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Primary Care Transformation

Richard K Zimmerman, Anthony E Brown, Valory N Pavlik, Krissy K Moehling, Jonathan M Raviotta, Chyongchiou J Lin, Song Zhang, Mary Hawk, Shakala Kyle, Suchita Patel, Faruque Ahmed, Mary Patricia Nowalk
OBJECTIVES: To test the effectiveness of a step-by step, evidence-based guide, the 4 Pillars Practice Transformation Program, to increase adult pneumococcal vaccination. DESIGN: Randomized controlled cluster trial (RCCT) in Year 1 (June 1, 2013 to May 31, 2014) and pre-post study in Year 2 (June 1, 2014 to January 31, 2015) with data analyzed in 2016. Baseline year was June 1, 2012, to May 31, 2013. Demographic and vaccination data were derived from deidentified electronic medical record extractions...
October 18, 2016: Journal of the American Geriatrics Society
Steven Steinhubl
Despite having the basic tools necessary to appropriately identify and manage individuals with hypertension for over half a century it remains the single greatest contributing risk factor to morbidity and mortality worldwide today. Since diagnosis and effective treatment availability are not issues, this major failing in care can be attributed to inadequate systems of care: systems that have led to only <20% of hypertensive individuals globally having their blood pressure adequately controlled. Even in the US, where it is one of the most common reasons for a primary care visit, and with over $42...
September 2016: Journal of Hypertension
Polly Hitchcock Noël, Salene Jones, Michael L Parchman
RATIONALE: Aims and Objective: The validation study of the Patient Assessment of Chronic Illness Care (PACIC) questionnaire suggested a 5-factor structure determined a priori, but subsequent analyses have questioned the validity of the original factor structure. This study analyzed the factor structure of the PACIC using a large and diverse patient sample, and evaluated the identified factors through the lens of recent transformational initiatives in primary care. METHODS: Convenience samples of adults completed surveys in waiting rooms during clinic visits...
2016: European Journal for Person Centered Healthcare
David Hamilton, Vinidh Paleri
Morbidity and mortality associated with increasingly radical doses of chemoradiotherapy have led many to question the current standard of care in head and neck cancer. Recently, surgeons have developed minimally invasive, transoral techniques which have demonstrated excellent survival and favourable functional outcomes. Transoral robotic surgery (TORS) is the most recent, cutting edge in the evolution of transoral techniques; TORS allows surgeons unprecedented access to and visualisation of the upper aerodigestive tract...
October 11, 2016: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Gerald Kayingo, Owais Gilani, Vasco Deon Kidd, Mary L Warner
BACKGROUND AND OBJECTIVES: The transformation of primary care (PC) training sites into patient-centered medical homes (PCMH) has implications for the education of health professionals. This study investigates the extent to which physician assistant (PA) students report learning about the PCMH model and how clinical exposure to PCMH might impact their interest in a primary care career. METHODS: An electronic survey was distributed to second-year PA students who had recently completed their PC rotation from 12 PA programs...
October 2016: Family Medicine
Yves Bergevin, Bettina Habib, Keesa Elicksen-Jensen, Stephen Samis, Jean Rochon, Jean-Louis Denis, Denis Roy
A study on the impact of regionalization on the Triple Aim of Better Health, Better Care and Better Value across Canada in 2015 identified major findings including: (a) with regard to the Triple Aim, the Canadian situation is better than before but variable and partial, and Canada continues to underperform compared with other industrialized countries, especially in primary healthcare where it matters most; (b) provinces are converging toward a two-level health system (provincial/regional); (c) optimal size of regions is probably around 350,000-500,000 population; d) citizen and physician engagement remains weak...
2016: HealthcarePapers
Glòria Jodar I Solà, Joan Gené I Badia, Pilar Delgado Hito, M Antonia Campo Osaba, Jose Luís Del Val García
BACKGROUND: The concept of leadership has been studied in various disciplines and from different theoretical approaches. It is a dynamic concept that evolves over time. There are few studies in our field on managers' self-perception of their leadership style. There are no pure styles, but one or another style is generally favoured to a greater or lesser degree. In the primary health care (PHC) setting, managers' leadership style is defined as a set of attitudes, behaviours, beliefs and values...
October 12, 2016: BMC Health Services Research
Maria M Lowe, David A Blaser, Lisa Cone, Steve Arcona, John Ko, Rahul Sasane, Paul Wicks
BACKGROUND: To ensure the creation of treatments that maximize value at the lowest cost, all aspects of the health care system need to align with patient needs and preferences. Despite growing efforts to engage patients in research and regulatory activities, the pharmaceutical industry has yet to maximize patient involvement in the drug development process. OBJECTIVE: To gain a better understanding of the present state of patient involvement in drug development...
September 2016: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Sonya L Heltshe, Jonathan Cogen, Kathleen J Ramos, Christopher H Goss
Cystic fibrosis (CF) is the most common life shortening monogenetic disorder involving the lung affecting over 70,000 people worldwide. It has now been over 25 years since the identification of the disease-causing gene defect [the gene producing cystic fibrosis transmembrane conductance regulator protein (CFTR)]. Since this discovery, dramatic advances have occurred both in the basic science underpinning our understanding of the clinical presentation of CF, and in clinical outcomes noted by improvement in lung function and survival...
October 6, 2016: American Journal of Respiratory and Critical Care Medicine
James C Rajotte, Deborah Garneau, Nancy Sutton, Ailis Clyne
"The goal of community health teams is to develop and implement care models that integrate clinical and community health promotion and preventive services for patients." -Association of State and Territorial Health Officials (ASTHO)1 Eleven community health teams (CHTs) operate in various geographies within Rhode Island. Physicians and payers refer their highest-risk patients to CHTs that serve as community extenders. Community health workers and others work to link referred individuals to primary care and work to address the other determinants affecting their health, such as safe housing...
October 4, 2016: Rhode Island Medical Journal
Jared Conley, Colin W O'Brien, Bruce A Leff, Shari Bolen, Donna Zulman
Importance: Determining innovative approaches that better align health needs to the appropriate setting of care remains a key priority for the transformation of US health care; however, to our knowledge, no comprehensive assessment exists of alternative management strategies to hospital admission for acute medical conditions. Objective: To examine the effectiveness, safety, and cost of managing acute medical conditions in settings outside of a hospital inpatient unit...
October 3, 2016: JAMA Internal Medicine
Ursula Koch, Somava Stout, Bruce E Landon, Russell S Phillips
Innovations in payment are encouraging clinical-community partnerships that address health determinants. However, little is known about how healthcare systems transform and partner to improve population health. We synthesized views of population health experts from nine organizations and illustrated the resulting model using examples from four health systems. The transformation requires a foundation of primary care, connectors and integrators that span the boundaries, sharing of goals among participants, aligned funding and incentives, and a supporting infrastructure, all leading to a virtuous cycle of collaboration...
September 28, 2016: Healthcare
Scott A Berkowitz, Patricia Brown, Daniel J Brotman, Amy Deutschendorf, Linda Dunbar, Anita Everett, Debra Hickman, Eric Howell, Leon Purnell, Carol Sylvester, Ray Zollinger, Michele Bellantoni, Samuel C Durso, Constantine Lyketsos, Paul Rothman
To address the challenging health care needs of the population served by an urban academic medical center, we developed the Johns Hopkins Community Health Partnership (J-CHiP), a novel care coordination program that provides services in homes, community clinics, acute care hospitals, emergency departments, and skilled nursing facilities. This case study describes a comprehensive program that includes: a community-based intervention using multidisciplinary care teams that work closely with the patient's primary care provider; an acute care intervention bundle with collaborative team-based care; and a skilled nursing facility intervention emphasizing standardized transitions and targeted use of care pathways...
September 29, 2016: Healthcare
Hui Shao, Lisanne Brown, Mark L Diana, Laura A Schmidt, Karen Mason, Carlos Irwin Oronce, Lizheng Shi
There is a need to understand the costs associated with supporting, implementing, and maintaining the system redesign of small and medium-sized safety-net clinics. The authors aimed to understand the characteristics of clinics that transformed into patient-centered medical homes and the incremental cost for transformation.The sample was 74 clinics in Greater New Orleans that received funds from the Primary Care Access and Stabilization Grant program between 2007 and 2010 to support their transformation. The study period was divided into baseline (September 21, 2007-March 21, 2008), transformation (March 22, 2008-March 21, 2009), and maintenance (March 22, 2009-September 20, 2010) periods, and data were collected at 6-month intervals...
September 2016: Medicine (Baltimore)
Amranul Haque, Pantea Gheibi, Yandong Gao, Elena Foster, Kyung Jin Son, Jungmok You, Gulnaz Stybayeva, Dipali Patel, Alexander Revzin
The approaches for maintaining hepatocytes in vitro are aimed at recapitulating aspects of the native liver microenvironment through the use of co-cultures, surface coatings and 3D spheroids. This study highlights the effects of spatial confinement-a less studied component of the in vivo microenvironment. We demonstrate that hepatocytes cultured in low-volume microfluidic channels (microchambers) retain differentiated hepatic phenotype for 21 days whereas cells cultured in regular culture plates under identical conditions de-differentiate after 7 days...
September 29, 2016: Scientific Reports
Valerie S Harder, Webb E Long, Susan E Varni, Jenney Samuelson, Judith S Shaw
Patient-centered medical home (PCMH) transformation has been challenging for pediatric practices, in part because of the National Committee for Quality Assurance (NCQA) PCMH focus on conditions and processes specific to adult patients. Realizing the potential challenges faced by pediatric practices, Vermont supported pediatric-informed facilitators to help practices during PCMH transformation. This study characterizes the impact of pediatric-informed facilitators; provides benchmark data on NCQA scores, number of facilitation meetings, and the time between facilitation start and end; and compares pediatric- and adult-serving practices...
September 27, 2016: Clinical Pediatrics
Fugen Cullu, Mehmet Vural
The general health status of the Turkish people has improved significantly in recent years. Improvements in the health status of the child population followed the introduction of health reforms, such as the Health Transformation Program. Presently, Turkey is undergoing further important changes concerning its medical system. The changes introduced during 2005-2015 have provided almost complete health insurance coverage and increased accessibility to primary health care givers. However, health providers realize that there are ongoing inefficiencies and deficiencies in both the health care system and health education...
October 2016: Journal of Pediatrics
Abigail Shatkin-Margolis, Maqdooda Merchant, Rebecca U Margulies, Olga Ramm
OBJECTIVES: Minimally invasive approaches to sacrocolpopexy have transformed it into a primary procedure for treatment of pelvic organ prolapse. Certain modifications are commonly used to facilitate the laparoscopic approach, but have not yet been widely studied. In this study, we investigated the efficacy and safety of titanium surgical tacks for the attachment of mesh to the anterior longitudinal ligament in laparoscopic sacrocolpopexy. METHODS: This retrospective cohort study involved all patients within 1 health care system who underwent laparoscopic sacrocolpopexy between January 2009 and December 2012...
September 21, 2016: Female Pelvic Medicine & Reconstructive Surgery
Steven Steinhubl
Despite having the basic tools necessary to appropriately identify and manage individuals with hypertension for over half a century it remains the single greatest contributing risk factor to morbidity and mortality worldwide today. Since diagnosis and effective treatment availability are not issues, this major failing in care can be attributed to inadequate systems of care: systems that have led to only <20% of hypertensive individuals globally having their blood pressure adequately controlled. Even in the US, where it is one of the most common reasons for a primary care visit, and with over $42...
September 2016: Journal of Hypertension
Steven Koslov, Elizabeth Trowbridge, Sandra Kamnetz, Sally Kraft, Jeffrey Grossman, Nancy Pandhi
BACKGROUND: Primary care is considered the foundation of an effective health care system. However, primary care departments at academic health centers have numerous challenges to overcome when trying to achieve the Triple Aim. METHODS: As part of an organizational initiative to redesign primary care at a large academic health center, departments of internal medicine, general pediatrics and adolescent medicine, and family medicine worked together to comprehensively redesign primary care...
September 2016: Healthcare
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