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medical home model

Li-Tzy Wu, Udi E Ghitza, He Zhu, Susan Spratt, Marvin Swartz, Paolo Mannelli
BACKGROUND: The majority of the U.S. healthcare resources are utilized by a small population characterized as high-risk, high-need persons with complex care needs (e.g., adults with multiple chronic conditions). Substance use disorders (SUDs) and mental health disorders (MHDs) are a driver of poor health and additional healthcare costs, but they are understudied among high-need patients. OBJECTIVE: We examine the prevalence and correlates of SUDs and MHDs among adults with high-risk diabetes, who are patients at the top 10% risk score for developing poor outcomes (hospital admission or death)...
March 3, 2018: Drug and Alcohol Dependence
Lonnie Wen, Christine Divers, Melissa Lingohr-Smith, Jay Lin, Scott Ramsey
OBJECTIVES: To provide an overview of alternative payment models (APMs) and describe how leading national organizations involved with oncology care and payment are linking quality improvement initiatives and payment reform. STUDY DESIGN: Literature review. METHODS: For this review, we summarized the literature on APMs and their goals of improving healthcare quality while jointly controlling the cost of care. We described the types of APMs that have been examined in the real-world setting, specifically in the area of oncology, and how they have affected the quality of oncology care...
March 1, 2018: American Journal of Managed Care
Nathan D Shippee, Michael Finch, Douglas R Wholey
OBJECTIVES: Patient-centered medical homes (PCMHs) represent a widespread model of healthcare transformation. Despite evidence that PCMHs can improve care quality, the mechanisms by which they improve outcomes are relatively unexamined. We aimed to assess the mechanisms linking certification as a Health Care Home (HCH), a statewide PCMH initiative, with asthma care quality and outcomes. We compared direct certification effects versus indirect clinical effects (via improved care process)...
March 1, 2018: American Journal of Managed Care
Mercedes Pilkington, Martin Situma, Andrea Winthrop, Dan Poenaru
PURPOSE: Favorable surgical outcomes depend on timely access to care. This study quantifies these delays and explores caregiver barriers to access in a Ugandan facility. METHODS: An interviewer-facilitated survey was administered over 8months to consecutive pediatric surgical families at Mbarara Regional Referral Hospital (MRRH). Delays were classified using the Three Delays Model: care-seeking, arrival at health facility, and from surgical consultation to surgery...
February 12, 2018: Journal of Pediatric Surgery
Terhi Toivo, Maarit Dimitrow, Juha Puustinen, Eeva Savela, Katariina Pelkonen, Valtteri Kiuru, Tuula Suominen, Sirkka Kinnunen, Mira Uunimäki, Sirkka-Liisa Kivelä, Saija Leikola, Marja Airaksinen
BACKGROUND: The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. METHODS: Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy...
March 16, 2018: BMC Geriatrics
Alberto Pilotto, Raffaella Boi, Jean Petermans
Recently, the interest of industry, government agencies and healthcare professionals in technology for aging people has increased. The challenge is whether technology may play a role in enhancing independence and quality of life and in reducing individual and societal costs of caring. Information and communication technologies, i.e. tools aimed at communicating and informing, assistive technologies designed to maintain older peoples' independence and increasing safety, and human-computer interaction technologies for supporting older people with motility and cognitive impairments as humanoid robots, exoskeletons, rehabilitation robots, service robots and companion-type are interdisciplinary topics both in research and in clinical practice...
March 13, 2018: Age and Ageing
Michael Matthew McClay, Stephen S O'Connor, Brittany Nicole Groh, Marissa Baudino, Lisa Venanzi, Angela Shields, Jo Ellen Wilson, John Bone, Stephen Nicolson
OBJECTIVE: Evidence suggests that suicide attempts by self-inflicted gunshot wound (GSW) are underreported and may in turn affect disposition following hospitalization. This study aimed to evaluate the clinical characteristics and use of services among individuals who do not disclose suicidal intent following a self-inflicted GSW. METHODS: Electronic medical record data from 128 survivors of self-inflicted GSWs at a level 1 trauma center were analyzed to identify factors associated with nondisclosure of a suicide attempt to medical staff...
March 15, 2018: Psychiatric Services: a Journal of the American Psychiatric Association
Ronald E Delanois, Chukwuweike U Gwam, Jeffrey J Cherian, Jennifer I Etcheson, Nicole E George, Kathleen A Schneider, Michael A Mont
BACKGROUND: The state of Maryland was granted a waiver by the Center for Medicare and Medicaid Services to implement a Global Budget Revenue (GBR) reimbursement model. This study aims to compare (1) costs of inpatient hospital stays; (2) postacute care costs; (3) lengths of stay (LOS); and (4) discharge disposition who underwent primary total hip arthroplasty at a single Maryland-based orthopedic institution before and after the implementation of GBR. METHODS: The Maryland Center for Medicare and Medicaid Services database was queried to obtain all Medicare patients who underwent total hip arthroplasty at a single institution before and after the implementation of GBR...
February 15, 2018: Journal of Arthroplasty
Frances M Wu, Lisa V Rubenstein, Jean Yoon
BACKGROUND: New models of patient-centered primary care such as the patient-centered medical home (PCMH) depend on high levels of interdisciplinary primary care team functioning to achieve improved outcomes. A few studies have qualitatively assessed barriers and facilitators to optimal team functioning; however, we know of no prior study that assesses PCMH team functioning in relationship to patient health outcomes. PURPOSE: The aim of the study was to assess the relationships between primary care team functioning, patients' use of acute care, and mortality...
March 12, 2018: Health Care Management Review
Federica Pederiva, Basem Khalil, Antonino Morabito, Sarah J Wood
BACKGROUND:  Short bowel syndrome (SBS) has an impact on children and their families not only physically, but also emotionally, mentally, and socially. This study aimed to evaluate quality of life and family impact in patients with SBS, using the Pediatric Quality of Life Inventory (PedsQL) measurement model. MATERIALS AND METHODS:  PedsQL questionnaires were administered to patients with SBS followed at the Pediatric Surgery of Royal Manchester Children's Hospital...
January 30, 2018: European Journal of Pediatric Surgery
Teresa Seeman, Duncan Thomas, Sharon Stein Merkin, Kari Moore, Karol Watson, Arun Karlamangla
Longitudinal, individual-specific data from the Multi-Ethnic Study of Atherosclerosis (MESA) provide support for the hypothesis that the 2008 to 2010 Great Recession (GR) negatively impacted the health of US adults. Results further advance understanding of the relationship by ( i ) illuminating hypothesized greater negative impacts in population subgroups exposed to more severe impacts of the GR and ( ii ) explicitly controlling for confounding by individual differences in age-related changes in health over time...
March 12, 2018: Proceedings of the National Academy of Sciences of the United States of America
Patricia A Lohr, Jennifer E Starling, James G Scott, Abigail R A Aiken
OBJECTIVE: To evaluate outcomes with simultaneous administration of mifepristone and misoprostol for medical abortion at 63 days of gestation or less in the year after its implementation in a British clinic system. METHODS: We conducted a retrospective cohort study using deidentified data from the electronic booking and complications databases and medical records of women who underwent medical abortion at British Pregnancy Advisory Service. Our primary outcome was treatment success with simultaneous dosing compared with a regimen with a 24- to 48-hour interval between medications...
March 8, 2018: Obstetrics and Gynecology
Alain Lekoubou, Kinfe G Bishu, Bruce Ovbiagele
BACKGROUND: Epilepsy is particularly frequent among children, yet updated and nationwide healthcare utilization estimates are scanty in the United States. OBJECTIVE: To analyze healthcare utilization among children with epilepsy. METHODS: Data on children (≤17-year-old) were extracted from the Medical Expenditure Panel Survey (MEPS) 2003-2014. Epilepsy was identified using the clinical classification code 83. Healthcare utilization (Inpatient admission, outpatient visits, prescription medication including refill, emergency room visits, and home health provider visits) was compared between children with epilepsy and those without epilepsy...
February 27, 2018: Epilepsy Research
Timothy P Hogan, Tana M Luger, Julie E Volkman, Mary Rocheleau, Nora Mueller, Anna M Barker, Kim M Nazi, Thomas K Houston, Barbara G Bokhour
BACKGROUND: As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages...
March 8, 2018: Journal of Medical Internet Research
Christopher J Udell, Julie L Ruddy, Philip M Procento
Introduction: US Navy recruits who have injuries preventing them from participating in intense physical conditioning are pulled out of boot camp training and receive treatment that includes daily physical therapy, pain medications, and psychoeducational groups. Graduation from boot camp for these recruits requires not only recovering from their injuries but also passing a required Physical Fitness Assessment consisting of a timed 1.5-mile run, curl-ups, and push-ups. About 50-60% of these recruits will eventually be separated out and sent home...
March 6, 2018: Military Medicine
Julia Upton, Anna Nowak-Wegrzyn
Baked milk (BM) and baked egg (BE) diets are increasingly used in the management of milk and egg allergy, rather than avoidance. Children with tolerance versus reactivity to BM and BE may have smaller skin prick test and lower specific IgE, and BM-tolerant children have less basophil reactivity and more peripheral T regulatory cells. However, most milk- and egg-allergic children tolerate BM and BE and an individual's reactivity is unpredictable. Non-reactivity is due to conformational changes in the allergens...
March 8, 2018: Clinical Reviews in Allergy & Immunology
Maria Chiara Corti, Francesco Avossa, Elena Schievano, Pietro Gallina, Eliana Ferroni, Natalia Alba, Matilde Dotto, Cristina Basso, Silvia Tiozzo Netti, Ugo Fedeli, Domenico Mantoan
BACKGROUND: The Italian National Health Service (NHS) provides universal coverage to all citizens, granting primary and hospital care with a copayment system for outpatient and drug services. Financing of Local Health Trusts (LHTs) is based on a capitation system adjusted only for age, gender and area of residence. We applied a risk-adjustment system (Johns Hopkins Adjusted Clinical Groups System, ACG® System) in order to explain health care costs using routinely collected administrative data in the Veneto Region (North-eastern Italy)...
March 4, 2018: European Journal of Internal Medicine
Kaia Skromme, Maria Vollsæter, Knut Øymar, Trond Markestad, Thomas Halvorsen
BACKGROUND: Advances in perinatal care have markedly increased the prospects of survival for infants born extremely preterm (EP). The aim of this study was to investigate hospitalisation rates and respiratory morbidity from five to 11 years of age in a prospective national cohort of EP children born in the surfactant era. METHODS: This was a national prospective cohort study of all children born in Norway during 1999 and 2000 with gestational age (GA) < 28 weeks or birth weight < 1000 grams, and of individually matched term-born controls recruited for a regional subsample...
March 7, 2018: BMC Pediatrics
Tessa L Walters, T Edward Kim, Edward R Mariano, Geoffrey Kenton Lighthall
BACKGROUND: The Perioperative Surgical Home (PSH) is an anesthesiologist-led, coordinated care model that may improve patient experience and safety. We hypothesized that PSH will decrease activation of the rapid response system for surgical inpatients. METHODS: This retrospective study was performed at an academic Veterans Affairs hospital with a PSH. Data from both medical and surgical cohorts admitted to a single ward were analyzed for the Pre-PSH (July 2006 to October 2010) and Post-PSH (November 2011 to May 2015) epochs...
March 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Sara Barsanti, Manila Bonciani
Healthcare systems have followed several strategies aimed at integrating primary care services and professionals. Medical homes in the USA and Canada, and primary care centres across Europe have collocated general practitioners and other health and social professionals in the same building in order to boost coordination among services and the continuity of care for patients. However, in the literature, the impact of co-location on primary care has led to controversial results. This article analyses the possible benefits of the co-location of services in primary care focusing on the Italian model of primary care centres (Case della Salute) in terms of general practitioners' perception...
January 1, 2018: Health Services Management Research
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