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Patient aligned care team

Sherine Ismail, Mohamed Osman, Rayf Abulezz, Hani Alhamdan, K H Mujtaba Quadri
Pharmacists possess pivotal competencies and expertise in developing clinical pathways (CPs). We present a tertiary care facility experience of pharmacists vis-a-vis interprofessional collaboration for designing and implementing CPs. We participated in the development of CPs as leading members of a collaborative team of healthcare professionals. We reviewed literature, aligning it with hospital formulary and institutional standards, and participated in weekly team meetings for six months. Several tools and services were adapted to guide prescribing and standardization of care through time-bound order sets...
March 16, 2018: Pharmacy (Basel, Switzerland)
Brittany L Cornwell, Laurie M Brockmann, Elaine C Lasky, Jennifer Mach, John F McCarthy
OBJECTIVES: The Veterans Health Administration (VHA) has achieved substantial national implementation of primary care-mental health integration (PC-MHI) services. However, little is known regarding program characteristics, variation in characteristics across settings, or associations between program fidelity and performance. This study identified core elements of PC-MHI services and evaluated their associations with program characteristics and performance. METHODS: A principal-components analysis (PCA) of reports from 349 sites identified factors associated with PC-MHI fidelity...
March 15, 2018: Psychiatric Services: a Journal of the American Psychiatric Association
Ajimsha M S, Smithesh Kooven, Noora Al-Mudahka
BACKGROUND: Clinical guidelines are systematically developed statements designed to help practitioners and patients to make decisions about appropriate health care. Clinical practice guideline adherence analysis is the best way to fine tune the best practices in a health care industry with international benchmarks. OBJECTIVE: To assess the physical therapist's adherence to structured stroke clinical practice guidelines in an active inpatient rehabilitation center in Qatar...
March 9, 2018: Disability and Rehabilitation
Fiona J Rowe, Lauren R Hepworth, Kerry L Hanna, Claire Howard
OBJECTIVE: To report and evaluate a new Vision Impairment Screening Assessment (VISA) tool intended for use by the stroke team to improve identification of visual impairment in stroke survivors. DESIGN: Prospective case cohort comparative study. SETTING: Stroke units at two secondary care hospitals and one tertiary centre. PARTICIPANTS: 116 stroke survivors were screened, 62 by naïve and 54 by non-naïve screeners. MAIN OUTCOME MEASURES: Both the VISA screening tool and the comprehensive specialist vision assessment measured case history, visual acuity, eye alignment, eye movements, visual field and visual inattention...
March 6, 2018: BMJ Open
Leslie Sheu, Catherine Burke, Dylan Masters, Patricia S O'Sullivan
Phenomenon: Preclerkship medical education has undergone extensive reform, and the clerkship years are growing targets for curricular innovation. As institutions implement new preclerkship curricula to better prepare medical students to practice medicine in the context of modern healthcare systems, the perspective of clerkship leaders regarding clerkship student roles and potential for change will facilitate redefining these roles so that preclerkship educational innovations can continue into clerkships. APPROACH: In this qualitative exploratory study, authors conducted semistructured interviews with clerkship and site directors for eight core clerkships from April to May 2016...
March 6, 2018: Teaching and Learning in Medicine
M Fung-Kee-Fung, D E Maziak, J R Pantarotto, J Smylie, L Taylor, T Timlin, T Cacciotti, P J Villeneuve, C Dennie, C Bornais, S Madore, J Aquino, P Wheatley-Price, R S Ozer, D J Stewart
Background: The Ottawa Hospital (toh) defined delay to timely lung cancer care as a system design problem. Recognizing the patient need for an integrated journey and the need for dynamic alignment of providers, toh used a learning health system (lhs) vision to redesign regional diagnostic processes. A lhs is driven by feedback utilizing operational and clinical information to drive system optimization and innovation. An essential component of a lhs is a collaborative platform that provides connectivity across silos, organizations, and professions...
February 2018: Current Oncology
Lee Galuska, Judith Hahn, E Carol Polifroni, Gregory Crow
Health care transformation is guided by the triple aim of improving health, enhancing the patient experience, and reducing costs. Experts have recommended the addition of a fourth aim, improving the experience of providing care. They advise that achievement of the triple aim will only be possible if we create the conditions where health care workers can find meaning and joy in their work. Nurses' experiences with meaning and joy in their practice have not been well described. In an effort to fill this knowledge gap, nurses across the nation recently participated in a qualitative study to share their experiences with meaning and joy in their nursing practice...
April 2018: Nursing Administration Quarterly
Thomas P O'Toole, Erin E Johnson, Matthew Borgia, Amy Noack, Jean Yoon, Elizabeth Gehlert, Jeanie Lo
INTRODUCTION: Although traditional patient-centered medical homes (PCMHs) are effective for patients with complex needs, it is unclear whether homeless-tailored PCMHs work better for homeless veterans. We examined the impact of enrollment in a Veterans Health Administration (VHA) homeless-tailored PCMH on health services use, cost, and satisfaction compared with enrollment in a traditional, nontailored PCMH. METHODS: We conducted a prospective, multicenter, quasi-experimental, single-blinded study at 2 VHA medical centers to assess health services use, cost, and satisfaction during 12 months among 2 groups of homeless veterans: 1) veterans receiving VHA homeless-tailored primary care (Homeless-Patient Aligned Care Team [H-PACT]) and 2) veterans receiving traditional primary care services (PACT)...
February 15, 2018: Preventing Chronic Disease
Maria T Britto, Sandra C Fuller, Heather C Kaplan, Uma Kotagal, Carole Lannon, Peter A Margolis, Stephen E Muething, Pamela J Schoettker, Michael Seid
The US National Academy of Sciences has called for the development of a Learning Healthcare System in which patients and clinicians work together to choose care, based on best evidence, and to drive discovery as a natural outgrowth of every clinical encounter to ensure innovation, quality and value at the point of care. However, the vision of a Learning Healthcare System has remained largely aspirational. Over the last 13 years, researchers, clinicians and families, with support from our paediatric medical centre, have designed, developed and implemented a network organisational model to achieve the Learning Healthcare System vision...
February 5, 2018: BMJ Quality & Safety
Davide Meani, Mladen Solarić, Harri Visapää, Rose-Marie Rosén, Robert Janknegt, Majana Soče
Background: Androgen deprivation therapy (ADT) with luteinizing hormone-releasing hormone (LHRH) agonists is well established for the treatment of men with metastatic prostate cancer. As clear differences in efficacy, safety, or tolerability between the available LHRH agonists are lacking, the healthcare management team needs to look to practical differences between the formulations when selecting therapy for their patients. Moreover, as the economic burden of prostate cancer rises alongside earlier diagnosis and improved survival, the possibility for cost savings by using products with specific features is growing in importance...
February 2018: Therapeutic Advances in Urology
Audrey L Jones, Roxanne Thomas, Daniel O Hedayati, Shaddy K Saba, James Conley, Adam J Gordon
BACKGROUND: The Veterans Health Administration (VHA) established a patient-centered medical home model of care for Veterans experiencing homelessness called Homeless Patient Aligned Care Teams (HPACTs) to improve engagement with primary care and reduce utilization of hospital-based services. To evaluate the impact of HPACT, we compare the number and type of health care visits in the twelve months before and after enrollment in one HPACT, and explore patient characteristics associated with increases and decreases in visits...
February 7, 2018: Substance Abuse
Terrance A Sgroi, Michelle Cilenti
PURPOSE OF REVIEW: With improvements in surgical techniques and increased knowledge of rotator cuff healing, there was a need to identify a safe progression after rotator cuff repair. The rehabilitation specialist plays an integral role in the care of these patients, and by implementing an evidence and criteria-based model, patients may be able to return to their prior levels of function sooner with fewer complications. RECENT FINDINGS: Timing of progression for rotator cuff patients should align not only with healing but also potential strain on the involved tissue...
February 5, 2018: Current Reviews in Musculoskeletal Medicine
Paul Marcus, Kelly Hautala, Nazima Allaudeen
BACKGROUND: The standard of care for hospital discharge planning includes arranging follow-up appointments, usually with a primary care provider. However, follow-up phone calls instead of face-to-face visits may be an appropriate alternative for some patients. This option was explored within the framework of the US Department of Veterans Affairs (VA) patient-centered medical home model of care, the Patient Aligned Care Team. METHODS: At a VA hospital, a pilot study was conducted on the use of phone calls from members of a patient's medical home as posthospital discharge follow-up rather than the traditional face-to-face provider model...
February 2018: Joint Commission Journal on Quality and Patient Safety
Jeffrey Sordahl, India C King, Kyle Davis, Rick Tivis, Scott C Smith, Amber Fisher, Janet Willis, Timothy Gordon, William G Weppner
Transition to interprofessional team-based care is a quickly progressing healthcare model and requires changes in medical training approaches. The Department of Veteran Affairs (VA) has taken a lead role in creating such training experiences, one of which is the establishment of multiple Centers of Excellence in Primary Care Education (CoEPCE). These sites are tasked with developing teaching innovations to better facilitate interprofessional team-based care. The patient-aligned care team interprofessional care update (PACT-ICU) is an interprofessional workplace learning activity with the goals of simultaneously addressing educational and patient care needs...
January 27, 2018: Translational Behavioral Medicine
Samuel T Edwards, Christian D Helfrich, David Grembowski, Elizabeth Hulen, Walter L Clinton, Gordon B Wood, Linda Kim, Danielle E Rose, Greg Stewart
PURPOSE: Appropriate delegation of clinical tasks from primary care providers (PCPs) to other team members may reduce employee burnout in primary care. However, (1) the extent to which delegation occurs within multidisciplinary teams, (2) factors associated with greater delegation, and (3) whether delegation is associated with burnout are all unknown. METHODS: We performed a national cross-sectional survey of Veterans Affairs (VA) PCP-nurse dyads in Department of VA primary care clinics, 4 years into the VA's patient-centered medical home initiative...
January 2018: Journal of the American Board of Family Medicine: JABFM
Christine P Kowalski, Deanna B McQuillan, Neetu Chawla, Courtney Lyles, Andrea Altschuler, Connie S Uratsu, Elizabeth A Bayliss, Michele Heisler, Richard W Grant
BACKGROUND: Choosing which issues to discuss in the limited time available during primary care visits is an important task for complex patients with chronic conditions. DESIGN, SETTING, AND PARTICIPANTS: We conducted sequential interviews with complex patients (n = 40) and their primary care physicians (n = 17) from 3 different health systems to investigate how patients and physicians prepare for visits, how visit agendas are determined, and how discussion priorities are established during time-limited visits...
January 2018: Journal of the American Board of Family Medicine: JABFM
Chrysanthi Papoutsi, Alan Poots, Jake Clements, Zoe Wyrko, Natalie Offord, Julie E Reed
Background: checklists are increasingly proposed as a means to enhance safety and quality of care. However, their use has been met with variable levels of success. The Frailsafe project focused on introducing a checklist with the aim to increase completion of key clinical assessments and to facilitate communication for the care of older patients in acute admissions. Objectives: to examine the use of the Frailsafe checklist, including potential to contribute to improved safety, quality and reliability of care...
March 1, 2018: Age and Ageing
Elizabeth A Rogers, Sarah Turcotte Manser, Joan Cleary, Anne M Joseph, Eileen M Harwood, Kathleen T Call
PURPOSE: Though evidence supports the value of community health workers (CHWs) in chronic disease self-management support, and authorities have called for expanding their roles within patient-centered medical homes (PCMHs), few PCMHs in Minnesota have incorporated these health workers into their care teams. We undertook a qualitative study to (1) identify facilitators and barriers to utilizing a CHW model among PCMHs in Minnesota, and (2) define roles played by this workforce within the PCMH team...
January 2018: Annals of Family Medicine
Andrew S Pomerantz
Comments on an article by J. A. Cigrang et al. (see record 2017-56601-006). At first glance, the article by Cigrang et al. is another in a long line of randomized clinical trials of psychotherapy for a common condition. Under closer scrutiny, however, it is a groundbreaking study that challenges many commonly held beliefs about effective interventions for posttraumatic stress disorder (PTSD). Cigrang et al. have begun to change the status quo with this study within the DoD. The same protocol is now in the early stages of implementation as a pilot in the VA's Patient Aligned Care Team (VA equivalent of the Patient Centered Medical Home)...
December 2017: Families, Systems & Health: the Journal of Collaborative Family Healthcare
Kirti D Doekhie, Martina Buljac-Samardzic, Mathilde M H Strating, Jaap Paauwe
BACKGROUND: Due to the growing prevalence of elderly patients with multi-morbidity living at home, there is an increasing need for primary care professionals from different disciplinary backgrounds to collaborate as primary care teams. However, it is unclear how primary care professionals conceptualize teams and what underlying factors influence their perception of being part of a team. Our research question is: What are primary care professionals' perceptions of teams and team membership among primary care disciplines and what factors influence their perceptions? METHODS: We conducted a mixed-methods study in the Dutch primary care setting...
December 28, 2017: BMC Family Practice
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