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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
https://www.readbyqxmd.com/read/28060053/safety-net-hospitals-face-more-barriers-yet-use-fewer-strategies-to-reduce-readmissions
#1
Jose F Figueroa, Karen E Joynt, Xiner Zhou, Endel J Orav, Ashish K Jha
OBJECTIVE: US hospitals that care for vulnerable populations, "safety-net hospitals" (SNHs), are more likely to incur penalties under the Hospital Readmissions Reduction Program, which penalizes hospitals with higher-than-expected readmissions. Understanding whether SNHs face unique barriers to reducing readmissions or whether they underuse readmission-prevention strategies is important. DESIGN: We surveyed leadership at 1600 US acute care hospitals, of whom 980 participated, between June 2013 and January 2014...
January 3, 2017: Medical Care
https://www.readbyqxmd.com/read/27990628/action-plans-with-brief-patient-education-for-exacerbations-in-chronic-obstructive-pulmonary-disease
#2
REVIEW
Maxwell Howcroft, E Haydn Walters, Richard Wood-Baker, Julia Ae Walters
BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) are a major driver of decline in health status and impose high costs on healthcare systems. Action plans offer a form of self-management that can be delivered in the outpatient setting to help individuals recognise and initiate early treatment for exacerbations, thereby reducing their impact. OBJECTIVES: To compare effects of an action plan for COPD exacerbations provided with a single short patient education component and without a comprehensive self-management programme versus usual care...
19, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27861836/out-of-network-emergency-department-use-among-managed-medicaid-beneficiaries
#3
Maria C Raven, David Guzman, Alice H Chen, John Kornak, Margot Kushel
OBJECTIVE: Out-of-network emergency department (ED) use, or use that occurs outside the contracted network, may lead to increased care fragmentation and cost. We examined factors associated with out-of-network ED use among Medicaid beneficiaries. DATA SOURCES AND STUDY SETTING: Enrollment, claims, and encounter data for adult Medi-Cal health plan members with 1+ ED visits and complete Medicaid eligibility during the study period from 2013 to 2014. STUDY DESIGN: We analyzed the data to identify factors associated with out-of-network ED use classified by mode of arrival (ambulance vs...
November 11, 2016: Health Services Research
https://www.readbyqxmd.com/read/27926614/clinical-coordination-in-accountable-care-organizations-a-qualitative-study
#4
Valerie A Lewis, Karen Schoenherr, Taressa Fraze, Aleen Cunningham
BACKGROUND: Accountable care organizations (ACOs) are becoming a common payment and delivery model. Despite widespread interest, little empirical research has examined what efforts or strategies ACOs are using to change care and reduce costs. Knowledge of ACOs' clinical efforts can provide important context for understanding ACO performance, particularly to distinguish arenas where ACOs have and have not attempted care transformation. PURPOSE: The aim of the study was to understand ACOs' efforts to change clinical care during the first 18 months of ACO contracts...
December 6, 2016: Health Care Management Review
https://www.readbyqxmd.com/read/27926663/the-impact-of-value-based-healthcare-for-inflammatory-bowel-diseases-on-healthcare-utilization-a-pilot-study
#5
Welmoed K van Deen, Arlen Spiro, A Burak Ozbay, Martha Skup, Adriana Centeno, Natalie E Duran, Precious N Lacey, Darius Jatulis, Eric Esrailian, Martijn G H van Oijen, Daniel W Hommes
BACKGROUND AND OBJECTIVES: Value-based healthcare (VBHC) is considered to be the solution that will improve quality and decrease costs in healthcare. Many hospitals are implementing programs on the basis of this strategy, but rigorous scientific reports are still lacking. In this pilot study, we present the first-year outcomes of a VBHC program for inflammatory bowel disease (IBD) management that focuses on highly coordinated care, task differentiation of providers, and continuous home monitoring...
December 6, 2016: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/27924187/evaluating-outcomes-in-patients-with-overactive-bladder-within-an-integrated-healthcare-delivery-system-using-a-treatment-patterns-analyzer
#6
Daniel B Ng, Melissa McCart, Christopher Klein, Chelsey Campbell, Robert Schoenhaus, Todd Berner
BACKGROUND: Overactive bladder (OAB) is a relatively common disease that has been linked to a variety of comorbidities, reductions in quality of life, and increased healthcare costs. Antimuscarinic agents are the standard of care among pharmacologic treatments for OAB, but these drugs are linked to high levels of anticholinergic burden, especially in the elderly. OBJECTIVE: To demonstrate how efficient data analysis can be used to identify gaps in care as a result of improvement strategies for OAB within an integrated healthcare delivery system setting...
September 2016: American Health & Drug Benefits
https://www.readbyqxmd.com/read/27512721/factors-associated-with-emergency-department-visits-a-multistate-analysis-of-adult-fee-for-service-medicaid-beneficiaries
#7
Parul Agarwal, Thomas K Bias, Suresh Madhavan, Nethra Sambamoorthi, Stephanie Frisbee, Usha Sambamoorthi
OBJECTIVE: The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED) visits among adult fee-for-service (FFS) Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia. METHODS: A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file...
January 2016: Health Services Research and Managerial Epidemiology
https://www.readbyqxmd.com/read/27552616/association-of-integrated-team-based-care-with-health-care-quality-utilization-and-cost
#8
COMPARATIVE STUDY
Brenda Reiss-Brennan, Kimberly D Brunisholz, Carter Dredge, Pascal Briot, Kyle Grazier, Adam Wilcox, Lucy Savitz, Brent James
IMPORTANCE: The value of integrated team delivery models is not firmly established. OBJECTIVE: To evaluate the association of receiving primary care in integrated team-based care (TBC) practices vs traditional practice management (TPM) practices (usual care) with patient outcomes, health care utilization, and costs. DESIGN: A retrospective, longitudinal, cohort study to assess the association of integrating physical and mental health over time in TBC practices with patient outcomes and costs...
August 23, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27724889/roles-of-disease-severity-and-post-discharge-outpatient-visits-as-predictors-of-hospital-readmissions
#9
Hao Wang, Carol Johnson, Richard D Robinson, Vicki A Nejtek, Chet D Schrader, JoAnna Leuck, Johnbosco Umejiego, Allison Trop, Kathleen A Delaney, Nestor R Zenarosa
BACKGROUND: Risks prediction models of 30-day all-cause hospital readmissions are multi-factorial. Severity of illness (SOI) and risk of mortality (ROM) categorized by All Patient Refined Diagnosis Related Groups (APR-DRG) seem to predict hospital readmission but lack large sample validation. Effects of risk reduction interventions including providing post-discharge outpatient visits remain uncertain. We aim to determine the accuracy of using SOI and ROM to predict readmission and further investigate the role of outpatient visits in association with hospital readmission...
October 10, 2016: BMC Health Services Research
https://www.readbyqxmd.com/read/27858564/preparing-for-value-based-payment-a-stepwise-approach-for-cancer-centers
#10
Kerin B Adelson, Salimah Velji, Kavita Patel, Basit Chaudhry, Catherine Lyons, Rogerio Lilenbaum
Most cancer centers are ill-equipped to pursue value-based payment (VBP) because of limited information on their population's cost of care. Herein, we outline the stepwise approach used by Smilow Cancer Hospital at Yale-New Haven in our pursuit of better value care. First, we addressed institutional barriers. A move toward value required demonstration to Yale-New Haven Health System leadership that OCM would improve patient care, fund new infrastructure, and provide the opportunity to gain experience with VBP without a major threat to the financial stability of the health system...
October 2016: Journal of Oncology Practice
https://www.readbyqxmd.com/read/27856087/hemodialysis-hospitalizations-and-readmissions-the-effects-of-payment-reform
#11
Kevin F Erickson, Wolfgang C Winkelmayer, Glenn M Chertow, Jay Bhattacharya
BACKGROUND: In 2004, the Centers for Medicare & Medicaid Services changed reimbursement for physicians and advanced practitioners caring for patients receiving hemodialysis from a capitated to a tiered fee-for-service system, encouraging increased face-to-face visits. This early version of a pay-for-performance initiative targeted a care process: more frequent provider visits in hemodialysis. Although more frequent provider visits in hemodialysis are associated with fewer hospitalizations and rehospitalizations, it is unknown whether encouraging more frequent visits through reimbursement policy also yielded these benefits...
November 14, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/23804841/enhancing-quality-of-primary-care-using-an-ambulatory-icu-to-achieve-a-patient-centered-medical-home
#12
Joy Lewis, Alex Hoyt, Rose M Kakoza
RESEARCH OBJECTIVE: The Patient-Centered Medical Home (PCMH) has been advocated as a model to address the lack of coordination and continuity in the health system. However, implementation in practice has been slow and incompletely described. STUDY DESIGN: Patients referred into the program received intensive nurse follow-up focused on medication adherence, care coordination, and education. Patients graduate from the program when treatment goals are met. POPULATION STUDIED: The first 100 patients enrolled into the PCMH focused program of a primary care clinic in an urban, academic medical center...
October 1, 2011: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/24195142/new-care-model-targets-high-utilizing-complex-patients-frees-up-emergency-providers-to-focus-on-acute-care-concerns
#13
(no author information available yet)
Hennepin County Medical Center in Minneapolis, MN, has developed a new model of care, designed to meet the needs of high-utilizing hospital and ED patients with complex medical, social, and behavioral needs.The Coordinated Care Center (CCC) provides easy access to patients with a history of high utilization, and delivers multidisciplinary care in a one-stop-shop format. In one year, the approach has slashed ED visits by 37%, freeing up emergency providers to focus on patients with acute needs. In-patient care stays are down by 25%...
November 2013: ED Management: the Monthly Update on Emergency Department Management
https://www.readbyqxmd.com/read/27864481/meaningful-use-in-chronic-care-improved-diabetes-outcomes-using-a-primary-care-extension-center-model
#14
Samuel Cykert, Ann Lefebvre, Thomas Bacon, Warren Newton
BACKGROUND: The effect of practice facilitation that provides onsite quality improvement (QI) and electronic health record (EHR) coaching on chronic care outcomes is unclear. This study evaluates the effectiveness of such a program-similar to an agricultural extension center model-that provides these services. METHODS: Through the Health Information Technology for Economic and Clinical Health (HITECH) portion of the American Recovery and Reinvestment Act, the North Carolina Area Health Education Centers program became the Regional Extension Center for Health Information Technology (REC) for North Carolina...
November 2016: North Carolina Medical Journal
https://www.readbyqxmd.com/read/27702961/rethinking-thirty-day-hospital-readmissions-shorter-intervals-might-be-better-indicators-of-quality-of-care
#15
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
https://www.readbyqxmd.com/read/27398874/effectiveness-of-a-multicomponent-quality-improvement-strategy-to-improve-achievement-of-diabetes-care-goals-a-randomized-controlled-trial
#16
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. (ClinicalTrials.gov: NCT01212328). SETTING: Diabetes clinics in India and Pakistan...
September 20, 2016: Annals of Internal Medicine
https://www.readbyqxmd.com/read/27373527/creating-a-lesion-specific-roadmap-for-ambulatory-care-following-surgery-for-complex-congenital-cardiac-disease
#17
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
https://www.readbyqxmd.com/read/27039304/the-use-and-impact-of-quality-of-life-assessment-tools-in-clinical-care-settings-for-cancer-patients-with-a-particular-emphasis-on-brain-cancer-insights-from-a-systematic-review-and-stakeholder-consultations
#18
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
https://www.readbyqxmd.com/read/27184992/encouraging-patient-centered-care-by-including-quality-of-life-questions-on-pre-encounter-forms
#19
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
https://www.readbyqxmd.com/read/27185320/pediatrician-preferences-local-resources-and-economic-factors-influence-referral-to-a-subspecialty-access-clinic
#20
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...
November 2016: Primary Health Care Research & Development
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