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Comanagement

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https://www.readbyqxmd.com/read/28328592/status-asthmaticus-and-central-herniation-a-case-for-multidisciplinary-critical-care
#1
Joelle B Karlik, Tristan Stani, Stephanie Nonas, Aclan Dogan, Ansgar Brambrink
A 24-year-old woman with history of asthma was intubated emergently for acute status asthmaticus triggered by acute respiratory syncytial virus infection and treated with permissive hypercapnia. Her ventilation was complicated by auto-positive end-expiratory pressure and elevated peak airway, plateau, and central venous pressures. On hospital day 2, she was noted to have anisocoria. Imaging showed diffuse cerebral edema with central herniation. Difficult ventilation and hypercapnia directly contributed to her severe cerebral edema...
March 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28282334/practitioner-application-using-a-comanagement-model-to-develop-a-hip-fracture-integrated-care-pathway
#2
Nancy Jacoby
No abstract text is available yet for this article.
March 2017: Journal of Healthcare Management / American College of Healthcare Executives
https://www.readbyqxmd.com/read/28282333/using-a-comanagement-model-to-develop-a-hip-fracture-integrated-care-pathway
#3
Gonzalo Barinaga, Zain Sayeed, Afshin Anoushiravani, Steven Scaife, Mouhanad El-Othmani, Khaled Jamal Saleh
Hip fracture care represents a service line that profoundly affects patients' quality of life. As hospitals and physicians are motivated to improve quality, reduce costs, and maximize efficiency of care, several alignment models have been proposed under new healthcare legislation. Evaluation of such models as they pertain to hip fracture care warrants further investigation. In this article, we identify the current model of operations present in large healthcare organizations, examine the reasoning behind hospital-physician alignment, and describe specific comanagement principles that are common in healthcare settings...
March 2017: Journal of Healthcare Management / American College of Healthcare Executives
https://www.readbyqxmd.com/read/28279638/which-pediatricians-comanage-mental-health-conditions
#4
Cori Green, Amy Storfer-Isser, Ruth E K Stein, Andrew S Garner, Bonnie D Kerker, Moira Szilagyi, Karen G O'Connor, Kimberly E Hoagwood, Sarah M Horwitz
OBJECTIVE: Given the prevalence of mental health (MH) conditions (MHC) in children, pediatricians should initiate treatment alone or in collaboration with a specialist for children with MHC. However, the majority of pediatricians do not manage or comanage common MHC even with an on-site MH provider. We examined which physician, practice, and training characteristics are associated with pediatricians' comanaging at least half of their patients with MHC. METHODS: We analyzed responses of general pediatricians (n = 305) from the American Academy of Pediatrics 2013 Periodic Survey...
March 6, 2017: Academic Pediatrics
https://www.readbyqxmd.com/read/28250024/care-system-redesign-for-preterm-children-after-discharge-from-the-nicu
#5
Dennis Z Kuo, Robert E Lyle, Patrick H Casey, Christopher J Stille
Approximately 1 in 8 children in the United States are born preterm. Existing guidelines and research examine the cost of prematurity from the NICU stay and developmental surveillance and outcomes after discharge from the NICU. Preterm children are at greater risk for excess hospitalizations, outpatient visits, and societal costs after NICU discharge. Improved delivery of care and health promotion from the community setting, particularly from the patient-centered medical home, may result in improved growth, health, and development, with accompanying reduction of post-NICU discharge costs and encounters...
March 1, 2017: Pediatrics
https://www.readbyqxmd.com/read/28228099/impact-of-adding-additional-providers-to-resident-workload-and-the-resident-experience-on-a-medical-consultation-rotation
#6
Michele Fang, Eric Linson, Manish Suneja, Ethan F Kuperman
BACKGROUND: Excellence in Graduate Medical Education requires the right clinical environment with an appropriate workload where residents have enough patients to gain proficiency in medicine with optimal time for reflection. The Accreditation Council for Graduate Medical Education (ACGME) has focused more on work hours rather than workload; however, high resident workload has been associated with lower resident participation in education and fatigue-related errors. Recognizing the potential risks associated with high resident workload and being mindful of the costs of reducing resident workload, we sought to reduce residents' workload by adding an advanced practice provider (APP) to the surgical comanagement service (SCM) and study its effect on resident satisfaction and perceived educational value of the rotation...
February 22, 2017: BMC Medical Education
https://www.readbyqxmd.com/read/28126152/impact-of-a-multidisciplinary-team-approach-including-an-intensivist-on-the-outcomes-of-critically-ill-patients-in-the-cardiac-care-unit
#7
Zaher Fanari, Armin Barekatain, Roger Kerzner, Sumaya Hammami, William S Weintraub, Vinay Maheshwari
OBJECTIVE: To investigate the impact of integrating a medical intensivist into a cardiac care unit (CCU) multidisciplinary team on the outcomes of CCU patients. PATIENTS AND METHODS: We conducted a retrospective cohort study of 2239 CCU admissions between July 1, 2011, and July 1, 2013, which constituted patients admitted in the 12 months before and 12 months after the introduction of intensivists into the CCU multidisciplinary team. This team included a cardiologist, a medical intensivist, medical house staff, nurses, a pharmacist, a dietitian, and physical and respiratory therapists...
December 2016: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28101033/maximizing-the-benefit-cost-ratio-of-anthracyclines-in-metastatic-breast-cancer-case-report-of-a-patient-with-a-complete-response-to-high-dose-doxorubicin
#8
Kevin Shee, Alan T Kono, Susan P D'Anna, Mark A Seltzer, Xiaoying Lu, Todd W Miller, Mary D Chamberlin
Despite the clinical efficacy of anthracycline agents such as doxorubicin, dose-limiting cardiac toxicities significantly limit their long-term use. Here, we present the case of a 33-year-old female patient with extensive metastatic ER+/PR+/HER2- mucinous adenocarcinoma of the breast, who was started on doxorubicin/cyclophosphamide therapy after progressing on paclitaxel and ovarian suppressor goserelin with aromatase inhibitor exemestane. The patient was comanaged by cardiology, who carefully monitored measures of cardiac function, including EKGs, serial echocardiograms, and profiling of lipids, troponin, and pro-BNP every 2 months...
September 2016: Case Reports in Oncology
https://www.readbyqxmd.com/read/28091432/depression-and-posttraumatic-stress-disorder-among-road-traffic-accident-victims-managed-in-a-tertiary-hospital-in-southern-nigeria
#9
J E Asuquo, B E Edet, I E Abang, E A Essien, O G Osakwe, E J Aigbomain, K C Chigbundu
BACKGROUND: Psychological responses to traumatic events vary widely across different cultures but studies in the developing countries are scant. The objective of this study is to determine prevalence of depression and posttraumatic stress disorder (PTSD) among patients involved in road traffic accident (RTA) compared with that of the general population using a matched control group. MATERIALS AND METHODS: The study design was case control and employed the convenient sampling technique...
February 2017: Nigerian Journal of Clinical Practice
https://www.readbyqxmd.com/read/28056665/the-patient-perspective-on-the-effects-of-medical-record-accessibility-a-systematic-review
#10
Peter Vermeir, Sophie Degroote, Dominique Vandijck, Hanne Van Tiggelen, Renaat Peleman, Rik Verhaeghe, An Mariman, Dirk Vogelaers
BACKGROUND: Health care is shifting from a paternalistic to a participatory model, with increasing patient involvement. Medical record accessibility to patients may contribute significantly to patient comanagement. OBJECTIVES: To systematically review the literature on the patient perspective of effects of personal medical record accessibility on the individual patient, patient-physician relationship and quality of medical care. METHODS: Screening of PubMed, Web of Science, Cinahl, and Cochrane Library on the keywords 'medical record', 'patient record', 'communication', 'patient participation', 'doctor-patient relationship', 'physician-patient relationship' between 1 January 2002 and 31 January 2016; systematic review after assessment for methodological quality...
January 6, 2017: Acta Clinica Belgica
https://www.readbyqxmd.com/read/27988160/vascular-surgeon-hospitalist-comanagement-improves-in-hospital-mortality-at-the-expense-of-increased-in-hospital-cost
#11
Rami O Tadros, Melissa L Tardiff, Peter L Faries, Michael Stoner, Chien Yi M Png, David Kaplan, Ageliki G Vouyouka, Michael L Marin
OBJECTIVE: We have shown that vascular surgeon- hospitalist co management resulted in improved in-hospital mortality rates. We now aim to assess the impact of the hospitalist co management service (HCS) on healthcare cost. METHODS: A total of 1558 patients were divided into three cohorts and compared: 516 in 2012, 525 in 2013, and 517 in 2014. The HCS began in January 2013. Data were standardized for six vascular surgeons that were present 2012-2014. New attendings were excluded...
March 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27929247/initial-management-of-patients-with-hiv-infection
#12
Ronald H Goldschmidt, Carolyn Chu, Betty J Dong
Human immunodeficiency virus (HIV) infection has become a treatable chronic disease with near-normal life expectancy when patients receive antiretroviral therapy (ART). Family physicians and other primary care clinicians commonly provide long-term comprehensive care for persons with HIV infection. This article describes the scope of initial care, including obtaining a thorough history; physical examination for HIV-associated manifestations; attention to HIV-specific immunization schedules; routine and HIV-specific laboratory evaluation; and ensuring standard health care maintenance to prevent HIV- and non-HIV-related morbidity and mortality...
November 1, 2016: American Family Physician
https://www.readbyqxmd.com/read/27870675/comanagement-and-gainsharing-opportunities-for-independent-physicians
#13
Chris McBride, Peter L Althausen
Gainsharing and comanagament programs are both successful means of achieving physician buy-in for all cost containment programs in Orthopaedic Trauma. Under comanagement agreements, physicians are reimbursed for their time and intellectual efforts in program and algorithm creation. The cost is minimal for the hospital in return for the millions of dollars in savings they achieve. Gainsharing models can incentivize physicians to quickly adopt cost-effective implant choices, care plans, and program development...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27870673/financial-impact-of-dual-vendor-matrix-pricing-and-sole-source-contracting-on-implant-costs
#14
Peter L Althausen, Joan Lapham, Lisa Mead
Implant costs comprise the largest proportion of operating room supply costs for orthopedic trauma care. Over the years, hospitals have devised several methods of controlling these costs with the help of physicians. With increasing economic pressure, these negotiations have a tremendous ability to decrease the cost of trauma care. In the past, physicians have taken no responsibility for implant pricing which has made cost control difficult. The reasons have been multifactorial. However, industry surgeon consulting fees, research support, and surgeon comfort with certain implant systems have played a large role in slowing adoption of cost-control measures...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27870671/surgeon-attitudes-regarding-the-use-of-generic-implants-an-ota-survey-study
#15
Justin A Walker, Peter L Althausen
OBJECTIVES: To determine the role of generic orthopaedic trauma implants in the current orthopaedic trauma market, as perceived by OTA members, and investigate potential hurdles to the use of generic implants and other cost-containment measures. DESIGN: Survey study. SETTING: Not applicable. PARTICIPANTS: All active OTA members with valid e-mail addresses were invited to participate. INTERVENTION: Participants completed a brief online survey with questions regarding participation in cost-containment and incentive programs, industry relationships, generic implant use, and the role of surgeons in cost containment...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27847675/an-orthopedic-hospitalist-comanaged-hip-fracture-service-reduces-inpatient-length-of-stay
#16
Daniel N Bracey, Tunc C Kiymaz, David C Holst, Kamran S Hamid, Johannes F Plate, Erik C Summers, Cynthia L Emory, Riyaz H Jinnah
INTRODUCTION: Hip fractures are common in the elderly patients with an incidence of 320 000 fractures/year in the United States, representing a health-care cost of US$9 to 20 billion. Hip fracture incidence is projected to increase dramatically. Hospitals must modify clinical models to accommodate this growing burden. Comanagement strategies are reported in the literature, but few have addressed orthopedic-hospitalist models. An orthopedic-hospitalist comanagement (OHC) service was established at our hospital to manage hip fracture patients...
December 2016: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/27831826/hospitalist-vascular-surgery-comanagement-effects-on-complications-and-mortality
#17
Colin T Iberti, Alan Briones, Erin Gabriel, Andrew S Dunn
OBJECTIVES: Hospitalized vascular surgery patients have multiple severe comorbidities, poor functional status, and high perioperative cardiac risk. Thus they may be ideal patients for a collaborative care model. However, there is little evidence for a comanagement model on clinical outcomes. METHODS: The two-year pre-post study consisted of a comanagement model where a hospitalist actively participated in the medical care of American Society of Anesthesiologist Physical Status Classification scale 3 or 4 vascular surgery patients...
December 2016: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/27824404/contracting-strategies-for-arthroplasty-bundles-to-population-health
#18
David J Jacofsky, Paul Jawin, Geoff Walton, Lisa Fraser
Orthopedics, and especially total joint replacement (TJR), is growing in payer prominence due to large projected increases in volume. The unsustainability of the fee-for-service payment system has lead Centers for Medicare and Medicaid Services to employ new value and risk-based contracting strategies on a population health basis and on an episode of care basis, with programs such as the Bundled Payment for Care Improvement program and the Comprehensive Care for Joint Replacement program. These trends are forcing hospitals and physicians to align to improve quality and reduce costs through new structures such as Accountable Care Organizations, comanagement programs, and gainsharing...
January 2017: Journal of Knee Surgery
https://www.readbyqxmd.com/read/27757421/empty-forest-or-empty-rivers-a-century-of-commercial-hunting-in-amazonia
#19
André P Antunes, Rachel M Fewster, Eduardo M Venticinque, Carlos A Peres, Taal Levi, Fabio Rohe, Glenn H Shepard
The Amazon basin is the largest and most species-rich tropical forest and river system in the world, playing a pivotal role in global climate regulation and harboring hundreds of traditional and indigenous cultures. It is a matter of intense debate whether the ecosystem is threatened by hunting practices, whereby an "empty forest" loses critical ecological functions. Strikingly, no previous study has examined Amazonian ecosystem resilience through the perspective of the massive 20th century international trade in furs and skins...
October 2016: Science Advances
https://www.readbyqxmd.com/read/27749348/perioperative-surgical-home-in-pediatric-settings-preliminary-results
#20
Karen Thomson, Sophie R Pestieau, Janish J Patel, Heather Gordish-Dressman, Ariana Mirzada, Zeev N Kain, Matthew E Oetgen
BACKGROUND: The Perioperative Surgical Home (PSH) is a patient-centered, team-based approach that aims to improve the value of perioperative care. We implemented a PSH for patients with adolescent idiopathic scoliosis who were undergoing posterior spinal fusion at Children's National Health System. We hypothesized that this PSH would improve patient surgical outcomes and reduce hospital length of stay (LOS). METHODS: A multidisciplinary group created evidence-based protocols for the preoperative, operative, postoperative, and postdischarge care of this patient population...
November 2016: Anesthesia and Analgesia
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