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Health Services Insights

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https://www.readbyqxmd.com/read/30083057/marketplace-coverage-and-limited-access-to-care-among-employed-beneficiaries-evidence-from-ohio
#1
Evan V Goldstein, Jie Cai, Anqi Liu
This article examines the initial effect of Affordable Care Act (ACA) Health Insurance Marketplace (Exchange) insurance on access to care among employed beneficiaries in a highly populated US state. Does Exchange insurance lead to better/worse health care access for employed beneficiaries, compared with similar individuals covered through standard employer-sponsored insurance (ESI) coverage? This retrospective study uses data from the 2015 Ohio Medicaid Assessment Survey, a dual-frame and computer-assisted telephone survey administered by the Ohio Colleges of Medicine Graduate Resource Center, the Ohio Department of Medicaid, the Ohio Department of Health, and Ohio State University, in conjunction with RTI International...
2018: Health Services Insights
https://www.readbyqxmd.com/read/30083056/investigating-risk-adjustment-methods-for-health-care-provider-profiling-when-observations-are-scarce-or-events-rare
#2
Timo B Brakenhoff, Karel Gm Moons, Jolanda Kluin, Rolf Hh Groenwold
Background: When profiling health care providers, adjustment for case-mix is essential. However, conventional risk adjustment methods may perform poorly, especially when provider volumes are small or events rare. Propensity score (PS) methods, commonly used in observational studies of binary treatments, have been shown to perform well when the amount of observations and/or events are low and can be extended to a multiple provider setting. The objective of this study was to evaluate the performance of different risk adjustment methods when profiling multiple health care providers that perform highly protocolized procedures, such as coronary artery bypass grafting...
2018: Health Services Insights
https://www.readbyqxmd.com/read/30046243/effects-on-clinical-outcomes-of-a-5-year-surgical-safety-checklist-implementation-experience-a-large-scale-population-based-difference-in-differences-study
#3
Stefania Rodella, Sabine Mall, Massimiliano Marino, Graziella Turci, Giorgio Gambale, Maria Teresa Montella, Stefano Bonilauri, Roberta Gelmini, Piera Zuin
The adoption of a surgical checklist is strongly recommended worldwide as an effective practice to improve patient safety; however, several studies have reported mixed results and a number of issues are still unresolved. The main objective of this study was to explore the impact of the first 5-year period of a surgical checklist-based intervention in a large regional health care system in Italy (4 500 000 inhabitants). We conducted a retrospective longitudinal study on 1 166 424 patients who underwent surgery in 48 public hospitals between 2006 and 2014...
2018: Health Services Insights
https://www.readbyqxmd.com/read/29511357/childhood-tuberculosis-in-nigeria-disease-presentation-and-treatment-outcomes
#4
Chidubem L Ogbudebe, Victor Adepoju, Christy Ekerete-Udofia, Ebere Abu, Ginika Egesemba, Nkem Chukwueme, Mustapha Gidado
Objectives: Understanding the factors that influence tuberculosis (TB) treatment outcomes in children is key to designing interventions to address them. This study aimed to determine the case category distribution of childhood TB in Nigeria and assess which clinical and demographic factors are associated with different treatment outcomes in childhood TB. Materials and methods: This was a retrospective cohort study involving a review of medical records of children (0-14 years) with TB in 3 states in Nigeria in 2015...
2018: Health Services Insights
https://www.readbyqxmd.com/read/29348709/perioperative-medicine-a-burgeoning-field-with-profound-importance-to-a-modern-clinician
#5
EDITORIAL
Vinaya Gaduputi, Sridhar Chilimuri, Kinesh Changela
AIMS AND SCOPE This article serves in introducing the readers to the developing field of perioperative medicine. We have made an effort to come up with the latest management guidelines covering multiple subspecialties in form of a special supplement. This compendium in perioperative medicine serves as a comprehensive guide to a practicing clinician, in managing patients with various medical comorbidities undergoing surgical procedures and avoiding common pitfalls.
2018: Health Services Insights
https://www.readbyqxmd.com/read/29162977/perioperative-management-of-patients-with-diabetes
#6
REVIEW
Vivien Leung, Kristal Ragbir-Toolsie
Hyperglycemia has long been recognized to have detrimental effects on postoperative outcomes in patients undergoing surgery. The manifestations of uncontrolled diabetes are manifold and can include risk of hyperglycemic crises, postoperative infection, poor wound healing, and increased mortality. There is substantial literature supporting the role of diligent glucose control in the prevention of adverse surgical outcomes, but considerable debate remains as to the optimal glucose targets. Hence, most organizations advocate the avoidance of hypoglycemia while striving for adequate glucose control in the perioperative period...
2017: Health Services Insights
https://www.readbyqxmd.com/read/28638240/perioperative-management-of-neurological-conditions
#7
REVIEW
Manjeet Singh Dhallu, Ahmed Baiomi, Madhavi Biyyam, Sridhar Chilimuri
Perioperative care of the patients with neurological diseases can be challenging. Most important consideration is the management and understanding of pathophysiology of these disorders and evaluation of new neurological changes that occur perioperatively. Perioperative generally refers to 3 phases of surgery: preoperative, intraoperative, and postoperative. We have tried to address few commonly encountered neurological conditions in clinical practice, such as delirium, stroke, epilepsy, myasthenia gravis, and Parkinson disease...
2017: Health Services Insights
https://www.readbyqxmd.com/read/28634428/marketization-in-long-term-care-a-cross-country-comparison-of-large-for-profit-nursing-home-chains
#8
Charlene Harrington, Frode F Jacobsen, Justin Panos, Allyson Pollock, Shailen Sutaria, Marta Szebehely
This article presents cross-country comparisons of trends in for-profit nursing home chains in Canada, Norway, Sweden, United Kingdom, and the United States. Using public and private industry reports, the study describes ownership, corporate strategies, costs, and quality of the 5 largest for-profit chains in each country. The findings show that large for-profit nursing home chains are increasingly owned by private equity investors, have had many ownership changes over time, and have complex organizational structures...
2017: Health Services Insights
https://www.readbyqxmd.com/read/28615955/reply-to-commentary-on-our-paper-palliative-care-and-patient-autonomy
#9
REVIEW
Samuel H LiPuma, Joseph P DeMarco
No abstract text is available yet for this article.
2017: Health Services Insights
https://www.readbyqxmd.com/read/28615954/response-to-lipuma-and-demarco-s-article-on-hastening-death
#10
REVIEW
Julia Zenz
The paper "Palliative care and patient autonomy: moving beyond prohibitions against hastening death" by LiPuma and DeMarco deals with an aspect of end of life care which is the source of considerable disagreement. It is important to emphasize that autonomy is not the unique feature for end of life care. There is always a medical and ethical commitment to care, i.e. beneficence and nonmaleficence. All of these aspects have to be taken into account when treating patients at the very end of life. There is considerable scientific proof indicating that most patients and families can experience a death in dignity when being cared for in palliative care or hospice units...
2017: Health Services Insights
https://www.readbyqxmd.com/read/28469459/cardiac-evaluation-and-monitoring-of-patients-undergoing-noncardiac-surgery
#11
REVIEW
Arsalan Rafiq, Eduard Sklyar, Jonathan N Bella
Surgical management of disease has a tremendous impact on our health system. Millions of people worldwide undergo surgeries every year. Cardiovascular complications in the perioperative period are one of the most common events leading to increased morbidity and mortality. Although such events are very small in number, they are associated with a high mortality rate making it essential for physicians to understand the importance of perioperative cardiovascular risk assessment and evaluation. Its involves a detailed process of history taking, patient's medical profile, medications being used, functional status of the patient, and knowledge about the surgical procedure and its inherent risks...
2017: Health Services Insights
https://www.readbyqxmd.com/read/28469458/engaging-community-leaders-in-the-development-of-a-cardiovascular-health-behavior-survey-using-focus-group-based-cognitive-interviewing
#12
Gwenyth R Wallen, Johnetta N Saygbe, Alyssa Todaro Brooks, Michael McClurkin, Samantha Thomas, Tiffany M Powell-Wiley
Establishing the validity of health behavior surveys used in community-based participatory research (CBPR) in diverse populations is often overlooked. A novel, group-based cognitive interviewing method was used to obtain qualitative data for tailoring a survey instrument designed to identify barriers to improved cardiovascular health in at-risk populations in Washington, DC. A focus group-based cognitive interview was conducted to assess item comprehension, recall, and interpretation and to establish the initial content validity of the survey...
2017: Health Services Insights
https://www.readbyqxmd.com/read/28469457/outcomes-of-surgeries-performed-in-physician-offices-compared-with-ambulatory-surgery-centers-and-hospital-outpatient-departments-in-florida
#13
Robert L Ohsfeldt, Pengxiang Li, John E Schneider, Ivana Stojanovic, Cara M Scheibling
BACKGROUND: The proportion of outpatient surgeries performed in physician offices has been increasing over time, raising concern about the impact on outcomes. OBJECTIVE: To use a private insurance claims database to compare 7-day and 30-day hospitalization rates following relatively complex outpatient surgical procedures across physician offices, freestanding ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPDs). METHODS: A multivariable logistic regression model was used to compare the risk-adjusted probability of hospitalization among patients after any of the 88 study outpatient procedures at physician offices, ASCs, and HOPDs over 2008-2012 in Florida...
2017: Health Services Insights
https://www.readbyqxmd.com/read/28469456/mental-health-service-provision-in-low-and-middle-income-countries
#14
REVIEW
Shanaya Rathod, Narsimha Pinninti, Muhammed Irfan, Paul Gorczynski, Pranay Rathod, Lina Gega, Farooq Naeem
This article discusses the provision of mental health services in low- and middle-income countries (LMICs) with a view to understanding the cultural dynamics-how the challenges they pose can be addressed and the opportunities harnessed in specific cultural contexts. The article highlights the need for prioritisation of mental health services by incorporating local population and cultural needs. This can be achieved only through political will and strengthened legislation, improved resource allocation and strategic organisation, integrated packages of care underpinned by professional communication and training, and involvement of patients, informal carers, and the wider community in a therapeutic capacity...
2017: Health Services Insights
https://www.readbyqxmd.com/read/28469455/perioperative-care-of-patients-with-liver-cirrhosis-a-review
#15
REVIEW
Naeem Abbas, Jasbir Makker, Hafsa Abbas, Bhavna Balar
The incidence of cirrhosis is rising, and identification of these patients prior to undergoing any surgical procedure is crucial. The preoperative risk stratification using validated scores, such as Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease, perioperative optimization of hemodynamics and metabolic derangements, and postoperative monitoring to minimize the risk of hepatic decompensation and complications are essential components of medical management. The advanced stage of cirrhosis, emergency surgery, open surgeries, old age, and coexistence of medical comorbidities are main factors influencing the clinical outcome of these patients...
2017: Health Services Insights
https://www.readbyqxmd.com/read/28469454/perioperative-management-of-thyroid-dysfunction
#16
REVIEW
Marcia Rashelle Palace
Due to the manifold effects of thyroid hormone across virtually all organ systems, the complications associated with thyroid dysfunction are numerous and diverse. The stresses encountered during the perioperative period may exacerbate underlying thyroid disorders, potentially precipitating decompensation and even death. Thus, it is of the utmost importance for the clinician to comprehend the mechanisms by which thyroid disease may complicate surgery and postoperative recovery and to be cognizant of the most effective means of optimizing the status of thyrotoxic and hypothyroid patients perioperatively...
2017: Health Services Insights
https://www.readbyqxmd.com/read/28469453/evaluation-and-monitoring-of-patients-with-cardiovascular-implantable-electronic-devices-undergoing-noncardiac-surgery
#17
REVIEW
Eduard Sklyar, Jonathan N Bella
In this article, the reader will get some insights into managing patient with implantable cardiac devices while undergoing noncardiac surgery. We will review basic concepts regarding normal function of pacemakers and implantable cardioverter defibrillators, understanding how their function will be influenced during noncardiac surgeries. You will be guided through management steps from preoperative, intraoperative, and postoperative aspects. In an ever-changing world of medicine, it is important to keep up with progress as more and more patients get implantable cardiac devices...
2017: Health Services Insights
https://www.readbyqxmd.com/read/28008269/perioperative-management-of-direct-oral-anticoagulants-doacs-a-systemic-review
#18
REVIEW
Tagore Sunkara, Emmanuel Ofori, Vadim Zarubin, Megan E Caughey, Vinaya Gaduputi, Madhavi Reddy
Direct oral anticoagulants (DOACs) are in wide use among patients requiring both short- and long-term anticoagulation, mainly due to their ease of use and the lack of monitoring requirements. With growing use of DOACs, it is imperative that physicians be able to manage patients on these medications, especially in the perioperative period. We aim to provide guidance on the management of DOACs in the perioperative period. In this review, we performed an extensive literature search summarizing the management of patients on direct-acting anticoagulants in the perioperative period...
2016: Health Services Insights
https://www.readbyqxmd.com/read/27980420/palliative-care-and-patient-autonomy-moving-beyond-prohibitions-against-hastening-death
#19
Samuel H LiPuma, Joseph P DeMarco
The National Hospice and Palliative Care Organization (NHPCO) upholds policies prohibiting practices that deliberately hasten death. We find these policies overly restrictive and unreasonable. We argue that under specified circumstances it is both reasonable and morally sound to allow for treatments that may deliberately hasten death; these treatments should be part of the NHPCO guidelines. Broadening such policies would be more consistent with the gold standard of bioethical principles, ie, respecting the autonomy of competent adults...
2016: Health Services Insights
https://www.readbyqxmd.com/read/27867301/perioperative-evaluation-of-patients-with-pulmonary-conditions-undergoing-non-cardiothoracic-surgery
#20
REVIEW
Gilda Diaz-Fuentes, Hafiz Rizwan Talib Hashmi, Sindhaghatta Venkatram
This review describes the perioperative management of patients with suspected or established pulmonary conditions undergoing non-cardiothoracic surgery, with a focus on common pulmonary conditions such as obstructive airway disease, pulmonary hypertension, obstructive sleep apnea, and chronic hypoxic respiratory conditions. Considering that postoperative pulmonary complications are common and given the increasing number of surgical procedures and the size of the aging population, familiarity with current guidelines for preoperative risk assessment and intra- and postoperative patient management is recommended to decrease the morbidity and mortality...
2016: Health Services Insights
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