"Primary care home"

BACKGROUND: Adolescents with chronic health conditions and/or disabilities (CHC/D's) often face challenges when transitioning to adult care, which leads to a higher risk of morbidity and mortality. Although it is recommended that establishing the medical home and family physician (FP) attachment prior to transfer will improve health outcomes, there is little evidence or policy surrounding the role of the FP during this transition. This study explores the described use of health services by adolescents with CHC/D's, as well as the adolescent's and caregiver's perceptions of their FP...

Background: Primary care models that offer comprehensive, accessible care to all patients may provide insufficient resources to meet the needs of patients with complex conditions who have the greatest risk for hospitalization. Objective: To assess whether augmenting usual primary care with team-based intensive management lowers utilization and costs for high-risk patients. Design: Randomized quality improvement trial. (ClinicalTrials.gov: NCT03100526)...

BACKGROUND: Patient-centered medical homes (PCMHs) are at the forefront of the transformation of primary care as part of health systems reform. Despite robust literature describing implementation challenges, few studies describe strategies being used to overcome these challenges. This article addresses this gap through observations of exemplary PCMHs in Oregon, where the Oregon Health Authority supports and recognizes Patient-Centered Primary Care Homes (PCPCH). METHODS: Twenty exemplary PCPCHs were selected using program scores, with considerations for diversity in clinic characteristics...

OBJECTIVE: We aim to evaluate the effectiveness of a broadly inclusive, comparatively low intensity intervention linking ED patients to a primary care home. METHODS: This retrospective cohort study evaluated ED patients referred for primary care linkage in a large, urban, academic ED. A care coordination specialist performed a brief interview to gauge access barriers and provide a clinic referral with optional scheduling assistance. Data were abstracted from program records and the electronic medical record...

Relatively few successful medication adherence interventions are translated into real-world clinical settings. The Prevention of Cardiovascular Outcomes in African Americans with Diabetes (CHANGE) intervention was originally conceived as a randomized controlled trial to improve cardiovascular disease-related medication adherence and health outcomes. The purpose of the study was to describe the translation of the CHANGE trial into two community-based clinical programs. CHANGE 2 was available to Medicaid patients with diabetes and hypertension whose primary care homes were part of a care management network in the Northern Piedmont region of North Carolina...

AIMS: To evaluate the health-related quality of life (HRQoL) and functional capacity in relation to glycemic control among older home-dwelling primary care patients. METHODS: Electronic patient records were used to identify 527 people over 65 years with diabetes. Of these, 259 randomly selected subjects were invited to a health examination and 172 of them attended and provided complete data. The participants were divided into three groups based on the HbA1c: good (HbA1c<48mmol/mol (N=95)), intermediate (HbA1c 48-57mmol/mol (N=48)) and poor (HbA1c>57mmol/mol (N=29)) glycemic control...

OBJECTIVE: To evaluate the mode of implementation, clinical outcomes, cost-effectiveness, and the factors influencing uptake and sustainability of collaborative care for psychiatric disorders in older adults. DESIGN: Systematic review. SETTING: Primary care, home health care, seniors' residence, medical inpatient and outpatient. PARTICIPANTS: Studies with a mean sample age of 60 years and older. INTERVENTION: Collaborative care for psychiatric disorders...

Nurturing environments within the context of families, schools, and communities all play an important role in enhancing youth's behavioral choices and health outcomes. The increasing prevalence rates of obesity among youth, especially among low income and ethnic minorities, highlight the need to develop effective and innovative intervention approaches that promote positive supportive environments across different contexts for at-risk youth. We propose that the integration of Social Cognitive Theory, Family Systems Theory, and Self-Determination Theory offers a useful framework for understanding how individual, family, and social-environmental-level factors contribute to the development of nurturing environments...

Importance: Several state Medicaid reforms are under way, but the relative performance of different approaches is unclear. Objective: To compare the performance of Oregon's and Colorado's Medicaid Accountable Care Organization (ACO) models. Design, Setting, and Participants: Oregon initiated its Medicaid transformation in 2012, supported by a $1.9 billion investment from the federal government, moving most Medicaid enrollees into 16 Coordinated Care Organizations, which managed care within a global budget...

Asthma is one of the most common chronic pediatric diseases. Patients with asthma often present to the emergency department for treatment for acute exacerbations. These patients may not have a primary care physician or primary care home, and thus are seeking care in the emergency department. Asthma care in the emergency department is multifaceted to treat asthma patients appropriately and provide quality care. National and international guidelines exist to help drive clinical care. Electronic and paper-based tools exist for both physicians and patients to help improve emergency, home, and preventive care...

INTRODUCTION: As part of its strategy to achieve the Triple Aim, the Oregon Health Authority implemented the Patient-Centered Primary Care Home (PCPCH) Program in 2009. In 2014, the program recognized more than 500 primary care practices and had become an essential component of Oregon's strategy for transforming health services delivery. To assist the Oregon Health Authority with evaluating practices' achievement of the PCPCH model along its 6 core attributes (access, accountability, comprehensive care, continuity, coordination, and person-centered care), the research team developed an innovative scoring method...

BACKGROUND: Effective implementation of a Primary Care Medical Home model of care (PCMH) requires integration of patients' contextual information (physical, mental, social and financial status) into an easily retrievable information source for the healthcare team and clinical decision-making. This project explored clinicians' perceptions about important attributes of contextual information for clinical decision-making, how contextual information is expressed in CPRS clinical documentation as well as how clinicians in a highly computerized environment manage information flow related to these areas...

Approximately four million adults in the United States are homebound, and many of them cannot access office-based primary care. Home-based medical care can improve outcomes and reduce health care costs, but this care operates in a quality measurement desert, having been largely left out of the national conversation on care quality. To address this shortcoming, two of the authors created the National Home-Based Primary and Palliative Care Network, an organization whose members include exemplary home-based medical practices, professional societies, and patient advocacy groups...

OBJECTIVE: Health system reform is largely dependent upon the transformation of primary care in addition to the alignment of incentives that mediate the allocation of resources. The Patient-Centered Medical Home (PCMH) is a model of enhanced primary care that encourages coordination, patient-centered care, integration of public health services, and innovative methods for improving population health-all critical elements of health system reform. Because it changes the way primary care is organized and delivered, the PCMH model has been adopted as a foundational component of Oregon's health system transformation...

PURPOSE: To identify insured services that are most important to Medicare beneficiaries with cancer and their family caregivers when coverage is limited. METHODS: A total of 440 participants (patients, n = 246; caregivers, n = 194) were enrolled onto the CHAT (Choosing Health Plans All Together) study from August 2010 to March 2013. The exercise elicited preferences about what benefits Medicare should cover for patients with cancer in their last 6 months of life...

Discussion on implementation of the Excellent Care for all Act, 2010 (ECFA Act), Bill 46, has focused on the hospital sector in Ontario, but it also has relevance outside the hospital setting. As primary healthcare, long-term care and home care all receive public funding, these sectors should be expected to be compliant with Bill 46. But does the act also govern government-funded (i.e., by other than the Ministry of Health and Long-Term Care) community-based programs such as adult day programs, meals-on-wheels, nutrition programs for children, and more? We propose that we cannot exclude any of these essential programs...

OBJECTIVE: To examine the extent to which local health department (LHD) assurance of select services known to promote and protect the health of older adults is associated with more favorable population health indicators among seniors. DESIGN: Data from the California Health Interview Survey (CHIS: 2003, 2005, and 2007) were linked with the 2005 wave of the National Association of County and City Health Officials profile survey and the Area Resource File to assess the association of LHD assurance and senior health indicators...

INTRODUCTION: The objective of the study is to assess the outcome of a Primary Care programme of replacing the Percutaneous Endoscopy Gastrostomy at home. MATERIAL AND METHODS: A retrospective descriptive study was conducted on all patients (n=44), of Zaragoza Health Sector III, carriers of a percutaneous endoscopy gastrostomy (PEG), who had a replacement at home by the Home Care Service (HCS), during the period from September 2008 to December 2010. Socio-demographic data, the number of PEG replacements performed on each patient, any incidents occurring with each replacement either by the Endoscopy Department or the HCS, as well as the time elapsed until the next replacement, were all recorded...

INTRODUCTION: The U.S. faces a critical gap between residency training and clinical practice that affects the recruitment and preparation of internal medicine residents for primary care careers. The patient-centered medical home (PCMH) represents a new clinical microsystem that is being widely promoted and implemented to improve access, quality, and sustainability in primary care practice. AIM: We address two key questions regarding the training of internal medicine residents for practice in PCMHs...

Because the Affordable Care Act will expand health insurance to cover an estimated thirty-two million additional people, new approaches are needed to expand the primary care workforce. One possible solution is Grand-Aides®, who are health care professionals operating under the direct supervision of nurses, and who are trained and equipped to conduct telephone consultations or make primary care home visits to patients who might otherwise be seen in emergency departments and clinics. We conducted pilot tests with Grand-Aides in two pediatric Medicaid settings: an urban federally qualified health center in Houston, Texas, and a semi-rural emergency department in Harrisonburg, Virginia...