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https://www.readbyqxmd.com/read/28636834/implementation-of-medical-homes-in-federally-qualified-health-centers
#1
Justin W Timbie, Claude M Setodji, Amii Kress, Tara A Lavelle, Mark W Friedberg, Peter J Mendel, Emily K Chen, Beverly A Weidmer, Christine Buttorff, Rosalie Malsberger, Mallika Kommareddi, Afshin Rastegar, Aaron Kofner, Lisa Hiatt, Ammarah Mahmud, Katherine Giuriceo, Katherine L Kahn
Background From 2011 through 2014, the Federally Qualified Health Center Advanced Primary Care Practice Demonstration provided care management fees and technical assistance to a nationwide sample of 503 federally qualified health centers to help them achieve the highest (level 3) medical-home recognition by the National Committee for Quality Assurance, a designation that requires the implementation of processes to improve access, continuity, and coordination. Methods We examined the achievement of medical-home recognition and used Medicare claims and beneficiary surveys to measure utilization of services, quality of care, patients' experiences, and Medicare expenditures in demonstration sites versus comparison sites...
June 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28634259/effectiveness-of-an-online-support-programme-supr-for-older-hearing-aid-users-study-protocol-for-a-cluster-randomised-controlled-trial
#2
Janine Fj Meijerink, Marieke Pronk, Bernadette Paulissen, Birgit I Witte, Bregje van der Wouden, Vera Jansen, Sophia E Kramer
BACKGROUND: An educational SUpport PRogramme called SUPR has been developed for hearing aid users (HAUs) and their communication partners (CPs) offering care beyond hearing aid fitting. SUPR teaches its users communication strategies, hearing aid handling skills and personal adjustment to hearing impairment. METHODS/DESIGN: Using a cluster randomised controlled trial design, 70 Dutch hearing aid dispenser practices were randomised into hearing aid fitting (care as usual, 34 practices) and hearing aid fitting including SUPR (36 practices)...
June 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28626106/-seedi-basic-strategies-for-the-primary-and-secondary-prevention-of-atherosclerotic-cardiovascular-disease
#3
Chunsong Hu
ABCDE strategy, mainly based on drugs or medications and the lifestyle modification (named as "main medical strategy"), is popular in the guideline for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in China and foreign countries. Here, the author recommends a non-invasive and non-pharmacologic "Zhongzi" rule, which includes 4 healthy elements: Sleep, emotion, exercise, and diet (SEED), and also called SEED intervention (SEEDi) strategy. It is the basic strategy for primary and secondary prevention of non-infectious diseases, especially for ASCVD...
May 28, 2017: Zhong Nan da Xue Xue Bao. Yi Xue Ban, Journal of Central South University. Medical Sciences
https://www.readbyqxmd.com/read/28623615/use-of-antipsychotic-drugs-by-elderly-primary-care-patients-and-the-effects-of-medication-reviews-a-cross-sectional-study-in-sweden
#4
Cecilia Lenander, Patrik Midlöv, Nina Viberg, John Chalmers, Kris Rogers, Åsa Bondesson
BACKGROUND: Antipsychotics form a class of drugs that should be used with caution among elderly people because of a high risk of adverse events. Despite the risks and modest effects, their use is estimated to be high, especially in nursing homes. OBJECTIVE: The aim was to explore the effects of medication reviews on antipsychotic drug use for elderly primary care patients and describe the extent of, and reasons for, the prescription of antipsychotics. METHODS: In this cross-sectional study in primary care in Skåne, Sweden, patients aged ≥75 years living in nursing homes or in their own homes with home care were included...
June 16, 2017: Drugs—Real World Outcomes
https://www.readbyqxmd.com/read/28620725/understanding-adaptations-to-patient-centered-medical-home-activities-the-pcmh-adaptations-model
#5
Tristen L Hall, Jodi Summers Holtrop, L Miriam Dickinson, Russell E Glasgow
Primary care practices have increasingly adopted the patient-centered medical home (PCMH) model and often adapted quality improvement efforts to fit local context. This paper implemented a modified framework for understanding adaptations in the context of primary care PCMH transformation efforts. We combined an adaptations model by Stirman et al. that categorized adaptations to evidence-based interventions in research studies with dimensions from the RE-AIM framework, as well as items specific to PCMH. The resulting constructs were translated into a "plain English" adaptations interview...
June 15, 2017: Translational Behavioral Medicine
https://www.readbyqxmd.com/read/28617244/continuity-of-care-in-infancy-and-early-childhood-health-outcomes
#6
Elizabeth Enlow, Molly Passarella, Scott A Lorch
BACKGROUND AND OBJECTIVES: Continuity of care is a key aspect of the patient-centered medical home and improves pediatric outcomes. Health care reform requires high-quality data to demonstrate its continued value. We hypothesized that increased provider continuity in infancy will reduce urgent health care use and increase receipt of preventive services in early childhood. METHODS: Continuity, using the Usual Provider of Care measure, was calculated across all primary care encounters during the first year of life in a prospectively-constructed cohort of 17 773 infants receiving primary care from birth through 3 years at 30 clinics...
June 15, 2017: Pediatrics
https://www.readbyqxmd.com/read/28617023/integrated-behavioral-health-practice-facilitation-in-patient-centered-medical-homes-a-promising-application
#7
Sarah S Roderick, Nelly Burdette, Debra Hurwitz, Pano Yeracaris
INTRODUCTION: The purpose of this study was to assess the degree of behavioral health (BH) integration change in patient-centered medical homes (PCMHs) when using a practice facilitator (PF) specially trained in implementing integrated care and how a quasi-experimental design assists in this process. METHOD: Twelve PCMHs, 8 Federally Qualified Health Centers and 4 private practices, with varying degrees of BH services participated in this study. The degree of BH integration was assessed with a quasi-experimental design using the Maine Health Access Foundation's Site Self Assessment (MeHAF SSA) at baseline and after implementing site-specific BH services...
June 2017: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/28614167/the-role-of-organizational-context-in-the-implementation-of-a-statewide-initiative-to-integrate-mental-health-services-into-pediatric-primary-care
#8
Melissa A King, Lawrence S Wissow, Rebecca A Baum
BACKGROUND: Although there is evidence that mental health services can be delivered in pediatric primary care with good outcomes, few changes in service delivery have been seen over the past decade. Practices face a number of barriers, making interventions that address determinants of change at multiple levels a promising solution. However, these interventions may need appropriate organizational contexts in place to be successfully implemented. PURPOSE: The objective of this study was to test whether organizational context (culture, climate, structures/processes, and technologies) influenced uptake of a complex intervention to implement mental health services in pediatric primary care...
June 13, 2017: Health Care Management Review
https://www.readbyqxmd.com/read/28611875/patient-perspectives-on-accessing-acute-illness-care
#9
Mary K Finta, Amy Borkenhagen, Nicole E Werner, Joyce Duckles, Craig R Sellers, Sandhya Seshadri, Denise Lampo, Manish N Shah
INTRODUCTION: Older adults use the emergency department (ED) at high rates, including for illnesses that could be managed by their primary care providers (PCP). Policymakers have implemented barriers and incentives, often financial, to try to modify use patterns but with limited success. This study aims to understand the factors that influence older adults' decision to obtain acute illness care from the ED rather than from their PCPs. METHODS: We performed a qualitative study using a directed content analysis approach from February to October 2013...
June 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28609187/integrating-social-services-and-home-based-primary-care-for-high-risk-patients
#10
Joe Feinglass, Greg Norman, Robyn L Golden, Naoko Muramatsu, Michael Gelder, Thomas Cornwell
There is a consensus that our current hospital-intensive approach to care is deeply flawed. This review article describes the research evidence for developing a better system of care for high-cost, high-risk patients. It reviews the evidence that home-centered care and integration of health care with social services are the cornerstones of a more humane and efficient system. The article describes the strengths and weaknesses of research evaluating the effects of social services in addressing social determinants of health, and how social support is critical to successful acute care transition programs...
June 13, 2017: Population Health Management
https://www.readbyqxmd.com/read/28604260/developing-high-functioning-teams-factors-associated-with-operating-as-a-real-team-and-implications-for-patient-centered-medical-home-development
#11
Somava Stout, Leah Zallman, Lisa Arsenault, Assaad Sayah, Karen Hacker
Team-based care is a foundation of health care redesign models like the patient-centered medical home (PCMH). Yet few practices rigorously examine how the implementation of PCMH relates to teamwork. We identified factors associated with the perception of a practice operating as a real team. An online workforce survey was conducted with all staff of 12 primary care sites of Cambridge Health Alliance at different stages of PCMH transformation. Bivariate and multivariate analyses of factors associated with teamwork perceptions were conducted...
January 1, 2017: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://www.readbyqxmd.com/read/28599674/cluster-randomized-trial-of-a-mhealth-intervention-imtecho-to-improve-delivery-of-proven-maternal-neonatal-and-child-care-interventions-through-community-based-accredited-social-health-activists-ashas-by-enhancing-their-motivation-and-strengthening-supervision
#12
Dhiren Modi, Shrey Desai, Kapilkumar Dave, Shobha Shah, Gayatri Desai, Nishith Dholakia, Ravi Gopalan, Pankaj Shah
BACKGROUND: To facilitate the delivery of proven maternal, neonatal, and child health (MNCH) services, a new cadre of village-based frontline workers, called the Accredited Social Health Activists (ASHAs), was created in 2005 under the aegis of the National Rural Health Mission in India. Evaluations have noted that coverage of selected MNCH services to be delivered by the ASHAs is low. Reasons for low coverage are inadequate supervision and support to ASHAs apart from insufficient skills, poor quality of training, and complexity of tasks to be performed...
June 9, 2017: Trials
https://www.readbyqxmd.com/read/28597854/decentralizing-provision-of-mental-health-care-in-sri-lanka
#13
Neil Fernando, Thirupathy Suveendran, Chithramalee de Silva
In the past, mental health services in Sri Lanka were limited to tertiary-care institutions, resulting in a large treatment gap. Starting in 2000, significant efforts have been made to reconfigure service provision and to integrate mental health services with primary health care. This approach was supported by significant political commitment to establishing island-wide decentralized mental health care in the wake of the 2004 tsunami. Various initiatives were consolidated in The mental health policy of Sri Lanka 2005-2015, which called for implementation of a comprehensive community-based, decentralized service structure...
April 2017: WHO South-East Asia Journal of Public Health
https://www.readbyqxmd.com/read/28591975/an-overview-of-home-based-primary-care-learning-from-the-field
#14
Sarah Klein, Martha Hostetter, Douglas McCarthy
ISSUE: Homebound and functionally limited individuals are often unable to access office-based primary care, leading to unmet needs and increased health care spending. GOAL: Show how home-based primary care affects outcomes and costs for Medicare and Medicaid beneficiaries with complex care needs. METHODS: Qualitative synthesis of expert perspectives and the experiences of six case-study sites. FINDINGS AND CONCLUSIONS: Successful home-based primary care practices optimize care by: fielding interdisciplinary teams, incorporating behavioral care and social supports into primary care, responding rapidly to urgent and acute care needs, offering palliative care, and supporting family members and caregivers...
June 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28587609/hypertension-with-unsatisfactory-sleep-health-hush-study-protocol-for-a-randomized-controlled-trial
#15
Jessica C Levenson, Bruce L Rollman, Lee M Ritterband, Patrick J Strollo, Kenneth J Smith, Jonathan G Yabes, Charity G Moore, Allison G Harvey, Daniel J Buysse
BACKGROUND: Insomnia is common in primary care medical practices. Although behavioral treatments for insomnia are safe, efficacious, and recommended in practice guidelines, they are not widely-available, and their effects on comorbid medical conditions remain uncertain. We are conducting a pragmatic clinical trial to test the efficacy of two cognitive behavioral treatments for insomnia (Brief Behavioral Treatment for Insomnia (BBTI) and Sleep Healthy Using the Internet (SHUTi)) versus an enhanced usual care condition (EUC)...
June 6, 2017: Trials
https://www.readbyqxmd.com/read/28585163/engaging-multilevel-stakeholders-in-an-implementation-trial-of-evidence-based-quality-improvement-in-va-women-s-health-primary-care
#16
Alison B Hamilton, Julian Brunner, Cindy Cain, Emmeline Chuang, Tana M Luger, Ismelda Canelo, Lisa Rubenstein, Elizabeth M Yano
The Veterans Health Administration (VHA) has undertaken primary care transformation based on patient-centered medical home (PCMH) tenets. VHA PCMH models are designed for the predominantly male Veteran population, and require tailoring to meet women Veterans' needs. We used evidence-based quality improvement (EBQI), a stakeholder-driven implementation strategy, in a cluster randomized controlled trial across 12 sites (eight EBQI, four control) that are members of a Practice-Based Research Network. EBQI involves engaging multilevel, inter-professional leaders and staff as stakeholders in reviewing evidence and setting QI priorities...
June 5, 2017: Translational Behavioral Medicine
https://www.readbyqxmd.com/read/28583968/racial-and-ethnic-disparities-persist-at-veterans-health-administration-patient-centered-medical-homes
#17
Donna L Washington, W Neil Steers, Alexis K Huynh, Susan M Frayne, Uchenna S Uchendu, Deborah Riopelle, Elizabeth M Yano, Fay S Saechao, Katherine J Hoggatt
Patient-centered medical homes are widely promoted as a primary care delivery model that achieves better patient outcomes. It is unknown if their benefits extend equally to all racial/ethnic groups. In 2010 the Veterans Health Administration, part of the Department of Veterans Affairs (VA), began implementing patient-centered medical homes nationwide. In 2009 significant disparities in hypertension or diabetes control were present for most racial/ethnic groups, compared with whites. In 2014 hypertension disparities were similar for blacks, had become smaller but remained significant for Hispanics, and were no longer significant for multiracial veterans, whereas disparities had become significant for American Indians/Alaska Natives and Native Hawaiians/other Pacific Islanders...
June 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28580565/-reducing-the-care-related-burdens-of-a-family-caregiver-of-a-person-with-mild-cognitive-impairment-a-home-based-case-management-program
#18
Min-Chia Chen, Yi-Chen Chiu, Pi-Mei Wei, Wen-Chuin Hsu
The long-term care of cognitively impaired patients with concomitant behavioral problems brings great stress and burdens to family caregivers. The present article describes a family caregiver with multiple chronic diseases who concurrently shouldered primary care responsibilities for her husband, a patient with mild cognitive impairment, problematic behaviors, and medication non-adherence issues. The period of care was between September 23rd and December 29th, 2015. Data on physiological, psychological, and social burdens were collected based on a stress process model for family caregiving...
June 2017: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/28576956/the-integral-role-of-the-clinical-pharmacist-practitioner-in-primary-care
#19
Mollie Ashe Scott, Jeffrey E Heck, Courtenay Gilmore Wilson
Clinical pharmacist practitioners serve as integral team members in primary care clinics. They extend the care provided for patients with chronic illnesses, improve health and wellness, and positively impact quality metrics in patient-centered medical homes and accountable care organizations.
May 2017: North Carolina Medical Journal
https://www.readbyqxmd.com/read/28571563/the-design-and-development-of-a-complex-multifactorial-falls-assessment-intervention-for-falls-prevention-the-prevention-of-falls-injury-trial-prefit
#20
Julie Bruce, Shvaita Ralhan, Ray Sheridan, Katharine Westacott, Emma Withers, Susanne Finnegan, John Davison, Finbarr C Martin, Sarah E Lamb
BACKGROUND: This paper describes the design and development of a complex multifactorial falls prevention (MFFP) intervention for implementation and testing within the framework of a large UK-based falls prevention randomised controlled trial (RCT). METHODS: A complex intervention was developed for inclusion within the Prevention of Falls Injury Trial (PreFIT), a multicentre pragmatic RCT. PreFIT aims to compare the clinical and cost-effectiveness of three alternative primary care falls prevention interventions (advice, exercise and MFFP), on outcomes of fractures and falls...
June 1, 2017: BMC Geriatrics
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