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Patient-centered medical home

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https://www.readbyqxmd.com/read/28441675/teaching-today-in-the-practice-setting-of-the-future-implementing-innovations-in-graduate-medical-education
#1
Jung G Kim, Carl G Morris, Paul Ford
PROBLEM: Implementing an innovation, such as offering new types of patient-physician encounters through the patient-centered medical home (PCMH) model while maintaining Accreditation Council for Graduate Medical Education (ACGME) accreditation standards (e.g., patient encounter minimums for trainees), is challenging. APPROACH: In 2009, the Group Health Family Medicine Residency (GHFMR) received an ACGME Program Experimentation and Innovation Project (PEIP) exception that redefined the minimum Family Medicine Resident Review Committee requirement to 1,400 face-to-face visits and 250 electronic visits (1 electronic visit defined as 3 secure message or telephone encounters)...
May 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28441092/self-evaluation-of-quality-of-life-among-patients-receiving-home-parenteral-nutrition-a-validation-study
#2
Miriam Theilla, Ilya Kagan, Karina Chernov, Jonathan Cohen, Ilya Kagan, Pierre Singer
BACKGROUND: Home parenteral nutrition (HPN) can increase survival and quality of life (QOL) in cases of chronic intestinal failure. The present study compares a gold standard-a validated QOL assessment by Baxter et al (hereafter, HPN-QOL)-with a shorter questionnaire for QOL evaluation (hereafter, New QOL). MATERIALS AND METHODS: Both questionnaires were completed by 58 patients attending the nutrition clinic of the Rabin Medical Center (Israel). A z score was used to equate means and variances...
April 1, 2017: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28435754/establishing-successful-patient-centered-medical-homes-in-rural-hawai-i-three-strategies-to-consider
#3
Melissa Nelson Scribner, Kasey Kehoe
The challenges to healthcare delivery posed by Hawai'i's unique geography, physician shortages, and dispersed population are of particular importance in light of implementing the Affordable Care Act (ACA). This study draws on central goals laid out in the ACA - to decrease costs, increase access, and improve patient outcomes. The use of the Patient-Centered Medical Homes (PCMHs) is a care model that has the potential to meet all three goals. How to identify the most effective way to develop PCMHs in the specific context of Hawai'i is the focus of this study...
March 2017: Hawai'i Journal of Medicine & Public Health: a Journal of Asia Pacific Medicine & Public Health
https://www.readbyqxmd.com/read/28435481/a-patient-centered-emergency-department-management-strategy-for-sickle-cell-disease-super-utilizers
#4
Grant G Simpson, Hallie R Hahn, Alex A Powel, Robert R Leverence, Linda A Morris, Lara G Thompson, Marc S Zumberg, Deepa J Borde, Joseph A Tyndall, Jonathan J Shuster, Donald M Yealy, Brandon R Allen
INTRODUCTION: A subpopulation of sickle-cell disease patients, termed super-utilizers, presents frequently to emergency departments (EDs) for vaso-occlusive events and may consume disproportionate resources without broader health benefit. To address the healthcare needs of this vulnerable patient population, we piloted a multidisciplinary intervention seeking to create and use individualized patient care plans that alter utilization through coordinated care. Our goals were to assess feasibility primarily, and to assess resource use secondarily...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28434390/how-preferences-for-continuity-and-access-differ-between-multimorbidity-and-healthy-patients-in-a-team-care-setting
#5
Katherine M Ehman, Mark Deyo-Svendsen, Zachary Merten, Anne Marie Kramlinger, Gregory M Garrison
INTRODUCTION: Team-based care has become an essential part of modern medical practice. Patient-centered medical homes often struggle to balance the dual competing goals of acute access and continuity of care. Multimorbidity patients may value continuity more than healthy patients, and thus may prefer to wait to see their primary care physician (PCP). METHODS: A total of 1700 randomly selected healthy adults and multimorbidity patients were asked to rate satisfaction with care and presented with 4 acute and 4 chronic scenarios to choose an access and continuity preference in an anonymous mailed survey...
April 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28420358/healthcare-utilization-in-older-patients-using-personal-emergency-response-systems-an-analysis-of-electronic-health-records-and-medical-alert-data-brief-description-a-longitudinal-retrospective-analyses-of-healthcare-utilization-rates-in-older-patients-using
#6
Stephen Agboola, Sara Golas, Nils Fischer, Mariana Nikolova-Simons, Jorn Op den Buijs, Linda Schertzer, Joseph Kvedar, Kamal Jethwani
BACKGROUND: Personal Emergency Response Systems (PERS) are traditionally used as fall alert systems for older adults, a population that contributes an overwhelming proportion of healthcare costs in the United States. Previous studies focused mainly on qualitative evaluations of PERS without a longitudinal quantitative evaluation of healthcare utilization in users. To address this gap and better understand the needs of older patients on PERS, we analyzed longitudinal healthcare utilization trends in patients using PERS through the home care management service of a large healthcare organization...
April 18, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28419414/association-between-aggressive-care-and-bereaved-families-evaluation-of-end-of-life-care-for-veterans-with-non-small-cell-lung-cancer-who-died-in-veterans-affairs-facilities
#7
Mary Ersek, Susan C Miller, Todd H Wagner, Joshua M Thorpe, Dawn Smith, Cari R Levy, Risha Gidwani, Katherine Faricy-Anderson, Karl A Lorenz, Bruce Kinosian, Vincent Mor
BACKGROUND: To the authors' knowledge, little is known regarding the relationship between patients' and families' satisfaction with aggressive end-of-life care. Herein, the authors examined the associations between episodes of aggressive care (ie, chemotherapy, mechanical ventilation, acute hospitalizations, and intensive care unit admissions) within the last 30 days of life and families' evaluations of end-of-life care among patients with non-small cell lung cancer (NSCLC). METHODS: A total of 847 patients with NSCLC (34% of whom were aged <65 years) who died in a nursing home or intensive care, acute care, or hospice/palliative care (HPC) unit at 1 of 128 Veterans Affairs Medical Centers between 2010 and 2012 were examined...
April 17, 2017: Cancer
https://www.readbyqxmd.com/read/28404600/qualitative-interviews-exploring-palliative-care-perspectives-of-latinos-on-dialysis
#8
Lilia Cervantes, Jacqueline Jones, Stuart Linas, Stacy Fischer
BACKGROUND AND OBJECTIVES: Compared with non-Latino whites with advanced illness, Latinos are less likely to have an advance directive or to die with hospice services. To improve palliative care disparities, international ESRD guidelines call for increased research on culturally responsive communication of advance care planning (ACP). The objective of our study was to explore the preferences of Latino patients receiving dialysis regarding symptom management and ACP. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Qualitative study design using semistructured face-to-face interviews of 20 Latinos on hemodialysis between February and July of 2015...
April 12, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28397131/making-a-medical-home-for-ibd-patients
#9
REVIEW
Lawrence R Kosinski, Joel Brill, Miguel Regueiro
PURPOSE OF REVIEW: The transformation from fee for service to fee for value requires structural changes to the way gastroenterologists manage patients with inflammatory bowel disease (IBD). A team-based approach using technology to engage patients is necessary for success. The Patient-Centered Medical Home (PCMH) represents a unique model that brings together these essential features. This paper describes how the PCMH model has been successfully applied to the management of patients with IBD...
May 2017: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/28396108/augmented-nurse-care-management-in-ckd-stages-4-to-5-a%C3%A2-randomized-trial
#10
Steven Fishbane, Sofia Agoritsas, Alessandro Bellucci, Candice Halinski, Hitesh H Shah, Vipul Sakhiya, Leah Balsam
BACKGROUND: Outcomes for patients with late-stage chronic kidney disease (CKD) in the United States are suboptimal. There is poor education and preparation for end-stage kidney disease, as well as a high rate of hospitalization in this group of patients. STUDY DESIGN: A randomized, parallel-group, 2-arm, controlled trial. SETTING & PARTICIPANTS: The study was conducted at 3 sites: a clinic of an academic medical center, a public hospital academic clinic, and a community-based private practice...
April 7, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28391984/-french-national-survey-on-incoming-phone-calls-in-oncology-departments
#11
Florence Joly, Aline Guillot, Yann-Alexandre Vano, Dominique Spaeth, Delphine Topart, Pascal Roffet, Rachid El Amarti, Ali Hasbini, Aude Fléchon
INTRODUCTION: Oral therapies have shifted the follow-up of patients with cancer from hospital to home. As a consequence, the number of incoming calls has increased. To understand the source, reasons, management and burden of calls, we underwent a French national survey. The objective was to describe the way calls are managed in oncology departments. METHODS: The study was a prospective survey in a representative sample of French oncology specialists using oral therapies...
April 6, 2017: Bulletin du Cancer
https://www.readbyqxmd.com/read/28387979/prescription-contraception-use-and-adherence-by-women-with-substance-use-disorders
#12
Gillian Griffith, Tara Kumaraswami, Stavroula A Chrysanthopoulou, Kristin M Mattocks, Robin E Clark
BACKGROUND AND AIMS: Unintended pregnancy rates are high among women with substance use disorders (SUDs), which could be partly explained by lower use of and adherence to contraception. We aimed to test: (1) the association of SUD with prescription contraceptive use, contraceptive method selection, and adherence; (2) whether practices participating in the Patient-Centered Medical Home Initiative (PCMHI) had better contraceptive use and adherence for patients with SUD; (3) for differences in the association of SUD with adherence by type of contraceptive used...
April 7, 2017: Addiction
https://www.readbyqxmd.com/read/28387598/patient-experiences-with-care-differ-with-chronic-care-management-in-a-federally-qualified-community-health-center
#13
Claude M Setodji, Denise D Quigley, Marc N Elliott, Q Burkhart, Michael E Hochman, Alex Y Chen, Ron D Hays
This study compares patient experience among practices that vary in adoption of the chronic care management (CCM) dimension of the patient-centered medical home (PCMH) model that focuses on care coordination and management of chronic diseases. Study participants were 2903 adult patients (ages 18 years or older) at 14 primary care centers in California. Seven of the sites were classified as high (more CCM) and the other 7 low on a CCM index. Hypotheses were tested using ordinary least squares regression models...
April 7, 2017: Population Health Management
https://www.readbyqxmd.com/read/28385024/patient-experience-midway-through-a-large-primary-care-practice-transformation-initiative
#14
Kaylyn E Swankoski, Deborah N Peikes, Stacy B Dale, Nancy A Clusen, Nikkilyn Morrison, John J Holland, Timothy J Day, Randall S Brown
OBJECTIVES: To determine how the multipayer Comprehensive Primary Care (CPC) initiative that transforms primary care delivery affects the patient experience of Medicare fee-for-service beneficiaries. The study examines how experience changed between the first and second years of CPC, how ratings of CPC practices have changed relative to ratings of comparison practices, and areas in which practices still have opportunities to improve patient experience. STUDY DESIGN: Prospective study using 2 serial cross-sectional samples of more than 25,000 Medicare fee-for-service beneficiaries attributed to 496 CPC practices and nearly 9000 beneficiaries attributed to 792 comparison practices...
March 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28379985/a-real-world-comparison-of-apnea-hypopnea-indices-of-positive-airway-pressure-device-and-polysomnography
#15
Ritwick Agrawal, Julie A Wang, Anita G Ko, Joanne E Getsy
The apnea hypopnea index (AHI) reported by positive airway pressure (PAP) device is widely used in clinical practice, yet its correlation with standardized AHI obtained during the sleep study is not established. The current study was conducted to investigate the correlation between AHI estimated by the PAP device and reported on the smart card with the AHI found during the PAP polysomnography (PSG) in the "real world" setting at an academic sleep center. We retrospectively reviewed the medical records of 280 patients who underwent a PAP titration PSG at Drexel sleep center, and were later prescribed a PAP device...
2017: PloS One
https://www.readbyqxmd.com/read/28379833/provision-of-palliative-care-services-by-family-physicians-is-common
#16
Claire K Ankuda, Anuradha Jetty, Andrew Bazemore, Stephen Petterson
OBJECTIVE: Provision of palliative care services by primary care physicians is increasingly important with an aging population, but it is unknown whether US primary care physicians see themselves as palliative practitioners. METHODS: This study used cross-sectional analysis of data from the 2013 American Board of Family Medicine Maintenance of Certification Demographic Survey. RESULTS: Of 10,894 family physicians, 33.1% (n = 3609) report providing palliative care...
March 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28376988/improving-nursing-home-compliance-via-revised-antipsychotic-use-survey-tool
#17
Linda L Bach, Donald L Lazzaretto, Clipper F Young, Paul W Lofholm
OBJECTIVE: To analyze the effect of using a pharmacist-initiated antipsychotic use survey tool on improving nursing home compliance for appropriate antipsychotic use in patients with dementia. DESIGN: Prospective chart review study. SETTING: Two nursing homes in Marin County, California. PARTICIPANTS: Nursing home residents diagnosed with dementia and receiving antipsychotic medication. INTERVENTION: Pharmacist performing survey tool screening for appropriate antipsychotic use based on Centers for Medicare & Medicaid Services guidelines and using information from the survey tool as part of the pharmacist recommendations to the prescriber...
April 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28375815/maryland-s-medical-orders-for-life-sustaining-treatment-form-use-reports-of-a-statewide-survey
#18
Anita J Tarzian, Nadia B Cheevers
BACKGROUND: Advance directives (ADs) and Physicians Orders for Life-Sustaining Treatment (POLST) orders perform different but complementary functions in documenting a patient's treatment preferences and translating them into actionable orders that change in keeping with the patient's evolving clinical picture. Maryland's Medical Orders for Life-Sustaining Treatment (MOLST) form developed through a stakeholder-driven process that deviates from other POLST forms. While a patient or surrogate can decline discussing MOLST orders with a clinician, clinicians must write MOLST orders for certain patients (e...
April 4, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28375108/efficacy-of-gingocap-as-compared-to-pyridoxine-in-the-treatment-of-nausea-and-vomiting-during-pregnancy
#19
Lala Rukh, Halima Nazar, Khan Usmanghani
Nausea and vomiting is the common problem disturbing almost 80% of the females in initial three months of conception and later sometime throughout pregnancy. To find out the efficacy and safety of herbal coded test drug Gingocap in comparison with the control drug Pyridoxine, a randomized clinical case control study was conducted at the OPD of Yusra Medical Centre, Karachi and Amir Habib Medical Center and Maternity Home, Karachi. After administration of test and control drug the frequency of nausea and vomiting was noted after every 2 weeks on 2nd, 4th, 6th and 8th weeks during 60 days of the course of study...
November 2016: Pakistan Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/28367682/feasibility-and-acceptability-of-a-colocated-homeless-tailored-primary-care-clinic-and-emergency-department
#20
Sonya Gabrielian, Jennifer C Chen, Beena P Minhaj, Rishi Manchanda, Lisa Altman, Ella Koosis, Lillian Gelberg
OBJECTIVES: Homeless adults have low primary care engagement and high emergency department (ED) utilization. Homeless-tailored, patient-centered medical homes (PCMH) decrease this population's acute care use. We studied the feasibility (focused on patient recruitment) and acceptability (conceptualized as clinicians' attitudes/beliefs) of a pilot initiative to colocate a homeless-tailored PCMH with an ED. After ED triage, low-acuity patients appropriate for outpatient care were screened for homelessness; homeless patients chose between a colocated PCMH or ED visit...
March 1, 2017: Journal of Primary Care & Community Health
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