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Primary Care Transformation

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https://www.readbyqxmd.com/read/28442054/when-colocation-is-not-enough-a-case-study-of-general-practitioner-super-clinics-in-australia
#1
Riki Lane, Grant Russell, Elizabeth A Bardoel, Jenny Advocat, Nicholas Zwar, P Gawaine Powell Davies, Mark F Harris
Developed nations are implementing initiatives to transform the delivery of primary care. New models have been built around multidisciplinary teams, information technology and systematic approaches for chronic disease management (CDM). In Australia, the General Practice Super Clinic (GPSC) model was introduced in 2010. A case study approach was used to illustrate the development of inter-disciplinary CDM over 12 months in two new, outer urban GPSCs. A social scientist visited each practice for two 3-4-day periods...
April 2017: Australian Journal of Primary Health
https://www.readbyqxmd.com/read/28441676/transitioning-from-volume-to-value-one-academic-medical-center-s-approach-to-improving-population-health
#2
Stephanie A C Halvorson, Mary E Tanski, Thomas R Yackel
PROBLEM: The U.S. health care system is undergoing a major transformation. Clinical delivery systems are now being paid according to the value of the care they provide, in accordance with the Triple Aim, which incorporates improving the quality and cost of care and the patient experience. Increasingly, financial risk is being transferred from insurers to clinical delivery systems that become responsible for both episode-based clinical care and the longitudinal care of patients. Thus, these delivery systems need to develop strategies to manage the health of populations...
May 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28434279/extended-use-of-electronic-health-records-by-primary-care-physicians-does-the-electronic-health-record-artefact-matter
#3
Louis Raymond, Guy Paré, Marie Marchand
The deployment of electronic health record systems is deemed to play a decisive role in the transformations currently being implemented in primary care medical practices. This study aims to characterize electronic health record systems from the perspective of family physicians. To achieve this goal, we conducted a survey of physicians practising in private clinics located in Quebec, Canada. We used valid responses from 331 respondents who were found to be representative of the larger population. Data provided by the physicians using the top three electronic health record software products were analysed in order to obtain statistically adequate sub-sample sizes...
April 1, 2017: Health Informatics Journal
https://www.readbyqxmd.com/read/28422816/why-not-wait-eight-institutions-share-their-experiences-moving-united-states-medical-licensing-examination-step-1-after-core-clinical-clerkships
#4
Michelle Daniel, Amy Fleming, Colleen O'Conner Grochowski, Vicky Harnik, Sibel Klimstra, Gail Morrison, Arnyce Pock, Michael L Schwartz, Sally Santen
The majority of medical students complete the United States Medical Licensing Examination Step 1 after their foundational sciences; however, there are compelling reasons to examine this practice. This article provides the perspectives of eight MD-granting medical schools that have moved Step 1 after the core clerkships, describing their rationale, logistics of the change, outcomes, and lessons learned. The primary reasons these institutions cite for moving Step 1 after clerkships are to foster more enduring and integrated basic science learning connected to clinical care and to better prepare students for the increasingly clinical focus of Step 1...
April 18, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28418117/articulating-the-ideal-50-years-of-interprofessional-collaboration-in-medical-education
#5
Elise Paradis, Mandy Pipher, Carrie Cartmill, J Cristian Rangel, Cynthia R Whitehead
CONTEXT: Health care delivery and the education of clinicians have changed immensely since the creation of the journal Medical Education. In this project, we seek to answer the following three questions: How has the concept of collaboration changed over the past 50 years in Medical Education? Have the participants involved in collaboration shifted over time? Has the idea of collaboration itself been transformed over the past 50 years? METHODS: Starting from a constructionist view of scientific discourse, we used directed content analysis to sample, code and analyse 144 collaboration-related articles over the 50-year life span of Medical Education...
April 18, 2017: Medical Education
https://www.readbyqxmd.com/read/28409557/randomised-controlled-trial-of-silk-therapeutic-garments-for-the-management-of-atopic-eczema-in-children-the-clothes-trial
#6
Kim S Thomas, Lucy E Bradshaw, Tracey H Sach, Fiona Cowdell, Jonathan M Batchelor, Sandra Lawton, Eleanor F Harrison, Rachel H Haines, Amina Ahmed, Taraneh Dean, Nigel P Burrows, Ian Pollock, Hannah K Buckley, Hywel C Williams, Joanne Llewellyn, Clare Crang, Jane D Grundy, Juliet Guiness, Andrew Gribbin, Eileen V Wake, Eleanor J Mitchell, Sara J Brown, Alan A Montgomery
BACKGROUND: Atopic eczema (AE) is a chronic, itchy, inflammatory skin condition that affects the quality of life of children and their families. The role of specialist clothing in the management of AE is poorly understood. OBJECTIVES: To assess the effectiveness and cost-effectiveness of silk garments for the management of AE in children with moderate to severe disease. DESIGN: Parallel-group, observer-blind, randomised controlled trial of 6 months' duration, followed by a 2-month observational period...
April 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28409068/redefining-health-implication-for-value-based-healthcare-reform
#7
REVIEW
Ikhwanuliman Putera
Health definition consists of three domains namely, physical, mental, and social health that should be prioritized in delivering healthcare. The emergence of chronic diseases in aging populations has been a barrier to the realization of a healthier society. The value-based healthcare concept seems in line with the true health objective: increasing value. Value is created from health outcomes which matter to patients relative to the cost of achieving those outcomes. The health outcomes should include all domains of health in a full cycle of care...
March 2, 2017: Curēus
https://www.readbyqxmd.com/read/28406035/diagnostic-accuracy-of-random-ecg-in-primary-care-for-early-asymptomatic-cardiac-autonomic-neuropathy
#8
Herbert F Jelinek, Marc T P Adam, Robert Krones, David J Cornforth
AIMS: Cardiac autonomic reflex tests (CARTs) are time consuming and require patient cooperation for detecting cardiac autonomic neuropathy (CAN). Heart rate variability (HRV) analysis requires less patient cooperation and is quicker to complete. However the reliability of HRV results as a clinical tool, with respect to length of recording and accuracy of diagnosis is inconclusive. The current study investigated the reproducibility associated with varying length of recording for early CAN (eCAN) assessment...
April 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28399154/silk-garments-plus-standard-care-compared-with-standard-care-for-treating-eczema-in-children-a-randomised-controlled-observer-blind-pragmatic-trial-clothes-trial
#9
Kim S Thomas, Lucy E Bradshaw, Tracey H Sach, Jonathan M Batchelor, Sandra Lawton, Eleanor F Harrison, Rachel H Haines, Amina Ahmed, Hywel C Williams, Taraneh Dean, Nigel P Burrows, Ian Pollock, Joanne Llewellyn, Clare Crang, Jane D Grundy, Juliet Guiness, Andrew Gribbin, Eleanor J Mitchell, Fiona Cowdell, Sara J Brown, Alan A Montgomery
BACKGROUND: The role of clothing in the management of eczema (also called atopic dermatitis or atopic eczema) is poorly understood. This trial evaluated the effectiveness and cost-effectiveness of silk garments (in addition to standard care) for the management of eczema in children with moderate to severe disease. METHODS AND FINDINGS: This was a parallel-group, randomised, controlled, observer-blind trial. Children aged 1 to 15 y with moderate to severe eczema were recruited from secondary care and the community at five UK medical centres...
April 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28394347/new-factors-in-mammalian-dna-repair-the-chromatin-connection
#10
REVIEW
G Raschellà, G Melino, M Malewicz
In response to DNA damage mammalian cells activate a complex network of stress response pathways collectively termed DNA damage response (DDR). DDR involves a temporary arrest of the cell cycle to allow for the repair of the damage. DDR also attenuates gene expression by silencing global transcription and translation. Main function of DDR is, however, to prevent the fixation of debilitating changes to DNA by activation of various DNA repair pathways. Proper execution of DDR requires careful coordination between these interdependent cellular responses...
April 10, 2017: Oncogene
https://www.readbyqxmd.com/read/28385024/patient-experience-midway-through-a-large-primary-care-practice-transformation-initiative
#11
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/28381386/high-grade-pancreatic-intraepithelial-lesions-prevalence-and-implications-in-pancreatic-neoplasia
#12
Jean R Park, Feng Li, Veeral M Oza, Brett C Sklaw, Kevin M Cronley, Michael Wellner, Benjamin Swanson, Somashekar G Krishna
BACKGROUND: High-grade pancreatic intraepithelial neoplasia (PanIN-3), a precursor of pancreatic ductal adenocarcinoma (PDAC), is not universally detected in resected pancreatic neoplasms. We sought to determine the prevalence and prognostic relevance of PanIN-3 lesions in primary surgical resections of PDACs and intraductal papillary mucinous neoplasms (IPMNs). METHODS: A retrospective review of a tertiary care center pathology database (1/2000-6/2014) was performed...
April 2017: Hepatobiliary & Pancreatic Diseases International: HBPD INT
https://www.readbyqxmd.com/read/28379820/physician-and-staff-acceptance-of-care-managers-in-primary-care-offices
#13
Jean M Malouin, Rebecca A Malouin, Issidoros Sarinopoulos, Marie Beisel, Diane Bechel-Marriot, Amanda First, Ginger M Gamble, Clare Tanner
INTRODUCTION: Embedded care managers are increasingly implemented as part of the care team within primary care practices, yet previous studies have indicated variability in acceptance by physicians and staff. This study assesses the acceptability of care managers among staff and physicians within the Michigan Primary Care Transformation (MiPCT) demonstration. METHODS: Care manager acceptance was measured using a web-based survey distributed to practices participating in the MiPCT demonstration...
March 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28379048/integrated-approaches-to-physical-therapy-education-a-new-comprehensive-model-from-the-university-of-illinois-chicago
#14
Ross Arena, Gay Girolami, Alexander Aruin, Aaron Keil, Jenna Sainsbury, Shane A Phillips
Demand for physical therapists in the United States (U.S.) is currently robust and expected to grow further. There are currently 228 physical therapy programs accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE), and 30 more are in development in the U.S.; 29,246 students are currently enrolled in these programs (2014-2015 data). A shortage of physical therapy faculty with an advanced doctoral degree (i.e., PhD, EdD, DSc) is a primary concern for these programs. Specialized residency and fellowship training in physical therapy continue to expand, preparing professionals to deliver advanced clinical care...
April 5, 2017: Physiotherapy Theory and Practice
https://www.readbyqxmd.com/read/28376771/ehealth-in-the-future-of-medications-management-personalisation-monitoring-and-adherence
#15
EDITORIAL
Josip Car, Woan Shin Tan, Zhilian Huang, Peter Sloot, Bryony Dean Franklin
BACKGROUND: Globally, healthcare systems face major challenges with medicines management and medication adherence. Medication adherence determines medication effectiveness and can be the single most effective intervention for improving health outcomes. In anticipation of growth in eHealth interventions worldwide, we explore the role of eHealth in the patients' medicines management journey in primary care, focusing on personalisation and intelligent monitoring for greater adherence. DISCUSSION: eHealth offers opportunities to transform every step of the patient's medicines management journey...
April 5, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28376461/increased-health-information-technology-adoption-and-use-among-small-primary-care-physician-practices-over-time-a-national-cohort-study
#16
Diane R Rittenhouse, Patricia P Ramsay, Lawrence P Casalino, Sean McClellan, Zosha K Kandel, Stephen M Shortell
PURPOSE: Implementation and meaningful use of health information technology (HIT) has been shown to facilitate delivery system transformation, yet implementation is far from universal. This study examined correlates of greater HIT implementation over time among a national cohort of small primary care practices in the United States. METHODS: We used data from a 40-minute telephone panel survey of 566 small primary care practices having 8 or fewer physicians to investigate adoption and use of HIT in 2007-2010 and 2012-2013...
January 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/28364926/transforming-vaccines-supply-chains-in-nigeria
#17
David Sarley, Mustafa Mahmud, Jide Idris, Modele Osunkiyesi, Onome Dibosa-Osadolor, Peter Okebukola, Owens Wiwa
Nigeria is the most populous country in Africa and in 2012 was suffering some of the lowest vaccination rates in the World. A combination of factors had resulted in a dysfunctional immunization cold chain and supply chain. Recognizing that the number of unimmunized children contributed to high levels of under-5-mortality, and that health MDGs would not be attained, Minister of State for Health Mohammed Pate launched a vaccines transformation project in 2013. In partnership with BMGF, GAVI, UNICEF, WHO, other donors and implementing partners the transformation journey has so far taken three years and achieved impressive results...
April 19, 2017: Vaccine
https://www.readbyqxmd.com/read/28356722/from-therapeutic-patient-education-principles-to-educative-attitude-the-perceptions-of-health-care-professionals-a-pragmatic-approach-for-defining-competencies-and-resources
#18
Benoit Pétré, Remi Gagnayre, Vincent De Andrade, Olivier Ziegler, Michèle Guillaume
Educative attitude is an essential, if implicit, aspect of training to acquire competency in therapeutic patient education (TPE). With multiple (or nonexistent) definitions in the literature, however, the concept needs clarification. The primary aim of this study was to analyze the representations and transformations experienced by health care professionals in the course of TPE training in order to characterize educative attitude. We conducted an exploratory qualitative study using several narrative research-based tools with participants of two TPE continuing education courses...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/28343236/effects-of-restricting-perioperative-use-of-intravenous-chloride-on-kidney-injury-in-patients-undergoing-cardiac-surgery-the-licra-pragmatic-controlled-clinical-trial
#19
David McIlroy, Deirdre Murphy, Jessica Kasza, Dhiraj Bhatia, Lisa Wutzlhofer, Silvana Marasco
PURPOSE: The administration of chloride-rich intravenous (IV) fluid and hyperchloraemia have been associated with perioperative renal injury. The aim of this study was to determine whether a comprehensive perioperative protocol for the administration of chloride-limited IV fluid would reduce perioperative renal injury in adults undergoing cardiac surgery. METHODS: From February 2014 through to December 2015, all adult patients undergoing cardiac surgery within a single academic medical center received IV fluid according to the study protocol...
March 25, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28342621/how-nurse-led-practices-perceive-implementation-of-the-patient-centered-medical-home
#20
Rosemary Frasso, A Golinkoff, Heather Klusaritz, Katherine Kellom, Helen Kollar-McArthur, Michelle Miller-Day, Robert Gabbay, Peter F Cronholm
PURPOSE: The Affordable Care Act (ACA) promotes the Patient-Centered Medical Home (PCMH) model as a way to improve healthcare quality, the patient experience, and has identified nurse-led primary care as a mechanism meeting the increasing demand for quality primary care. The purpose of this study was to investigate the implementation of a PCMH model in nurse-led primary care practices and to identify facilitators and barriers to the implementation of this model. METHODS: Data were collected through in-depth interviews with providers and staff in nurse-led practices...
April 2017: Applied Nursing Research: ANR
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