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https://www.readbyqxmd.com/read/28319519/process-improvement-initiative-for-the-perioperative-management-of-patients-with-a-cardiovascular-implantable-electronic-device
#1
Margaret K Menzel Ellis, Miriam M Treggiari, Jamie M Robertson, Marc A Rozner, Peter F Graven, Michael F Aziz, Matthias J Merkel, Edward A Kahl, Norman A Cohen, Eric C Stecker, Peter M Schulman
BACKGROUND: Economic, personnel, and procedural challenges often complicate and interfere with efficient and safe perioperative care of patients with cardiovascular implantable electronic devices (CIEDs). In the context of a process improvement initiative, we created and implemented a comprehensive anesthesiologist-run perioperative CIED service to respond to all routine requests for perioperative CIED consultations at a large academic medical center. This study was designed to determine whether this new care model was associated with improved operating room efficiency, reduced institutional cost, and adequate patient safety...
March 17, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28264952/synthesis-of-research-on-patient-centered-medical-homes-brings-systematic-differences-into-relief
#2
Anna D Sinaiko, Mary Beth Landrum, David J Meyers, Shehnaz Alidina, Daniel D Maeng, Mark W Friedberg, Lisa M Kern, Alison M Edwards, Signe Peterson Flieger, Patricia R Houck, Pamela Peele, Robert J Reid, Katharine McGraves-Lloyd, Karl Finison, Meredith B Rosenthal
The patient-centered medical home (PCMH) model emphasizes comprehensive, coordinated, patient-centered care, with the goals of reducing spending and improving quality. To evaluate the impact of PCMH initiatives on utilization, cost, and quality, we conducted a meta-analysis of methodologically standardized findings from evaluations of eleven major PCMH initiatives. There was significant heterogeneity across individual evaluations in many outcomes. Across evaluations, PCMH initiatives were not associated with changes in the majority of outcomes studied, including primary care, emergency department, and inpatient visits and four quality measures...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28254203/factors-associated-with-poor-controller-medication-use-in-children-with-high-asthma-emergency-department-use
#3
Arlene Butz, Tricia Morphew, Cassia Lewis-Land, Joan Kub, Melissa Bellin, Jean Ogborn, Shawna S Mudd, Mary Elizabeth Bollinger, Mona Tsoukleris
BACKGROUND: Understanding health and social factors associated with controller medication use in children with high-risk asthma may inform disease management in the home and community. OBJECTIVE: To examine health and social factors associated with the Asthma Medication Ratio (AMR), a measure of guideline-based care and controller medication use, in children with persistent asthma and frequent emergency department (ED) use. METHODS: Study questionnaires, serum allergen sensitization, salivary cotinine, and pharmacy record data were collected for 222 children enrolled from August 2013 to February 2016 in a randomized clinical trial that tested the efficacy of an ED- and home-based intervention...
February 18, 2017: Annals of Allergy, Asthma & Immunology
https://www.readbyqxmd.com/read/28245657/perceptions-of-the-medical-home-by-parents-of-children-with-chronic-illnesses
#4
Emily B Vander Schaaf, Elisabeth P Dellon, Rachael A Carr, Neal A deJong, Asheley C Skinner, Michael J Steiner
OBJECTIVES: The patient-centered medical home (PCMH) strives to improve the quality of care in the primary care setting. Recently, certification programs for patient-centered coordinated care have expanded to subspecialty care. Children with chronic conditions are particularly in need of patient-centered and coordinated care. Our objective was to compare parent perceptions of PCMH elements at primary care and specialty practices for children receiving specialty care. STUDY DESIGN: Cross-sectional survey study...
February 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28243873/closing-the-false-divide-sustainable-approaches-to-integrating-mental-health-services-into-primary-care
#5
Kurt Kroenke, Jurgen Unutzer
Mental disorders account for 25% of all health-related disability worldwide. More patients receive treatment for mental disorders in the primary care sector than in the mental health specialty setting. However, brief visits, inadequate reimbursement, deficits in primary care provider (PCP) training, and competing demands often limit the capacity of the PCP to produce optimal outcomes in patients with common mental disorders. More than 80 randomized trials have shown the benefits of collaborative care (CC) models for improving outcomes of patients with depression and anxiety...
February 27, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28152802/integrating-nursing-into-oral-chemotherapy-education
#6
Nancy Weinstein, Jessica A Zerillo
81 Background:The shift of chemotherapy administration from the oncology infusion suite to the home has unwound systems and left patients vulnerable to errors. Many of the safeguards for parenteral chemotherapy, including education by an oncology nurse, are absent for oral chemotherapy. The 2013 American Society of Clinical Oncology/Oncology Nursing Society Standards served as the framework for improving the initiation of oral chemotherapy at Beth Israel Deaconess Medical Center. METHODS: Clinicians caring for patients with melanoma and renal cell cancer were surveyed...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28141731/growth-and-documentation-deficits-where-to-start-in-helping-families
#7
Wilhelmina Hernandez, Deborah A Frank, Samantha Morton, Carmen Palacios, Marilyn Augustyn
Pedro is a 2-year 7-month-old boy who was presented for the first time after a visit to a local emergency room (ER) for diarrhea. At the time of his birth, his undocumented mother, Clara, was 20 years old, uninsured, and with limited English proficiency living approximately 400 miles south of our practice in a different state. Although she had been brought to the United States as a child, she had never finished high school. Pedro was born what mother thought was full-term at his parent's home, where a lay midwife assisted during the delivery...
February 2017: Journal of Developmental and Behavioral Pediatrics: JDBP
https://www.readbyqxmd.com/read/28132694/buprenorphine-prescribing-practice-trends-and-attitudes-among-new-york-providers
#8
Andrea Kermack, Mara Flannery, Babak Tofighi, Jennifer McNeely, Joshua D Lee
Buprenorphine office-based opioid maintenance is an increasingly common form of treatment for opioid use disorders. However, total prescribing has not kept pace with the current opioid and overdose epidemic and access remains scarce among the underserved. This study sought to assess current provider attitudes and clinical practices among a targeted sample of primarily New York City public sector buprenorphine prescribers. A cross-sectional online survey purposefully sampled buprenorphine prescribers in NYC with a focus on those serving Medicaid and uninsured patient populations...
March 2017: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/28112433/usual-care-for-rural-veterans-with-posttraumatic-stress-disorder
#9
Kathleen M Grubbs, John C Fortney, Tim Kimbrell, Jeffrey M Pyne, Teresa Hudson, Dean Robinson, William Mark Moore, Paul Custer, Ronald Schneider, Paula P Schnurr
PURPOSE: Community-Based Outpatient Clinics (CBOCs) provide primary-care-based mental health services to rural veterans who live long distances from Veterans Affairs (VA) hospitals. Characterizing the composition of usual care will highlight the need and potential strategies to improve access to and engagement in evidence-based psychotherapy for posttraumatic stress disorder (PTSD). METHOD: Veterans (N = 132) with PTSD recruited from 5 large- (5,000-10,000 patients) and 6 medium-sized (1,500-4,999) CBOCs were enrolled in the usual care arm of a randomized control trial for a PTSD collaborative care study...
January 23, 2017: Journal of Rural Health
https://www.readbyqxmd.com/read/28089817/patient-centered-specialty-practice-defining-the-role-of-specialists-in-value-based-healthcare
#10
REVIEW
Lawrence Ward, Rhea E Powell, Michael L Scharf, Andrew Chapman, Mani Kavuru
Healthcare is at a crossroads, under pressure to add value by improving patient experience and health outcomes and reducing costs to the system. Efforts to improve the care model in primary care, such as the patient-centered medical home, have enjoyed some success. Yet primary care accounts for only a small portion of total healthcare spending, and there is a need for policies and frameworks to support high quality, cost-efficient care in specialty practices of the "medical neighborhood". The Patient-Centered Specialty Practice (PCSP) model offers ambulatory-based specialty practices one such framework, supported by a formal recognition program through the National Committee for Quality Assurance...
January 13, 2017: Chest
https://www.readbyqxmd.com/read/28068138/payment-reform-in-the-patient-centered-medical-home-enabling-and-sustaining-integrated-behavioral-health-care
#11
Benjamin F Miller, Kaile M Ross, Melinda M Davis, Stephen P Melek, Roger Kathol, Patrick Gordon
The patient-centered medical home (PCMH) is a promising framework for the redesign of primary care and more recently specialty care. As defined by the Agency for Healthcare Research and Quality, the PCMH framework has 5 attributes: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety. Evidence increasingly demonstrates that for the PCMH to best achieve the Triple Aim (improved outcomes, decreased cost, and enhanced patient experience), treatment for behavioral health (including mental health, substance use, and life stressors) must be integrated as a central tenet...
January 2017: American Psychologist
https://www.readbyqxmd.com/read/28068137/meeting-evolving-workforce-needs-preparing-psychologists-for-leadership-in-the-patient-centered-medical-home
#12
Abbie O Beacham, Kristi S Van Sickle, Parinda Khatri, Mana K Ali, Daniel Reimer, Eugene W Farber, Nadine J Kaslow
Behavioral health integration in the patient-centered medical home (PCMH) offers opportunities for psychologists to play leadership roles. Widespread practice transition to PCMH models of care are expected to substantially impact the psychology workforce. Conservative estimates suggest that approximately 90% of the 93,000 clinically trained psychologists would be required to meet projected need in these settings. This has implications for how health service psychologists are trained. In addition to relevant clinical competencies, they must be versed in system/program development, administration, evaluation, quality improvement, and interprofessional collaboration...
January 2017: American Psychologist
https://www.readbyqxmd.com/read/28027163/the-business-of-health-physics-jobs-in-a-changing-market
#13
Matthew P Moeller
The health physics profession was born abruptly when once rare and precious radioactive materials became commonplace. The technological advancements that triggered an industrial complex and ended World War II demanded radiation safety on an unprecedented scale. Until then, protective measures against radiation were largely absent in laboratories. Over the subsequent decades, health physicists began protecting people and the environment in a wide range of settings including medical, research, and industrial...
February 2017: Health Physics
https://www.readbyqxmd.com/read/27999778/burnout-syndrome-and-job-satisfaction-in-greek-residents-exploring-differences-between-trainees-inside-and-outside-the-country
#14
Ilias I Salpigktidis, Dimitrios Paliouras, Apostolos S Gogakos, Thomas Rallis, Nikolaos C Schizas, Fotios Chatzinikolaou, Dimitrios Niakas, Pavlos Sarafis, Panagiotis Bamidis, Achilleas Lazopoulos, Sophia Triadafyllidou, Paul Zarogoulidis, Nikolaos Barbetakis
BACKGROUND: The purpose of this study is to investigate the levels of burnout among Greek residents, highlighting potential differences between those practicing at home and abroad, as well as to investigate correlations with demographic, individual and labor factors. METHODS: The research was conducted on a sample of 131 residents, using an anonymous questionnaire which included demographic, individual and labor characteristics, Maslach's Burnout Inventory, questions regarding job and life satisfaction levels, working conditions and the impacts of the economic recession...
November 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/27927193/demographic-profile-of-physician-participants-in-short-term-medical-missions
#15
Paul H Caldron, Ann Impens, Milena Pavlova, Wim Groot
BACKGROUND: The US is the leading sending country for short term medical missions (STMMs), an unregulated and unsanctioned, grass roots form of direct medical service aid from richer countries to low and middle income countries. The objective of this study is to profile US physicians who go on such missions by means of a survey sample of the US physician population. METHODS: An online survey solicited information on physician participation in STMMS as well as demographic and professional features...
December 7, 2016: BMC Health Services Research
https://www.readbyqxmd.com/read/27901516/psychotropic-drug-changes-contributing-to-readmissions-in-medically-hospitalized-psychiatric-patients-a-retrospective-study
#16
Subramoniam Madhusoodanan, Biling Xu, Srikanth Prayaga, Piotr Slowik, Ronald Brenner, Wallace Thomas, Natalie Schwartz
BACKGROUND: Psychotropic drug changes during medical hospitalizations may lead to psychiatric and medical readmissions. METHODS: One-year hospitalization records of nursing home patients with chronic mental illness and a psychotropic drug change during medical admission were reviewed. We calculated the readmission rates for 30, 60, and 90 days; the classes of the psychotropic drugs changed; the reason for change; and the specialties of the responsible physicians...
November 2016: Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists
https://www.readbyqxmd.com/read/27833396/strengthening-the-coordination-of-pediatric-mental-health-and-medical-care-piloting-a-collaborative-model-for-freestanding-practices
#17
Carolyn A Greene, Julian D Ford, Barbara Ward-Zimmerman, Lisa Honigfeld, Anne E Pidano
BACKGROUND: Collaborative pediatric mental health and primary care is increasingly recognized as optimal for meeting the needs of children with mental health problems. This paper describes the challenges faced by freestanding specialty mental health clinics and pediatric health practices to provide such coordinated mind-and-body treatment. It describes critical elements of a proactive approach to achieving collaborative pediatric care under real-world circumstances using the patient-centered medical home neighborhood (PCMH-N) model...
October 2016: Child & Youth Care Forum
https://www.readbyqxmd.com/read/27795294/impact-of-consultant-specialty-on-discharge-decisions-in-patients-admitted-as-medical-emergencies-to-hospitals-in-the-united-kingdom
#18
C P Subbe, Ivan Le Jeune, D Ward, S Pradhan, C Masterton-Smith
BACKGROUND: The Society for Acute Medicine's Benchmarking Audit (SAMBA) annually examines Clinical Quality Indicators (CQIs) of the care of patients admitted to UK hospitals as medical emergencies. AIM: The aim of this study is to review the impact of consultant specialty on discharge decisions in the SAMBA data-set. DESIGN AND METHODS: Prospective audit of patients admitted to acute medical units (AMUs) on 25 June 2015 to participating hospitals throughout the UK with subgroup analysis...
October 18, 2016: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/27783702/who-treats-patients-with-diabetes-and-compensated-cirrhosis
#19
Tsai-Ling Liu, A Sidney Barritt Iv, Morris Weinberger, John E Paul, Bruce Fried, Justin G Trogdon
BACKGROUND: Increasingly, patients with multiple chronic conditions are being managed in patient-centered medical homes (PCMH) that coordinate primary and specialty care. However, little is known about the types of providers treating complex patients with diabetes and compensated cirrhosis. OBJECTIVE: We examined the mix of physician specialties who see patients dually-diagnosed with diabetes and compensated cirrhosis. DESIGN: Retrospective cross-sectional study using 2000-2013 MarketScan® Commercial Claims and Encounters and Medicare Supplemental Databases...
2016: PloS One
https://www.readbyqxmd.com/read/27766621/through-the-looking-glass-estimating-effects-of-medical-homes-for-people-with-severe-mental-illness
#20
Marisa Elena Domino, Mona Kilany, Rebecca Wells, Joseph P Morrissey
OBJECTIVE: To examine whether medical homes have heterogeneous effects in different subpopulations, leveraging the interpretations from a variety of statistical techniques. DATA SOURCES/STUDY SETTING: Secondary claims data from the NC Medicaid program for 2004-2007. The sample included all adults with diagnoses of schizophrenia, bipolar disorder, or major depression who were not dually enrolled in Medicare or in a nursing facility. STUDY DESIGN: We modeled a number of monthly service use, adherence, and expenditure outcomes using fixed effects, generalized estimating equation with and without inverse probability of treatment weights, and instrumental variables analyses...
October 21, 2016: Health Services Research
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