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Physician assistants and quality of care

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https://www.readbyqxmd.com/read/28915822/what-hinders-the-uptake-of-computerized-decision-support-systems-in-hospitals-a-qualitative-study-and-framework-for-implementation
#1
Elisa G Liberati, Francesca Ruggiero, Laura Galuppo, Mara Gorli, Marien González-Lorenzo, Marco Maraldi, Pietro Ruggieri, Hernan Polo Friz, Giuseppe Scaratti, Koren H Kwag, Roberto Vespignani, Lorenzo Moja
BACKGROUND: Advanced Computerized Decision Support Systems (CDSSs) assist clinicians in their decision-making process, generating recommendations based on up-to-date scientific evidence. Although this technology has the potential to improve the quality of patient care, its mere provision does not guarantee uptake: even where CDSSs are available, clinicians often fail to adopt their recommendations. This study examines the barriers and facilitators to the uptake of an evidence-based CDSS as perceived by diverse health professionals in hospitals at different stages of CDSS adoption...
September 15, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28914285/hospital-medicine-point-of-care-ultrasound-credentialing-an-example-protocol
#2
Benji K Mathews, Michael Zwank
Though the use of point-of-care ultrasound (POCUS) has increased over the last decade, formal hospital credentialing for POCUS may still be a challenge for hospitalists. This document details the Hospital Medicine Department Ultrasound Credentialing Policy from Regions Hospital, which is part of the HealthPartners organization in Saint Paul, Minnesota. National organizations from internal medicine and hospital medicine (HM) have not published recommended guidelines for POCUS credentialing. Revised guidelines for POCUS have been published by the American College of Emergency Physicians, though these are not likely intended to guide hospitalists when working with credentialing committees and medical boards...
September 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28910992/physician-assisted-suicide-a-clean-bill-of-health
#3
Robert Preston
Background: Physician-assisted suicide (PAS) laws have been enacted in five US States and, along with physician-administered euthanasia, in Canada and the Netherlands. Sources of data: Annual reports of the Oregon Health Authority and published research papers. Areas of agreement: Not all recipients of lethal drugs use them to end their lives. Improvements in palliative care provision. Areas of controversy: Rising numbers of deaths from PAS...
September 1, 2017: British Medical Bulletin
https://www.readbyqxmd.com/read/28906390/empathy-and-burnout-of-emergency-professionals-of-a-health-region-a-cross-sectional-study
#4
Oriol Yuguero, Carles Forné, Montserrat Esquerda, Josep Pifarré, María José Abadías, Joan Viñas
The objective of this study is to assess the association between levels of empathy and burnout of emergency professionals in all the assistance levels.A cross-sectional observational study was conducted in the health region of Lleida and the Pyrenees with 100 professionals from the field of Urgency. Participation reached 40.8%. Empathy and burnout were measured using the Spanish versions of the Jefferson Scale of Physician Empathy (JSPE) and Maslach Burnout Inventory (MBI) respectively. The total MBI score and its 3 dimensions (emotional exhaustion, depersonalization, and personal accomplishment) were analyzed...
September 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28893693/current-status-of-worldwide-use-of-patient-reported-outcome-measures-proms-in-spine-care
#5
Asdrubal Falavigna, Diego Cassol Dozza, Alisson R Teles, Chung Chek Wong, Giuseppe Barbagallo, Darrel Brodke, Abdulaziz Al-Mutair, Zoher Ghogawala, K Daniel Riew
OBJECTIVES: Patient-reported outcome measures PROMs are the most widely accepted means of measuring outcomes following spine procedures. We sought to determine the current status of worldwide use of PROMs in Latin America (LA), Europe (EU), Asia Pacific (AP), North America (NA), and Middle East (ME) in order to determine the barrier to its full implementation. METHODS: A questionnaire survey was sent by e-mail to members of AOSpine to evaluate their familiarity and use of PROMs instruments, and to assess the barriers to their use in spine care practice in LA, EU, AP, NA, and ME...
September 8, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28893514/nurse-practitioners-physician-assistants-and-physicians-are-comparable-in-managing-the-first-five-years-of-diabetes
#6
Yihan Yang, Qi Long, Sandra L Jackson, Mary K Rhee, Anne Tomolo, Darin Olson, Lawrence S Phillips
BACKGROUND: Increasing use of nurse practitioners (NPs) and physician assistants (PAs) is a possible solution to the shortage of primary care providers (PCPs) in the US, but the quality of care they provide is not well understood. METHODS: Since the scope of practice of the three provider types is similar in the Veterans Health Administration (VA), we determined whether patients managed by primary care NPs, PAs or physicians had similar HbA1c levels at comparable times in the natural history of diabetes...
September 8, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28887347/pharmacists-supporting-population-health-in-patient-centered-medical-homes
#7
Antoinette B Coe, Hae Mi Choe
PURPOSE: The integral role of pharmacists in supporting population health initiatives in the patient-centered medical home (PCMH) model of care is described. SUMMARY: Population health initiatives focus on the health outcomes of a group of patients; in the PCMH model, such groups of patients, known as panels, may be defined as patients assigned to a care team or provider. The basic characteristics of the PCMH model include physician-led, team-based practice; coordinated and integrated care within the PCMH and in the patient's community; provision of safe, evidence-based, high-quality care; incorporation of health information technology and continuous quality improvement strategies into panel identification, documentation, and care processes; improved access to care (e...
September 15, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28887346/leveraging-electronic-medical-record-data-for-population-health-management-in-the-veterans-health-administration-successes-and-lessons-learned
#8
Jannet M Carmichael, Joy Meier, Amy Robinson, Janice Taylor, Diana T Higgins, Shardool Patel
PURPOSE: The process and operational elements to establish a population health program using electronic medical record data in a Veterans Health Administration region are described. SUMMARY: Pharmacists are uniquely qualified to assume important roles in population health through the use of their clinical knowledge, assisted by electronic tools that consolidate and report patient-specific data for clinical care. Veterans Integrated Services Network (VISN) 21 has developed 300 dashboards and reports to improve the quality, safety, and value of healthcare to veterans...
September 15, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28875593/implementing-an-evidence-based-clinical-decision-support-tool-to-improve-the-detection-evaluation-and-referral-patterns-of-adult-chronic-kidney-disease-patients-in-primary-care
#9
Mary E Regan
BACKGROUND AND PURPOSE: Chronic kidney disease (CKD) is undertreated and under-recognized in primary care. The majority of primary care providers (PCPs) are not aware or knowledgeable of current CKD guidelines. The purpose of this project was to develop a quality improvement intervention for PCPs through the delivery of evidence-based guidelines at the point of care. METHODS: An evidence-based clinical algorithm was developed in the electronic medical record for providers to access within one organization comprising 11 primary care offices with 80 PCPs...
September 6, 2017: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/28865642/adapting-the-patient-centered-medical-home-to-address-psychosocial-adversity-results-of-a-qualitative-study
#10
Cecilia Vu, Emily Rothman, Caroline J Kistin, Kelly Barton, Barb Bulman, Ann Budzak-Garza, Denyse Olson-Dorff, Megan H Bair-Merritt
OBJECTIVE: The patient-centered medical home (PCMH) seeks to improve population health. However, PCMH models often focus on improving treatment of chronic diseases rather than on addressing psychosocial adversity. We sought to gather key stakeholder input about how PCMHs might feasibly and sustainably address psychosocial adversity within their patient populations. METHODS: We conducted 25 semistructured interviews with key stakeholders, such as physicians, nurses, medical assistants, and patients...
September 2017: Academic Pediatrics
https://www.readbyqxmd.com/read/28855774/studying-the-variability-in-patient-inflow-and-staffing-trends-on-sundays-versus-other-days-in-the-academic-emergency-department
#11
K T Madavan Nambiar, Nisanth Menon Nedungalaparambil, Ottapura Prabhakaran Aslesh
BACKGROUND: Resource limitation, staff deficiency, and variability in patient inflow contribute to emergency department (ED) overcrowding, associated with delayed care, poor care, and poor patient outcomes. This study seeks to describe and analyze patient inflow variability and staffing trends on Sundays versus other days in a tertiary academic ED from South India. METHODS: Patient inflow and staffing data for 2 years were collected from hospital records, cross-checked, and statistically analyzed using Epi Info 7...
July 2017: Journal of Emergencies, Trauma, and Shock
https://www.readbyqxmd.com/read/28839395/staphylococcus-lugdunensis-and-trichophyton-tonsurans-infection-in-synthetic-hair-implants
#12
Pedro Colli, Antonia Fellas, Ralph M Trüeb
Synthetic hair implants are considered in alopecia when the patient requests an immediate result with minor surgery and with a poor donor area. However, the procedure has historically been marred by poor quality fiber and performance resulting in serious complications. Nevertheless, companies continue to market the procedure with the claim that previous problems have been sorted out. We report a case of inflammation in synthetic hair implants, in which microbiological studies revealed infection with Staphylococcus lugdunensis and Trichophyton tonsurans...
April 2017: International Journal of Trichology
https://www.readbyqxmd.com/read/28832459/learning-to-overcome-hierarchical-pressures-to-achieve-safer-patient-care-an-interprofessional-simulation-for-nursing-medical-and-physician-assistant-students
#13
Susan A Reeves, Deanna Denault, Jonathan T Huntington, Greg Ogrinc, Douglas R Southard, Renee Vebell
To positively impact patient safety, the Institute of Medicine, as well as the Quality and Safety Education for Nurses initiative, has recommended clinician training in structured communication techniques. Such techniques are particularly useful in overcoming hierarchical barriers in health care settings. This article describes an interprofessional simulation program to teach structured communication techniques to preprofessional nursing, medical, and physician assistant students. The teaching and evaluation plans are described to aid replication...
September 2017: Nurse Educator
https://www.readbyqxmd.com/read/28831661/bariatric-surgery-is-gaining-ground-as-treatment-of-obesity-after-heart-transplantation-report-of-two-cases
#14
Levan Tsamalaidze, Enrique F Elli
Experience with bariatric surgery in patients after orthotopic heart transplantation (OHT) is still limited. We performed a retrospective review of patients who underwent bariatric surgery after OHT from January 1, 2010 to December 31, 2016. Two post-OHT patients with BMI of 37.5 and 36.2 kg/m² underwent laparoscopic robotic-assisted Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy, respectively. Quality of life substantially improved for both patients. Bariatric surgery is safe and feasible in OHT patients, despite numerous risk factors...
August 22, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/28818632/the-views-of-clergy-regarding-ethical-controversies-in-care-at-the-end-of-life
#15
Michael J Balboni, Adam Sullivan, Patrick T Smith, Danish Zaidi, Christine Mitchell, James A Tulsky, Daniel Sulmasy, Tyler J VanderWeele, Tracy A Balboni
CONTEXT: While religion often informs ethical judgments, little is known about the views of American clergy regarding controversial end-of-life ethical issues including allowing to die and physician-aid in dying or physician-assisted suicide (PAD/PAS). OBJECTIVE: To describe the views of U.S. clergy concerning allowing to die and PAD/PAS. METHODS: A survey was mailed to 1665 nationally representative clergy between 8/2014 to 3/2015 (60% response rate)...
August 14, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28818507/optimizing-quality-of-endoscopy-in-inflammatory-bowel-disease-focus-on-surveillance-and-management-of-colorectal-dysplasia-using-interactive-image-and-video-based-teaching
#16
Tonya R Kaltenbach, Roy M Soetikno, Rebecca DeVivo, Loren A Laine, Alan Barkun, Kenneth R McQuaid
BACKGROUND & AIMS: Varying recommendations regarding the detection and management of dysplasia can lead to uncertainty and may have impeded the uptake of strategies that could improve surveillance in patients with inflammatory bowel disease (IBD). As such, an educational event was held to assist in disseminating the recently published Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients: International Consensus Recommendations (SCENIC)...
August 14, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28806896/the-u-s-department-of-state-s-mental-health-services-a-model-for-integrated-care
#17
Kenneth Dekleva
Since it was established in 1979, the U.S. Department of State's mental health service has functioned as a unique program of care for U.S. diplomats and their family members, currently encompassing more than 250 U.S. embassies and consulates worldwide. Such an approach has allowed for rapid delivery of high-quality care in collaboration with regional medical officers, nurse practitioners, physician assistants, nurses, and local assets. Data from the past three decades indicate that the program has had low rates of medical evacuation and repatriation and low rates of mortality...
August 15, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28803080/palliative-care-development-in-kyrgyzstan
#18
Aibek Mukambetov, Taalaigul Sabyrbekova, Lola Asanalieva, Ilim Sadykov, Alexander Aralbaev, Stephen Connor
Palliative care began in Kyrgyzstan in 2005 as a pilot home based care program in Osh Cancer Center and was supported by a small group of nurses and one physician from Scotland. In 2010, the Soros Foundation-Kyrgyzstan (SFK) and the Open Society Foundation's International Palliative Care Initiative (IPCI) began supporting work on palliative care policy, legislation, essential medicine availability, education, advocacy and implementation. A Ministry of Health working group was established to lead this initiative and technical assistance was provided by an international palliative care consultant...
August 9, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28800276/enhancing-informed-consent-for-physician-aid-in-dying-potential-role-of-handout-on-possible-benefits-of-palliative-care
#19
Harry Peled, Kathleen E Bickel, Christina Puchalski
In the United States, physician aid in dying (PAD) is now legal in several states. However, neither a requirement for a palliative care (PC) consultation nor a defined education in PC exists for physicians participating in PAD or patients requesting assistance. Patients with advanced chronic and serious illness often experience complex physical, psychosocial, and spiritual distress. PC focuses on relieving this distress and improving patient quality of life through early identification and intervention in all domains of suffering, including physical, psychological, social, and spiritual...
August 11, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28793317/the-impact-of-the-implementation-of-physician-assistants-in-inpatient-care-a-multicenter-matched-controlled-study
#20
Marijke J C Timmermans, Anneke J A H van Vught, Yvonne A S Peters, Geert Meermans, Joseph G M Peute, Cornelis T Postma, P Casper Smit, Emiel Verdaasdonk, Tammo S de Vries Reilingh, Michel Wensing, Miranda G H Laurant
BACKGROUND: Medical care for admitted patients in hospitals is increasingly reallocated to physician assistants (PAs). There is limited evidence about the consequences for the quality and safety of care. This study aimed to determine the effects of substitution of inpatient care from medical doctors (MDs) to PAs on patients' length of stay (LOS), quality and safety of care, and patient experiences with the provided care. METHODS: In a multicenter matched-controlled study, the traditional model in which only MDs are employed for inpatient care (MD model) was compared with a mixed model in which besides MDs also PAs are employed (PA/MD model)...
2017: PloS One
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