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Ravi B Parikh, Justin E Bekelman, Amanda Hodlofksi, Amol S Navathe
No abstract text is available yet for this article.
March 3, 2018: Healthcare
Jill D Nault Connors, Bonnie L Binkley, J Carolyn Graff, Satya Surbhi, James E Bailey
No abstract text is available yet for this article.
February 21, 2018: Healthcare
Anne C Jones, Trudy Li, Meg Zomorodi, Rob Broadhurst, Amy B Weil
No abstract text is available yet for this article.
February 15, 2018: Healthcare
Marcela Colom, Kirsten Austad, Neftali Sacuj, Karen Larson, Peter Rohloff
The utilization of existing social networks is increasingly being recognized as a powerful strategy for delivering healthcare services to underserved populations in low- and middle-income countries. In Guatemala, multiple barriers prevent access to healthcare services for rural and indigenous populations, and strategies for delivering healthcare in more efficient ways are needed. The case study we describe here is a unique collaboration between a microfinance institution (Friendship Bridge) and a primary care organization (Wuqu' Kawoq | Maya Health Alliance) to scale up healthcare through an existing lending-borrowing social network...
February 7, 2018: Healthcare
Miranda B Lam, Laura G Burke, E John Orav, Ashish K Jha
BACKGROUND: A small proportion of patients account for the majority of health care spending. Of this group, little is known about what proportion have a cancer diagnosis and how their spending pattern compares to those without cancer. METHODS: Using national Medicare data of enrollees 65 or older, we identified patients in the top decile of spending in 2014 and designated them as high-cost. We used ICD-9 codes to identify patients with a cancer diagnosis and examined cancer prevalence among both high-cost and non-high-cost patients...
February 2, 2018: Healthcare
Virginia Wang, Matthew L Maciejewski, Christian D Helfrich, Bryan J Weiner
In this paper, we discuss de-implementation as an implicit part of implementation and organizational change, and consider its underlying processes of unlearning to discontinue or deviate from ineffective practice and learning to applying newer, more effective practices. We describe a typology of de-implementation that represents four types of change: partial reduction, complete reversal, substitution with related replacement and substitution with unrelated replacement of existing practice. We also explicate how learning and unlearning needed for effective change vary in these four types of de-implementation...
December 23, 2017: Healthcare
Jennifer M Polinski, Linda M Harris, William H Shrank, Andrew Sussman, John Barron
BACKGROUND: We studied whether integrating the US Department of Health and Human Services' myHealthfinder tool, an interactive tool that recommends preventive services, into CVS Health's digital platforms could increase preventive service uptake at its retail clinic, MinuteClinic. METHODS: We used a quasi-experimental, pre-post, difference-in-differences design. In a web-based campaign, consumers in "exposed" states visiting CVS pharmacy and MinuteClinic websites could view and use the myHealthfinder tool...
December 21, 2017: Healthcare
Lisa D DiMartino, Bryan J Weiner, Laura C Hanson, Morris Weinberger, Sarah A Birken, Katherine Reeder-Hayes, Justin G Trogdon
INTRODUCTION: Studies show palliative care delivered concurrently with cancer treatment improves outcomes, yet palliative care integration with inpatient oncology is underused. A promising approach to improve integration is a triggered palliative care consultation (TPCC). This study evaluated the impact of two TPCC approaches on consistency and quality of consult implementation, operationalized as uptake and timeliness, on solid tumor medical and gynecologic oncology services at an academic hospital...
December 19, 2017: Healthcare
Elise Fields, Smriti Neogi, Pamela J Schoettker, Jennifer Lail
BACKGROUND: An improvement team from the Complex Care Center at our large pediatric medical center participated in a 60-day initiative to use Lean methodologies to standardize their processes, eliminate waste and improve the timely and reliable provision of durable medical equipment and supplies. METHODS: The team used value stream mapping to identify processes needing improvement. Improvement activities addressed the initial processing of a request, provider signature on the form, returning the form to the sender, and uploading the completed documents to the electronic medical record...
December 12, 2017: Healthcare
Amrita G Shenoy, Charles E Begley, Lee Revere, Stephen H Linder, Stephen P Daiger
INTRODUCTION: Adoption of Medicaid Section 1115 waiver is one of the many ways of innovating healthcare delivery system. The Delivery System Reform Incentive Payment (DSRIP) pool, one of the two funding pools of the waiver has four categories viz. infrastructure development, program innovation and redesign, quality improvement reporting and lastly, bringing about population health improvement. BACKGROUND: A metric of the fourth category, preventable hospitalization (PH) rate was analyzed in the context of eight conditions for two time periods, pre-reporting years (2010-2012) and post-reporting years (2013-2015) for two hospital cohorts, DSRIP participating and non-participating hospitals...
December 7, 2017: Healthcare
Michael J Yedidia
BACKGROUND: Patients who heavily utilize hospitals and emergency departments frequently have complex needs requiring services spanning medical, behavioral, and social service sectors. This study identifies essential competencies for caring for high-needs patients and highlights their importance to primary care delivery. METHODS: Transcripts of in-depth interviews with 30 clinical and administrative staff at 23 complex care programs across the United States were analyzed using standard qualitative techniques...
December 4, 2017: Healthcare
Sachin H Jain
No abstract text is available yet for this article.
December 2017: Healthcare
Jose F Figueroa, Austin B Frakt, Zoe M Lyon, Xiner Zhou, Ashish K Jha
BACKGROUND: Given that health care costs in Massachusetts continue to grow despite great efforts to contain them, we seek to understand characteristics and spending patterns of the costliest non-elderly adults in Massachusetts based on type of insurance. METHODS: We used the Massachusetts All-Payer Claims Database (APCD) from 2012 and analyzed demographics, utilization patterns and spending patterns across payers (Medicaid, Medicaid managed care, and private insurers) for high cost patients (those in the top 10% of spending) and non-high cost patients (the remaining 90%)...
December 2017: Healthcare
Ashley-Kay Fryer, Mark W Friedberg, Ryan W Thompson, Sara J Singer
BACKGROUND: Patients with multiple chronic conditions have garnered particular attention from policymakers and health service researchers because these patients utilize more services and contribute disproportionally to rising health care expenses. The growing prevalence of patients with multiple chronic conditions has increased the importance of achieving better health care integration for this patient population. Patients may be well positioned to assess integration of their care, but the relationship between patients' perceptions of care integration and use of health services has not been studied...
December 2017: Healthcare
James B Kirby, Ravi Sharma
BACKGROUND: Community Health Centers (CHCs) funded by Section 330 of the Public Health Service Act are an essential part of the health care safety net in the US. The Patient Protection and Affordable Care Act expanded the program significantly, but the extent to which the availability of CHCs improve access to care in general is not clear. In this paper, we examine the associations between the availability of CHC services in communities and two key measures of ambulatory care access - having a usual source of care and having any office-based medical visits over a one year period...
December 2017: Healthcare
Emily Aaronson, Elizabeth Mort, Samara Soghoian
Emergency Department (ED) overcrowding has become a global concern as the number of countries with formalized emergency care systems has expanded, and the burden of trauma and non-communicable diseases in low and middle-income countries increased. In light of this, the international Emergency Medicine literature has outlined the need for operational projects in low and middle income countries which focus on the process of care. Despite this, there is limited published literature describing these types of projects...
December 2017: Healthcare
Nasim Afsar-Manesh, Sarah Lonowski, Aram A Namavar
INTRODUCTION: UCLA Health embarked to transform care by integrating lean methodology in a key clinical project, Readmission Reduction Initiative (RRI). METHODS: The first step focused on assembling a leadership team to articulate system-wide priorities for quality improvement. The lean principle of creating a culture of change and accountability was established by: 1) engaging stakeholders, 2) managing the process with performance accountability, and, 3) delivering patient-centered care...
December 2017: Healthcare
Ravi B Parikh, Dhruv Khullar
Recent US healthcare policy changes set the stage for integrating palliative and end-of-life care into routine medicine. However, these changes may not affect the daily practice of medical trainees-fellows, residents, and medical students-who as front-line care providers are not always equipped with the skills needed to treat terminally ill patients. We review evidence on trainees' discomfort with end-of-life care and highlight limitations of recent policy changes. Key barriers to proficiency include inadequate conversational training, prognostic uncertainty, and unfamiliarity with hospice and palliative care...
December 2017: Healthcare
Ishani Ganguli, Ryan W Thompson, Timothy G Ferris
The highest cost patients account for a disproportionately large share of American healthcare costs and are increasingly the focus of research and policy efforts to stem the rapid growth of these costs. These patients tend to be medically complex and frail, but we know little about how such characteristics influence healthcare spending from the perspectives of the patients and their caregivers. Therefore, we examined five of the highest cost patients at an academic medical center in a case series. We interviewed the patients, their family members, and their clinicians and analyzed their claims data and medical charts to explore how patient and health system characteristics influenced their health costs...
December 2017: Healthcare
Brian Powers
No abstract text is available yet for this article.
December 2017: Healthcare
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