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Ambulatory Care

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https://www.readbyqxmd.com/read/28651587/acsc-indicator-testing-reliability-for-hypertension
#1
Robin L Walker, William A Ghali, Guanmin Chen, Tej K Khalsa, Birinder K Mangat, Norm R C Campbell, Elijah Dixon, Doreen Rabi, Nathalie Jette, Robyn Dhanoa, Hude Quan
BACKGROUND: With high-quality community-based primary care, hospitalizations for ambulatory care sensitive conditions (ACSC) are considered avoidable. The purpose of this study was to test the inter-physician reliability of judgments of avoidable hospitalizations for one ACSC, uncomplicated hypertension, derived from medical chart review. METHODS: We applied the Canadian Institute for Health Information's case definition to obtain a random sample of patients who had an ACSC hospitalization for uncomplicated hypertension in Calgary, Alberta...
June 26, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28650922/randomized-trial-of-reducing-ambulatory-malpractice-and-safety-risk-results-of-the-massachusetts-promises-project
#2
Gordon D Schiff, Harry Reyes Nieva, Paula Griswold, Nicholas Leydon, Judy Ling, Frank Federico, Carol Keohane, Bonnie R Ellis, Cathy Foskett, E John Orav, Catherine Yoon, Don Goldmann, Joel S Weissman, David W Bates, Madeleine Biondolillo, Sara J Singer
OBJECTIVE: Evaluate application of quality improvement approaches to key ambulatory malpractice risk and safety areas. STUDY SETTING: In total, 25 small-to-medium-sized primary care practices (16 intervention; 9 control) in Massachusetts. STUDY DESIGN: Controlled trial of a 15-month intervention including exposure to a learning network, webinars, face-to-face meetings, and coaching by improvement advisors targeting "3+1" high-risk domains: test result, referral, and medication management plus culture/communication issues evaluated by survey and chart review tools...
June 23, 2017: Medical Care
https://www.readbyqxmd.com/read/28650873/perceptions-of-ambulatory-workflow-changes-in-an-academic-primary-care-setting
#3
Michael A Hanak, Colleen McDevitt, Daniel P Dunham
As health care moves to a value-based system, the need for team-based models of care becomes increasingly important to adequately address the growing number of clinical quality metrics required of health care providers. Finding ways to better engage certified medical assistants (CMAs) in the process allows providers to focus on more complex tasks while improving the efficiency of each office visit. Although the roles and responsibilities for CMAs across the specialties can vary widely, standardizing the work can be a helpful step in scaling best practices across an institution...
June 23, 2017: Health Care Manager
https://www.readbyqxmd.com/read/28650679/establishing-maximal-medical-improvement-after-arthroscopic-rotator-cuff-repair
#4
William A Zuke, Timothy S Leroux, Bonnie P Gregory, Austin Black, Brian Forsythe, Anthony A Romeo, Nikhil N Verma
BACKGROUND: As health care transitions from a pay-for-service to a pay-for-performance infrastructure, the value of orthopaedic care must be defined accurately. Significant efforts have been made in defining quality and cost in arthroplasty; however, there remains a lag in ambulatory orthopaedic care. PURPOSE: Two-year follow-up has been a general requirement for reporting outcomes after rotator cuff repair. However, this time requirement has not been established scientifically and is of increasing importance in the era of value-based health care...
June 1, 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28650246/economic-outcomes-of-first-line-regimen-switching-among-stable-patients-with-hiv
#5
Lisa Rosenblatt, Ami R Buikema, Jerry Seare, Lindsay G S Bengtson, Jonathan Johnson, Feng Cao, Angelina Villasis-Keever
BACKGROUND: Although switching of antiretroviral therapy (ART) is a valid approach for addressing treatment failure in patients with human immunodeficiency virus (HIV), ART changes among those who are well maintained on their current regimens may lead to the development of new side effects or resistance. OBJECTIVE: To examine the effect of first-line regimen switching on subsequent health care utilization and cost among stable HIV patients. METHODS: This was a retrospective claims data study of adult patients with HIV who initiated ART between 2007 and 2013 and had been treated with their initial regimens for at least 6 continuous months...
July 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28649860/do-racial-ethnic-disparities-exist-in-recommended-migraine-treatments-in-us-ambulatory-care
#6
Larry Charleston Iv, James Francis Burke
Background Racial disparities in migraine have been reported in the US. Migraine in African Americans (AA) is more frequent, more severe, more likely to become chronic and associated with more depression and lower quality of life compared to non-Hispanic Whites (NHW). It is possible that racial differences in prescribing practices contribute to these differences, but little is known about the quality of migraine prescribing patterns in the US or whether racial differences exist. Objective To determine if racial differences in quality of migraine medical prescription care exist...
January 1, 2017: Cephalalgia: An International Journal of Headache
https://www.readbyqxmd.com/read/28648522/are-children-born-with-birth-defects-at-increased-risk-of-injuries-in-early-childhood
#7
Rachel E Rutkowski, Jason L Salemi, Jean Paul Tanner, Suzanne Anjohrin, Philip Cavicchia, Heather Lake-Burger, Russell S Kirby
OBJECTIVE: To investigate the extent to which children with birth defects experience differential likelihood of various injuries and injury-related hospitalizations in early childhood. STUDY DESIGN: The Florida Birth Defects Registry was used to identify infants born 2006-2010 with select birth defects. Injury matrices were used to detect injuries in inpatient, ambulatory, and emergency department admissions for each infant up to their third birthday. χ(2)tests were used to compare sociodemographic and perinatal characteristics of children, by presence of an injury-related hospital admission...
June 22, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28648494/characteristics-and-prevalence-of-wilson-s-disease-a-2013-observational-population-based-study-in-france
#8
Aurélia Poujois, France Woimant, Solène Samson, Pascal Chaine, Nadège Girardot-Tinant, Philippe Tuppin
BACKGROUND AND AIMS: Only a few epidemiological studies on the incidence and prevalence of Wilson's disease (WD) have been performed to date, and the results vary widely according to the reports. The aim of the study was to investigate the prevalence, ambulatory care and treatments of patients with WD in France. METHODS: Among the 58 million general health scheme beneficiaries (86% of the French population), people managed for WD in 2013 were identified using hospitalisation diagnosis in 2011-2013 or specific long-term disease status with a 100% reimbursement for specific healthcare in 2013...
June 22, 2017: Clinics and Research in Hepatology and Gastroenterology
https://www.readbyqxmd.com/read/28648221/designing-and-implementing-an-electronic-patient-registry-to-improve-warfarin-monitoring-in-the-ambulatory-setting
#9
Shin-Yu Lee, Roy Cherian, Irene Ly, Claire Horton, Alaya Levi Salley, Urmimala Sarkar
BACKGROUND: Warfarin requires individualized dosing and monitoring in the ambulatory setting for protection against thromboembolic disease. Yet in multiple settings, patients spend upwards of 30% of time outside the therapeutic range, subjecting them to an increased risk of adverse events. At an urban, publicly funded clinic, the electronic health record (EHR) would not support integration with extant warfarin management software, which led to the creation and implementation of an electronic patient registry and a complementary team-based work flow to provide real-time health-system-level data for warfarin patients...
July 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28647442/the-impact-of-the-transition-from-volume-to-value-on-heart-failure-care-implications-of-novel-payment-models-and-quality-improvement-initiatives
#10
REVIEW
Dushyanth Srinivasan, Nihar R Desai
In response to wide variation in quality and outcomes as well as escalating health care costs, the U.S. health care system is transitioning away from a volume based payment system to a quality- and value-based system. Medicare, the largest insurer and payer of healthcare, has accelerated the movement towards value-based care with the development and implementation of myriad alternative payment models and pay for performance programs as part of the Affordable Care Act. Given that heart failure affects a significant number of Medicare patients and these patients account for a disproportionate amount of healthcare utilization and spending, heart failure has become a focal point for these initiatives...
June 21, 2017: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/28646886/implementation-science-for-ambulatory-care-safety-a-novel-method-to-develop-context-sensitive-interventions-to-reduce-quality-gaps-in-monitoring-high-risk-patients
#11
Kathryn M McDonald, George Su, Sarah Lisker, Emily S Patterson, Urmimala Sarkar
BACKGROUND: Missed evidence-based monitoring in high-risk conditions (e.g., cancer) leads to delayed diagnosis. Current technological solutions fail to close this safety gap. In response, we aim to demonstrate a novel method to identify common vulnerabilities across clinics and generate attributes for context-flexible population-level monitoring solutions for widespread implementation to improve quality. METHODS: Based on interviews with staff in otolaryngology, pulmonary, urology, breast, and gastroenterology clinics at a large urban publicly funded health system, we applied journey mapping to co-develop a visual representation of how patients are monitored for high-risk conditions...
June 24, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28646519/the-association-of-health-literacy-with-preventable-ed-visits-a-cross-sectional-study
#12
Meenakshi P Balakrishnan, Jill Boylston Herndon, Jingnan Zhang, Thomas Payton, Jonathan Shuster, Donna L Carden
BACKGROUND: Policy-makers argue that emergency department (ED) visits for conditions preventable with high-quality outpatient care contribute to waste in the healthcare system. However, access to ambulatory care is uneven, especially for vulnerable populations like minorities, the poor and those with limited health literacy. The impact of limited health literacy on ED visits that are preventable with timely, high-quality ambulatory care is unknown. OBJECTIVE: To determine the association of health literacy and preventable ED visits...
June 24, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28645999/ambulatory-care-pharmacy-realizing-the-potential-for-patient-access-and-operational-excellence
#13
Philip J Almeter, Gary L Johnson, Philip A Schwieterman, Daniel A Grantz, Priya P Pasala
No abstract text is available yet for this article.
July 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28645997/temperature-profiles-of-antibiotic-containing-elastomeric-infusion-devices-used-by-ambulatory-care-patients
#14
Toni Docherty, Michael Montalto, Joni Leslie, Katrina King, Suzanne Niblett, Tim Garrett
PURPOSE: The temperature profiles of antibiotic-containing elastomeric infusion devices used by ambulatory care patients under various environmental conditions were evaluated. METHODS: A prospective, descriptive survey of temperature exposure was conducted in 4 publically funded hospitals. Over a 12-month period, electronic temperature-recording devices were attached to the antibiotic infusion devices (infusers) of prospectively randomized hospital-in-the-home (HITH) participants...
July 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28645890/tailored-communication-within-mobile-apps-for-diabetes-self-management-a-systematic-review
#15
Heidi Holmen, Astrid Klopstad Wahl, Milada Cvancarova Småstuen, Lis Ribu
BACKGROUND: The prevalence of diabetes is increasing and with the requirements for self-management and risk of late complications, it remains a challenge for the individual and society. Patients can benefit from support from health care personnel in their self-management, and the traditional communication between patients and health care personnel is changing. Smartphones and apps offer a unique platform for communication, but apps with integrated health care personnel communication based on patient data are yet to be investigated to provide evidence of possible effects...
June 23, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28645288/a-cohort-study-of-a-general-surgery-electronic-consultation-system-safety-implications-and-impact-on-surgical-yield
#16
Jesus G Ulloa, Marika D Russell, Alice Hm Chen, Delphine S Tuot
BACKGROUND: Electronic consultation (eConsult) systems have enhanced access to specialty expertise and enhanced care coordination among primary care and specialty care providers, while maintaining high primary care provider (PCP), specialist and patient satisfaction. Little is known about their impact on the efficiency of specialty care delivery, in particular surgical yield (percent of ambulatory visits resulting in a scheduled surgical case). METHODS: Retrospective cohort of a random selection of 150 electronic consults from PCPs to a safety-net general surgery clinic for the three most common general surgery procedures (herniorrhaphy, cholecystectomy, anorectal procedures) in 2014...
June 23, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28645125/-epidemiology-of-parkinson-s-disease-and-current-concepts%C3%A2-of-outpatient-care-in-germany
#17
Lars Tönges, Reinhard Ehret, Michael Lorrain, Peter Riederer, Martina Müngersdorf
The ambulatory care of patients with Parkinson's disease (PD) in Germany has been established for a long time. As the prevalence of Parkinson's disease continues to increase, the outpatient neurological sector is becoming more and more important and needs to adapt itself to current needs. This includes an optimization of the care structures for Parkinson's patients as well as adequate concepts for the execution of differentiated diagnostics and therapy. For many patients care is provided by non-specialized neurological practices or general practitioners, without exchange of views with neurologists or a specialized university outpatient clinic for movement disorders...
June 2017: Fortschritte der Neurologie-Psychiatrie
https://www.readbyqxmd.com/read/28644693/supplemental-oxygen-in-interstitial-lung-disease-an-art-in-need-of-science
#18
Kerri A Johannson, Sachin R Pendharkar, Kirk Mathison, Charlene D Fell, Jordan A Guenette, Meena Kalluri, Martin Kolb, Christopher J Ryerson
Interstitial lung disease (ILD) comprises a large and heterogeneous group of disorders that often lead to progressive fibrosis and premature death. Oxygen supplementation is typically used in advanced lung disease patients with resting hypoxemia; however, there is a paucity of evidence guiding the use of supplemental oxygen in ILD, and significant heterogeneity in clinical practice. It remains unclear whether supplemental oxygen improves clinically meaningful outcomes, and the role of ambulatory oxygen supplementation in isolated exertional hypoxemia is particularly controversial...
June 23, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28639465/an-innovative-approach-to-addressing-the-hiv-care-continuum-implementation-of-a-clinical-pharmacy-resident-in-a-veterans-affairs-hiv-specialty-clinic
#19
Autumn Bagwell, M Shawn McFarland, Todd Hulgan
PURPOSE: Engagement of patients in the HIV care continuum and adherence to antiretroviral therapy (ART) continue to limit successful viral suppression. Innovative practices to improve this continuum and ameliorate potential physician shortages are needed. The objective of this evaluation was to determine the clinical benefits of incorporating pharmacy resident involvement on a multidisciplinary team in caring for patients with HIV. METHODS: A single-center pre-post cohort pilot evaluation was conducted at the Tennessee Valley Healthcare Systems VA Medical Center...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28638844/predictors-of-unplanned-hospitalization-in-patients-receiving-outpatient-parenteral-antimicrobial-therapy-across-a-large-integrated-healthcare-network
#20
Monica Schmidt, Bevin Hearn, Michael Gabriel, Melanie D Spencer, Lewis McCurdy
BACKGROUND: Outpatient parenteral antimicrobial therapy (OPAT) prescribing has increased along with the trend toward early discharge of hospitalized patients who have infections. There is limited literature that assesses unplanned hospitalizations during OPAT. This study aims to elucidate the predictors of unplanned hospitalization in OPAT patients after discharge from acute-care facilities within Carolinas HealthCare System (CHS). Understanding these predictors may inform future interventions to improve treatment efficacy and patient outcomes...
2017: Open Forum Infectious Diseases
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