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Primary Care Transformation

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https://www.readbyqxmd.com/read/28648219/primary-care-collaboration-to-improve-diagnosis-and-screening-for-colorectal-cancer
#1
Gordon D Schiff, Trudy Bearden, Lindsay Swain Hunt, Jennifer Azzara, Jay Larmon, Russell S Phillips, Sara Singer, Brandon Bennett, Jonathan R Sugarman, Asaf Bitton, Andrew Ellner
BACKGROUND: Colorectal cancer (CRC) is a leading cause of cancer death, reducible by screening and early diagnosis, yet many patients fail to receive recommended screening. As part of an academic improvement collaborative, 25 primary care practices worked to improve CRC screening and diagnosis. METHODS: The project featured triannual learning sessions, monthly conference calls, practice coach support, and monthly reporting. The project phases included literature review and interviews with national leaders/organizations, development of driver diagrams to identify key factors and change ideas, project launch and practice team planning, and a practice improvement phase...
July 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28639548/a-leadership-perspective-on-a-shared-vision-for-healthcare
#2
Tracy Kitch
Our country's recent negotiations for a new Health Accord have shone light on the importance of more accessible and better home care. The direction being taken on health funding investments has sent a strong message about healthcare system redesign. It is time to design a healthcare system that moves us away from a hospital-focused model to one that is more effective, integrated and sustainable and one that places a greater emphasis on primary care, community care and home care. The authors of the lead paper (Sharkey and Lefebre 2017) provide their vision for people-powered care and explore the opportunity for nursing leaders to draw upon the unique expertise and insights of home care nursing as a strategic lever to bring about real health system transformation across all settings...
2017: Nursing Leadership
https://www.readbyqxmd.com/read/28620725/understanding-adaptations-to-patient-centered-medical-home-activities-the-pcmh-adaptations-model
#3
Tristen L Hall, Jodi Summers Holtrop, L Miriam Dickinson, Russell E Glasgow
Primary care practices have increasingly adopted the patient-centered medical home (PCMH) model and often adapted quality improvement efforts to fit local context. This paper implemented a modified framework for understanding adaptations in the context of primary care PCMH transformation efforts. We combined an adaptations model by Stirman et al. that categorized adaptations to evidence-based interventions in research studies with dimensions from the RE-AIM framework, as well as items specific to PCMH. The resulting constructs were translated into a "plain English" adaptations interview...
June 15, 2017: Translational Behavioral Medicine
https://www.readbyqxmd.com/read/28617024/evaluating-transformation-with-available-resources-the-influence-of-apex-on-depression-screening
#4
Peter C Smith, Shandra M Brown Levey, Corey Lyon
OBJECTIVE: The University of Colorado developed and piloted a team-based primary care delivery model called ambulatory process excellence (APEX) in a family medicine residency in 2015. We evaluated its impact on depression screening using found data and tools readily available to practice-based evaluators. METHOD: The APEX model calls for 5 medical assistants (MAs) supporting 2 providers. MAs have dedicated time to provide delegated care, including depression screening with 2 versions of the Patient Health Questionnaire: PHQ-2 and PHQ-9...
June 2017: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/28604260/developing-high-functioning-teams-factors-associated-with-operating-as-a-real-team-and-implications-for-patient-centered-medical-home-development
#5
Somava Stout, Leah Zallman, Lisa Arsenault, Assaad Sayah, Karen Hacker
Team-based care is a foundation of health care redesign models like the patient-centered medical home (PCMH). Yet few practices rigorously examine how the implementation of PCMH relates to teamwork. We identified factors associated with the perception of a practice operating as a real team. An online workforce survey was conducted with all staff of 12 primary care sites of Cambridge Health Alliance at different stages of PCMH transformation. Bivariate and multivariate analyses of factors associated with teamwork perceptions were conducted...
January 1, 2017: Inquiry: a Journal of Medical Care Organization, Provision and Financing
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
#6
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/28598250/telehealth-centers-a-proposal-of-a-theoretical-model-for-evaluation
#7
Luana Gabriele Nilson, Luise Lüdke Dolny, Sônia Natal, Josimari Telino de Lacerda, Maria Cristina Marino Calvo
BACKGROUND: Telehealth is a form of assistance support and continuing education for professionals who work in Primary Healthcare. INTRODUCTION: The implementation of the Brazilian Telehealth Program has extended the need for evaluation of its results to improve its use and benefits. Thus, it is necessary to systematize the theory, principals, and guidelines that guide the program organization, its activities, and resources. The objective of this study is to propose a theoretical model of functioning and organization for telehealth centers of the Brazilian Telehealth Program...
June 9, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28594714/tailored-treatment-strategy-for-locally-advanced-rectal-carcinoma-based-on-the-tumor-response-to-induction-chemotherapy-preliminary-results-of-the-french-phase-ii-multicenter-greccar4-trial
#8
Philippe Rouanet, Eric Rullier, Bernard Lelong, Philippe Maingon, Jean-Jacques Tuech, Denis Pezet, Florence Castan, Stéphanie Nougaret
BACKGROUND: Preoperative radiochemotherapy and total mesorectal excision are the standard-of-care for locally advanced rectal carcinoma, but some patients could be over- or undertreated. OBJECTIVE: This study aimed to assess the feasibility of radiochemotherapy tailored based on the tumor response to induction chemotherapy (FOLFIRINOX) to obtain a minimum R0 resection rate of 90% in the 4 arms of the study. DESIGN: This study is a multicenter randomized trial (NCT01333709)...
July 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28585163/engaging-multilevel-stakeholders-in-an-implementation-trial-of-evidence-based-quality-improvement-in-va-women-s-health-primary-care
#9
Alison B Hamilton, Julian Brunner, Cindy Cain, Emmeline Chuang, Tana M Luger, Ismelda Canelo, Lisa Rubenstein, Elizabeth M Yano
The Veterans Health Administration (VHA) has undertaken primary care transformation based on patient-centered medical home (PCMH) tenets. VHA PCMH models are designed for the predominantly male Veteran population, and require tailoring to meet women Veterans' needs. We used evidence-based quality improvement (EBQI), a stakeholder-driven implementation strategy, in a cluster randomized controlled trial across 12 sites (eight EBQI, four control) that are members of a Practice-Based Research Network. EBQI involves engaging multilevel, inter-professional leaders and staff as stakeholders in reviewing evidence and setting QI priorities...
June 5, 2017: Translational Behavioral Medicine
https://www.readbyqxmd.com/read/28582981/professional-nurses-perceptions-and-experiences-with-the-implementation-of-an-integrated-chronic-care-model-at-primary-healthcare-clinics-in-south-africa
#10
Ozayr H Mahomed, Shaidah Asmall
BACKGROUND: An integrated chronic disease management model has been implemented across primary healthcare clinics in order to transform the delivery of services for patients with chronic diseases. The sustainability and rapid scale-up of the model is dependent on positive staff perceptions and experiences. OBJECTIVES: The aim of the study was to determine the perceptions and experiences of professional nurses with the integrated chronic care model that has been implemented...
May 23, 2017: Curationis
https://www.readbyqxmd.com/read/28580776/do-we-have-enough-evidence-for-minimally-invasive-cardiac-surgery-a-critical-review-of-scientific-and-non-scientific-information
#11
REVIEW
Torsten Doenst, Joseph Lamelas
Reducing surgical trauma by minimizing skin incisions has transformed abdominal surgery resulting in significant improvements in outcome. In cardiac surgery, such efforts have also been made, but similar benefits could not be demonstrated. In addition, any potential benefit comes at the cost of increased cardiopulmonary bypass and clamp times, leading to questions regarding the safety of minimally invasive cardiac surgery (MICS). Nevertheless, outcomes have been equivalent to matched sternotomy cases and there is no doubt that the number of patients undergoing minimally-invasive mitral or aortic procedures is slowly increasing...
August 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28569614/stability-of-blood-eosinophil-count-in-patients-with-copd-in-the-uk-clinical-practice-research-datalink
#12
Sarah H Landis, Robert Suruki, Emma Hilton, Chris Compton, Nicholas W Galwey
Blood eosinophil counts may be predictive of corticosteroid response in chronic obstructive pulmonary disease (COPD) patients. However, little is known about measurement stability, which is important for understanding the utility of blood eosinophil counts as a potential biomarker. We evaluated the stability of blood eosinophil counts over 1 year in a population-based cohort of patients with COPD in primary care. Patients were aged ≥ 40 years with forced expiratory volume in 1 second/forced vital capacity < 0...
June 1, 2017: COPD
https://www.readbyqxmd.com/read/28568245/quality-metrics-and-systems-transformation-are-we-advancing-alcohol-and-drug-screening-in-primary-care
#13
Traci Rieckmann, Stephanie Renfro, Dennis McCarty, Robin Baker, K John McConnell
OBJECTIVE: To examine the influence of Oregon's coordinated care organizations (CCOs) and pay-for-performance incentive model on completion of screening and brief intervention (SBI) and utilization of substance use disorder (SUD) treatment services. DATA SOURCES/STUDY SETTING: Secondary analysis of Medicaid encounter data from 2012 to 2015 and semiannual qualitative interviews with stakeholders in CCOs. STUDY DESIGN: Longitudinal mixed-methods design with simultaneous data collection with equal importance...
May 31, 2017: Health Services Research
https://www.readbyqxmd.com/read/28545159/the-value-transformation-of-health-care-impact-on-neuromuscular-and-electrodiagnostic-medicine
#14
Pushpa Narayanaswami, Millie Suk, Lyell K Jones
INTRODUCTION: Beginning in 2017, most physicians who participate in Medicare are subject to the Medicare Access and CHIP Reauthorization Act (MACRA), the milestone legislation that signals the US health care system's transition from volume-based to value-based care. METHODS: Review of emerging trends in development of value-based healthcare systems in the US. RESULTS: MACRA and the resulting Quality Payment Program (QPP) create two participation pathways, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (AAPM) pathway...
May 25, 2017: Muscle & Nerve
https://www.readbyqxmd.com/read/28542080/manuscript-title-multidisciplinary-point-of-care-testing-in-south-african-primary-healthcare-clinics-accelerates-hiv-art-initiation-but-does-not-alter-retention-in-care
#15
Wendy S Stevens, Natasha M Gous, William B MacLeod, Lawrence C Long, Ebrahim Variava, Neil A Martinson, Ian Sanne, Regina Osih, Lesley E Scott
BACKGROUND: Lack of accessible laboratory infrastructure limits HIV antiretroviral (ART) treatment initiation, monitoring and retention in many resource-limited settings. Point-of-care testing (POCT) is advocated as a mechanism to overcome these limitations. We executed a pragmatic, prospective, randomized, controlled trial comparing the impact of POCT versus standard-of-care (SOC) on treatment initiation and retention in care. METHOD: Selected POC technologies were embedded at 3 primary health clinics in South Africa...
May 23, 2017: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/28535480/ozonation-of-the-oxybenzone-octinoxate-and-octocrylene-uv-filters-reaction-kinetics-absorbance-characteristics-and-transformation-products
#16
Zachary R Hopkins, Sebastian Snowberger, Lee Blaney
UV-filters (UVFs) are active ingredients in personal care products that protect skin from exposure to UV light. Environmentally-relevant concentrations of UVFs have recently been linked to toxicity in aquatic organisms, necessitating research into improved UVF removal in water/wastewater treatment. Here, we investigated ozonation of the three most commonly employed UVFs: octinoxate (OMC), octocrylene (OC), and oxybenzone (OXY). Specific second-order rate constants for UVF reaction with ozone were identified as follows: OMC, 5...
May 10, 2017: Journal of Hazardous Materials
https://www.readbyqxmd.com/read/28532306/from-instinct-to-evidence-the-role-of-data-in-country-decision-making-in-chile
#17
Ximena Paz Aguilera, Consuelo Espinosa-Marty, Carla Castillo-Laborde, Claudia Gonzalez
BACKGROUND: The Chilean health system has undergone profound reforms since 1990, while going through political upheaval and facing demographic, health, and economic transformations. The full information requirements to develop an evidence-informed process implied the best possible use of the available data, as well as efforts to improve information systems. OBJECTIVE: To examine, from a historical perspective, the use of evidence during the health sector reforms undertaken in Chile from 1990 to date, and to identify the factors that have both determined improvements in the data and facilitated their use...
January 2017: Global Health Action
https://www.readbyqxmd.com/read/28515919/programmed-death-ligand-1-expression-is-associated-with-fibrosarcomatous-transformation-of-dermatofibrosarcoma-protuberans
#18
Kenji Tsuchihashi, Hitoshi Kusaba, Yuichi Yamada, Yuta Okumura, Hozumi Shimokawa, Masato Komoda, Keita Uchino, Tomoyasu Yoshihiro, Nobuhiro Tsuruta, Fumiyasu Hanamura, Kyoko Inadomi, Mamoru Ito, Kosuke Sagara, Michitaka Nakano, Kenta Nio, Shuji Arita, Hiroshi Ariyama, Kenichi Kohashi, Ryuji Tominaga, Yoshinao Oda, Koichi Akashi, Eishi Baba
Dermatofibrosarcoma protuberans (DFSP) is a locally invading tumor, characterized by the presence of the collagen type I α 1 (COL1A1)-platelet-derived growth factor (PDGF) β fusion gene. We herein report the case of a 31-year-old man with a history of resection of an abdominal wall DFSP. The patient presented with chest pain and a computed tomography scan revealed a large mass in the posterior mediastinum and another mass in the right lung. The mediastinal mass was a sarcomatous lesion expressing the COL1A1-PDGFβ fusion gene, suggesting that it represented a metastasis of the DFSP following fibrosarcomatous (FS) transformation...
May 2017: Molecular and Clinical Oncology
https://www.readbyqxmd.com/read/28513769/the-situation-of-nursing-education-in-latin-america-and-the-caribbean-towards-universal-health
#19
Silvia Helena De Bortoli Cassiani, Lynda Law Wilson, Sabrina de Souza Elias Mikael, Laura Morán Peña, Rosa Amarilis Zarate Grajales, Linda L McCreary, Lisa Theus, Maria Del Carmen Gutierrez Agudelo, Adriana da Silva Felix, Jacqueline Molina de Uriza, Nathaly Rozo Gutierrez
Objective: to assess the situation of nursing education and to analyze the extent to which baccalaureate level nursing education programs in Latin America and the Caribbean are preparing graduates to contribute to the achievement of Universal Health. Method: quantitative, descriptive/exploratory, cross-sectional study carried out in 25 countries. Results: a total of 246 nursing schools participated in the study. Faculty with doctoral level degrees totaled 31...
May 11, 2017: Revista Latino-americana de Enfermagem
https://www.readbyqxmd.com/read/28506022/breast-osteoblastoma-and-recurrence-after-resection-demonstration-by-color-doppler-ultrasound
#20
Xia Li, Hua Xin, Shifeng Yang, Miaoqing Zhao, Ximing Wang, Nan Zhang
Osteoblastoma is a rare benign primary bone tumor, which occurs in any part of the skeleton. Extraskeletal osteoblastoma is rather rare. We presented an extremely rare case of extraskeletal osteoblastoma located in the breast. The tumor recurred 7 months later after resection and transformed to aggressive osteoblastoma. The histopathological features, ultrasonic manifestations and ultrasonic differential diagnoses of the primary and recurrent tumors were discussed. The recommended treatment of the tumor is surgical excision...
May 6, 2017: Journal of X-ray Science and Technology
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