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Journal of Ambulatory Care Management

Howard Gardner
No abstract text is available yet for this article.
March 31, 2017: Journal of Ambulatory Care Management
Robert D Lieberthal, Colleen Payton, Mona Sarfaty, George Valko
To explore the cost for individual practices to become more patient-centered, we inventoried and calculated the cost of costly activities involved in implementing the Patient-Centered Medical Home (PCMH) as defined by the National Committee for Quality Assurance. There were 3 key findings. The cost of each PCMH-related clinical activity can be classified in 1 of 3 major categories. Cost offsets can be used to defray part of the cost recognition. The cost of PCMH transformation varied by practice with no clear level or pattern of costs...
March 27, 2017: Journal of Ambulatory Care Management
Anna M Afonso, Susana Alfonso, Toyosi O Morgan
We studied a primary care clinic transitioning to Meaningful Use stage 1 and a comparison clinic within the same health system. In the 6 months following implementation, after adjusting for confounders, mean systolic blood pressure worsened (+3.3 mm Hg; P = .004) in the intervention clinic compared with the comparison clinic. We did not see a change in the mean or proportion of patients meeting target goals for diabetes (hemoglobin A1c) or obesity (body mass index). Our findings suggest that the worsening of systolic blood pressure associated with Meaningful Use implementation is likely due to distractions of system changes negatively impacting health outcomes...
March 27, 2017: Journal of Ambulatory Care Management
Ruth A Bush, Cynthia D Connelly, Alexa Pérez, Neilson Chan, Cynthia Kuelbs, George J Chiang
The patient portal, increasingly available to patients, allows secure electronic communication with physicians. Although physician attitude toward the portal plays a crucial role in patient adoption, little information regarding physician opinion of the portal is available, with almost no information gathered in the pediatric environment. Using a mixed-methods approach, physicians in a large pediatric medical facility and integrated delivery network were surveyed using an online quantitative questionnaire and structured interviews...
March 27, 2017: Journal of Ambulatory Care Management
David Y Ming, Alyssa M Stephany, John A Gallis, Benjamin J Powers
Primary care physicians (PCPs) experience differential postdischarge access to electronic health records, depending upon affiliation with the discharging hospital's health network. To better understand whether this affiliation impacts discharge communication preferences, we surveyed a convenience sample of PCPs in and out of our hospital's health network. We also surveyed hospitalists and compared PCPs' and hospitalists' responses. We found that PCP discharge communication preferences differed by hospital health network affiliation...
March 27, 2017: Journal of Ambulatory Care Management
Joseph M Massaro, Joanne M Murabito, Rhoda Au, Emily Carnahan, Tamara S Morgan, Christopher Murray, Elliott S Fisher, Eugene C Nelson, Stephen S Lim, Ralph B DʼAgostino
A novel, comprehensive health risk index for adults has been validated and is now ready for use to improve the health of individuals and populations. This health risk index provides an estimate of the avoidable risk of death for adults 30 years or older. It includes 12 evidence-based clinical and behavioral risk factors and was validated on discrimination and calibration using the NHANES (National Health and Nutrition Examination Survey) and Framingham Heart Study cohorts. The results from both cohorts were consistent and similar...
March 27, 2017: Journal of Ambulatory Care Management
Kerstin M Reinschmidt, Maia Ingram, Stephanie Morales, Samantha J Sabo, John Blackburn, Lucy Murrieta, Cassalyn David, Scott C Carvajal
The Patient Protection and Affordable Care Act provided community health workers (CHWs) with new opportunities, and current efforts develop evidence-based guidelines for CHW integration into clinical teams. This qualitative study documents CHW roles and activities in 3 federally qualified health care centers in southern Arizona. Community health worker clinical roles, activities, and integration varied by health center and were in flux. Integration included complementary roles, scheduled and everyday communications with team members, and documentation in the electronic health records...
March 27, 2017: Journal of Ambulatory Care Management
Patricia K Foo, Richard M Frankel, Thomas G McGuire, Alan M Zaslavsky, Jennifer Elston Lafata, Ming Tai-Seale
This study investigated racial differences in patient-physician communication around mental health versus biomedical issues. Data were collected from audiorecorded periodic health examinations of adults with mental health needs in the Detroit area (2007-2009). Patients and their primary care physicians conversed for twice as long, and physicians demonstrated greater empathy during mental health topics than during biomedical topics. This increase varied by patient and physician race. Patient race predicted physician empathy, but physician race predicted talk time...
March 27, 2017: Journal of Ambulatory Care Management
Margaret Flinter, Clarissa Hsu, DeAnn Cromp, MaryJoan D Ladden, Edward H Wagner
The years since the passage of the Affordable Care Act have seen substantial changes in the organization and delivery of primary care. These changes have emphasized greater team involvement in care and expansion of the roles of each team member including registered nurses (RNs). This study examined the roles of RNs in 30 exemplary primary care practices. We identified the emergence of new roles and activities for RNs characterized by greater involvement in face-to-face patient care and care management, their own daily schedule of patient visits and contacts, and considerable autonomy in the care of their patients...
March 20, 2017: Journal of Ambulatory Care Management
Langs de Arantes Ferreira de Mello, Teresa Tonini, Alexandre Sousa da Silva, Steven Dutt-Ross, Luciane de Souza Velasque
To assess the quality of the primary health care network, the Ministry of Health created the Program for Improving Access and Quality in Primary Care (PMAQ), a national evaluation of family health teams. Thus, this study aims to present the geolocation of PMAQ 2012 quality indicators in the city of Rio de Janeiro. The PMAQ data show that, in the city of Rio de Janeiro, 65% of the teams achieved the performances "good" or "excellent," 34.7% "regular," and 0.3% "unsatisfactory." The results show a clear PMAQ polarization between teams units classified as optimal and regular in program areas 5 and 3, respectively...
April 2017: Journal of Ambulatory Care Management
Márcia Cristina Rodrigues Fausto, Aylene Bousquat, Juliana Gagno Lima, Ligia Giovanella, Patty Fidelis de Almeida, Maria Helena Magalhães de Mendonça, Helena Seidl, Andréa Tenório Correia da Silva
The objective of this study was to examine the experience of primary care center (PCC) users in Brazil, classified according to the quality of its structure, in relation to the aspects of accessibility, continuity, and acceptability. The source of information was the National Program to Improve Access and Quality of Primary Care in 2013-2014. A total of 109 919 interviewees in 24 055 PCCs comprised the sample. Results show that the structure of a PCC was associated with better indicators of accessibility (oral health and medicines) and continuity of care (patient navigation in the health system)...
April 2017: Journal of Ambulatory Care Management
Antônio Thomaz Gonzaga Matta-Machado, Ângela Maria L Dayrell de Lima, Daisy Maria Xavier de Abreu, Lucas Lobato Araújo, Délcio Fonseca Sobrinho, Érica Araújo Silva Lopes, Gabriel Henrique Silva Teixeira, Alaneir de Fátima Dos Santos
The use of information and communication technology (ICT) is on the increase in the health systems, representing a means of improving the quality of health care. This study analyzed the ICT incorporation in primary care in Brazil and identified the different aspects that may be associated with better quality in the care provided, in relation to certain aspects of women's care. We noted an unevenness regarding ICT incorporation in Brazil. However, the findings indicate an association between ICT and certain aspects of the quality provided in women's health care, which reinforces the need for further studies on this type of evaluation...
April 2017: Journal of Ambulatory Care Management
Matheus Neves, Jessye Melgarejo do Amaral Giordani, Alcindo Antônio Ferla, Fernando Neves Hugo
This cross-sectional study aimed to evaluate the association between sociodemographic characteristics, health care indicators, work process characteristics, and the performance of preventive dental procedures by oral health care teams (OHCTs) assessed during the first phase of the PMAQ in Brazil. A census of 10 334 primary OHCTs was conducted. The outcome included topical application of fluoride, application of sealants, detection of oral lesions, and monitoring of suspected or confirmed cases of oral cancer...
April 2017: Journal of Ambulatory Care Management
Thiago Augusto Hernandes Rocha, Núbia Cristina da Silva, Erika Bárbara Abreu Fonseca Thomaz, Rejane Christine de Sousa Queiroz, Marta Rovery de Souza, Adriana Lein, João Victor Muniz Rocha, Viviane Alvares, Dante Grapiuna de Almeida, Allan Claudius Queiroz Barbosa, Elaine Thumé, Catherine Staton, João Ricardo Nickenig Vissoci, Luiz Augusto Facchini
Cervical cancer is a common neoplasm that is responsible for nearly 230 000 deaths annually in Brazil. Despite this burden, cervical cancer is considered preventable with appropriate care. We conducted a longitudinal ecological study from 2002 to 2012 to examine the relationship between the delivery of preventive primary care and cervical cancer mortality rates in Brazil. Brazilian states and the federal district were the unit of analysis (N = 27). Results suggest that primary health care has contributed to reducing cervical cancer mortality rates in Brazil; however, the full potential of preventive care has yet to be realized...
April 2017: Journal of Ambulatory Care Management
Elaine Tomasi, Maria Aurora Dropa Chrestani Cesar, Rosália Garcia Neves, Paulo Ricardo Correa Schmidt, Elaine Thumé, Denise Silva da Silveira, Fernando Carlos Vinholes Siqueira, Bruno Pereira Nunes, Anaclaudia Gastal Fassa, Mirelle de Oliveira Saes, Suele Manjourany Silva Duro, Pamela Moraes Volz, Luiz Augusto Facchini
This article describes the primary health care offered to 8118 service users with diabetes in Brazil based on data from the PMAQ (Program to Improve Primary Care Access and Quality) first survey. Structure, access, service organization and management, and clinical care quality were analyzed. Prevalence of self-reported receipt of appropriate treatment was 14.3% (95% confidence interval [CI]: 13.4-15.2). Following adjustment, it was 26% higher (prevalence ratio [PR] = 1.26; 95% CI: 1.04-1.54) when primary health care centers had all the structure items investigated, it was 13% higher (PR = 1...
April 2017: Journal of Ambulatory Care Management
James Macinko, Matthew J Harris, Marcia Gomes Rocha
Despite some remarkable achievements, there are several challenges facing Brazil's Family Health Strategy (FHS), including expanding access to primary care and improving its quality. These concerns motivated the development of the National Program for Improving Primary Care Access and Quality (PMAQ). Although voluntary, the program now includes nearly 39 000 FHS teams in the country and has led to a near doubling of the federal investment in primary care in its first 2 rounds. In this article, we introduce the PMAQ and advance several recommendations to ensure that it continues to improve primary care access and quality in Brazil...
April 2017: Journal of Ambulatory Care Management
James Macinko, Matthew J Harris, Marcia Gomes Rocha
No abstract text is available yet for this article.
April 2017: Journal of Ambulatory Care Management
Rushika Fernandopulle
No abstract text is available yet for this article.
April 2017: Journal of Ambulatory Care Management
Kevin Quinn
This commentary analyzes the patient-centered medical home (PCMH) model within a framework of the 8 basic payment methods in health care. PCMHs are firmly within the fee-for-service tradition. Changes to the process and structure of the Resource Based Relative Value Scale, which underlies almost all physician fee schedules, could make PCMHs more financially viable. Of the alternative payment methods being considered, shared savings models are unlikely to transform medical practice whereas capitation models place unrealistic expectations on providers to accept epidemiological risk...
April 2017: Journal of Ambulatory Care Management
Billy Millwee
No abstract text is available yet for this article.
April 2017: Journal of Ambulatory Care Management
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