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https://www.readbyqxmd.com/read/28340229/meaningful-use-in-the-safety-net-a-rapid-ethnography-of-patient-portal-implementation-at-five-community-health-centers-in-california
#1
Sara L Ackerman, Urmimala Sarkar, Lina Tieu, Margaret A Handley, Dean Schillinger, Kenneth Hahn, Mekhala Hoskote, Gato Gourley, Courtney Lyles
Objective: US health care institutions are implementing secure websites (patient portals) to achieve federal Meaningful Use (MU) certification. We sought to understand efforts to implement portals in "safety net" health care systems that provide services for low-income populations. Materials and Methods: Our rapid ethnography involved visits at 4 California safety net health systems and in-depth interviews at a fifth. Visits included interviews with clinicians and executives ( n  = 12), informal focus groups with front-line staff ( n  = 35), observations of patient portal sign-up procedures and clinic work, review of marketing materials and portal use data, and a brief survey ( n  = 45)...
March 15, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28315177/physical-symptoms-screening-for-cardiopulmonary-complications-of-obesity-using-audio-computer-assisted-self-interviews
#2
Jorge L Morales-Estrella, Farah D Ciftci, William E Trick, Keiki Hinami
PURPOSE: The main study objective was to assess the predictive value of selected physical symptoms for screening obstructive sleep apnea and major cardiac conditions in adults with obesity, thus providing the evidence for routine symptom screening of obesity complications endorsed by obesity management clinical practice guidelines. METHODS: We performed a retrospective cohort study using patient-reported outcomes data including the physical symptoms severity component of the Memorial Symptom Assessment Scale administered through Audio Computer-Assisted Self-Interviews combined with data from the electronic medical records of an urban safety-net primary care clinic...
March 17, 2017: Quality of Life Research
https://www.readbyqxmd.com/read/28296752/racial-ethnic-differences-in-obesity-and-comorbidities-between-safety-net-and-non-safety-net-integrated-health-systems
#3
Bijal A Balasubramanian, Michael P Garcia, Douglas A Corley, Chyke A Doubeni, Jennifer S Haas, Aruna Kamineni, Virginia P Quinn, Karen Wernli, Yingye Zheng, Celette Sugg Skinner
Previous research shows that patients in integrated health systems experience fewer racial disparities compared with more traditional healthcare systems. Little is known about patterns of racial/ethnic disparities between safety-net and non safety-net integrated health systems.We evaluated racial/ethnic differences in body mass index (BMI) and the Charlson comorbidity index from 3 non safety-net- and 1 safety-net integrated health systems in a cross-sectional study. Multinomial logistic regression modeled comorbidity and BMI on race/ethnicity and health care system type adjusting for age, sex, insurance, and zip-code-level incomeThe study included 1...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28296574/high-initiation-of-adjuvant-hormonal-therapy-among-uninsured-stages-i-iii-breast-cancer-patients-treated-in-a-safety-net-healthcare-system
#4
Caitlin C Murphy, Jasmin A Tiro, Gary W Jean, Bijal A Balasubramian, Carlos A Alvarez
OBJECTIVE: Despite benefits of adjuvant hormonal therapy (AHT), many eligible breast cancer patients do not complete therapy as recommended. Patterns of AHT use have not been well studied among uninsured breast cancer patients who fall into coverage gaps or are ineligible for public insurance programs. METHODS: We identified 291 patients newly diagnosed with stages I-III hormone receptor-positive breast cancer from January 2008 to December 2012. All patients were treated at a safety-net healthcare system and enrolled in an income-based medical assistance program that fills AHT prescriptions at low cost...
March 15, 2017: Journal of Women's Health
https://www.readbyqxmd.com/read/28293640/cost-analysis-of-a-novel-enzymatic-debriding-agent-for-management-of-burn-wounds
#5
Giuseppe Giudice, Angela Filoni, Giulio Maggio, Domenico Bonamonte, Michelangelo Vestita
Introduction. Given its efficacy and safety, NexoBrid™ (NXB) has become part of our therapeutic options in burns treatment with satisfactory results. However, no cost analysis comparing NXB to the standard of care (SOC) has been carried out as of today. Aim. To assess the cost of treatment with NXB and compare it to the SOC cost. Methods. 20 patients with 14-22% of TBSA with an intermediate-deep thermal burn related injury were retrospectively and consecutively included. 10 of these patients were treated with the SOC, while the other 10 with NXB...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28289116/patients-typing-their-own-visit-agendas-into-an-electronic-medical-record-pilot-in-a-safety-net-clinic
#6
McHale O Anderson, Sara L Jackson, Natalia V Oster, Sue Peacock, Janice D Walker, Galen Y Chen, Joann G Elmore
Collaborative visit agenda setting between patient and doctor is recommended. We assessed the feasibility, acceptability, and utility of patients attending a large primary care safety-net clinic typing their agendas into the electronic visit note before seeing their clinicians. One hundred and one patients and their 28 clinicians completed post-visit surveys. Patients and clinicians agreed that the agendas improved patient-clinician communication (patients 79%, clinician 74%), and wanted to continue having patients type agendas in the future (73%, 82%)...
March 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/28279550/tale-of-2-health-care-systems-disparities-in-demographic-and-clinical-characteristics-between-2-ischemic-stroke-populations-in-los-angeles-county
#7
Amytis Towfighi, Erica Patel, Nerses Sanossian, Natalie P Valle, Bruce Ovbiagele
BACKGROUND: Individuals who present to the emergency departments of safety-net systems often have poorly controlled risk factors due to lack of primary care. Little is known about potential differences in presenting characteristics, discharge medications, and discharge destinations of patients with acute ischemic stroke (AIS) who present to safety-net settings versus university medical centers (UMCs). METHODS: Demographic characteristics, medical history, premorbid medication use, stroke severity, discharge medications, and discharge destination were assessed among consecutive admissions for AIS over a 2-year period at a UMC (n = 385) versus 2 university-affiliated safety-net hospitals (SNHs) (n = 346) in Los Angeles County...
March 6, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28279251/oral-anticoagulants-for-primary-prevention-treatment-and-secondary-prevention-of-venous-thromboembolic-disease-and-for-prevention-of-stroke-in-atrial-fibrillation-systematic-review-network-meta-analysis-and-cost-effectiveness-analysis
#8
Jonathan Ac Sterne, Pritesh N Bodalia, Peter A Bryden, Philippa A Davies, Jose A López-López, George N Okoli, Howard Hz Thom, Deborah M Caldwell, Sofia Dias, Diane Eaton, Julian Pt Higgins, Will Hollingworth, Chris Salisbury, Jelena Savović, Reecha Sofat, Annya Stephens-Boal, Nicky J Welton, Aroon D Hingorani
BACKGROUND: Warfarin is effective for stroke prevention in atrial fibrillation (AF), but anticoagulation is underused in clinical care. The risk of venous thromboembolic disease during hospitalisation can be reduced by low-molecular-weight heparin (LMWH): warfarin is the most frequently prescribed anticoagulant for treatment and secondary prevention of venous thromboembolism (VTE). Warfarin-related bleeding is a major reason for hospitalisation for adverse drug effects. Warfarin is cheap but therapeutic monitoring increases treatment costs...
March 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28274601/producing-a-worthy-illness-personal-crowdfunding-amidst-financial-crisis
#9
Lauren S Berliner, Nora J Kenworthy
For Americans experiencing illnesses and disabilities, crowdfunding has become a popular strategy for addressing the extraordinary costs of health care. The political, social, and health consequences of austerity--along with fallout from the 2008 financial collapse and the shortcomings of the Affordable Care Act (ACA)--are made evident in websites like GoFundMe. Here, patients and caregivers create campaigns to solicit donations for medical care, hoping that they will spread widely through social networks. As competition increases among campaigns, patients and their loved ones are obliged to produce compelling and sophisticated appeals...
February 8, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28265579/the-next-frontier-in-communication-and-the-eclippse-study-bridging-the-linguistic-divide-in-secure-messaging
#10
REVIEW
Dean Schillinger, Danielle McNamara, Scott Crossley, Courtney Lyles, Howard H Moffet, Urmimala Sarkar, Nicholas Duran, Jill Allen, Jennifer Liu, Danielle Oryn, Neda Ratanawongsa, Andrew J Karter
Health systems are heavily promoting patient portals. However, limited health literacy (HL) can restrict online communication via secure messaging (SM) because patients' literacy skills must be sufficient to convey and comprehend content while clinicians must encourage and elicit communication from patients and match patients' literacy level. This paper describes the Employing Computational Linguistics to Improve Patient-Provider Secure Email (ECLIPPSE) study, an interdisciplinary effort bringing together scientists in communication, computational linguistics, and health services to employ computational linguistic methods to (1) create a novel Linguistic Complexity Profile (LCP) to characterize communications of patients and clinicians and demonstrate its validity and (2) examine whether providers accommodate communication needs of patients with limited HL by tailoring their SM responses...
2017: Journal of Diabetes Research
https://www.readbyqxmd.com/read/28264951/los-angeles-safety-net-program-econsult-system-was-rapidly-adopted-and-decreased-wait-times-to-see-specialists
#11
Michael L Barnett, Hal F Yee, Ateev Mehrotra, Paul Giboney
Lack of timely access to specialty care is a significant problem among disadvantaged populations, such as those served by the Los Angeles County Department of Health Services. In 2012 the department implemented an electronic system for the provision of specialty care called the eConsult system, in which all requests from primary care providers for specialty assistance were reviewed by specialists. In many cases, the specialist can address the primary care provider's question via an electronic dialogue, thereby eliminating the need for the patient to see a specialist in person...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28255807/predictors-of-psychological-distress-among-cancer-patients-receiving-care-at-a-safety-net-institution-the-role-of-younger-age-and-psychosocial-problems
#12
Chiara Acquati, Karen Kayser
PURPOSE: The present study examined prevalence and predictors of psychological distress among cancer patients receiving care at a safety-net institution during the first year of implementation of a distress screening protocol. Differences between screened and unscreened patients were also analyzed. METHODS: Data on 182 breast and lung cancer patients who were treated at a NCI-designated Academic Comprehensive Cancer Center (ACAD) were abstracted from the patients' medical charts for a period of 1 year...
March 2, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28245872/public-sector-low-threshold-office-based-buprenorphine-treatment-outcomes-at-year-7
#13
Elenore Patterson Bhatraju, Ellie Grossman, Babak Tofighi, Jennifer McNeely, Danae DiRocco, Mara Flannery, Ann Garment, Keith Goldfeld, Marc N Gourevitch, Joshua D Lee
BACKGROUND: Buprenorphine maintenance for opioid dependence remains of limited availability among underserved populations, despite increases in US opioid misuse and overdose deaths. Low threshold primary care treatment models including the use of unobserved, "home," buprenorphine induction may simplify initiation of care and improve access. Unobserved induction and long-term treatment outcomes have not been reported recently among large, naturalistic cohorts treated in low threshold safety net primary care settings...
February 28, 2017: Addiction Science & Clinical Practice
https://www.readbyqxmd.com/read/28241912/end-stage-renal-disease-outcomes-among-the-kaiser-permanente-southern-california-creatinine-safety-program-creatinine-surenet-opportunities-to-reflect-and-improve
#14
John J Sim, Michael Batech, Kim N Danforth, Mark P Rutkowski, Steven J Jacobsen, Michael H Kanter
OBJECTIVES: The Kaiser Permanente Southern California (KPSC) creatinine safety program (Creatinine SureNet) identifies and outreaches to thousands of people annually who may have had a missed diagnosis for chronic kidney disease (CKD). We sought to determine the value of this outpatient program and evaluate opportunities for improvement. METHODS: Longitudinal cohort study (February 2010 through December 2015) of KPSC members captured into the creatinine safety program who were characterized using demographics, laboratory results, and different estimations of glomerular filtration rate...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28241908/implementation-and-evaluation-of-the-safety-net-specialty-care-program-in-the-denver-metropolitan-area
#15
Meredith P Fort, Lynnette M Namba, Sarah Dutcher, Tracy Copeland, Neysa Bermingham, Chris Fellenz, Deborah Lantz, John J Reusch, Elizabeth A Bayliss
OBJECTIVES: In response to limited access to specialty care in safety-net settings, an integrated delivery system and three safety-net organizations in the Denver, CO, metropolitan area launched a unique program in 2013. The program offers safety-net providers the option to electronically consult with specialists. Uninsured patients may be seen by specialists in office visits for a defined set of services. This article describes the program, identifies aspects that have worked well and areas that need improvement, and offers lessons learned...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28241907/physicians-perceptions-of-volunteer-service-at-safety-net-clinics
#16
Laura Mcgeehan, Michael A Takehara, Ellen Daroszewski
BACKGROUND: Volunteer physicians are crucial for the operation of safety-net clinics, which provide medical care for uninsured and underinsured populations. Thus, identifying ways to maximize the number of physicians volunteering at such clinics is an important goal. OBJECTIVE: To investigate the perceptions, motivations, functions, and barriers associated with physician volunteering in four safety-net clinics in San Bernardino County, Southern California, a location of great medical need with many barriers to care...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28239019/specialty-care-access-in-the-safety-net-the-role-of-public-hospitals-and-health-systems
#17
Lena K Makaroun, Chelsea Bowman, Kevin Duan, Nathan Handley, Daniel J Wheeler, Edgar Pierluissi, Alice Hm Chen
Access to specialty care in the United States safety net, already strained, is fac-ing increasing pressure with an influx of patients following the passage of the Affordable Care Act (ACA). We surveyed 18 public hospitals and health systems across the country to describe the current state of specialty care delivery in safety-net systems. We elicited information regarding challenges, provider models, metrics of access and productivity, and strategies for improving access. Based on our findings, we propose a framework for assessing and improving specialty care access with a focus on population health planning...
2017: Journal of Health Care for the Poor and Underserved
https://www.readbyqxmd.com/read/28221275/changes-in-emergency-department-utilization-after-early-medicaid-expansion-in-california
#18
Lindsay M Sabik, Peter J Cunningham, Ali Bonakdar Tehrani
BACKGROUND: Medicaid expansions aim to improve access to primary care, which could reduce nonemergent (NE) use of the emergency department (ED). In contrast, Medicaid enrollees use the ED more than other groups, including the uninsured. Thus, the expected impact of Medicaid expansion on ED use is unclear. OBJECTIVES: To estimate changes in total and NE ED visits as a result of California's early Medicaid expansion under the Affordable Care Act. In addition to overall changes in the number of visits, changes by payer and safety net hospital status are examined...
February 17, 2017: Medical Care
https://www.readbyqxmd.com/read/28212969/lessons-learned-when-introducing-pharmacogenomic-panel-testing-into-clinical-practice
#19
Marc B Rosenman, Brian Decker, Kenneth D Levy, Ann M Holmes, Victoria M Pratt, Michael T Eadon
OBJECTIVES: Implementing new programs to support precision medicine in clinical settings is a complex endeavor. We describe challenges and potential solutions based on the Indiana GENomics Implementation: an Opportunity for the Underserved (INGenious) program at Eskenazi Health-one of six sites supported by the Implementing GeNomics In pracTicE network grant of the National Institutes of Health/National Human Genome Research Institute. INGenious is an implementation of a panel of genomic tests...
January 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28207344/the-future-of-the-affordable-care-act-and-insurance-coverage
#20
Sherry Glied, Adlan Jackson
We describe the patterns of coverage gains associated with the Affordable Care Act (ACA) expansions and use these patterns to assess the potential impact of alternative repeal or repeal and replace strategies because Congress and the president are weighing options to repeal or replace the ACA. We find that specific provisions of the ACA, including the Medicaid expansion and the structure of premium subsidies, have been associated with large and robust gains in insurance coverage. We evaluate the impact of retaining dependent coverage and high-risk pool provisions and show, on the basis of the ACA experience, that these provisions would have little effect on coverage...
April 2017: American Journal of Public Health
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