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Safety net care

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https://www.readbyqxmd.com/read/28629348/applying-the-plan-do-study-act-pdsa-approach-to-a-large-pragmatic-study-involving-safety-net-clinics
#1
Jennifer Coury, Jennifer L Schneider, Jennifer S Rivelli, Amanda F Petrik, Evelyn Seibel, Brieshon D'Agostini, Stephen H Taplin, Beverly B Green, Gloria D Coronado
BACKGROUND: The Plan-Do-Study-Act (PDSA) cycle is a commonly used improvement process in health care settings, although its documented use in pragmatic clinical research is rare. A recent pragmatic clinical research study, called the Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC), used this process to optimize the research implementation of an automated colon cancer screening outreach program in intervention clinics. We describe the process of using this PDSA approach, the selection of PDSA topics by clinic leaders, and project leaders' reactions to using PDSA in pragmatic research...
June 19, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28624037/trauma-care-in-a-multiethnic-population-effects-of-being-undocumented
#2
Jonathan M Wyrick, Brittany A Kalosza, George N Coritsidis, Raymond Tse, George Agriantonis
BACKGROUND: Epidemiologic studies have shown that undocumented immigrants (UIs) display characteristics of having a low socioeconomic status and are primarily of ethnic minorities. These social determinants of health are known to be associated with diminished health care access and poor clinical outcomes. We therefore investigated the impact of documentation status on the clinical outcomes of patients with traumatic injuries. MATERIALS AND METHODS: We conducted a retrospective review of the trauma registry at our safety net institution for all adult patients who were admitted from 2010 to 2014...
June 15, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28622094/self-care-behavior-change-and-depression-among-low-income-predominantly-hispanic-patients-in-safety-net-clinics
#3
Hyunsung Oh, Kathleen Ell, Lawrence A Palinkas
This study examined whether changes in self-care behaviors during a 12-month period predicted the likelihood of screening positive for depression concurrently and prospectively among low-income Hispanic patients with diabetes. Secondary analyses were conducted with longitudinal data collected from a randomized controlled trial that had tested effectiveness of collaborative depression care. We examined whether changes in self-care behaviors observed during the 12 months after baseline predicted the likelihood of screening positive for depression at 12-, 18-, and 24-month follow-up...
June 16, 2017: Social Work in Health Care
https://www.readbyqxmd.com/read/28618290/defining-trauma-in-complex-care-management-safety-net-providers-perspectives-on-structural-vulnerability-and-time
#4
Ariana Thompson-Lastad, Irene H Yen, Mark D Fleming, Meredith Van Natta, Sara Rubin, Janet K Shim, Nancy J Burke
In this paper, we delineate how staff of two complex care management (CCM) programs in urban safety net hospitals in the United States understand trauma. We seek to (1) describe how staff in CCM programs talk about trauma in their patients' lives; (2) discuss how trauma concepts allow staff to understand patients' symptoms, health-related behaviors, and responses to care as results of structural conditions; and (3) delineate the mismatch between long-term needs of patients with histories of trauma and the short-term interventions that CCM programs provide...
June 12, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28609176/mothers-of-infants-with-congenital-diaphragmatic-hernia-describe-breastfeeding-in-the-neonatal-intensive-care-unit-as-long-as-it-s-my-milk-i-m-happy
#5
Elizabeth B Froh, Janet A Deatrick, Martha A Q Curley, Diane L Spatz
BACKGROUND: Very little is known about the breastfeeding experience of mothers of infants born with congenital anomalies and cared for in the neonatal intensive care unit (NICU). Often, studies related to breastfeeding and lactation in the NICU setting are focused on the mothers of late preterm, preterm, low-birth-weight, and very-low-birth-weight infants. Congenital diaphragmatic hernia (CDH) is an anatomic malformation of the diaphragm and affects 1 in every 2,000 to 4,000 live births...
June 1, 2017: Journal of Human Lactation: Official Journal of International Lactation Consultant Association
https://www.readbyqxmd.com/read/28605216/drug-avoidance-self-efficacy-among-exclusive-cannabis-users-vs-other-drug-users-visiting-the-emergency-department
#6
Sarah E Clingan, Susan I Woodruff
BACKGROUND: Medical care in the emergency department (ED) is a growing and complex area of outpatient care, with about 256 visits made to EDs every minute in 2013. Studies report that, compared to people who do not use drugs, people who use illicit drugs are more likely to use the ED for their medical care. Self-efficacy has been shown to be a predictor of abstinence or reduced use among drug-using individuals. OBJECTIVES: The current study describes drug avoidance self-efficacy among exclusive cannabis-using individuals and other drug-using individuals who use the ED for any reason...
June 12, 2017: Substance Use & Misuse
https://www.readbyqxmd.com/read/28602461/adapting-systems-of-care-for-people-aging-with-hiv
#7
Eugenia L Siegler, Mark Brennan-Ing
People aging with HIV have medical and psychosocial needs that require more than the HIV services network can provide. HIV providers may lack experience managing multimorbidity or the functional consequences of aging. Social support services may be unable to provide necessary services for people living with HIV (PLWH) who are becoming increasingly frail or facing cognitive impairment. HIV providers will be caring for aging PLWH whose HIV management may seem simple compared with the significant burdens of stigma, mental health needs, social isolation, multimorbidity, and aging-related syndromes...
May 26, 2017: Journal of the Association of Nurses in AIDS Care: JANAC
https://www.readbyqxmd.com/read/28599142/opioid-pharmacovigilance-a-clinical-social-history-of-the-changes-in-opioid-prescribing-for-patients-with-co-occurring-chronic-non-cancer-pain-and-substance-use
#8
Kelly R Knight, Margot Kushel, Jamie S Chang, Kara Zamora, Rachel Ceasar, Emily Hurstak, Christine Miaskowski
There is growing concern among US-based clinicians, patients, policy makers, and in the media about the personal and community health risks associated with opioids. Perceptions about the efficacy and appropriateness of opioids for the management of chronic non-cancer pain (CNCP) have dramatically transformed in recent decades. Yet, there is very little social scientific research identifying the factors that have informed this transformation from the perspectives of prescribing clinicians. As part of an on-going ethnographic study of CNCP management among clinicians and their patients with co-occurring substance use, we interviewed 23 primary care clinicians who practice in safety-net clinical settings...
May 23, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28597203/assessing-patient-activation-among-high-need-high-cost-patients-in-urban-safety-net-care-settings
#9
Tessa M Napoles, Nancy J Burke, Janet K Shim, Elizabeth Davis, David Moskowitz, Irene H Yen
We sought to examine the literature using the Patient Activation Measure (PAM) or the Patient Enablement Instrument (PEI) with high-need, high-cost (HNHC) patients receiving care in urban safety net settings. Urban safety net care management programs serve low-income, racially/ethnically diverse patients living with multiple chronic conditions. Although many care management programs track patient progress with the PAM or the PEI, it is not clear whether the PAM or the PEI is an effective and appropriate tool for HNHC patients receiving care in urban safety net settings in the United States...
June 8, 2017: Journal of Urban Health: Bulletin of the New York Academy of Medicine
https://www.readbyqxmd.com/read/28594619/managing-acute-respiratory-tract-infections-in-children
#10
Bruce C Schuster, Clare Hoare, Atanu Mukherjee, Siba Prosad Paul
Respiratory tract infections (RTIs), including community-acquired pneumonia (CAP), bronchiolitis, viral-induced wheeze and croup, account for more primary care consultations than any other illness group and are the most likely reason for a parent or carer to contact a health professional. The majority of RTIs in fully immunised children are usually self-limiting. However, in a small percentage of children RTIs may become life threatening and it is crucial that all front-line health professionals are able to recognise and identify these children who are at risk of deterioration...
June 8, 2017: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/28594278/clinical-and-educational-impact-of-pharmacogenomics-testing-a-case-series-from-the-ingenious-trial
#11
Rebecca C Pierson, Brandon T Gufford, Zeruesenay Desta, Michael T Eadon
Pharmacogenomic testing has become increasingly widespread. However, there remains a need to bridge the gap between test results and providers lacking the expertise required to interpret these results. The Indiana Genomics Implementation trial is underway at our institution to examine total healthcare cost and patient outcomes after genotyping in a safety-net healthcare system. As part of the study, trial investigators and clinical pharmacology fellows interpret genotype results, review patient histories and medication lists and evaluate potential drug-drug interactions...
June 8, 2017: Pharmacogenomics
https://www.readbyqxmd.com/read/28590945/addressing-the-global-zika-epidemic-locally-an-interprofessional-model-of-universal-screening-at-one-center
#12
Rosha N Forman, Pooja K Mehta, Kettie R Louis, Molly K Finneseth, Christina D Yarrington
Escalating evidence for the fetal impact of Zika virus infection required a change in care by all prenatal providers. This article describes an effective model of rapid implementation of universal prenatal screening at one hospital and its network of community health centers for a large and diverse immigrant population exploring the challenges, experiences, and lessons learned. Implementation of national recommendations required a workflow change, challenging a system with a heterogeneity of settings and providers...
June 6, 2017: Journal of Perinatal & Neonatal Nursing
https://www.readbyqxmd.com/read/28583245/-they-told-me-to-take-him-somewhere-else-caregivers-experiences-seeking-emergency-dental-care-for-their-children
#13
Beau D Meyer, Jessica Y Lee, Lewis N Lampiris, Paul Mihas, Sarah Vossers, Kimon Divaris
PURPOSE: The purpose of this mixed-methods study was to examine pediatric emergency dental trends in two safety net clinics and care-seeking experiences of young children's caregivers. METHODS: Administrative data were used to describe and compare emergency first visits of children ages zero to six years in a community-based (CC) and a University-based (UC) safety net clinic from 2010 to 2014. In-person interviews were conducted with 11 caregivers of children ages zero to six presenting for nontrauma-related emergency visits at the UC from January to August 2016...
May 15, 2017: Pediatric Dentistry
https://www.readbyqxmd.com/read/28577666/a-prospective-randomized-open-label-trial-of-6-month-versus-12-month-dual-antiplatelet-therapy-after-drug-eluting-stent-implantation-in-st-elevation-myocardial-infarction-rationale-and-design-of-the-dapt-stemi-trial
#14
Elvin Kedhi, Enrico Fabris, Martin van der Ent, Mark W Kennedy, Pawel Buszman, Clemens von Birgelen, Stéphane Cook, Hans Wedel, Felix Zijlstra
BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention with second-generation drug eluting stents (DESs) is unclear. Because prolonged DAPT is associated with higher bleeding risk and health care costs, establishing optimal DAPT duration is of paramount importance. No other randomized controlled trials have evaluated the safety of shorter DAPT duration in ST-elevation myocardial infarction (STEMI) patients treated with second-generation DESs and latest P2Y12 platelet receptor inhibitors...
June 2017: American Heart Journal
https://www.readbyqxmd.com/read/28574233/the-impact-of-the-aca-s-medicaid-expansion-on-hospitals-uncompensated-care-burden-and-the-potential-effects-of-repeal
#15
David Dranove, Craig Gartwaite, Christopher Ody
ISSUE: By increasing health insurance coverage, the Affordable Care Act's Medicaid eligibility expansion was also expected to lessen the uncompensated care burden on hospitals. The expansion currently faces an uncertain future. GOAL: To compare the change in hospitals' uncompensated care burden in the 31 states (plus the District of Columbia) that chose to expand Medicaid to the changes in states that did not, and to estimate how these expenses would be affected by repeal or further expansion. METHODS: Analysis of uncompensated care data from Medicare Hospital Cost Reports from 2011 to 2015...
May 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28560769/patient-experience-of-chronic-illness-care-and-medical-home-transformation-in-safety-net-clinics
#16
Elizabeth L Tung, Yue Gao, Monica E Peek, Robert S Nocon, Kathryn E Gunter, Sang Mee Lee, Marshall H Chin
OBJECTIVE: To examine the relationship between medical home transformation and patient experience of chronic illness care. STUDY SETTING: Thirteen safety net clinics located in five states enrolled in the Safety Net Medical Home Initiative. STUDY DESIGN: Repeated cross-sectional surveys of randomly selected adult patients were completed at baseline (n = 303) and postintervention (n = 271). DATA COLLECTION METHODS: Questions from the Patient Assessment of Chronic Illness Care (PACIC) (100-point scale) were used to capture patient experience of chronic illness care...
May 30, 2017: Health Services Research
https://www.readbyqxmd.com/read/28558709/beneficiaries-perceptions-and-reported-use-of-unconditional-cash-transfers-intended-to-prevent-acute-malnutrition-in-children-in-poor-rural-communities-in-burkina-faso-qualitative-results-from-the-mam-out-randomized-controlled-trial
#17
Audrey Tonguet-Papucci, Freddy Houngbe, Palamanga Lompo, Wambi Maurice Evariste Yameogo, Jean-François Huneau, Myriam Ait Aissa, Patrick Kolsteren
BACKGROUND: Acute malnutrition is a public health issue worldwide, and particularly in the Eastern region of Burkina Faso. Following a needs assessment, unconditional seasonal, multiannual cash transfers were implemented as a safety net to prevent childhood undernutrition. The objectives of this study were to explore the types of purchases made by beneficiaries of this cash transfer program and to understand the perceived effects of and changes induced by regular cash transfers in the daily lives of women, and at the household and community level...
May 30, 2017: BMC Public Health
https://www.readbyqxmd.com/read/28557523/postdischarge-telephone-calls-by-hospitalists-as-a-transitional-care-strategy
#18
Sarah A Stella, Angela Keniston, Maria G Frank, Dan Heppe, Katarzyna Mastalerz, Jason Lones, David Brody, Richard K Albert, Marisha Burden
OBJECTIVES: To determine whether treating hospitalists can identify and address early postdischarge problems through a structured telephone call. STUDY DESIGN: Prospective cohort study. METHODS: We studied patients insured through a managed care program who were discharged from a general internal medicine service of a university-affiliated public safety net hospital (Denver Health Medical Center) between March 1, 2012, and October 31, 2013...
October 1, 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/28556358/buffering-the-uneven-impact-of-the-affordable-care-act-immigrant-serving-safety-net-providers-in-new-mexico
#19
Christina M Getrich, Jacqueline M García, Angélica Solares, Miria Kano
We conducted a study in early 2014 to document how the initial implementation of the Affordable Care Act (ACA) affected health care provision to different categories of immigrants from the perspective of health care providers in New Mexico. Though ACA navigators led enrollment, providers nevertheless became involved by necessity, expressing concern about how immigrants were faring in the newly configured health care environment and taking on advocacy roles. Providers described interpreting shifting eligibility and coverage, attending to vulnerable under/uninsured patients, and negotiating new bureaucratic barriers for insured patients...
May 29, 2017: Medical Anthropology Quarterly
https://www.readbyqxmd.com/read/28538499/expectations-and-experiences-of-follow-up-and-self-care-after-living-kidney-donation-a-focus-group-study
#20
Karine E Manera, Camilla S Hanson, Jeremy R Chapman, John Kanellis, John Gill, Jonathan C Craig, Steve J Chadban, Germaine Wong, Angelique F Ralph, Allison Tong
BACKGROUND: Ensuring donor wellbeing warrants ongoing monitoring following living kidney donation. However, there is considerable variability in donor follow up processes, including information provided to donors regarding self-care. Loss to follow up is common, suggesting that the aims and benefits of monitoring and follow up may not be apparent. We aimed to describe the experiences and expectations of living kidney donors regarding follow up and self-care after donation. METHODS: Participants from 3 transplant centers in Australia and Canada participated in 14 focus groups (n=123)...
May 24, 2017: Transplantation
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