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https://www.readbyqxmd.com/read/27909251/-in-principle-we-have-agreement-but-in-practice-it-is-a-bit-more-difficult-obtaining-organizational-buy-in-to-patient-centered-medical-home-transformation
#1
Janelle Applequist, Michelle Miller-Day, Peter F Cronholm, Robert A Gabbay, Deborah S Bowen
The patient-centered medical home (PCMH) is a model of care that emphasizes the coordination of patient treatment among health care providers. Practice transformation to this model, however, presents a number of challenges. One of these challenges is getting the buy-in of all personnel to commit to making organizational changes in the journey to becoming a nationally recognized medical home. This study investigated internal messages of buy-in as communicated by practices transitioning to this type of care. Grounding itself in stakeholder theory, this study analyzed interviews with staff, administration, and practitioners from 20 medical practices in a mid-Atlantic state...
November 30, 2016: Qualitative Health Research
https://www.readbyqxmd.com/read/27908354/a-test-in-context-hemoglobin-a1c-and-cardiovascular-disease
#2
REVIEW
M Odette Gore, Darren K McGuire
Measurement of glycated hemoglobin (HbA1c), the most widely accepted indicator of long-term glycemic exposure, is central for the diagnosis and management of diabetes mellitus. Levels of HbA1c track epidemiologically with diabetic complications, and glycemic control, as reflected by HbA1c reduction, results in decreased risk of microvascular complications, including diabetic kidney disease, neuropathy, and retinopathy. The relationship between HbA1c reduction and cardiovascular disease prevention in patients with diabetes is more complex, with data from large randomized trials published over the past decade providing clear evidence that lowering of HbA1c per se is an inadequate marker for a therapeutic regimen's impact on cardiovascular outcomes and patient survival...
December 6, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27906931/repeal-and-replace-of-affordable-care-a-complex-but-not-an-impossible-task
#3
Laxmaiah Manchikanti, Joshua A Hirsch
The Affordable Care Act (ACA), signature legislation of President Obama, was arguably the most consequential and comprehensive health care reform since Medicare was introduced as part of President Lyndon B. Johnson's great society. It has been claimed that many of the law's reforms are now so integrated in the health system that full repeal would be impractical, while others including President Elect Trump have rejected that idea and called for full repeal and replacement claiming ACA law cannot be fixed. A tsunami of increasing regulatory burden over the past 8 years, the current health care milieu has moved independent practitioners towards hospital employment in great numbers...
November 2016: Pain Physician
https://www.readbyqxmd.com/read/27906731/association-between-clinical-nurse-specialist-s-presence-and-open-visitation-in-us-intensive-care-units
#4
Sukardi Suba, DorAnne Donesky, Elizabeth Ann Scruth, Virginia Carrieri-Kohlman
BACKGROUND: Current evidence shows that an open visitation policy can benefit patients and families during intensive care unit (ICU) stays. Therefore, an unrestricted visitation policy in the ICU has been proposed as part of patient-centered care. PURPOSE: The purpose of this secondary analysis is to explore the likelihood of an ICU with a clinical nurse specialist (CNS) having an open visitation policy when compared with an ICU without a CNS. DESIGN: This is a secondary analysis of a survey conducted between 2008 and 2009, describing the ICU visitation practices in more than 600 hospitals across the United States...
January 2017: Clinical Nurse Specialist CNS
https://www.readbyqxmd.com/read/27905860/a-scoping-review-on-models-of-integrative-medicine-what-is-known-from-the-existing-literature
#5
Eun Jin Lim, Janette L Vardy, Byeong Sang Oh, Haryana M Dhillon
OBJECTIVES: Integrative medicine (IM) has been recognized and introduced into Western healthcare systems over the past two decades. Limited information on IM models is available to guide development of an optimal healthcare service. A scoping review was carried out to evaluate IM models in the extant literature, including the distinctive features of each model, to gain an understanding of the core requirements needed to develop models of IM that best meet the needs of patients. DESIGN: Directed content analysis was used to classify the IM models into systems based on coding schema developed from theoretical models and to identify the key concepts of each system...
December 1, 2016: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice, and Policy
https://www.readbyqxmd.com/read/27903489/finding-important-terms-for-patients-in-their-electronic-health-records-a-learning-to-rank-approach-using-expert-annotations
#6
Jinying Chen, Jiaping Zheng, Hong Yu
BACKGROUND: Many health organizations allow patients to access their own electronic health record (EHR) notes through online patient portals as a way to enhance patient-centered care. However, EHR notes are typically long and contain abundant medical jargon that can be difficult for patients to understand. In addition, many medical terms in patients' notes are not directly related to their health care needs. One way to help patients better comprehend their own notes is to reduce information overload and help them focus on medical terms that matter most to them...
November 30, 2016: JMIR Medical Informatics
https://www.readbyqxmd.com/read/27901274/forensic-psychiatric-patients-perspectives-on-their-care-a-narrative-view
#7
Riitta Askola, Merja Nikkonen, Eija Paavilainen, Päivi Soininen, Hanna Putkonen, Olavi Louheranta
PURPOSE: The purpose of this study is to describe forensic psychiatric patients' experiences of and perspectives on forensic psychiatric treatment. DESIGN AND METHODS: Eight forensic psychiatric patients were interviewed, and the resultant research material was analyzed by narrative analysis. FINDINGS: Patients' narratives contain different themes telling different things and the personnel need to pay attention to these. PRACTICE IMPLICATIONS: The findings of the present study should direct the forensic psychiatric personnel's attention to the notion that forensic psychiatric patients' experiences of their treatment can improve the quality of patient-centered care and reduce bureaucracy...
November 30, 2016: Perspectives in Psychiatric Care
https://www.readbyqxmd.com/read/27899886/relearning-and-retaining-personally-relevant-words-using-computer-based-flashcard-software-in-primary-progressive-aphasia
#8
William S Evans, Megan Quimby, Michael Walsh Dickey, Bradford C Dickerson
Although anomia treatments have often focused on training small sets of words in the hopes of promoting generalization to untrained items, an alternative is to directly train a larger set of words more efficiently. The current case study reports on a novel treatment for a patient with semantic variant Primary Progressive Aphasia (svPPA), in which the patient was taught to make and practice flashcards for personally-relevant words using an open-source computer program (Anki). Results show that the patient was able to relearn and retain a large subset of her studied words for up to 20 months, the full duration of the study period...
2016: Frontiers in Human Neuroscience
https://www.readbyqxmd.com/read/27898562/patient-centered-treatment-in-atrial-fibrillation
#9
Mary C Cox, Vijay K Gulati
Patients with atrial fibrillation (AF) and clinicians treating them are faced with innumerable management choices. Minimizing thromboembolic events and strokes related to AF is paramount. Estimating the risks with the various therapies is important for optimal therapy. Also, patients must choose a rate control or a rhythm control strategy. With so many options, clinical presentations, and patient desires, patients with AF are rarely treated identically. This allows for shared decision-making and patient-centered care...
December 2016: JAAPA: Official Journal of the American Academy of Physician Assistants
https://www.readbyqxmd.com/read/27898135/complementary-and-integrative-therapies-for-persistent-pain-management-in-older-adults-a-review
#10
Patricia Bruckenthal, Marie Ann Marino, Lisa Snelling
Management of persistent pain in older adults is challenging given the prevalence of multiple comorbid painful conditions, polypharmacy, age-related changes restricting pharmacological options, and socioeconomic factors. The influences of these factors along with current concern for the use of opioid analgesics highlight the importance of incorporating complementary and integrative medicine approaches. Evidence suggests efficacy and satisfaction with integrating complementary pain management strategies for older adults, especially yoga, massage, and natural products...
December 1, 2016: Journal of Gerontological Nursing
https://www.readbyqxmd.com/read/27893955/using-a-patient-centered-outcome-measure-to-test-methylphenidate-versus-placebo-in-children-with-autism-spectrum-disorder
#11
Lawrence Scahill, Karen Bearss, Rena Sarhangian, Christopher J McDougle, L Eugene Arnold, Michael G Aman, James T McCracken, Elaine Tierney, Scott Gillespie, Valentina Postorino, Benedetto Vitiello
OBJECTIVES: Parent rating scales are commonly used to evaluate change in clinical trials. Despite advantages, these measures may not capture parental impression of the child's most salient problems. We examine the use of parent target problems (PTPs) in a randomized trial of methylphenidate (MPH) in children with autism spectrum disorder and symptoms of attention-deficit/hyperactivity disorder. METHODS: This multisite, 4-week, randomized crossover trial compared three dose levels (low, medium, and high) of MPH with placebo...
November 28, 2016: Journal of Child and Adolescent Psychopharmacology
https://www.readbyqxmd.com/read/27893952/acceptability-and-impact-of-a-required-palliative-care-rotation-with-prerotation-and-postrotation-observed-simulated-clinical-experience-during-internal-medicine-residency-training-on-primary-palliative-communication-skills
#12
Maxwell T Vergo, Sharona Sachs, Meredith A MacMartin, Kathryn B Kirkland, Amelia M Cullinan, Lisa A Stephens
BACKGROUND: Improving communication training for primary palliative care using a required palliative care rotation for internal medicine (IM) residents has not been assessed. OBJECTIVE: To assess skills acquisition and acceptability for IM residents not selecting an elective. DESIGN: A consecutive, single-arm cohort underwent preobjective structured clinical examination (OSCE) with learner-centric feedback, two weeks of clinical experience, and finally a post-OSCE to crystallize learner-centric take home points...
November 28, 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27893924/deciding-how-best-to-treat-cartilage-defects
#13
Lucy Oliver-Welsh, Justin W Griffin, Maximilian A Meyer, Matthew E Gitelis, Brian J Cole
The decision-making regarding and treatment of cartilage abnormalities requires a systematic approach. This article reviews the concepts and principles that guide the management of this complex problem. The precise incidence, demographics, and progression of cartilage lesions have not been clearly delineated. Pursuing a patient-centered approach that considers the available nonsurgical and surgical options remains the cornerstone of patient care. The importance of determining concomitant knee pathologies, the proper interpretation and implications of imaging findings, and an accurate determination of the intra-articular and subchondral findings represent the primary elements of the decision analysis...
January 0: Orthopedics
https://www.readbyqxmd.com/read/27893520/impact-of-a-patient-centered-medical-home-pilot-on-utilization-quality-and-costs-and-variation-in-medical-homeness
#14
Signe Peterson Flieger
This study evaluated the impact of a patient-centered medical home (PCMH) pilot on utilization, costs, and quality and assessed variation in PCMH components. Data included the New Hampshire Comprehensive Healthcare Information System and Medical Home Index (MHI) scores for 9 pilot sites. A quasi-experimental, difference-in-difference model with propensity score-matched comparison group was employed. MHI scores were collected in late 2011. There were no statistically significant findings for utilization, cost, or quality in the expected direction...
November 23, 2016: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27893519/effects-of-hospital-systems-on-medical-home-transformation-in-primary-care-residency-training-practices
#15
Kyle Knierim, Tristen Hall, Douglas Fernald, Thomas J Staff, Emilie Buscaj, Jessica Cornett Allen, Mary Onysko, W Perry Dickinson
Most primary care residency training practices have close financial and administrative relationships with teaching hospitals and health systems. Many residency practices have begun integrating the core principles of the patient-centered medical home (PCMH) into clinical workflows and educational experiences. Little is known about how the relationships with hospitals and health systems affect these transformation efforts. Data from the Colorado Residency PCMH Project were analyzed. Results show that teaching hospitals and health systems have significant opportunities to influence residency practices' transformation, particularly in the areas of supporting team-based care, value-based payment reforms, and health information technology...
November 23, 2016: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27893518/patient-centered-medical-home-implementation-and-burnout-among-va-primary-care-employees
#16
Joseph A Simonetti, Philip W Sylling, Karin Nelson, Leslie Taylor, David C Mohr, Idamay Curtis, Gordon Schectman, Stephan D Fihn, Christian D Helfrich
Burnout is widespread throughout primary care and is associated with negative consequences for providers and patients. The relationship between the patient-centered medical home model and burnout remains unclear. Using survey data from 8135 and 7510 VA primary care employees in 2012 and 2013, respectively, we assessed whether clinic-level medical home implementation was independently associated with burnout prevalence and estimated whether burnout changed among this workforce from 2012 to 2013. Adjusting for differences in respondent and clinic characteristics, we found that burnout was common among primary care employees, increased by 3...
November 23, 2016: Journal of Ambulatory Care Management
https://www.readbyqxmd.com/read/27893033/effect-of-a-decision-aid-on-access-to-total-knee-replacement-for-black-patients-with-osteoarthritis-of-the-knee-a-randomized-clinical-trial
#17
Said A Ibrahim, Marissa Blum, Gwo-Chin Lee, Pekka Mooar, Elina Medvedeva, Aliya Collier, Diane Richardson
Importance: Black patients with advanced osteoarthritis (OA) of the knee are significantly less likely than white patients to undergo surgery. No strategies have been proved to improve access to surgery for black patients with end-stage OA of the knee. Objective: To assess whether a decision aid improves access to total knee replacement (TKR) surgery for black patients with OA of the knee. Design, Setting, and Participants: In a randomized clinical trial, 336 eligible participants who self-identified as black and 50 years or older with chronic and frequent knee pain, a Western Ontario McMaster Universities Osteoarthritis Index score of at least 39, and radiographic evidence of OA of the knee were recruited from December 1, 2010, to May 31, 2014, at 3 medical centers...
November 23, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27890646/laparoscopic-hysterectomy-with-morcellation-versus-abdominal-hysterectomy-for-presumed-fibroids-an-updated-decision-analysis-following-the-2014-fda-safety-communications
#18
Matthew T Siedhoff, Kemi M Doll, Daniel L Clarke-Pearson, Sarah E Rutstein
Previous decision analyses demonstrate the safety of minimally invasive hysterectomy for presumed benign fibroids, accounting for the risk of occult leiomyosarcoma and the differential mortality risk associated with laparotomy. Studies published since the 2014 Food and Drug Administration safety communications offer updated leiomyosarcoma incidence estimates. Incorporating these studies suggests that mortality rates are low following hysterectomy for presumed benign fibroids overall, and a minimally invasive approach remains a safe option...
November 24, 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27889030/locally-recurrent-disease-related-to-anal-canal-cancers
#19
REVIEW
Tarik Sammour, Miguel A Rodriguez-Bigas, John M Skibber
Surgery for anal cancer is usually reserved for patients with persistent disease or local recurrence after definitive chemoradiation therapy. Patients with local recurrence should be re-evaluated for evidence of metastatic disease using positron emission tomography-computed tomography, and the local anatomy should be delineated with MRI. Eligible patients should undergo tailored surgery with the aim of achieving an R0 resection. Management is best undertaken within a specialized multidisciplinary setting. Careful patient selection and shared decision making are paramount for achieving acceptable patient-centered outcomes...
January 2017: Surgical Oncology Clinics of North America
https://www.readbyqxmd.com/read/27888950/social-media-and-the-patient-experience
#20
C Matthew Hawkins, Andrew J DeLaO, Colin Hung
As patients continue to turn to online resources for health care information to guide their care decisions, it is becoming increasingly important for radiologists to engage with patients online via social media platforms. There are many ways physicians can use social media to provide patients with valuable information and improve the overall patient experience. By optimizing online discoverability, curating radiology content, engaging with patient communities, and producing mineable social media content, radiologists can emerge as thought leaders in this new form of patient-centered communication and information exchange...
December 2016: Journal of the American College of Radiology: JACR
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