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https://www.readbyqxmd.com/read/28231023/increasing-nocardia-incidence-associated-with-bronchiectasis-at-a-tertiary-care-center
#1
Michael H Woodworth, Jennifer L Saullo, Paul M Lantos, Gary M Cox, Jason E Stout
RATIONALE: Nocardia is a genus of pathogens that most commonly afflicts immunocompromised hosts, but may be an emerging infection among persons with bronchiectasis. OBJECTIVES: To examine the epidemiology and clinical presentation of adult patients with Nocardia and bronchiectasis relative to other patient groups. METHODS: We examined a retrospectively-assembled cohort of adults at Duke University Hospital in Durham, North Carolina with at least one positive culture from a bodily fluid or tissue specimen for Nocardia between January 1996 and December 2013...
February 23, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28225695/how-should-therapeutic-decisions-about-expensive-drugs-be-made-in-imperfect-environments
#2
Leonard M Fleck, Marion Danis
Clinicians must inevitably make therapeutic decisions under nonideal conditions. They practice in circumstances that involve incomplete evidence. They deliver care in health care systems that are complex and poorly coordinated. Each of the patients that they take care of is unique while research offers evidence regarding relatively homogeneous populations of patients. Under these circumstances, many parties-medical scientists, reviewing agencies, insurers, and accountable care organizations-can and should contribute to optimizing the development, approval, funding, and prescription of therapies-particularly expensive and marginally beneficial therapies...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28222988/thirty-day-and-90-day-hospital-readmission-after-outpatient-upper-extremity-hemodialysis-access-creation
#3
Jeffrey J Siracuse, Nishant K Shah, Matthew R Peacock, Georges Tahhan, Jeffrey A Kalish, Denis Rybin, Mohammad H Eslami, Alik Farber
OBJECTIVE: Patients with end-stage renal disease have multiple comorbidities and are at increased risk for postoperative complications and resource utilization. Our goal was to determine the rate and causes of 30-day and 90-day hospital readmissions after the creation of outpatient hemodialysis access. METHODS: We retrospectively reviewed all outpatient upper extremity hemodialysis access creations performed at our medical center from 2008 to 2015. Readmission was defined as any inpatient status admission ≤30 and 90 days...
February 17, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28219374/the-right-to-health-of-non-nationals-and-displaced-persons-in-the-sustainable-development-goals-era-challenges-for-equity-in-universal-health-care
#4
EDITORIAL
Claire E Brolan, Lisa Forman, Stéphanie Dagron, Rachel Hammonds, Attiya Waris, Lyla Latif, Ana Lorena Ruano
INTRODUCTION: Under the Millennium Development Goals (MDGs), United Nations (UN) Member States reported progress on the targets toward their general citizenry. This focus repeatedly excluded marginalized ethnic and linguistic minorities, including people of refugee backgrounds and other vulnerable non-nationals that resided within a States' borders. The Sustainable Development Goals (SDGs) aim to be truly transformative by being made operational in all countries, and applied to all, nationals and non-nationals alike...
February 21, 2017: International Journal for Equity in Health
https://www.readbyqxmd.com/read/28217305/redesigning-care-delivery-with-patient-support-personnel-learning-from-accountable-care-organizations
#5
Ksenia O Gorbenko, Taressa Fraze, Valerie A Lewis
INTRODUCTION: Accountable care organizations (ACOs) are a value-based payment model in the United States rooted in holding groups of healthcare providers financially accountable for the quality and total cost of care of their attributed population. To succeed in reaching their quality and efficiency goals, ACOs implement a variety of care delivery changes, including workforce redesign. Patient support personnel (PSP)-non-physician staff such as care coordinators, community health workers, and others-are critical to restructuring care delivery...
September 2016: Int J Care Coord
https://www.readbyqxmd.com/read/28215356/the-financial-burden-of-prescription-drugs-for-neurological-conditions-in-canada-results-from-the-national-population-health-study-of-neurological-conditions
#6
Sara Guilcher, Sarah Munce, James Conklin, Tanya Packer, Molly Verrier, Connie Marras, Tarik Bereket, Joan Versnel, Richard Riopelle, Susan Jaglal
This paper describes the current situation in Canada concerning the availability and use of prescription drugs for neurological conditions. We conducted semi-structured qualitative interviews with health care providers, administrators, community organization representatives, opinion leaders and policy makers. The analysis revealed three primary themes related to the availability of and access to prescription drugs to treat neurological conditions. First, we learned that across Canada there is significant vulnerability and a need for advocacy on behalf of people living with these conditions...
February 4, 2017: Health Policy
https://www.readbyqxmd.com/read/28215127/characteristics-and-outcomes-of-critically-ill-patients-with-drug-overdose-in-australia-and-new-zealand
#7
Luca Cioccari, Nora Luethi, Michael Bailey, David Pilcher, Rinaldo Bellomo
OBJECTIVE: The epidemiology of patients admitted to the intensive care unit after a drug overdose (OD) is poorly defined. We aimed to study the incidence, characteristics and outcomes of patients admitted to the ICU because of OD in Australia and New Zealand. DESIGN, SETTING AND PATIENTS: Retrospective study of data from the Australian and New Zealand Intensive Care Society Adult Patient Database, including all patients admitted to an ICU with OD from 2005 to 2013...
March 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/28212967/decision-making-on-medical-innovations-in-a-changing-health-care-environment-insights-from-accountable-care-organizations-and-payers-on-personalized-medicine-and-other-technologies
#8
Julia R Trosman, Christine B Weldon, Michael P Douglas, Patricia A Deverka, John B Watkins, Kathryn A Phillips
BACKGROUND: New payment and care organization approaches, such as those of accountable care organizations (ACOs), are reshaping accountability and shifting risk, as well as decision making, from payers to providers, within the Triple Aim context of health reform. The Triple Aim calls for improving experience of care, improving health of populations, and reducing health care costs. OBJECTIVES: To understand how the transition to the ACO model impacts decision making on adoption and use of innovative technologies in the era of accelerating scientific advancement of personalized medicine and other innovations...
January 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28212182/what-s-new-in-obstetric-anesthesia-the-2016-gerard-w-ostheimer-lecture
#9
Philip E Hess
This special article presents potentially important trends and issues affecting the field of obstetric anesthesia drawn from publications in 2015. Both maternal mortality and morbidity in the United States have increased in recent years because, in part, of the changing demographics of the childbearing population. Pregnant women are older and have more pre-existing conditions and complex medical histories. Cardiovascular and noncardiovascular medical diseases now account for half of maternal deaths in the United States...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28202052/primary-care-focus-and-utilization-in-the-medicare-shared-savings-program-accountable-care-organizations
#10
Lindsey A Herrel, John Z Ayanian, Scott R Hawken, David C Miller
BACKGROUND: Although Accountable Care Organizations (ACOs) are defined by the provision of primary care services, the relationship between the intensity of primary care and population-level utilization and costs of health care services has not been examined during early implementation of Medicare Shared Savings Program (MSSP) ACOs. Our objective was to evaluate the association between primary care focus and healthcare utilization and spending in the first performance period of the Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs)...
February 15, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28199277/funding-accountable-care-in-oregon-financial-models-in-two-coordinated-care-organizations
#11
Lauren Broffman, Kristin Brown, Bruce K Bayley, Lucy Savitz, Jill Rissi
Oregon's coordinated care organizations (CCOs) are an integral part of a massive statewide reform that brings accountable care to Medicaid. CCOs are regional collaboratives among health plans, providers, county public health, and communitybased organizations that administer a single global budget covering physical, mental, and dental healthcare for low-income Oregonians. CCOs have been given freedom within the global budget to implement reforms that might capture efficiencies in cost and quality. For this study-fielded between 2012 and 2015-we traced the path of the global budget through the interior structures of two of Oregon's most promising CCOs...
July 2016: Journal of Healthcare Management / American College of Healthcare Executives
https://www.readbyqxmd.com/read/28199273/strategic-plan-for-maximizing-shared-savings-in-accountable-care-organizations
#12
Savanna B Williams
One of the major benefits to a provider beginning or joining an accountable care organization (ACO) is the potential for achieving shared savings from the Medicare Shared Savings Program. This essay provides a strategic plan for ACO participants to maximize their shared savings through a physician-led structure and the creation of a high-value referral network. Physician-led ACOs are generally more flexible than those affiliated with a hospital and can implement more effective cost-saving initiatives, focus more intently on lowering the cost of delivering primary care, and achieve higher shared saving rates...
July 2016: Journal of Healthcare Management / American College of Healthcare Executives
https://www.readbyqxmd.com/read/28199262/practitioner-application-perceived-ethics-dilemmas-among-pioneer-accountable-care-organizations
#13
Jason Lesandrini, John A Brennan
No abstract text is available yet for this article.
January 2017: Journal of Healthcare Management / American College of Healthcare Executives
https://www.readbyqxmd.com/read/28199261/perceived-ethics-dilemmas-among-pioneer-accountable-care-organizations
#14
Craig R Westling, Thom Walsh, William A Nelson
This study of Pioneer accountable care organizations (ACOs) suggests that the ACO model is creating moral distress for physicians and business leaders in seven critical ways:Despite an overall sense of optimism associated with the ACO model, our research identified an underlying sense of moral distress at most sites. A clear opportunity exists for ACOs to use a more comprehensive, coordinated approach to proactively resolving ethical dilemmas while continuing the march toward risk-based contracts.
January 2017: Journal of Healthcare Management / American College of Healthcare Executives
https://www.readbyqxmd.com/read/28196113/chasm-in-primary-care-provision-in-a-universal-health-system-findings-from-a-nationally-representative-survey-of-health-facilities-in-malaysia
#15
Huy Ming Lim, Sheamini Sivasampu, Ee Ming Khoo, Kamaliah Mohamad Noh
BACKGROUND: Malaysia has achieved universal health coverage since 1980s through the expansion of direct public provision, particularly in rural areas. However, no systematic examination of the rural-urban distribution of primary care services and resources has been conducted to date for policy impact evaluation. METHODS: We conducted a national cross-sectional survey of 316 public and 597 private primary care clinics, selected through proportionate stratified random sampling, from June 2011 through February 2012...
2017: PloS One
https://www.readbyqxmd.com/read/28194689/exploring-physician-perspectives-of-residency-holdover-handoffs-a-qualitative-study-to-understand-an-increasingly-important-type-of-handoff
#16
Jonathan A Duong, Trevor P Jensen, Sasha Morduchowicz, Michelle Mourad, James D Harrison, Sumant R Ranji
BACKGROUND: The term "holdover admissions" refers to patients admitted by an overnight physician and whose care is then transferred to a new primary team the next morning. Descriptions of the holdover process in internal medicine are sparse. OBJECTIVE: To identify important factors affecting the quality of holdover handoffs at an internal medicine (IM) residency program and to compare them to previously identified factors for other handoffs. DESIGN: We undertook a qualitative study using structured focus groups and interviews...
February 13, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28193376/radiology-research-in-quality-and-safety-current-trends-and-future-needs
#17
REVIEW
Matthew E Zygmont, Jason N Itri, Andrew B Rosenkrantz, Phuong-Anh T Duong, Lori Mankowski Gettle, Mishal Mendiratta-Lala, Elena P Scali, Ronald S Winokur, Linda Probyn, Justin W Kung, Eric Bakow, Nadja Kadom
Promoting quality and safety research is now essential for radiology as reimbursement is increasingly tied to measures of quality, patient safety, efficiency, and appropriateness of imaging. This article provides an overview of key features necessary to promote successful quality improvement efforts in radiology. Emphasis is given to current trends and future opportunities for directing research. Establishing and maintaining a culture of safety is paramount to organizations wishing to improve patient care. The correct culture must be in place to support quality initiatives and create accountability for patient care...
March 2017: Academic Radiology
https://www.readbyqxmd.com/read/28192568/early-performance-in-medicaid-accountable-care-organizations-a-comparison-of-oregon-and-colorado
#18
K John McConnell, Stephanie Renfro, Benjamin K S Chan, Thomas H A Meath, Aaron Mendelson, Deborah Cohen, Jeanette Waxmonsky, Dennis McCarty, Neal Wallace, Richard C Lindrooth
Importance: Several state Medicaid reforms are under way, but the relative performance of different approaches is unclear. Objective: To compare the performance of Oregon's and Colorado's Medicaid Accountable Care Organization (ACO) models. Design, Setting, and Participants: Oregon initiated its Medicaid transformation in 2012, supported by a $1.9 billion investment from the federal government, moving most Medicaid enrollees into 16 Coordinated Care Organizations, which managed care within a global budget...
February 13, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28192556/changes-in-postacute-care-in-the-medicare-shared-savings-program
#19
J Michael McWilliams, Lauren G Gilstrap, David G Stevenson, Michael E Chernew, Haiden A Huskamp, David C Grabowski
Importance: Postacute care is thought to be a major source of wasteful spending. The extent to which accountable care organizations (ACOs) can limit postacute care spending has implications for the importance and design of other payment models that include postacute care. Objective: To assess changes in postacute care spending and use of postacute care associated with provider participation as ACOs in the Medicare Shared Savings Program (MSSP) and the pathways by which they occurred...
February 13, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28192555/moving-forward-with-accountable-care-organizations-some-answers-more-questions
#20
Carrie H Colla, Elliott S Fisher
No abstract text is available yet for this article.
February 13, 2017: JAMA Internal Medicine
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