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Primary Care Transformation

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https://www.readbyqxmd.com/read/29045984/results-of-the-2017-national-resident-matching-program%C3%A2-and-the-american-osteopathic-association-intern-resident-registration-program
#1
Stanley M Kozakowski, Alexandra Travis, Julie P Marcinek, Ashley Bentley, Gerald T Fetter
The purpose of medicine as a profession is to meet the health needs of people and communities. Despite empirical evidence worldwide that an appropriate foundation of primary care in a health care system leads to improved health outcomes, improved experience of health care, a reduction in health disparities, and lower overall cost of care, publicly available data from National Resident Matching Program® (NRMP) and the American Osteopathic Association (AOA) Intern/Resident Registration Program show that PGY-1 family medicine and primary care positions offered in the NRMP Match continue to grow, but are losing ground in comparison to the growth of non-primary care specialties...
October 2017: Family Medicine
https://www.readbyqxmd.com/read/29045609/stakeholder-perspectives-on-the-optimizing-patient-transfers-impacting-medical-quality-and-improving-symptoms-transforming-institutional-care-optimistic-project
#2
Mary Ersek, Susan E Hickman, Anne C Thomas, Brittany Bernard, Kathleen T Unroe, Suzanne Meeks
Background and Objectives: The need to reduce burdensome and costly hospitalizations of frail nursing home residents is well documented. The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project achieved this reduction through a multicomponent collaborative care model. We conducted an implementation-focused project evaluation to describe stakeholders' perspectives on (a) the most and least effective components of the intervention; (b) barriers to implementation; and (c) program features that promoted its adoption...
October 17, 2017: Gerontologist
https://www.readbyqxmd.com/read/29034825/a-tale-of-four-practices
#3
Michelle Miller-Day, Janelle Applequist, Keri Zabokrtsky, Alexandra Dalton, Katherine Kellom, Robert Gabbay, Peter F Cronholm
Purpose The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. This transformation presents a challenge to many care delivery organizations. The purpose of this paper is to describe attributes shaping successful and unsuccessful practice transformation within four medical practice groups. Design/methodology/approach As part of a larger study of 25 practices transitioning into a PCMH, the current study focused on diabetes care and identified high- and low-improvement medical practices in terms of quantitative patient measures of glycosylated hemoglobin and qualitative assessments of practice performance...
September 18, 2017: Journal of Health Organization and Management
https://www.readbyqxmd.com/read/29029629/effects-of-age-and-gender-on-reference-levels-of-biomarkers-comprising-the-pediatric-renal-activity-index-for-lupus-nephritis-p-rail
#4
Michael R Bennett, Qing Ma, Jun Ying, Prasad Devarajan, Hermine Brunner
BACKGROUND: Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune disease that disproportionately effects women and children of minorities. Renal involvement (lupus nephritis, or LN) occurs in up to 80% of children with SLE and is a major determinant of poor prognosis. We have developed a non-invasive pediatric Renal Activity Index for Lupus (p-RAIL) that consists of laboratory measures that reflect histologic LN activity. These markers are neutrophil gelatinase associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), monocyte chemotactic protein (MCP-1), adiponectin (APN), ceruloplasmin (CP) and hemopexin (HPX)...
October 13, 2017: Pediatric Rheumatology Online Journal
https://www.readbyqxmd.com/read/29026780/status-of-iran-s-primary-health-care-system-in-terms-of-health-systems-control-knobs-a-review-article
#5
REVIEW
Jafar Sadegh Tabrizi, Faramarz Pourasghar, Raana Gholamzadeh Nikjoo
BACKGROUND: After the establishment of Primary Health Care (PHC) program in Iran, health indicators have improved every year. This progress was so rapid that a number of shortcomings and weaknesses of the PHC program remained silent behind its successes. This study aimed to assess the status of Iran's PHC system (strengths, weaknesses, opportunities and threats) in terms of health system's control knobs. METHODS: The search was conducted through two English 'databases of Web of Knowledge and PubMed, two English publications of Science Direct and Springer and two Persian databases of Magiran and SID...
September 2017: Iranian Journal of Public Health
https://www.readbyqxmd.com/read/29025038/selective-progesterone-receptor-modulators-for-fertility-preservation-in-women-with-symptomatic-uterine-fibroids
#6
Mohamed Ali, Ayman Al-Hendy
Uterine Fibroids (UF, AKA: leiomyoma) are the most important benign neoplastic threat to women's health, with costs up to hundreds of billions of health care dollars worldwide. UF caused-morbidities exert a tremendous health toll, impacting the quality of life of women of all ethnicities, especially women of color. Clinical presentations include heavy vaginal bleeding, pelvic pain, bulk symptoms, subfertility, and obstetric complications. Current management strategies heavily lean towards surgical procedures, nonetheless the choice of treatment is generally subject to patient's age and her desire to preserve future fertility...
August 28, 2017: Biology of Reproduction
https://www.readbyqxmd.com/read/29019720/sustainability-and-transformation-plans-translating-the-perspectives
#7
Sonali V Thakrar, Diane Bell
Each local health economy has been tasked with producing a sustainability and transformation plan. A health economy is a system that controls and contributes to health-care resource and the effects of health services on its population. This includes commissioners, acute providers, primary care providers, community services, public health and the voluntary sector. Sustainability and transformation plans represent a shift in the way health care is planned for in England. The aim of each sustainability and transformation plan is to deliver care within existing resource limits by improving quality of care, developing new models of care and improving efficiency of care provision...
October 2, 2017: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/28993306/experiences-with-online-consultation-systems-in-primary-care-case-study-of-one-early-adopter-site
#8
Michael Casey, Sara Shaw, Deborah Swinglehurst
BACKGROUND: There is a strong policy drive towards implementing alternatives to face-to-face consultations in general practice to improve access, efficiency, and cost-effectiveness. These alternatives embrace novel technologies that are assumed to offer potential to improve care. AIM: To explore the introduction of one online consultation system (Tele-Doc) and how it shapes working practices. DESIGN AND SETTING: Mixed methods case study in an inner-city general practice...
October 9, 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/28976423/effectiveness-and-costs-of-a-vocational-advice-service-to-improve-work-outcomes-in-patients-with-musculoskeletal-pain-in-primary-care-a-cluster-randomised-trial-swap-trial-isrctn-52269669
#9
Gwenllian Wynne-Jones, Majid Artus, Annette Bishop, Sarah A Lawton, Martyn Lewis, Sue Jowett, Jesse Kigozi, Chris Main, Gail Sowden, Simon Wathall, A Kim Burton, Danielle A van der Windt, Elaine M Hay, Nadine E Foster
Musculoskeletal pain is a common cause of work absence and early intervention is advocated to prevent the adverse health and economic consequences of longer-term absence. This cluster randomised controlled trial investigated the effect of introducing a vocational advice service, into primary care to provide occupational support. Six general practices were randomised, patients were eligible if they were consulting their general practitioner (GP) with musculoskeletal pain, were employed and struggling at work or absent from work <6 months...
September 30, 2017: Pain
https://www.readbyqxmd.com/read/28973067/cancer-survivorship-care-in-advanced-primary-care-practices-a-qualitative-study-of-challenges-and-opportunities
#10
Ellen B Rubinstein, William L Miller, Shawna V Hudson, Jenna Howard, Denalee O'Malley, Jennifer Tsui, Heather Sophia Lee, Alicja Bator, Benjamin F Crabtree
Importance: Despite a decade of effort by national stakeholders to bring cancer survivorship to the forefront of primary care, there is little evidence to suggest that primary care has begun to integrate comprehensive services to manage the care of long-term cancer survivors. Objective: To explain why primary care has not begun to integrate comprehensive cancer survivorship services. Design, Setting, and Participants: Comparative case study of 12 advanced primary care practices in the United States recruited from March 2015 to February 2017...
September 25, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28971065/preclinical-modeling-and-therapeutic-avenues-for-cancer-metastasis-to-the-central-nervous-system
#11
REVIEW
Mohini Singh, David Bakhshinyan, Chitra Venugopal, Sheila K Singh
Metastasis is the dissemination of cells from the primary tumor to other locations within the body, and continues to be the predominant cause of death among cancer patients. Metastatic progression within the adult central nervous system is 10 times more frequent than primary brain tumors. Metastases affecting the brain parenchyma and leptomeninges are associated with grave prognosis, and even after successful control of the primary tumor the median survival is a dismal 2-3 months with treatment options typically limited to palliative care...
2017: Frontiers in Oncology
https://www.readbyqxmd.com/read/28968275/association-of-hospital-level-neuraxial-anesthesia-use-for-hip-fracture-surgery-with-outcomes-a-population-based-cohort-study
#12
Daniel I McIsaac, Duminda N Wijeysundera, Allen Huang, Gregory L Bryson, Carl van Walraven
BACKGROUND: There is consistent and significant variation in neuraxial anesthesia use for hip fracture surgery across jurisdictions. We measured the association of hospital-level utilization of neuraxial anesthesia, independent of patient-level use, with 30-day survival (primary outcome) and length of stay and costs (secondary outcomes). METHODS: We conducted a population-based cohort study using linked administrative data in Ontario, Canada. We identified all hip fracture patients more than 65 yr of age from 2002 to 2014...
October 2, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28963077/payment-and-care-for-hematopoietic-cellular-transplant-patients-toward-a-specialized-medical-home-for-complex-care-patients
#13
James L Gajewski, Mark B McClellan, Navneet S Majhail, Parameswaran N Hari, Christopher N Bredeson, Richard T Maziarz, Charles F LeMaistre, Michael C Lill, Stephanie H Farnia, Krishna V Komanduri, Michael J Boo
Patient-centered medical home models are fundamental to the advanced alternative payment models (APM) defined in the Medicare Access and Children's Health Insurance Plan (CHIP) Reauthorization Act (MACRA). The patient-centered medical home is a model of health care delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time...
September 26, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28963061/simplifying-the-use-of-pharmacogenomics-in-clinical-practice-building-the-genomic-prescribing-system
#14
Keith Danahey, Brittany A Borden, Brian Furner, Patrick Yukman, Sheena Hussain, Donald Saner, Samuel L Volchenboum, Mark J Ratain, Peter H O'Donnell
BACKGROUND: A barrier to the use of genomic information during prescribing is the limited number of software solutions that combine a user-friendly interface with complex medical data. We built and designed an online, secure, electronic custom interface termed the Genomic Prescribing System (GPS). METHODS: Actionable pharmacogenomic (PGx) information was reviewed, collected, and stored in the back-end of GPS to enable creation of customized drug- and variant-specific clinical decision support (CDS) summaries...
September 26, 2017: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/28961654/qualitative-methodologies-as-an-intervention-beyond-program-planning-and-implementation
#15
Heather Farb, Lisanne Brown, Alexandra Priebe
The Primary Care Capacity Project (PCCP), implemented by the Louisiana Public Health Institute, systematically and rigorously applied qualitative methodologies beyond simple interviews and focus groups to develop the project areas of focus, evaluate clinical transformation interventions in selected heath centers along the Gulf Coast, and provide data and support to foster ongoing quality improvement approaches. Qualitative methodologies were utilized for formative, implementation, and summative evaluation. During the early formative stages of PCCP, community prioritization meetings were conducted in Louisiana, Mississippi, Alabama, and Florida, in which key stakeholders were asked to brainstorm and prioritize major health issues and recommendations in their communities...
November 2017: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/28961651/embedding-a-social-work-led-behavioral-health-program-in-a-primary-care-system-a-2012-2018-case-study
#16
Tim Rehner, Michelle Brazeal, Stephanie T Doty
INTRODUCTION: The focus of this case study was the implementation of a fully integrated system of care that brought mental health into a federally qualified health center's primary care activities. OBJECTIVE: The Mississippi Integrated Health and Disaster Program aimed to increase the federally qualified health center's capacity for providing mental health services and in so doing increase patients' access to mental and behavioral health services in primary care...
November 2017: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/28947346/using-the-4-pillars%C3%A2-practice-transformation-program-to-increase-adolescent-human-papillomavirus-meningococcal-tetanus-diphtheria-pertussis-and-influenza-vaccination
#17
Richard K Zimmerman, Jonathan M Raviotta, Mary Patricia Nowalk, Krissy K Moehling, Evelyn Cohen Reis, Sharon G Humiston, Chyongchiou Jeng Lin
OBJECTIVES: To report the results of an intervention using the 4 Pillars™ Practice Transformation Program (4 Pillars™ Program) to increase adolescent vaccinations including human papillomavirus vaccine (HPV) and influenza vaccines, which remain underutilized in this population. STUDY DESIGN: Eleven pediatric and family medicine practices, previously control sites from a randomized controlled cluster trial, with ≥50 adolescent patients participated. The 4 Pillars™ Program was the foundation of the intervention...
October 27, 2017: Vaccine
https://www.readbyqxmd.com/read/28944141/nationwide-trends-of-hospitalizations-for-cystic-fibrosis-in-the-united-states-from-2003-to-2013
#18
Abhinav Agrawal, Abhishek Agarwal, Dhruv Mehta, Rutuja R Sikachi, Doantrang Du, Janice Wang
Cystic fibrosis (CF) is a multisystem autosomal recessive genetic disorder with significant advances in early diagnosis and treatment in the last decade. It is important to provide updated information regarding these changing demographics as they also reflect a considerable improvement in survival. We analyzed the National Inpatient Sample Database (NIS) in the United States for all patients in which CF was the primary discharge diagnosis (ICD-9: 277.0-277.09) from 2003 to 2013 to evaluate the rate of hospitalizations and determine the cost and mortality associated with CF along with other epidemiological findings...
August 2017: Intractable & Rare Diseases Research
https://www.readbyqxmd.com/read/28930164/liver-cancer-molecular-characterization-clonal-evolution-and-cancer-stem-cells
#19
REVIEW
Germana Castelli, Elvira Pelosi, Ugo Testa
Liver cancer is the second most common cause of cancer-related death. The major forms of primary liver cancer are hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA). Both these tumors develop against a background of cirrhotic liver, non-alcoholic fatty liver disease, chronic liver damage and fibrosis. HCC is a heterogeneous disease which usually develops within liver cirrhosis related to various etiologies: hepatitis B virus (HBV) infection (frequent in Asia and Africa), hepatitis C virus (HCV), chronic alcohol abuse, or metabolic syndrome (frequent in Western countries)...
September 20, 2017: Cancers
https://www.readbyqxmd.com/read/28923809/a-randomized-trial-of-high-value-change-using-practice-facilitation
#20
LeAnn Michaels, Tracy Anastas, Elizabeth Needham Waddell, Lyle Fagnan, David A Dorr
PURPOSE: To understand how focused versus general practice facilitation can impact goal setting, action planning, and team performance in primary care transformation. BACKGROUND: Practice transformation in primary care is a crucial part of health reform, but can fatigue teams, leading to variable results. Practice facilitation may reduce primary care fatigue to help teams reach challenging transformation goals, but may require a more focused approach than previous studies suggest...
September 2017: Journal of the American Board of Family Medicine: JABFM
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