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https://www.readbyqxmd.com/read/28441676/transitioning-from-volume-to-value-one-academic-medical-center-s-approach-to-improving-population-health
#1
Stephanie A C Halvorson, Mary E Tanski, Thomas R Yackel
PROBLEM: The U.S. health care system is undergoing a major transformation. Clinical delivery systems are now being paid according to the value of the care they provide, in accordance with the Triple Aim, which incorporates improving the quality and cost of care and the patient experience. Increasingly, financial risk is being transferred from insurers to clinical delivery systems that become responsible for both episode-based clinical care and the longitudinal care of patients. Thus, these delivery systems need to develop strategies to manage the health of populations...
May 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28441671/swimming-upstream-creating-a-culture-of-high-value-care
#2
Reshma Gupta, Christopher Moriates
As health system leaders strategize the best ways to encourage the transition toward value-based health care, the underlying culture-defined as a system of shared assumptions, values, beliefs, and norms existing within an environment-continues to shape clinician practice patterns. The current prevailing medical culture contributes to overtesting, overtreatment, and health care waste. Choosing Wisely lists, appropriateness criteria, and guidelines codify best practices, but academic medicine as a whole must recognize that faculty and trainees are all largely still operating within the same cultural climate...
May 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28441493/systematic-study-on-hydrated-arginine-clear-theoretical-evidence-for-the-canonical-to-zwitterionic-structure-transition
#3
Hongbao Li, Andong Hu, Jun Jiang, Yi Luo
Extensive ab initio investigations have been performed to characterize the stable conformers of hydrated arginine (Arg-H2O). Many new low-energy canonical Arg-H2O conformers were identified and they are more stable than previous results. The large energy differences (more than 5.00 kcal mol(-1)) between the canonical and zwitterionic Arg-H2O isomers calculated by the composite CBS-QB3 method confirmed the dominance of the zwitterions. The micro effects of corrections of the zero-point energy and the basis set superposition error on the stability of hydrated isomers were carefully examined for the first time...
April 25, 2017: Journal of Physical Chemistry. A
https://www.readbyqxmd.com/read/28441324/designing-fit-for-purpose-health-and-social-services-for-ageing-populations
#4
Jean Woo
Population ageing is occurring in all countries, regardless of the level of economic development. While the rising burden of chronic diseases and disabilities as a consequence of this demographic transition is well recognized, the increasing prevalence of geriatric syndromes as a public health issue is not as well recognized. Recently the World Health Organization's World Health and Ageing Report emphasized functional ability as an important outcome for aging populations, highlighting the concept of raising intrinsic capacity throughout the life course...
April 25, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/28441271/alternative-payment-models-and-urology
#5
Deborah R Kaye, David C Miller, Chad Ellimoottil
PURPOSE OF REVIEW: The Medicare Access and CHIP Reauthorization Act (MACRA) is a historic bill that was recently passed that establishes how quality measurement and practice patterns will affect physician reimbursement. Alternative payment models (APMs) are an essential component of MACRA and Medicare's vision of paying for high-value care. This review describes APMs in the context of MACRA and their impact on urology. RECENT FINDINGS: The majority of urologists will be affected by MACRA...
April 22, 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28440016/outcomes-and-feasibility-of-the-short-transitional-intervention-in-psychiatry-in-improving-the-transition-from-inpatient-treatment-to-the-community-a-pilot-study
#6
Anna Hegedüs, Bernd Kozel, Niklaus Fankhauser, Ian Needham, Johann Behrens
Discharge from psychiatric inpatient care is frequently described as chaotic, stressful, and emotionally charged. Following discharge, service users are vulnerable to becoming overwhelmed by the challenges involved in readapting to their home environments, which could result in serious problems and lead to readmission. The short transitional intervention in psychiatry (STeP) is a bridging intervention that includes pre- and post-discharge sections. It aims to prepare patients for specific situations in the period immediately following discharge from a psychiatric hospital...
April 25, 2017: International Journal of Mental Health Nursing
https://www.readbyqxmd.com/read/28439357/resident-dyads-providing-transition-care-to-adolescents-and-young-adults-with-chronic-illnesses-and-neurodevelopmental-disabilities
#7
Richard J Chung, Joan Jasien, Gary R Maslow
BACKGROUND: Youth with special health care needs often experience difficulty transitioning from pediatric to adult care. These difficulties may derive in part from lack of physician training in transition care and the challenges health care providers experience establishing interdisciplinary partnerships to support these patients. OBJECTIVE: This educational innovation sought to improve pediatrics and adult medicine residents' interdisciplinary communication and collaboration...
April 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/28439351/residents-exposure-to-educational-experiences-in-facilitating-hospital-discharges
#8
Eric Young, Chad Stickrath, Monica McNulty, Aaron J Calderon, Elizabeth Chapman, Jed D Gonzalo, Ethan F Kuperman, Max Lopez, Christopher J Smith, Joseph R Sweigart, Cecelia N Theobald, Robert E Burke
BACKGROUND: There is an incomplete understanding of the most effective approaches for motivating residents to adopt guideline-recommended practices for hospital discharges. OBJECTIVE: We evaluated internal medicine (IM) residents' exposure to educational experiences focused on facilitating hospital discharges and compared those experiences based on correlations with residents' perceived responsibility for safely transitioning patients from the hospital. METHODS: A cross-sectional, multi-center survey of IM residents at 9 US university- and community-based training programs in 2014-2015 measured exposure to 8 transitional care experiences, their perceived impact on care transitions attitudes, and the correlation between experiences and residents' perceptions of postdischarge responsibility...
April 2017: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/28438820/use-of-an-argatroban-based-purge-solution-in-a-percutaneous-ventricular-assist-device
#9
Benjamin Laliberte, Brent N Reed
PURPOSE: The use of an argatroban-based percutaneous ventricular assist device (pVAD) purge solution in a patient with suspected heparin-induced thrombocytopenia (HIT) is described. SUMMARY: A 70-year-old woman in cardiogenic shock was admitted to a coronary care unit after being discovered unresponsive at home. A transthoracic echocardiogram revealed a low ejection fraction and findings consistent with takotsubo cardiomyopathy. Administration of multiple inotropes and vasopressors was initially required for hemodynamic support...
May 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28438589/specialty-palliative-care-consultations-for-nursing-home-residents-with-dementia
#10
Susan C Miller, Julie C Lima, Orna Intrator, Edward Martin, Janet Bull, Laura C Hanson
CONTEXT: U.S. nursing home (NH) residents with dementia have limited access to specialty palliative care beyond Medicare hospice. OBJECTIVES: To examine the value of expanded palliative care access for NH residents with moderate to very severe dementia. METHODS: We merged palliative care consultation data in 31 NHs in two states to Medicare data to identify residents with consultations, moderate to very severe dementia, and deaths in 2006-2010...
April 21, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28437928/terahertz-optical-bistability-of-graphene-in-thin-layers-of-dielectrics
#11
Kwang Jun Ahn, Fabian Rotermund
We theoretically studied in terahertz frequency regime optical bistability of graphene placed at the interface between thin dielectric layers. We solved self-consistently the nonlinear wave equations containing the third-order optical conductivity of graphene in four-layer structures and obtained hysteresis response of the transmitted power as a function of the incident power. We numerically observed that the critical powers for the up and down transitions and the Fermi-energy of graphene required for terahertz optical bistability can be reduced by carefully choosing material properties and the thicknesses of dielectric layers...
April 17, 2017: Optics Express
https://www.readbyqxmd.com/read/28437261/training-in-intraoperative-handover-and-display-of-a-checklist-improve-communication-during-transfer-of-care-an-interventional-cohort-study-of-anaesthesia-residents-and-nurse-anaesthetists
#12
Marion Jullia, Anaïs Tronet, Fabiola Fraumar, Vincent Minville, Olivier Fourcade, Xavier Alacoque, Yannick LeManach, Matt M Kurrek
BACKGROUND: Handovers during anaesthesia are common, and failures in communication may lead to morbidity and mortality. OBJECTIVES: We hypothesised that intraoperative handover training and display of a checklist would improve communication during anaesthesia care transition in the operating room. DESIGN: Interventional cohort study. SETTING: Single-centre tertiary care university hospital. PARTICIPANTS: A total of 204 random observations of handovers between anaesthesia providers (residents and nurse anaesthetists) over a 6-month period in 2016...
April 21, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28435497/improved-accuracy-and-quality-of-information-during-emergency-department-care-transitions
#13
Nnaemeka Okafor, Justin Mazzillo, Sara Miller, Kimberly A Chambers, Samar Yusuf, Vanessa Garza-Miranda, Yashwant Chathampally
INTRODUCTION: Suboptimal communication during emergency department (ED) care transitions has been shown to contribute to medical errors, sometimes resulting in patient injury and litigation. The study objective was to determine whether a standardized checkout process would decrease the number of relevant missed clinical items (MCI). METHODS: In this prospective pre- and post-intervention study conducted in an urban academic ED, we collected data on omitted or inaccurately conveyed medical information before and after the initiation of a standardized checkout process...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28435418/-you-never-know-what-happens-next-young-adult-service-users-experience-with-mental-health-care-and-treatment-through-one-year
#14
Marian Ådnanes, Sissel Steihaug
Fragmented services are a well-known problem in the mental health sector. Mental health service users' experiences of treatment and care can provide knowledge for developing more user-oriented continuity of care. We followed nine young adults with mental health illnesses and complex needs, conducting four interviews with each informant in the course of a year. The aim was to capture their experiences and views about treatment and care, focusing on (dis)continuities and episodes occurring through that year. The users' experiences were affected by shifts and transitions between institutions, units and practitioners while their need was predictability and stability...
July 22, 2016: International Journal of Integrated Care
https://www.readbyqxmd.com/read/28434275/cost-effectiveness-of-a-transitional-home-based-palliative-care-program-for-patients-with-end-stage-heart-failure
#15
Frances Kam Yuet Wong, Ching So, Alina Yee Man Ng, Po-Tin Lam, Jeffrey Sheung Ching Ng, Nancy Hiu Yim Ng, June Chau, Michael Mau Kwong Sham
BACKGROUND: Studies have shown positive clinical outcomes of specialist palliative care for end-stage heart failure patients, but cost-effectiveness evaluation is lacking. AIM: To examine the cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure patients as compared to the customary palliative care service. DESIGN: A cost-effectiveness analysis was conducted alongside a randomized controlled trial (Trial number: NCT02086305)...
April 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28433407/patient-provider-communication-in-nephrology-care-for-adolescents-and-young-adults
#16
S S Coburn, M N Eakin, D Roter, C Pruette, T Brady, S Mendley, S Tuchman, B Fivush, K A Riekert
OBJECTIVE: To compare the relative quantity of talk between providers, caregivers, and adolescents and young adults (AYAs) with chronic kidney disease (CKD) and how communication differs by age. METHODS: During nephrology clinic visits, conversations between AYAs with CKD (N=99, ages 11-20, median=15), their caregivers, and providers (N=19) were audiotaped and coded using the Roter Interaction Analysis System. Linear mixed models tested AYA age differences in talk frequency by AYAs, caregivers, and providers...
March 24, 2017: Patient Education and Counseling
https://www.readbyqxmd.com/read/28430963/integrated-care-for-older-populations-and-its-implementation-facilitators-and-barriers-a-rapid-scoping-review
#17
Diane E Threapleton, Roger Y Chung, Samuel Y S Wong, Eliza Wong, Patsy Chau, Jean Woo, Vincent C H Chung, Eng-Kiong Yeoh
Purpose: Inform health system improvements by summarizing components of integrated care in older populations. Identify key implementation barriers and facilitators. Data sources: A scoping review was undertaken for evidence from MEDLINE, the Cochrane Library, organizational websites and internet searches. Eligible publications included reviews, reports, individual studies and policy documents published from 2005 to February 2017. Study selection: Initial eligible documents were reviews or reports concerning integrated care approaches in older/frail populations...
April 20, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/28429611/consensus-statement-on-inpatient-use-of-continuous-glucose-monitoring
#18
Amisha Wallia, Guillermo E Umpierrez, Robert J Rushakoff, David C Klonoff, Daniel J Rubin, Sherita Hill Golden, Curtiss B Cook, Bithika Thompson
In June 2016, Diabetes Technology Society convened a panel of US experts in inpatient diabetes management to discuss the current and potential role of continuous glucose monitoring (CGM) in the hospital. This discussion combined with a literature review was a follow-up to a meeting, which took place in May 2015. The panel reviewed evidence on use of CGM in 3 potential inpatient scenarios: (1) the intensive care unit (ICU), (2) non-ICU, and (3) transitioning outpatient CGM use into the hospital setting. Panel members agreed that data from limited studies and theoretical considerations suggested that use of CGM in the hospital had the potential to improve patient clinical outcomes, and in particular reduction of hypoglycemia...
April 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28428716/transition-after-pediatric-liver-transplantation-perceptions-of-adults-adolescents-and-parents
#19
Norman Junge, Katarina Migal, Imeke Goldschmidt, Ulrich Baumann
AIM: To develop a locally adapted, patient-focused transition-program, we evaluated the perceptions of adult and adolescent patients and parents regarding transition-programs and transfer. METHODS: We evaluated these perceptions by analyzing the responses of pre-transfer adolescents (n = 57), their parents (n = 57) and post-transfer adults (n = 138) from a cohort of pediatric-liver-transplant-patients using a self-designed questionnaire. Furthermore, we compared a responder group with a non-responder group as well as the provided answers with baseline characteristics and clinical outcomes to exclude selection bias, characterize high-risk patients for non-adherence and test for gender differences...
April 7, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28428097/care-coordination-and-comprehensive-electronic-health-records-are-associated-with-increased-transition-planning-activities
#20
Niraj Sharma, Kitty O'Hare, Karen G O'Connor, Umbereen Nehal, Megumi J Okumura
OBJECTIVE: Youth with Special Health Care Needs (YSHCN) require assistance from their pediatricians to transition to adult care. There is little data on what transition resources pediatricians have. This paper studies if care coordination and/or comprehensive electronic health record (CEHR) implementation are associated with improved transition processes. METHODS: Using AAP Periodic Survey #79, we report whether practices generated written transition plans, assisted in finding adult providers, and discussed confidentiality issues...
April 18, 2017: Academic Pediatrics
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