJD, Hernández-Mocholí MÁ, Madruga-Vicente M, Prado-Solano A, Mendoza-Muñoz M, Carlos-Vivas J, Pérez-Gómez J, Pastor-Cisneros R, Fuentes-Flores P, Pereira-Payo D, De Los Ríos-Calonge J, Urbano-Mairena J, Guerra-Bustamante J, Adsuar JC. Cost-Effectiveness of the Comprehensive Interdisciplinary Program-Care in Informal Caregivers of People with Alzheimer's Disease. Int J Environ Res Public Health 2022; 19:ijerph192215243. [PMID: 36429962 PMCID: PMC9691117 DOI: 10.3390/ijerph192215243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 05/27/2023]
Abstract
People with Alzheimer's disease (AD) diagnosis who get informal care remain at home longer, reducing the demand for healthcare resources but increasing the stress of caregiving. Research on the effectiveness of physical training, psychoeducational, cognitive-behavioural, and health education programs in reducing the caregiver load and enhancing health-related quality of life (HRQoL) exist, but none exist about an integrated interdisciplinary program. The goals of this project are (1) to assess the Integral-CARE Interdisciplinary Program (IP) applicability, safety, effects on HRQoL, and the incremental cost-effectiveness ratio for AD caregivers; (2) to evaluate the IP applicability and cost-effectiveness to enhance the physical, psychoemotional, cognitive-behavioural dimensions, and the health education status of informal caregivers, and (3) to study the transference of the results to the public and private sectors. A randomized controlled trial will be conducted with an experimental (IP) and a control group (no intervention). The PI will be conducted over nine months using face-to-face sessions (twice a week) and virtual sessions on an online platform (once a week). There will be an initial, interim (every three months), and final assessment. Focus groups with social and health agents will be organized to determine the most important information to convey to the public and private sectors in Extremadura (Spain). Applicability, safety, HRQoL, incremental cost-effectiveness ratio, and HRQoL will be the main outcome measures, while secondary measures will include sociodemographic data; physical, psychoemotional, health education, and cognitive-behavioural domains; program adherence; and patient health status. Data will be examined per procedure and intention to treat. A cost-effectiveness study will also be performed from the viewpoints of private and public healthcare resources.
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Affiliation(s)
- Laura Muñoz-Bermejo
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain
| | | | - Sabina Barrios-Fernández
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain
| | - Salvador Postigo-Mota
- Department of Nursing, Faculty of Medicine, University of Extremadura, 06006 Badajoz, Spain
| | - María del Rocío Jerez-Barroso
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain
| | - Juan Agustín Franco Martínez
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Belén Suárez-Lantarón
- Education Sciences Department, Faculty of Education, University of Extremadura, 06006 Badajoz, Spain
| | - Diego Muñoz Marín
- Department of Musical, Plastic and Corporal Expression, Faculty of Sport Sciences, University of Extremadura, Av. de la Universidad, s/n, 10003 Cáceres, Spain
| | - Nieves Martín-Bermúdez
- Department of Educational Sciences, Faculty of Education and Education and Psychology, University of Extremadura, 10003 Cáceres, Spain
| | - Raquel Ortés-Gómez
- Area Specialist in the Extremadura Health Service, Geriatrics Service of the Hospital Virgen del Puerto de Plasencia, 10600 Plasencia, Spain
| | - Martín Gómez-Ullate-García de León
- Department of Teaching of Musical, Plastic and Body Expression, Faculty of Teacher Training, University of Extremadura, 10004 Cáceres, Spain
| | | | - Lara Rocha-Gómez
- Gpex-Eshaex Superior School of Hotel Management and Agrotourism of Extremadura, 06800 Mérida, Spain
| | - Sara Espejo-Antúnez
- Department of Educational Sciences, Faculty of Teacher Training, University of Extremadura, 10004 Cáceres, Spain
| | - Mercedes Fraile-Bravo
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - María Gloria Solís Galán
- Department of Educational Sciences, Faculty of Teacher Training, University of Extremadura, 10004 Cáceres, Spain
| | - Ignacio Chato-Gonzalo
- Department of Social Sciences, Language and Literature Teaching, Faculty of Teacher Training, University of Extremadura, 10004 Cáceres, Spain
| | - Francisco Javier Domínguez Muñoz
- Physical Activity and Quality of Life (AFYCAV) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Miguel Ángel Hernández-Mocholí
- Physical Activity and Quality of Life (AFYCAV) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Miguel Madruga-Vicente
- Physical Activity and Quality of Life (AFYCAV) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Angelina Prado-Solano
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain
| | - María Mendoza-Muñoz
- Physical and Health Literacy and Health-Related Quality of Life (PHYQOL) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - Jorge Carlos-Vivas
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Jorge Pérez-Gómez
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - Raquel Pastor-Cisneros
- Social Impact and Innovation in Health (InHEALTH) Research Group, University Centre of Mérida, University of Extremadura, 06800 Mérida, Spain
| | - Paulina Fuentes-Flores
- Promoting a Healthy Society (PHeSo) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Damián Pereira-Payo
- Promoting a Healthy Society (PHeSo) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Javier De Los Ríos-Calonge
- Promoting a Healthy Society (PHeSo) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Javier Urbano-Mairena
- Promoting a Healthy Society (PHeSo) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Joan Guerra-Bustamante
- Health Economy Motricity and Education (HEME) Research Group, Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain
| | - José Carmelo Adsuar
- Promoting a Healthy Society (PHeSo) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
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Kuo NIH, Polizzotto MN, Finfer S, Garcia F, Sönnerborg A, Zazzi M, Böhm M, Kaiser R, Jorm L, Barbieri S. The Health Gym: synthetic health-related datasets for the development of reinforcement learning algorithms. Sci Data 2022; 9:693. [PMID: 36369205 PMCID: PMC9652426 DOI: 10.1038/s41597-022-01784-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
In recent years, the machine learning research community has benefited tremendously from the availability of openly accessible benchmark datasets. Clinical data are usually not openly available due to their confidential nature. This has hampered the development of reproducible and generalisable machine learning applications in health care. Here we introduce the Health Gym - a growing collection of highly realistic synthetic medical datasets that can be freely accessed to prototype, evaluate, and compare machine learning algorithms, with a specific focus on reinforcement learning. The three synthetic datasets described in this paper present patient cohorts with acute hypotension and sepsis in the intensive care unit, and people with human immunodeficiency virus (HIV) receiving antiretroviral therapy. The datasets were created using a novel generative adversarial network (GAN). The distributions of variables, and correlations between variables and trends in variables over time in the synthetic datasets mirror those in the real datasets. Furthermore, the risk of sensitive information disclosure associated with the public distribution of the synthetic datasets is estimated to be very low.
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Affiliation(s)
- Nicholas I-Hsien Kuo
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
| | | | - Simon Finfer
- The George Institute for Global Health, Sydney, Australia
- University of New South Wales, Sydney, Australia
- Imperial College London, London, United Kingdom
| | | | | | | | - Michael Böhm
- Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Rolf Kaiser
- Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Sebastiano Barbieri
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
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Renghea A, Cuevas-Budhart MA, Yébenes-Revuelto H, Gómez Del Pulgar M, Iglesias-López MT. "Comprehensive Care" Concept in Nursing: Systematic Review. Invest Educ Enferm 2022; 40:e05. [PMID: 36867778 PMCID: PMC10017140 DOI: 10.17533/udea.iee.v40n3e05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/05/2022] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Integrated health care is a concept widely used in the planning and organisation of nursing care. It is a highly topical concept, but at the same time it is deeply rooted in the theory and models of Nursing right from its inception as a science. There is no clear, agreed definition that describes it. OBJETIVE To systematise the knowledge available on the concept of "comprehensive care" in Nursing from the point of view of nursing care, its domains and characteristics. METHODS A literature search has been carried out in several languages (Spanish, Portuguese, English and Romanian) in the databases Web of Science, Scopus, Medline, PubMed, Cochrane and Dialnet, covering the period between 2013 and 2019. The search terms used were: comprehensive health care, health and nursing. Prospero register 170327. RESULTS Sixteen documents were identified, which grouped 8 countries, mainly Brazil, being the country with the highest output on this context 10 documents were found within the qualitative paradigm and 6 quantitative ones. The concept "Comprehensive Care" is commonly used to refer to comprehensive nursing care techniques, protocols, programmes and plans, covering care in all aspects of the individual as a complement to or independent of the clinical needs arising from health care. CONCLUSIONS The definition of features pertaining to the concept "Comprehensive Care" encourages the use and standardisation of nursing care plans, improving patient follow-up, the detection of new risk factors, complications and new health problems not related to the reason for admission.This increases the capacity for prevention and improves the patients quality of life, and their primary and/or family caregivers, which translates into lower costs in the health system.
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Affiliation(s)
- Alina Renghea
- Facultad de Ciencias de la Salud. Universidad Francisco de Vitoria
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Farkas AH, Merriam S, Frayne S, Hardman L, Schwartz R, Kolehmainen C. Retaining Providers with Women's Health Expertise: Decreased Provider Loss Among VHA Women's Health Faculty Development Program Attendees. J Gen Intern Med 2022; 37:786-790. [PMID: 36042098 PMCID: PMC9427435 DOI: 10.1007/s11606-022-07575-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 04/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Veterans Health Administration (VHA) provides care for over 500,000 women. In 2010 VHA instituted a policy requiring each facility to identify a designated women's health provider (WH-PCP) who could offer comprehensive gender-specific primary care. Access to WH-PCPs remains a challenge at some sites with high turnover among WH-PCPs. Faculty development programs have been demonstrated to foster professional development, networks, and mentorship; these can enhance job satisfaction and provide one potential solution to address WH-PCP turnover. One such program, the VHA's Women's Health Mini-Residency (WH-MR), was developed in 2011 to train WH-PCPs through case-based hands-on training. OBJECTIVE The objective of this program evaluation was to determine the association of WH-MR participation with WH-PCP retention. DESIGN Using the Women's Health Assessment of Workforce Capacity-Primary Care survey, we assessed the relationship between WH-MR participation and retention of WH-PCP status between fiscal year 2018 and 2019. PARTICIPANTS All WH-PCPs (N = 2664) at the end of fiscal year 2018 were included. MAIN MEASURES We assessed retention of WH-PCP status the following year by WH-MR participation. For our adjusted analysis, we controlled for provider gender, provider degree (MD, DO, NP, PA), women's health leadership position, number of clinical sessions per week, and clinical setting (general primary care clinic, designated women's health clinic, or a combination). KEY RESULTS WH-MR participants were more likely to remain WH-PCPs in FY2019 in both unadjusted analyses (OR 1.91, 95%CI 1.54-2.36) and adjusted analyses (OR 1.96, 95%CI 1.58-2.44). CONCLUSIONS WH-PCPs who participate in WH-MRs are more likely to remain WH-PCPs in the VHA system. Given the negative impact of provider turnover on patient care and the significant financial cost of onboarding a new WH-PCP, the VHA should continue to encourage all WH-PCPs to participate in the WH-MR.
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Affiliation(s)
- Amy H Farkas
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Medicine, Milwaukee VA Medical Center, Milwaukee, WI, USA.
- Office of Women's Health, Veterans Health Administration, Washington, DC, USA.
| | - Sarah Merriam
- Office of Women's Health, Veterans Health Administration, Washington, DC, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Susan Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Lisa Hardman
- Office of Women's Health, Veterans Health Administration, Washington, DC, USA
| | - Rachel Schwartz
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
- WellMD Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine Kolehmainen
- Office of Women's Health, Veterans Health Administration, Washington, DC, USA
- Division of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Whitmarsh-Brown MA, Bozic KJ. Value-based Healthcare: Has the Time Come for Comprehensive Infection Care Centers? Clin Orthop Relat Res 2022; 480:1452-1454. [PMID: 35767807 PMCID: PMC9278902 DOI: 10.1097/corr.0000000000002291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Meghan A. Whitmarsh-Brown
- Fellow, Orthopaedic Surgery and Value-Based Health Care Delivery, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Kevin J. Bozic
- Professor of Orthopedic Surgery and Chair, Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, TX, USA
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Fu N, Singh P, Dale S, Orzol S, Peikes D, Ghosh A, Brown R, Day TJ. Long-Term Effects of the Comprehensive Primary Care Model on Health Care Spending and Utilization. J Gen Intern Med 2022; 37:1713-1721. [PMID: 34236603 PMCID: PMC9130381 DOI: 10.1007/s11606-021-06952-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Centers for Medicare & Medicaid Services launched the 4-year Comprehensive Primary Care Initiative (CPC Classic) in 2012 and its 5-year successor, CPC Plus (CPC+), in 2017 to test whether improving primary care delivery in five areas-and providing practices with financial and technical support-reduced spending and improved quality. This is the first study to examine long-term effects of a primary care practice transformation model. OBJECTIVE To test whether long-term primary care transformation-the 4-year CPC Classic and the first 2 years of its successor, CPC+-reduced hospitalizations, emergency department (ED) visits, and spending over 6 years. DESIGN We used a difference-in-differences analysis to compare outcomes for beneficiaries attributed to CPC Classic practices with outcomes for beneficiaries attributed to comparison practices during the year before and 6 years after CPC Classic began. PARTICIPANTS The study involved 565,674 Medicare fee-for-service beneficiaries attributed to 502 CPC Classic practices and 1,165,284 beneficiaries attributed to 908 comparison practices, with similar beneficiary-, practice-, and market-level characteristics as the CPC Classic practices. INTERVENTIONS The interventions required primary care practices to improve 5 care areas and supported their transformation with substantially enhanced payment, data feedback, and learning support and, for CPC+, added health information technology support. MAIN MEASURES Hospitalizations (all-cause), ED visits (outpatient and total), and Medicare Part A and B expenditures. KEY RESULTS Relative to comparison practices, beneficiaries in intervention practices experienced slower growth in hospitalizations-3.1% less in year 5 and 3.5% less in year 6 (P < 0.01) and roughly 2% (P < 0.1) slower growth each year in total ED visits during years 3 through 6. Medicare Part A and B expenditures (excluding care management fees) did not change appreciably. CONCLUSIONS The emergence of favorable effects on hospitalizations in years 5 and 6 suggests primary care transformation takes time to translate into lower hospitalizations. Longer tests of models are needed.
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Affiliation(s)
- Ning Fu
- Mathematica, Cambridge, MA, USA.
| | | | | | | | | | | | | | - Timothy J Day
- Center for Medicare and Medicaid Innovation, Baltimore, MA, USA
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Barbezat G. Comprehensive healthcare system needed. N Z Med J 2022; 135:143-144. [PMID: 35728195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Gil Barbezat
- Emeritus Professor of Medicine and Retired Gastroenterologist, University of Otago, Dunedin, New Zealand
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Jacobs AK, Ali MJ, Best PJ, Bieniarz MC, Bufalino VJ, French WJ, Henry TD, Hollowell L, Jauch EC, Kurz MC, Levy M, Patel P, Spier T, Stone RH, Tataris KL, Thomas RJ, Zègre-Hemsey JK. Systems of Care for ST-Segment-Elevation Myocardial Infarction: A Policy Statement From the American Heart Association. Circulation 2021; 144:e310-e327. [PMID: 34641735 DOI: 10.1161/cir.0000000000001025] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The introduction of Mission: Lifeline significantly increased timely access to percutaneous coronary intervention for patients with ST-segment-elevation myocardial infarction (STEMI). In the years since, morbidity and mortality rates have declined, and research has led to significant developments that have broadened our concept of the STEMI system of care. However, significant barriers and opportunities remain. From community education to 9-1-1 activation and emergency medical services triage and from emergency department and interfacility transfer protocols to postacute care, each critical juncture presents unique challenges for the optimal care of patients with STEMI. This policy statement sets forth recommendations for how the ideal STEMI system of care should be designed and implemented to ensure that patients with STEMI receive the best evidence-based care at each stage in their illness.
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Alizadeh F, Addepalli A, Chaudhuri SR, Budongo AM, Owembabazi I, Chaw GF, Musominali S, Paccione G. Family health sheets: a vital instrument for village health workers providing comprehensive healthcare. BMC Health Serv Res 2021; 21:1138. [PMID: 34674694 PMCID: PMC8530699 DOI: 10.1186/s12913-021-07180-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 10/08/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Community Health Worker (CHW) programs have long been used to provide acute care for children and women in healthcare shortage areas, but their provision of comprehensive longitudinal care for chronic problems is rare. The Village Health Worker (VHW) program, initiated in 2007, is an example of a long standing "horizontal" CHW program in rural Southwestern Uganda that has delivered village-level care for chronic disease based on a biannual village health census that identifies individual and family health risks. To facilitate continuity of care for problems identified, health census data were electronically transformed into family-specific Family Health Sheets (FHS) in 2016 which summarize the pertinent demographic and health data for each family, as well as health topics the family would like to learn more about. The FHS, evaluated and discussed here, serves as an epidemiologically-informed "bedside" tool to help VHWs provide longitudinal care in their villages. METHODS 48 VHWs in the program completed a survey on the utility of the FHS and 24 VHWs participated in small discussion groups. Responses were analyzed using both quantitative and standard conceptual content analysis models RESULTS: 46 out of 48 VHWs reported that the FHS made them a "much better VHW." In addition to helping target interventions in child health, women's health, and sanitation, the FHS assisted follow-up of non-communicable diseases in the community. In discussion groups, VHWs reported that the FHS helped them understand risks for future disease, facilitated earning stipends, and increased credibility and trust in the community. Limitations cited were the infrequent updates of the FHS, only biannually with the census, and the lack of cross-reference capability by health problem. DISCUSSION The FHS supports VHWs in providing longitudinal and comprehensive healthcare of chronic diseases in their villages. Limitations, potential solutions, and future directions are discussed.
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Affiliation(s)
- Faraz Alizadeh
- Boston Children’s Hospital & Doctor’s for Global Health, 300 Longwood Ave, Boston, MA 02115 USA
| | - Aravind Addepalli
- Albert Einstein College of Medicine & Doctor’s for Global Health, 1300 Morris Park Ave, Bronx, NY 10461 USA
| | - Shombit R. Chaudhuri
- Albert Einstein College of Medicine & Doctor’s for Global Health, 1300 Morris Park Ave, Bronx, NY 10461 USA
| | - Annie Modesta Budongo
- Kisoro District Hospital & Doctors for Global Health, Kisoro District Hospital, Kisoro, Uganda
| | - Immaculate Owembabazi
- Kisoro District Hospital & Doctors for Global Health, Kisoro District Hospital, Kisoro, Uganda
| | - Gloria Fung Chaw
- Montefiore Medical Center & Doctor’s for Global Health, 111 E 210th St, Bronx, NY 10467 USA
| | - Sam Musominali
- Kisoro District Hospital & Doctors for Global Health, Kisoro District Hospital, Kisoro, Uganda
| | - Gerald Paccione
- Montefiore Medical Center & Doctor’s for Global Health, 111 E 210th St, Bronx, NY 10467 USA
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Chertok D, Konchak C, Shah N, Singh K, Au L, Hammernik J, Murray B, Solomonides A, Wang E, Halasyamani L. An operationally implementable model for predicting the effects of an infectious disease on a comprehensive regional healthcare system. PLoS One 2021; 16:e0258710. [PMID: 34669732 PMCID: PMC8528335 DOI: 10.1371/journal.pone.0258710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open
Abstract
An operationally implementable predictive model has been developed to forecast the number of COVID-19 infections in the patient population, hospital floor and ICU censuses, ventilator and related supply chain demand. The model is intended for clinical, operational, financial and supply chain leaders and executives of a comprehensive healthcare system responsible for making decisions that depend on epidemiological contingencies. This paper describes the model that was implemented at NorthShore University HealthSystem and is applicable to any communicable disease whose risk of reinfection for the duration of the pandemic is negligible.
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Affiliation(s)
- Daniel Chertok
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Chad Konchak
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Nirav Shah
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States of America
| | - Kamaljit Singh
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Loretta Au
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Jared Hammernik
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Brian Murray
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Anthony Solomonides
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Ernest Wang
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Lakshmi Halasyamani
- NorthShore University HealthSystem, Evanston, Illinois, United States of America
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States of America
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Higgins TC, O'Malley AS, Keith RE. Exploring and Overcoming the Challenges Primary Care Practices Face with Care Management of High-Risk Patients in CPC+: a Mixed-Methods Study. J Gen Intern Med 2021; 36:3008-3014. [PMID: 33496929 PMCID: PMC8481356 DOI: 10.1007/s11606-020-06528-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Longitudinal care management (LCM) for high-risk patients is a cornerstone of primary care models aiming to improve quality and reduce costs. OBJECTIVE Describe the extent to which LCM was implemented in the second year of Comprehensive Primary Care Plus (CPC+), and barriers to and facilitators of implementation. DESIGN Mixed-methods. PARTICIPANTS Quantitative: 2715 practices participating in CPC+ in 2018. Qualitative: Interviews with practitioners and staff in 23 representative CPC+ practices. MAIN MEASURES Across all CPC+ practices, we report median percentages of empaneled patients placed in the highest-risk tiers and, of those, the median percentage receiving LCM. Across 23 CPC+ practices, we report qualitative findings on LCM implementation. KEY RESULTS While practices reported benefits of LCM, a small proportion of patients received LCM. Practices placed 2.4% (median) of patients in the highest-risk tier; of these, 30% (median) received LCM. Practices placed 10% (median) of patients in the second-highest-risk tier; of these, 7% (median) received LCM. Interviews revealed LCM uptake across tiers was low because of insufficient care manager staffing. Other challenges included lack of practitioner buy-in to using risk stratification to identify high-risk patients, patients' reluctance to engage in LCM or change behaviors, and limited health information technology functionality for developing, maintaining, and accessing high-risk patients' care plans. Facilitators included embedding care managers within practices and electronic health record functionalities that support LCM. CONCLUSIONS Despite substantial financial and other supports, and practices' perceived benefits of LCM, insufficient care manager staffing and other barriers have limited its potential in CPC+ to date. To expand LCM's reach, practices need additional care managers, training to overcome barriers to patient engagement, better identification of patients who might benefit from LCM, improved information technology tools for risk stratification and care plans, and more practitioner buy-in to risk stratification.
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Agarwal P, Mukerji G, Laur C, Chandra S, Pimlott N, Heisey R, Stovel R, Goulbourne E, Bhatia RS, Bhattacharyya O, Martin D. Adoption, feasibility and safety of a family medicine-led remote monitoring program for patients with COVID-19: a descriptive study. CMAJ Open 2021; 9:E324-E330. [PMID: 33795222 PMCID: PMC8034257 DOI: 10.9778/cmajo.20200174] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Virtual care for patients with coronavirus disease 2019 (COVID-19) allows providers to monitor COVID-19-positive patients with variable trajectories while reducing the risk of transmission to others and ensuring health care capacity in acute care facilities. The objective of this descriptive analysis was to assess the initial adoption, feasibility and safety of a family medicine-led remote monitoring program, COVIDCare@Home, to manage the care of patients with COVID-19 in the community. METHODS COVIDCare@Home is a multifaceted, interprofessional team-based remote monitoring program developed at an ambulatory academic centre, the Women's College Hospital in Toronto. A descriptive analysis of the first cohort of patients admitted from Apr. 8 to May 11, 2020, was conducted. Lessons from the implementation of the program are described, focusing on measure of adoption (number of visits per patient total, with a physician or with a nurse; length of follow-up), feasibility (received an oximeter or thermometer; consultation with general internal medicine, social work or mental health, pharmacy or acute ambulatory care unit) and safety (hospitalizations, mortality and emergency department visits). RESULTS The COVIDCare@Home program cared for a first cohort of 97 patients (median age 41 yr, 67% female) with 415 recorded virtual visits. Patients had a median time from positive testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to first appointment of 3 (interquartile range [IQR] 2-4) days, with a median virtual follow-up time of 8 (IQR 5-10) days. A total of 4 (4%) had an emergency department visit, with no patients requiring hospitalization and no deaths; 16 (16%) of patients required support with mental and social health needs. INTERPRETATION A family medicine-led, team-based remote monitoring program can safely manage the care of outpatients diagnosed with COVID-19. Virtual care approaches, particularly those that support patients with more complex health and social needs, may be an important part of ongoing health system efforts to manage subsequent waves of COVID-19 and other diseases.
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Affiliation(s)
- Payal Agarwal
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont.
| | - Geetha Mukerji
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Shivani Chandra
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Nick Pimlott
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Ruth Heisey
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Rebecca Stovel
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Elaine Goulbourne
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - R Sacha Bhatia
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Onil Bhattacharyya
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Danielle Martin
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
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Affiliation(s)
- Johann A. Sigurdsson
- Chair of the Nordic Federation of General Practice, GP, Professor emeritus, Development Centre for Primary Health Care, Iceland; Department of Public Health and Nursing; General Practice Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anders Beich
- Chair of the Danish College of General Practice, GP, Copenhagen, Denmark
| | - Anna Stavdal
- WONCA World, GP, President Elect, The Norwegian College of General Practice, Oslo, Norway
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Lemire F. Comprehensiveness during and after a pandemic. Can Fam Physician 2020; 66:868. [PMID: 33208435 PMCID: PMC8302415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Barbosa P, Huchital MJ, Weiss JJ. Empathy in Podiatric Medical Education: Challenges and Opportunities for Comprehensive Care. J Am Podiatr Med Assoc 2020; 110:447706. [PMID: 33179063 DOI: 10.7547/18-187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Many regard empathy as a critical component of comprehensive health care. Much interest has been generated in the field of medical empathy, in particular as it relates to education. Many desirable outcomes correlate with perceived empathy during the patient encounter, but paradoxically, empathy levels have been reported to decline during the years of medical education. Several new approaches have been described in the literature that intend to teach or develop empathy skills in health-care students. METHODS PubMed, PsycINFO, and Google Scholar databases were searched for the terms empathy education, medical education, medical student, podiatric medical education, medical empathy, compassion, emotional intelligence, biopsychosocial model, and bedside manner. After implementing inclusion and exclusion criteria, articles were selected for preparation of a literature review. Analysis of the podiatric medical education on empathy was conducted by reviewing descriptions of all courses listed on each of the nine US podiatric medical schools' Web sites. The 2018 Curricular Guide for Podiatric Medical Education was analyzed. RESULTS In this review, we examine the current state of empathy from a context of medical education in general, followed by a specific analysis in podiatric medicine. We define key terms, describe the measuring of empathy in medicine, explore outcomes of empathy in the health-care setting, review the reports of a decline in medical education, and highlight some of the current efforts to develop the skill in education. An overview of empathy in the podiatric medical curriculum is presented. CONCLUSIONS To improve the quality of care that physicians provide, a transformation in podiatric medical education is necessary. A variety of tools are available for education reform with the target of developing empathy skills in podiatric medical students.
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