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Coordination of care

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By Jamie Jarmul Md / PhD student at UNC - Chapel Hill, PhD in Health Policy and Management
David L Chin, Heejung Bang, Raj N Manickam, Patrick S Romano
Public reporting and payment programs in the United States have embraced thirty-day readmissions as an indicator of between-hospital variation in the quality of care, despite limited evidence supporting this interval. We examined risk-standardized thirty-day risk of unplanned inpatient readmission at the hospital level for Medicare patients ages sixty-five and older in four states and for three conditions: acute myocardial infarction, heart failure, and pneumonia. The hospital-level quality signal captured in readmission risk was highest on the first day after discharge and declined rapidly until it reached a nadir at seven days, as indicated by a decreasing intracluster correlation coefficient...
October 1, 2016: Health Affairs
Mohammed K Ali, Kavita Singh, Dimple Kondal, Raji Devarajan, Shivani A Patel, Roopa Shivashankar, Vamadevan S Ajay, A G Unnikrishnan, V Usha Menon, Premlata K Varthakavi, Vijay Viswanathan, Mala Dharmalingam, Ganapati Bantwal, Rakesh Kumar Sahay, Muhammad Qamar Masood, Rajesh Khadgawat, Ankush Desai, Bipin Sethi, Dorairaj Prabhakaran, K M Venkat Narayan, Nikhil Tandon
BACKGROUND: Achievement of diabetes care goals is suboptimal globally. Diabetes-focused quality improvement (QI) is effective but remains untested in South Asia. OBJECTIVE: To compare the effect of a multicomponent QI strategy versus usual care on cardiometabolic profiles in patients with poorly controlled diabetes. DESIGN: Parallel, open-label, pragmatic randomized, controlled trial. ( NCT01212328). SETTING: Diabetes clinics in India and Pakistan...
September 20, 2016: Annals of Internal Medicine
Gil Wernovsky, Stacey L Lihn, Melissa M Olen
Over the past 20 years, the successes of neonatal and infant surgery have resulted in dramatically changed demographics in ambulatory cardiology. These school-aged children and young adults have complex and, in some cases, previously unexpected cardiac and non-cardiac consequences of their surgical and/or transcatheter procedures. There is a growing need for additional cardiac and non-cardiac subspecialists, and coordination of care may be quite challenging. In contrast to hospital-based care, where inpatient care protocols are common, and perioperative expectations are more or less predictable for most children, ambulatory cardiologists have evolved strategies of care more or less independently, based on their education, training, experience, and individual styles, resulting in highly variable follow-up strategies...
July 4, 2016: Cardiology in the Young
Sarah King, Josephine Exley, Sarah Parks, Sarah Ball, Teresa Bienkowska-Gibbs, Calum MacLure, Emma Harte, Katherine Stewart, Jody Larkin, Andrew Bottomley, Sonja Marjanovic
PURPOSE: Patient-reported data are playing an increasing role in health care. In oncology, data from quality of life (QoL) assessment tools may be particularly important for those with limited survival prospects, where treatments aim to prolong survival while maintaining or improving QoL. This paper examines the use and impact of using QoL measuresĀ on health care of cancer patients within a clinical setting, particularly those with brain cancer. It also examines facilitators and challenges, and provides implications for policy and practice...
September 2016: Quality of Life Research
Becky A Purkaple, James W Mold, Sixia Chen
PURPOSE: Patient participation in clinical decision making improves outcomes, including quality of life (QOL), but the typical problem-oriented approach may impede consideration of functional goals. We wondered if patients could encourage primary care physicians to pay attention to their QOL goals by writing them on pre-encounter forms. METHODS: We conducted a randomized controlled trial comparing the impact of 2 different pre-visit questionnaires on the content of patient-physician encounters in a family medicine practice at an academic medical center...
May 2016: Annals of Family Medicine
Matthew D Di Guglielmo, Jay S Greenspan, Diane J Abatemarco
BACKGROUND: Pediatric patients seek timely access to subspecialty care within a complex delivery system while facing barriers: distance, economics, and clinician shortages. Aim We examined stakeholder perceptions about solutions to the access challenge. We engaged over 300 referring primary care pediatricians in the evaluation of Access Clinics at an academic children's hospital. METHODS: Using an anonymous online survey, we asked pediatricians about their and their patients' experiences and analyzed factors that may influence referrals...
May 17, 2016: Primary Health Care Research & Development
Olena Chorna, H Scott Baldwin, Jamie Neumaier, Shirley Gogliotti, Deborah Powers, Amanda Mouvery, David Bichell, Nathalie L Maitre
Infants with complex congenital heart disease are at high risk for poor neurodevelopmental outcomes. However, implementation of dedicated congenital heart disease follow-up programs presents important infrastructure, personnel, and resource challenges. We present the development, implementation, and retrospective review of 1- and 2-year outcomes of a Complex Congenital Heart Defect Neurodevelopmental Follow-Up program. This program was a synergistic approach between the Pediatric Cardiology, Cardiothoracic Surgery, Pediatric Intensive Care, and Neonatal Intensive Care Unit Follow-Up teams to provide a feasible and responsible utilization of existing infrastructure and personnel, to develop and implement a program dedicated to children with congenital heart disease...
July 2016: Circulation. Cardiovascular Quality and Outcomes
Andrew S Mackie, Gwen R Rempel, Adrienne H Kovacs, Miriam Kaufman, Kathryn N Rankin, Ahlexxi Jelen, Cedric Manlhiot, Samantha J Anthony, Joyce Magill-Evans, David Nicholas, Renee Sananes, Erwin Oechslin, Dimi Dragieva, Sonila Mustafa, Elina Williams, Michelle Schuh, Brian W McCrindle
BACKGROUND: The population of adolescents and young adults with congenital heart disease (CHD) is growing exponentially. These survivors are at risk of late cardiac complications and require lifelong cardiology care. However, there is a paucity of data on how to prepare adolescents to assume responsibility for their health and function within the adult health care system. Evidence-based transition strategies are required. METHODS: The Congenital Heart Adolescents Participating in Transition Evaluation Research (CHAPTER 2) Study is a two-site cluster randomized clinical trial designed to evaluate the efficacy of a nurse-led transition intervention for 16-17 year olds with moderate or complex CHD...
2016: BMC Cardiovascular Disorders
Keane K Lee, Jingrong Yang, Adrian F Hernandez, Anthony E Steimle, Alan S Go
BACKGROUND: Readmission within 30 days after hospitalization for heart failure (HF) is a major public health problem. OBJECTIVE: To examine whether timing and type of post-discharge follow-up impacts risk of 30-day readmission in adults hospitalized for HF. DESIGN: Nested matched case-control study (January 1, 2006-June 30, 2013). SETTING: A large, integrated health care delivery system in Northern California. PARTICIPANTS: Hospitalized adults with a primary diagnosis of HF discharged to home without hospice care...
April 2016: Medical Care
Bianca Perez, Janelle Schrag
Safety-net hospitals are resource-constrained and serve complex patients yet are innovators in chronic disease care. Their strategies include personalized care, multidisciplinary teams, and information systems yielding real-time data. Safety-net providers are prime examples from which the health care community can learn to improve the delivery of chronic disease care.
February 2015: Journal of Health Care for the Poor and Underserved
Ruben Rhoades, Caitlin Dietsche, Rebecca Jaffe, Cara Reynolds, Michael Latreille, Albert Crawford, Lawrence Ward
No abstract text is available yet for this article.
May 2015: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Marlon P Mundt, Valerie J Gilchrist, Michael F Fleming, Larissa I Zakletskaia, Wen-Jan Tuan, John W Beasley
PURPOSE: Cardiovascular disease is the leading cause of mortality and morbidity in the United States. Primary care teams can be best suited to improve quality of care and lower costs for patients with cardiovascular disease. This study evaluates the associations between primary care team communication, interaction, and coordination (ie, social networks); quality of care; and costs for patients with cardiovascular disease. METHODS: Using a sociometric survey, 155 health professionals from 31 teams at 6 primary care clinics identified with whom they interact daily about patient care...
March 2015: Annals of Family Medicine
Leena K Saastamoinen, Jouko Verho
BACKGROUND: Excessive polypharmacy is often associated with inappropriate drug use. Because drug expenditures are heavily skewed and a considerable share of patients in the top 5% of the cost distribution have excessive polypharmacy, the appropriateness of their drug use should be reviewed. OBJECTIVES: The aim of this study was to review the quality of drug use in patients with extremely high costs and excessive polypharmacy and to compare them with all drug users...
June 2015: Pharmacoepidemiology and Drug Safety
Pei-Ju Liao, Zu-Yu Lin, Jui-Chu Huang, Kuang-Hung Hsu
The literature has demonstrated that the continuity of diabetes care can lower medical service utilization and expenses. However, few studies have examined the effects of patients' medical care-seeking behaviors in the early stage after the diagnosis of diabetes on their long-term prognoses. This study aimed to examine the association of medical care-seeking behavior in the first year following diabetes diagnosis on the occurrence of diabetes-related complications among patients in Taiwan. This is a retrospective data collection with follow-up analysis and a nationwide population-based dataset in Taiwan...
February 2015: Medicine (Baltimore)
William H Shrank, Andrew Sussman, Troyen A Brennan
No abstract text is available yet for this article.
November 2014: American Journal of Managed Care
Wayne A Mathews
The processes of care coordination of patient transition from hospital to outpatient settings are an integral part of the Patient-Centered Medical Home. We report a cooperative initiative between our admission hospital and family medicine residency to analyze the discharge process using the Agency for Healthcare Research and Quality's Re-engineering Discharge initiative, focusing on efficient information transfer and communication with discharged patients to insure rapid follow-up in the clinic. Our project yielded markedly reduced readmission rates compared with both local hospital and national rates...
November 2014: American Journal of Managed Care
Kevin Hawkins, Ronald J Ozminkowski, Asif Mujahid, Timothy S Wells, Gandhi R Bhattarai, Sara Wang, Cynthia E Hommer, Jinghua Huang, Richard J Migliori, Charlotte S Yeh
The objective was to develop a propensity to succeed (PTS) process for prioritizing outreach to individuals with Medicare Supplement (ie, Medigap) plans who qualified for a high-risk case management (HRCM) program. Demographic, socioeconomic, health status, and local health care supply data from previous HRCM program participants and nonparticipants were obtained from Medigap membership and health care claims data and public data sources. Three logistic regression models were estimated to find members with higher probabilities of engaging in the HRCM program, receiving high quality of care once engaged, and incurring enough monetary savings related to program participation to more than offset program costs...
December 2015: Population Health Management
Donna Rocks, Elizer Cooper-Audain
Patients with multiple chronic conditions have been shown to have significant Medicare expenditures. Care coordination programs have been implemented targeting this population by organizations striving to achieve the triple aim of (a) improving healthcare quality, (b) improving the patient experience, and (c) reducing costs. Outcomes of these programs have been mixed. This research brief profiles four published articles that address different aspects of care coordination. Readers are encouraged to access the full articles to learn more details about the intervention strategies and findings described in these articles...
February 2015: Home Healthcare Now
Reena A Koshy, Douglas A Conrad, David Grembowski
The Washington State Multi-Payer Medical Home Reimbursement Pilot (Pilot) tested a payment method for the patient-centered medical home (PCMH) model intended to reduce avoidable emergency department (ED) and hospitalization rates. Very little is known about the primary care clinic (clinic) experience with various payment methods designed for the medical home model. The objective was to elicit and describe the primary care clinic experience among various medical groups in Washington State's payment Pilot. This was a qualitative analysis of semi-structured interviews conducted in January 2014 to identify enabling features (or "facilitators") as well as barriers to successful implementation of PCMH in this multi-payer pilot...
August 2015: Population Health Management
Debra Bick, Sarah Beake, Lucy Chappell, Khaled M Ismail, David R McCance, James S A Green, Cath Taylor
BACKGROUND: More women with an increased risk of poor pregnancy outcome due to pre-existing medical conditions are becoming pregnant. Although clinical care provided through multi-disciplinary team (MDT) working is recommended, little is known about the structure or working practices of different MDT models, their impact on maternal and infant outcomes or healthcare resources. The objectives of this review were to consider relevant international evidence to determine the most appropriate MDT models of care to manage complex medical conditions during and after pregnancy, with a specific focus on pre-existing diabetes or cardiac disease in high income country settings...
2014: BMC Pregnancy and Childbirth
2015-01-20 21:34:07
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