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Sample records for health center patients

  1. Patients' satisfaction evaluation with the health center of elis province.

    Science.gov (United States)

    Karavida, Angeliki; Stamouli, Maria-Aggeliki; Balis, Charalampos

    2014-01-01

    Patient satisfaction related to the provided health services is a key indicator of the quality of the health sector. The SERVQUAL model was employed as a way of measuring the level of patient satisfaction with the services of the Health Center of Elis Province. Although certain aspects such as "Assurance" and "Empathy" meet the users' needs, improvements like a detailed medical record and an overhaul of the equipment need to be introduced.

  2. Health care employee perceptions of patient-centered care.

    Science.gov (United States)

    Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L

    2015-03-01

    Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspectives is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among U.S. Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, they identified several areas for improvement. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. © The Author(s) 2014.

  3. User-Centered Design and Interactive Health Technologies for Patients

    Science.gov (United States)

    De Vito Dabbs, Annette; Myers, Brad A.; Mc Curry, Kenneth R.; Dunbar-Jacob, Jacqueline; Hawkins, Robert P.; Begey, Alex; Dew, Mary Amanda

    2010-01-01

    Despite recommendations that patients be involved in the design and testing of health technologies, few reports describe how to involve patients in systematic and meaningful ways to ensure that applications are customized to meet their needs. User-centered design (UCD) is an approach that involves end-users throughout the development process so that technology support tasks, are easy to operate, and are of value to users. In this paper we provide an overview of UCD and use the development of Pocket Personal Assistant for Tracking Health (Pocket PATH), to illustrate how these principles and techniques were applied to involve patients in the development of this interactive health technology. Involving patient-users in the design and testing ensured functionality and usability, therefore increasing the likelihood of promoting the intended health outcomes. PMID:19411947

  4. Health Status and Health Care Experiences among Homeless Patients in Federally Supported Health Centers: Findings from the 2009 Patient Survey

    Science.gov (United States)

    Lebrun-Harris, Lydie A; Baggett, Travis P; Jenkins, Darlene M; Sripipatana, Alek; Sharma, Ravi; Hayashi, A Seiji; Daly, Charles A; Ngo-Metzger, Quyen

    2013-01-01

    Objective To examine health status and health care experiences of homeless patients in health centers and to compare them with their nonhomeless counterparts. Data Sources/Study Setting Nationally representative data from the 2009 Health Center Patient Survey. Study Design Cross-sectional analyses were limited to adults (n = 2,683). We compared sociodemographic characteristics, health conditions, access to health care, and utilization of services among homeless and nonhomeless patients. We also examined the independent effect of homelessness on health care access and utilization, as well as factors that influenced homeless patients' health care experiences. Data Collection Computer-assisted personal interviews were conducted with health center patients. Principal Findings Homeless patients had worse health status—lifetime burden of chronic conditions, mental health problems, and substance use problems—compared with housed respondents. In adjusted analyses, homeless patients had twice the odds as housed patients of having unmet medical care needs in the past year (OR = 1.98, 95 percent CI: 1.24–3.16) and twice the odds of having an ED visit in the past year (OR = 2.00, 95 percent CI: 1.37–2.92). Conclusions There is an ongoing need to focus on the health issues that disproportionately affect homeless populations. Among health center patients, homelessness is an independent risk factor for unmet medical needs and ED use. PMID:23134588

  5. Patient-centered medical home model: do school-based health centers fit the model?

    Science.gov (United States)

    Larson, Satu A; Chapman, Susan A

    2013-01-01

    School-based health centers (SBHCs) are an important component of health care reform. The SBHC model of care offers accessible, continuous, comprehensive, family-centered, coordinated, and compassionate care to infants, children, and adolescents. These same elements comprise the patient-centered medical home (PCMH) model of care being promoted by the Affordable Care Act with the hope of lowering health care costs by rewarding clinicians for primary care services. PCMH survey tools have been developed to help payers determine whether a clinician/site serves as a PCMH. Our concern is that current survey tools will be unable to capture how a SBHC may provide a medical home and therefore be denied needed funding. This article describes how SBHCs might meet the requirements of one PCMH tool. SBHC stakeholders need to advocate for the creation or modification of existing survey tools that allow the unique characteristics of SBHCs to qualify as PCMHs.

  6. Patient-Centered e-Health Record over the Cloud.

    Science.gov (United States)

    Koumaditis, Konstantinos; Themistocleous, Marinos; Vassilacopoulos, George; Prentza, Andrianna; Kyriazis, Dimosthenis; Malamateniou, Flora; Maglaveras, Nicos; Chouvarda, Ioanna; Mourouzis, Alexandros

    2014-01-01

    The purpose of this paper is to introduce the Patient-Centered e-Health (PCEH) conceptual aspects alongside a multidisciplinary project that combines state-of-the-art technologies like cloud computing. The project, by combining several aspects of PCEH, such as: (a) electronic Personal Healthcare Record (e-PHR), (b) homecare telemedicine technologies, (c) e-prescribing, e-referral, e-learning, with advanced technologies like cloud computing and Service Oriented Architecture (SOA), will lead to an innovative integrated e-health platform of many benefits to the society, the economy, the industry, and the research community. To achieve this, a consortium of experts, both from industry (two companies, one hospital and one healthcare organization) and academia (three universities), was set to investigate, analyse, design, build and test the new platform. This paper provides insights to the PCEH concept and to the current stage of the project. In doing so, we aim at increasing the awareness of this important endeavor and sharing the lessons learned so far throughout our work.

  7. Integration of pharmacists into patient-centered medical homes in federally qualified health centers in Texas.

    Science.gov (United States)

    Wong, Shui Ling; Barner, Jamie C; Sucic, Kristina; Nguyen, Michelle; Rascati, Karen L

    To describe the integration and implementation of pharmacy services in patient-centered medical homes (PCMHs) as adopted by federally qualified health centers (FQHCs) and compare them with usual care (UC). Four FQHCs (3 PCMHs, 1 UC) in Austin, TX, that provide care to the underserved populations. Pharmacists have worked under a collaborative practice agreement with internal medicine physicians since 2005. All 4 FQHCs have pharmacists as an integral part of the health care team. Pharmacists have prescriptive authority to initiate and adjust diabetes medications. The PCMH FQHCs instituted co-visits, where patients see both the physician and the pharmacist on the same day. PCMH pharmacists are routinely proactive in collaborating with physicians regarding medication management, compared with UC in which pharmacists see patients only when referred by a physician. Four face-to-face, one-on-one semistructured interviews were conducted with pharmacists working in 3 PCMH FQHCs and 1 UC FQHC to compare the implementation of PCMH with emphasis on 1) structure and workflow, 2) pharmacists' roles, and 3) benefits and challenges. On co-visit days, the pharmacist may see the patient before or after physician consultation. Pharmacists in 2 of the PCMH facilities proactively screen to identify diabetes patients who may benefit from pharmacist services, although the UC clinic pharmacists see only referred patients. Strengths of the co-visit model include more collaboration with physicians and more patient convenience. Payment that recognizes the value of PCMH is one PCMH principle that is not fully implemented. PCMH pharmacists in FQHCs were integrated into the workflow to address specific patient needs. Specifically, full-time in-house pharmacists, flexible referral criteria, proactive screening, well defined collaborative practice agreement, and open scheduling were successful strategies for the underserved populations in this study. However, reimbursement plans and provider

  8. Patient-Centered Personal Health Record and Portal Implementation Toolkit for Ambulatory Clinics: A Feasibility Study.

    Science.gov (United States)

    Nahm, Eun-Shim; Diblasi, Catherine; Gonzales, Eva; Silver, Kristi; Zhu, Shijun; Sagherian, Knar; Kongs, Katherine

    2017-04-01

    Personal health records and patient portals have been shown to be effective in managing chronic illnesses. Despite recent nationwide implementation efforts, the personal health record and patient portal adoption rates among patients are low, and the lack of support for patients using the programs remains a critical gap in most implementation processes. In this study, we implemented the Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit in a large diabetes/endocrinology center and assessed its preliminary impact on personal health record and patient portal knowledge, self-efficacy, patient-provider communication, and adherence to treatment plans. Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit is composed of Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General, clinic-level resources for clinicians, staff, and patients, and Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit Plus, an optional 4-week online resource program for patients ("MyHealthPortal"). First, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General was implemented, and all clinicians and staff were educated about the center's personal health record and patient portal. Then general patient education was initiated, while a randomized controlled trial was conducted to test the preliminary effects of "MyHealthPortal" using a small sample (n = 74) with three observations (baseline and 4 and 12 weeks). The intervention group showed significantly greater improvement than the control group in patient-provider communication at 4 weeks (t56 = 3.00, P = .004). For other variables, the intervention group tended to show greater improvement; however, the differences were not significant. In this preliminary study, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit showed potential for filling the gap in the current

  9. The Oral Health Care Manager in a Patient-Centered Health Facility.

    Science.gov (United States)

    Theile, Cheryl Westphal; Strauss, Shiela M; Northridge, Mary Evelyn; Birenz, Shirley

    2016-06-01

    The dental hygienist team member has an opportunity to coordinate care within an interprofessional practice as an oral health care manager. Although dental hygienists are currently practicing within interprofessional teams in settings such as pediatric offices, hospitals, nursing homes, schools, and federally qualified health centers, they often still assume traditional responsibilities rather than practicing to the full extent of their training and licenses. This article explains the opportunity for the dental hygiene professional to embrace patient-centered care as an oral health care manager who can facilitate integration of oral and primary care in a variety of health care settings. Based on an innovative model of collaboration between a college of dentistry and a college of nursing, an idea emerged among several faculty members for a new management method for realizing continuity and coordination of comprehensive patient care. Involved faculty members began working on the development of an approach to interprofessional practice with the dental hygienist serving as an oral health care manager who would address both oral health care and a patient's related primary care issues through appropriate referrals and follow-up. This approach is explained in this article, along with the results of several pilot studies that begin to evaluate the feasibility of a dental hygienist as an oral health care manager. A health care provider with management skills and leadership qualities is required to coordinate the interprofessional provision of comprehensive health care. The dental hygienist has the opportunity to lead closer integration of oral and primary care as an oral health care manager, by coordinating the team of providers needed to implement comprehensive, patient-centered care. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

    OpenAIRE

    Bao, Yuhua; Casalino, Lawrence P.; Pincus, Harold Alan

    2013-01-01

    Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the H...

  11. Cultural health capital and the interactional dynamics of patient-centered care

    OpenAIRE

    Dubbin, Leslie A.; Chang, Jamie Suki; Shim, Janet K.

    2013-01-01

    As intuitive and inviting as it may appear, the concept of patient-centered care has been difficult to conceptualize, institutionalize and operationalize. Informed by Bourdieu's concepts of cultural capital and habitus, we employ the framework of cultural health capital to uncover the ways in which both patients' and providers' cultural resources, assets, and interactional styles influence their abilities to mutually achieve patient-centered care. Cultural health capital is defined as a speci...

  12. Relationship of Interpersonal Behaviors and Health-Related Control Appraisals to Patient Satisfaction and Compliance in a University Health Center

    Science.gov (United States)

    Campbell, Thomas A.; Auerbach, Stephen M.; Kiesler, Donald J.

    2007-01-01

    Objective: The authors' aim was to evaluate patient-provider relationships in a college health center. Participants: Eighty student patients and their health-care providers. Methods: Patients completed a measure of perceived health competence before a consultation and measures of provider participatory behavior and interpersonal behavior before…

  13. Cultural health capital and the interactional dynamics of patient-centered care.

    Science.gov (United States)

    Dubbin, Leslie A; Chang, Jamie Suki; Shim, Janet K

    2013-09-01

    As intuitive and inviting as it may appear, the concept of patient-centered care has been difficult to conceptualize, institutionalize and operationalize. Informed by Bourdieu's concepts of cultural capital and habitus, we employ the framework of cultural health capital to uncover the ways in which both patients' and providers' cultural resources, assets, and interactional styles influence their abilities to mutually achieve patient-centered care. Cultural health capital is defined as a specialized collection of cultural skills, attitudes, behaviors and interactional styles that are valued, leveraged, and exchanged by both patients and providers during clinical interactions. In this paper, we report the findings of a qualitative study conducted from 2010 to 2011 in the Western United States. We investigated the various elements of cultural health capital, how patients and providers used cultural health capital to engage with each other, and how this process shaped the patient-centeredness of interactions. We find that the accomplishment of patient-centered care is highly dependent upon habitus and the cultural health capital that both patients and providers bring to health care interactions. Not only are some cultural resources more highly valued than others, their differential mobilization can facilitate or impede engagement and communication between patients and their providers. The focus of cultural health capital on the ways fundamental social inequalities are manifest in clinical interactions enables providers, patients, and health care organizations to consider how such inequalities can confound patient-centered care. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization.

    Science.gov (United States)

    Bao, Yuhua; Casalino, Lawrence P; Pincus, Harold Alan

    2013-01-01

    Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient-Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools-accountability measures and payment designs-to improve access to and quality of care for patients with behavioral health needs.

  15. Health Care Employee Perceptions of Patient-Centered Care: A Photovoice Project

    Science.gov (United States)

    Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L.

    2015-01-01

    Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspective is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, several areas for improvement were identified. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. PMID:25274626

  16. Barriers and facilitators to implementing a patient-centered model of contraceptive provision in community health centers.

    Science.gov (United States)

    Politi, Mary C; Estlund, Amy; Milne, Anne; Buckel, Christina M; Peipert, Jeffrey F; Madden, Tessa

    2016-01-01

    The Contraceptive CHOICE Project developed a patient-centered model for contraceptive provision including: (1) structured, evidence-based counseling; (2) staff and health care provider education; and (3) removal of barriers such as cost and multiple appointments to initiate contraception. In preparation for conducting a research study of the CHOICE model in three community health settings, we sought to identify potential barriers and facilitators to implementation. Using a semi-structured interview guide guided by a framework of implementation research, we conducted 31 qualitative interviews with female patients, staff, and health care providers assessing attitudes, beliefs, and barriers to receiving contraception. We also asked about current contraceptive provision and explored organizational practices relevant to implementing the CHOICE model. We used a grounded theory approach to identify major themes. Many participants felt that current contraceptive provision could be improved by the CHOICE model. Potential facilitators included agreement about the necessity for improved contraceptive knowledge among patients and staff; importance of patient-centered contraceptive counseling; and benefits to same-day insertion of long-acting reversible contraception (LARC). Potential barriers included misconceptions about contraception held by staff and providers; resistance to new practices; costs associated with LARC; and scheduling challenges required for same-day insertion of LARC. In addition to staff and provider training, implementing a patient-centered model of contraceptive provision needs to be supplemented by strategies to manage patient and system-level barriers. Community health center staff, providers, and patients support patient-centered contraceptive counseling to improve contraception provision if organizations can address these barriers.

  17. School Based Health Centers

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    Children's Aid Society, 2012

    2012-01-01

    School Based Health Centers (SBHC) are considered by experts as one of the most effective and efficient ways to provide preventive health care to children. Few programs are as successful in delivering health care to children at no cost to the patient, and where they are: in school. For many underserved children, The Children's Aid Society's…

  18. Understanding and Predicting Social Media Use Among Community Health Center Patients: A Cross-Sectional Survey

    Science.gov (United States)

    2014-01-01

    Background The use of social media by health care organizations is growing and provides Web-based tools to connect patients, caregivers, and providers. Objective The aim was to determine the use and factors predicting the use of social media for health care–related purposes among medically underserved primary care patients. Methods A cross-sectional survey was administered to 444 patients of a federally qualified community health center. Results Community health center patients preferred that their providers use email, cell phones for texting, and Facebook and cell phone apps for sharing health information. Significantly more Hispanic than white patients believed their providers should use Facebook (P=.001), YouTube (P=.01), and Twitter (P=.04) for sharing health information. Use and intentions to use social media for health-related purposes were significantly higher for those patients with higher subjective norm scores. Conclusions Understanding use and factors predicting use can increase adoption and utilization of social media for health care–related purposes among underserved patients in community health centers. PMID:25427823

  19. Patient Engagement in Community Health Center Leadership: How Does it Happen?

    Science.gov (United States)

    Sharma, Anjana E; Huang, Beatrice; Knox, Margae; Willard-Grace, Rachel; Potter, Michael B

    2018-05-18

    Patient engagement in primary care leadership is an important means to involve community voices at community health centers. Federally qualified health centers (FQHCs) are mandated to have patient representation within their governing boards, while practices seeking patient-centered medical home certification receive credit for implementing patient advisory councils (PACs). Our objective was to compare and contrast how community health centers engage patients in clinic management, decision-making and planning within governing boards versus PACs. Qualitative study conducted from August 2016 to June 2017 at community health centers in California, Arizona and Hawaii. We interviewed practice leaders of patient engagement programs at their site. Eligible clinics had patient representatives within their governing board, PAC, or both. We assessed patient demographics, roles and responsibilities of patients participating, and extent of involvement in quality improvement among governing boards versus PACs. We interviewed 19 sites, of which 17 were FQHCs that had governing boards. Of the 17 FQHCs, 11 had also implemented PACs. Two non-FQHC safety-net sites had PACs but did not have governing boards. Governing board members had formal, structured membership responsibilities such as finances and hiring personnel. PAC roles were more flexible, focusing on day-to-day clinic operations. Clinics tended to recruit governing board patient members for their skill set and professional experience; PAC member recruitment focused more on demographic representation of the clinic's patient population. Both groups worked on quality improvement, but governing boards tended to review clinic performance metrics, while PAC members were involved in specific project planning and implementation to improve clinical outcomes and patient experience. Patient involvement in clinic improvement in CHCs includes higher-level decision-making and governance through mechanisms such as governing boards, as

  20. John M. Eisenberg Patient Safety Awards. System innovation: Veterans Health Administration National Center for Patient Safety.

    Science.gov (United States)

    Heget, Jeffrey R; Bagian, James P; Lee, Caryl Z; Gosbee, John W

    2002-12-01

    In 1998 the Veterans Health Administration (VHA) created the National Center for Patient Safety (NCPS) to lead the effort to reduce adverse events and close calls systemwide. NCPS's aim is to foster a culture of safety in the Department of Veterans Affairs (VA) by developing and providing patient safety programs and delivering standardized tools, methods, and initiatives to the 163 VA facilities. To create a system-oriented approach to patient safety, NCPS looked for models in fields such as aviation, nuclear power, human factors, and safety engineering. Core concepts included a non-punitive approach to patient safety activities that emphasizes systems-based learning, the active seeking out of close calls, which are viewed as opportunities for learning and investigation, and the use of interdisciplinary teams to investigate close calls and adverse events through a root cause analysis (RCA) process. Participation by VA facilities and networks was voluntary. NCPS has always aimed to develop a program that would be applicable both within the VA and beyond. NCPS's full patient safety program was tested and implemented throughout the VA system from November 1999 to August 2000. Program components included an RCA system for use by caregivers at the front line, a system for the aggregate review of RCA results, information systems software, alerts and advisories, and cognitive acids. Following program implementation, NCPS saw a 900-fold increase in reporting of close calls of high-priority events, reflecting the level of commitment to the program by VHA leaders and staff.

  1. A Research on Patient Satisfaction with Primary Health Care in the Center of Afyonkarahisar

    Directory of Open Access Journals (Sweden)

    Nazli Sensoy

    2013-10-01

    Full Text Available Aim: Patient satisfaction is an important indicator to evaluate the quality of primary health care service. It is also significant to improve the quality of medical care, expectation from health staff, priority of patient needs, views and feedbacks about medical services in primary health care. Our objective in this study is to determine the patient satisfaction and the factors effecting this aspect in the evaluation of primary health care quality. Material and Method: This research was carried out in one Mother and Child Health and Family Planning Centre and nine Health Centers in January 2009 at Afyonkarahisar center. The questionnaire was performed to investigate the degree of satisfaction about health services, and socio-demographic characteristics of patients admitted to primary health care by face to face interview method. The data was evaluated by SPSS 15.00.Results: 1227 patients participating in the study, 809 women and 418 were male, married 878, 290 were single.Their education level was 408 graduated from primary school. At the same time, their job distributions were 596 housewives, 133 retired. When the patients had health problems, the most preferable institutione was health center, the choice of the reasons they were satisfied with the services in general, determined as to obtain quick results and confidence in solving problems.75% of the patients waiting time for admission and registration procedures were 0-5minutes. The admission reasons were mostly physical examination and prescription. Patients who are male, aged above 50 years and low educated had much higher satisfaction levels. Discussion: As a result, decreased satisfaction with higher education level, satisfaction increased with increasing age and a short waiting period for the application-registration and examination procedures were being influenced patient satisfaction.

  2. Improving patient-centered communication while using an electronic health record: Report from a curriculum evaluation.

    Science.gov (United States)

    Fogarty, Colleen T; Winters, Paul; Farah, Subrina

    2016-05-01

    Researchers and clinicians are concerned about the impact of electronic health record use and patient-centered communication. Training about patient-centered clinical communication skills with the electronic health record may help clinicians adapt and remain patient-centered. We developed an interactive workshop eliciting challenges and opportunities of working with the electronic health record in clinical practice, introduction of specific patient-centered behaviors and mindful practice techniques, and video demonstrating contrasts in common behavior and "better practices." One hundred thirty-nine resident physicians and faculty supervisors in five residency training programs at the University of Rochester Medical Center participated in the workshops. Participants were asked to complete an 11-item survey of behaviors related to their use of the electronic health record prior to training and after attending training. We used paired t-tests to assess changes in self-reported behavior from pre-intervention to post-intervention. We trained 139 clinicians in the workshops; 110 participants completed the baseline assessment and 39 completed both the baseline and post-intervention assessment. Data from post-curriculum respondents found a statistically significant increase in "I told the patient when turning my attention from the patient to the computer," from 60% of the time prior to the training to 70% of the time after. Data from our program evaluation demonstrated improvement in one communication behavior. Sample size limited the detection of other changes; further research should investigate effective training techniques for patient-centered communication while using the electronic health record. © The Author(s) 2016.

  3. Prevalence of psychological disorders among patients attending community health centers, Perak, Malaysia

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    Asma Perveen

    2017-09-01

    Full Text Available Objective: The purpose of this study was to explore the prevalence of psychological disorders among community health centers in Batang Padang district Perak. Material & Methods: To conduct this study survey research method was used, seven community health centers in Batang Padang District, Perak were contacted to collect data from (N=216 respondents, who attended health facilities in Batang Padang District. There is no age limit, no education difference and no other requirement needed. Instrument and Materials: Depression, Anxiety and Stress Scale (DASS-21 PRIME Screen and PRIME MD Patient Health Questionnaire (PHQ. Results: Data collected from seven health community centers revealed that prevalence of Stress 86%, anxiety 124%, depression 67, psychotic symptoms 16%, somatoform symptoms 52%, panic symptoms 28%, and substance abuse 21%. the higher prevalence was stress and depression among people attending health centers. Conclusion: Results findings indicated that there is significant prevalence of psychological disorder among community health centers. Analysis of the results help us to determine that there is strong need to provide psychological services, awareness and education plan, management and prevention for psychological disorders

  4. Prevalence of psychological disorders among patients attending community health centers, Perak, Malaysia

    Directory of Open Access Journals (Sweden)

    Asma Perveen

    2017-09-01

    Full Text Available Objective: The purpose of this study was to explore the prevalence of psychological disorders among community health centers in Batang Padang district Perak. Material & Methods: To conduct this study survey research method was used, seven community health centers in Batang Padang District, Perak were contacted to collect data from (N=216 respondents, who attended health facilities in Batang Padang District. There is no age limit, no education difference and no other requirement needed. Instrument and Materials: Depression, Anxiety and Stress Scale (DASS-21 PRIME Screen and PRIME MD Patient Health Questionnaire (PHQ. Results: Data collected from seven health community centers revealed that prevalence of Stress 86%, anxiety 124%, depression 67, psychotic symptoms 16%, somatoform symptoms 52%, panic symptoms 28%, and substance abuse 21%. the higher prevalence was stress and depression among people attending health centers. Conclusion: Results findings indicated that there is significant prevalence of psychological disorder among community health centers. Analysis of the results help us to determine that there is strong need to provide psychological services, awareness and education plan, management and prevention for psychological disorders

  5. [The role of county health center in the management of patients with acute coronary syndrome].

    Science.gov (United States)

    Krcmar, Nevenka; Pristas, Ivan; Stevanović, Ranko

    2009-02-01

    Health emergency service teams play an important role in the management of patients with acute coronary syndrome. They have to be educated, equipped, skilful and supported by the entire health care system. The role of county health center in the management of patients with acute coronary syndrome is illustrated in the article, based on the experience acquired at Medimurje County Health Center from Cakovec. The reformed Health Center activities including organization, coordination and linking of teams, population health monitoring at the local level, epidemiologic surveillance, education (active and passive, on both sides of college chair), joint diagnostic and other services, and quality control are discussed in detail. In contrast to a bureaucratic and formal one, a real and innovative reform should take account of necessary changes in the management and organization, not just in standards, rights and obligations. The management protocol for acute coronary syndrome patients is described: setting the main objective (acute coronary disease morbidity and mortality reduction), setting short-term and long-term specific goals, adoption of strategy based on the main objective (education, completion and particular programs pursuit, connecting, collaboration, quality assurance through clinical guidelines and protocols) and other elements, including dignity, leadership, teamwork, adoption and implementation of patient management protocols.

  6. Examining Health Information Technology Implementations: Case of the Patient-Centered Medical Home

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    Behkami, Nima A.

    2012-01-01

    It has been shown that the use of Health Information Technology (HIT) is associated with reduced cost and increased quality of care. This dissertation examined the use of registries in Patient Centered Medical Home (PCMH) practices. A survey questionnaire was sent to a nationwide group of clinics certified for being a PCMH. They were asked to…

  7. Design of a consumer health record for supporting the patient-centered management of chronic diseases.

    NARCIS (Netherlands)

    de Clerq, P.A.; Hasman, A.; Wolffenbuttel, B.H.R.

    2001-01-01

    : Medinfo 2001;10(Pt 2):1445-9 Related Articles, Books, LinkOut Design of a consumer health record for supporting the patient-centered management of chronic diseases. de Clercq PA, Hasman A, Wolffenbuttel BH. Department of Medical Informatics, University of Maastricht, Maastricht, The Netherlands.

  8. Crossing the patient-centered divide: transforming health care quality through enhanced faculty development.

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    Frankel, Richard M; Eddins-Folensbee, Florence; Inui, Thomas S

    2011-04-01

    In the report "Crossing the Quality Chasm," the Institute of Medicine asserted that patient-centered care is one of the six domains of quality. In this article, the authors consider how the patient- and relationship-centered components of quality can be achieved in all aspects of medical care. They suggest that faculty development in three key areas-mindful practice, formation, and training in communication skills-is necessary to achieve patient- and relationship-centeredness.The authors first review the philosophical and scientific foundations of patient-centered and relationship-centered care. They next describe and provide concrete examples to illustrate the underlying theory and practices associated with each of the three faculty development areas. They then propose five key areas for faculty development in patient- and relationship-centered care: (1) making it a central competency in all health care interactions, (2) developing a national curriculum framework, (3) requiring performance metrics for professional development, (4) partnering with national health care organizations to disseminate the curriculum framework, and (5) preserving face-to-face educational methods for delivering key elements of the curriculum. Finally, the authors consider the issues faced in faculty development today in light of the medical education issues Abraham Flexner identified more than a century ago. © by the Association of American Medical Colleges.

  9. Designing a patient-centered personal health record to promote preventive care

    Directory of Open Access Journals (Sweden)

    Krist Alex H

    2011-11-01

    Full Text Available Abstract Background Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the technology's full potential. Methods Using a previously described model to make information technology more patient-centered, we developed an interactive preventive health record (IPHR designed to more deeply engage patients in preventive care and health promotion. We recruited 14 primary care practices to promote the IPHR to all adult patients and sought practice and patient input in designing the IPHR to ensure its usability, salience, and generalizability. The input involved patient usability tests, practice workflow observations, learning collaboratives, and patient feedback. Use of the IPHR was measured using practice appointment and IPHR databases. Results The IPHR that emerged from this process generates tailored patient recommendations based on guidelines from the U.S. Preventive Services Task Force and other organizations. It extracts clinical data from the practices' electronic medical record and obtains health risk assessment information from patients. Clinical content is translated and explained in lay language. Recommendations review the benefits and uncertainties of services and possible actions for patients and clinicians. Embedded in recommendations are self management tools, risk calculators, decision aids, and community resources - selected to match patient's clinical circumstances. Within six months, practices had encouraged 14.4% of patients to use the IPHR (ranging from 1.5% to 28.3% across the 14 practices. Practices successfully incorporated the IPHR into workflow, using it to prepare patients for visits, augment health behavior counseling, explain test results

  10. Application of a marketing concept to patient-centered care: co-producing health with heart failure patients.

    Science.gov (United States)

    Leone, Robert P; Walker, Charles A; Curry, Linda Cox; Agee, Elizabeth J

    2012-04-03

    Increasing numbers of patients are being treated for heart failure each year. One out of four of the heart failure patients who receives care in a hospital is readmitted to the hospital within 30 days of discharge. Effective discharge instruction is critical to prevent these patient readmissions. Co-production is a marketing concept whereby the customer is a partner in the delivery of a good or service. For example, a patient and nurse may partner to co-produce a patient-centered health regimen to improve patient outcomes. In this article we review the cost of treating heart failure patients and current strategies to decrease hospital readmissions for these patients along with the role of the nurse and the concept of co-producing health as related to heart failure patients. Next we describe our study assessing the degree to which discharge processes were co-produced on two hospital units having a preponderance of heart failure patients, and present our findings indicating minimal evidence of co-production. A discussion of our findings, along with clinical implications of these findings, recommendations for change, and suggestions for future research are offered. We conclude that standardized discharge plans lead to a mindset of 'one size fits all,' a mindset inconsistent with the recent call for patient-centered care. We offer co-production as a patient-centered strategy for customizing discharge teaching and improving health outcomes for heart failure patients.

  11. Challenges and Opportunities to Improve Cervical Cancer Screening Rates in US Health Centers through Patient-Centered Medical Home Transformation

    Directory of Open Access Journals (Sweden)

    Olga Moshkovich

    2015-01-01

    Full Text Available Over the last 50 years, the incidence of cervical cancer has dramatically decreased. However, health disparities in cervical cancer screening (CCS persist for women from racial and ethnic minorities and those residing in rural and poor communities. For more than 45 years, federally funded health centers (HCs have been providing comprehensive, culturally competent, and quality primary health care services to medically underserved communities and vulnerable populations. To enhance the quality of care and to ensure more women served at HCs are screened for cervical cancer, over eight HCs received funding to support patient-centered medical home (PCMH transformation with goals to increase CCS rates. The study conducted a qualitative analysis using Atlas.ti software to describe the barriers and challenges to CCS and PCMH transformation, to identify potential solutions and opportunities, and to examine patterns in barriers and solutions proposed by HCs. Interrater reliability was assessed using Cohen’s Kappa. The findings indicated that HCs more frequently described patient-level barriers to CCS, including demographic, cultural, and health belief/behavior factors. System-level barriers were the next commonly cited, particularly failure to use the full capability of electronic medical records (EMRs and problems coordinating with external labs or providers. Provider-level barriers were least frequently cited.

  12. Find a Health Center

    Data.gov (United States)

    U.S. Department of Health & Human Services — HRSA Health Centers care for you, even if you have no health insurance – you pay what you can afford based on your income. Health centers provide services that...

  13. Patient-centered communication in the era of electronic health records: What does the evidence say?

    Science.gov (United States)

    Rathert, Cheryl; Mittler, Jessica N; Banerjee, Sudeep; McDaniel, Jennifer

    2017-01-01

    Patient-physician communication is essential for patient-centered health care. Physicians are concerned that electronic health records (EHRs) negatively affect communication with patients. This study identified a framework for understanding communication functions that influence patient outcomes. We then conducted a systematic review of the literature and organized it within the framework to better understand what is known. A comprehensive search of three databases (CINAHL, Medline, PsycINFO) yielded 41 articles for analysis. Results indicated that EHR use improves capture and sharing of certain biomedical information. However, it may interfere with collection of psychosocial and emotional information, and therefore may interfere with development of supportive, healing relationships. Patient access to the EHR and messaging functions may improve communication, patient empowerment, engagement, and self-management. More rigorous examination of EHR impacts on communication functions and their influences on patient outcomes is imperative for achieving patient-centered care. By focusing on the role of communication functions on patient outcomes, future EHRs can be developed to facilitate care. Training alone is likely to be insufficient to address disruptions to communication processes. Processes must be improved, and EHRs must be developed to capture useful data without interfering with physicians' and patients' abilities to effectively communicate. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. A Survey on Health Literacy of Referred Diabetic Patients to Yazd Diabetes Research Center

    Directory of Open Access Journals (Sweden)

    z Rezaee Esfahrood

    2016-09-01

    Full Text Available Introduction:The ability to use skills such as reading, listening, analysis and decision making in health status depends on the degree to which individuals have the capacity to obtain, process, and understanding basic health information and services needed which is defined in term of health literacy. The purpose of this study was to determine the level of health literacy in referred patients to Yazd Diabetes Research Center. Methods: This cross-sectional study performed on 432 patients referred to Yazd Diabetes Research Center in 2014. Health literacy was measured by the Test of Functional Health Literacy in Adults (TOFHLA and analyzed using the SPSS-17 software and analytical statistics (T-Test, Chi-Square, A-Nova and linear regression. Results: The mean age of studied population was 55.02 ± 6.32 years old and the mean duration of diabetes was 10.24 ± 7.13 years old. Increase age and decrease the Duration of diabetes, Increase health literacy scores. The average of Health literacy scores was significantly higher in men than women. Retired people, people living in the city, people with high educational level and good economic situation were more literate. (P-Value <0.001 Conclusion: The results showed that health literacy in 59.3 percent of patients was insufficient, in 18.5 percent was border and only 22.2 percent of patients had adequate health literacy that providing facilities and health literacy education seems to be necessary for them.  

  15. PROACT: Iterative Design of a Patient-Centered Visualization for Effective Prostate Cancer Health Risk Communication.

    Science.gov (United States)

    Hakone, Anzu; Harrison, Lane; Ottley, Alvitta; Winters, Nathan; Gutheil, Caitlin; Han, Paul K J; Chang, Remco

    2017-01-01

    Prostate cancer is the most common cancer among men in the US, and yet most cases represent localized cancer for which the optimal treatment is unclear. Accumulating evidence suggests that the available treatment options, including surgery and conservative treatment, result in a similar prognosis for most men with localized prostate cancer. However, approximately 90% of patients choose surgery over conservative treatment, despite the risk of severe side effects like erectile dysfunction and incontinence. Recent medical research suggests that a key reason is the lack of patient-centered tools that can effectively communicate personalized risk information and enable them to make better health decisions. In this paper, we report the iterative design process and results of developing the PROgnosis Assessment for Conservative Treatment (PROACT) tool, a personalized health risk communication tool for localized prostate cancer patients. PROACT utilizes two published clinical prediction models to communicate the patients' personalized risk estimates and compare treatment options. In collaboration with the Maine Medical Center, we conducted two rounds of evaluations with prostate cancer survivors and urologists to identify the design elements and narrative structure that effectively facilitate patient comprehension under emotional distress. Our results indicate that visualization can be an effective means to communicate complex risk information to patients with low numeracy and visual literacy. However, the visualizations need to be carefully chosen to balance readability with ease of comprehension. In addition, due to patients' charged emotional state, an intuitive narrative structure that considers the patients' information need is critical to aid the patients' comprehension of their risk information.

  16. Patient-Centered Specialty Practice: Defining the Role of Specialists in Value-Based Health Care.

    Science.gov (United States)

    Ward, Lawrence; Powell, Rhea E; Scharf, Michael L; Chapman, Andrew; Kavuru, Mani

    2017-04-01

    Health care is at a crossroads and 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. However, primary care accounts for only a small portion of total health-care 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. The key elements of the PCSP model include processes to support timely access to referral requests, improved communication and coordination with patients and referring clinicians, reduced unnecessary and duplicative testing, and an emphasis on continuous measurement of quality, safety, and performance improvement for a population of patients. Evidence to support the model remains limited, and estimates of net costs and value to practices are not fully understood. The PCSP model holds promise for promoting value-based health care in specialty practices. The continued development of appropriate incentives is required to ensure widespread adoption. Copyright © 2017. Published by Elsevier Inc.

  17. Payment reform in the patient-centered medical home: Enabling and sustaining integrated behavioral health care.

    Science.gov (United States)

    Miller, Benjamin F; Ross, Kaile M; Davis, Melinda M; Melek, Stephen P; Kathol, Roger; Gordon, Patrick

    2017-01-01

    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. However, challenges to implementing the PCMH framework are compounded for real-world practitioners because payment reform rarely happens concurrently. Nowhere is this more evident than in attempts to integrate behavioral health clinicians into primary care. As behavioral health clinicians find opportunities to work in integrated settings, a comprehensive understanding of payment models is integral to the dialogue. This article describes alternatives to the traditional fee for service (FFS) model, including modified FFS, pay for performance, bundled payments, and global payments (i.e., capitation). We suggest that global payment structures provide the best fit to enable and sustain integrated behavioral health clinicians in ways that align with the Triple Aim. Finally, we present recommendations that offer specific, actionable steps to achieve payment reform, complement PCMH, and support integration efforts through policy. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  18. 77 FR 22691 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

    Science.gov (United States)

    2012-04-17

    ... 1545-BK59 Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes... certain health insurance policies and plan sponsors of certain self-insured health plans to fund the... health insurance policies) or R. Lisa Mojiri-Azad at (202) 622-6080 (regarding self- insured health...

  19. The Patient Centered Assessment Method (PCAM: integrating the social dimensions of health into primary care

    Directory of Open Access Journals (Sweden)

    Rebekah Pratt

    2015-07-01

    Full Text Available Background: Social dimensions of health are known to contribute to what is often termed “patient complexity”, which is particularly common among patients with multimorbidity. Health-care professionals require tools to help them identify and manage these aspects of patient needs. Objectives: To examine: (i the Patient Centered Assessment Method (PCAM, a tool for assessing patient complexity in ways that are sensitive to the biopsychosocial dimensions of health, in primary care settings in Scotland; (ii the impact of the PCAM on referral patterns and its perceived value; and (iii the PCAM’s perceived applicability for use in a complex patient population. Design: Two studies are described: (i a mixed-methods prospective cohort study of the implementation of the PCAM in primary care clinics; and (ii a qualitative exploratory study that evaluated the value of the PCAM in a complex patient population. Results: Use of the PCAM did not impact patient satisfaction or perception of practitioners’ empathy, but it did increase both the number of onward referrals per referred patient (9–12% and the proportion of referrals to non-medical services addressing psychological, social, and lifestyle needs. Nurses valued the PCAM, particularly its ability to help them address psychological and social domains of patients’ lives, and found it to be highly relevant for use in populations with known high complexity. Conclusions: The PCAM represents a feasible approach for assessing patient needs with consideration to the social dimensions of health, and allows practitioners to refer patients to a broader range of services to address patient complexity.

  20. 77 FR 72721 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

    Science.gov (United States)

    2012-12-06

    ... 1545-BK59 Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes... Patient Protection and Affordable Care Act on issuers of certain health insurance policies and plan... arrangements) or Rebecca L. Baxter at (202) 622-3970 (regarding health insurance policies). SUPPLEMENTARY...

  1. Case-mix adjustment and the comparison of community health center performance on patient experience measures.

    Science.gov (United States)

    Johnson, M Laura; Rodriguez, Hector P; Solorio, M Rosa

    2010-06-01

    To assess the effect of case-mix adjustment on community health center (CHC) performance on patient experience measures. A Medicaid-managed care plan in Washington State collected patient survey data from 33 CHCs over three fiscal quarters during 2007-2008. The survey included three composite patient experience measures (6-month reports) and two overall ratings of care. The analytic sample includes 2,247 adult patients and 2,859 adults reporting for child patients. We compared the relative importance of patient case-mix adjusters by calculating each adjuster's predictive power and variability across CHCs. We then evaluated the impact of case-mix adjustment on the relative ranking of CHCs. Important case-mix adjusters included adult self-reported health status or parent-reported child health status, adult age, and educational attainment. The effects of case-mix adjustment on patient reports and ratings were different in the adult and child samples. Adjusting for race/ethnicity and language had a greater impact on parent reports than adult reports, but it impacted ratings similarly across the samples. The impact of adjustment on composites and ratings was modest, but it affected the relative ranking of CHCs. To ensure equitable comparison of CHC performance on patient experience measures, reports and ratings should be adjusted for adult self-reported health status or parent-reported child health status, adult age, education, race/ethnicity, and survey language. Because of the differential impact of case-mix adjusters for child and adult surveys, initiatives should consider measuring and reporting adult and child scores separately.

  2. Development and evaluation of a patient centered cardiovascular health education program for insured patients in rural Nigeria (QUICK - II

    Directory of Open Access Journals (Sweden)

    Osibogun Akin

    2011-03-01

    Full Text Available Abstract Background In Sub Saharan Africa, the incidence of hypertension and other modifiable cardiovascular risk factors is growing rapidly. Poor adherence to prescribed prevention and treatment regimens by patients can compromise treatment outcomes. Patient-centered cardiovascular health education is likely to improve shortcomings in adherence. This paper describes a study that aims to develop a cardiovascular health education program for patients participating in a subsidized insurance plan in Nigeria and to evaluate the applicability and effectiveness in patients at increased risk for cardiovascular disease. Methods/Design Design: The study has two parts. Part 1 will develop a cardiovascular health education program, using qualitative interviews with stakeholders. Part 2 will evaluate the effectiveness of the program in patients, using a prospective (pre-post observational design. Setting: A rural primary health center in Kwara State, Nigeria. Population: For part 1: 40 patients, 10 healthcare professionals, and 5 insurance managers. For part 2: 150 patients with uncontrolled hypertension or other cardiovascular risk factors after one year of treatment. Intervention: Part 2: patient-centered cardiovascular health education program. Measurements: Part 1: Semi-structured interviews to identify stakeholder perspectives. Part 2: Pre- and post-intervention assessments including patients' demographic and socioeconomic data, blood pressure, body mass index and self-reporting measures on medication adherence and perception of care. Feasibility of the intervention will be measured using process data. Outcomes: For program development (part 1: overview of healthcare professionals' perceptions on barriers and facilitators to care, protocol for patient education, and protocol implementation plan. For program evaluation (part 2: changes in patients' scores on adherence to medication and life style changes, blood pressure, and other physiological and self

  3. Patient safety goals for the proposed Federal Health Information Technology Safety Center.

    Science.gov (United States)

    Sittig, Dean F; Classen, David C; Singh, Hardeep

    2015-03-01

    The Office of the National Coordinator for Health Information Technology is expected to oversee creation of a Health Information Technology (HIT) Safety Center. While its functions are still being defined, the center is envisioned as a public-private entity focusing on promotion of HIT related patient safety. We propose that the HIT Safety Center leverages its unique position to work with key administrative and policy stakeholders, healthcare organizations (HCOs), and HIT vendors to achieve four goals: (1) facilitate creation of a nationwide 'post-marketing' surveillance system to monitor HIT related safety events; (2) develop methods and governance structures to support investigation of major HIT related safety events; (3) create the infrastructure and methods needed to carry out random assessments of HIT related safety in complex HCOs; and (4) advocate for HIT safety with government and private entities. The convening ability of a federally supported HIT Safety Center could be critically important to our transformation to a safe and effective HIT enabled healthcare system. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. Launch of patient-centered website is associated with reduced health care utilization: a nationwide natural experiment.

    NARCIS (Netherlands)

    Spoelman, W.; Bonten, T.; Waal, M. de; Drenthen, T.; Smeele, I.; Nielen, M.; Chavannes, N.

    2016-01-01

    Background: Health care costs and utilization are rising. High quality patient-centered online information may reduce health care utilization, but evidence of the effect of online health information on health care utilization is scarce. We hypothesized that the release of a nationwide evidence-based

  5. Patient-centered activity monitoring in the self-management of chronic health conditions.

    Science.gov (United States)

    Chiauzzi, Emil; Rodarte, Carlos; DasMahapatra, Pronabesh

    2015-04-09

    As activity tracking devices become smaller, cheaper, and more consumer-accessible, they will be used more extensively across a wide variety of contexts. The expansion of activity tracking and personal data collection offers the potential for patient engagement in the management of chronic diseases. Consumer wearable devices for activity tracking have shown promise in post-surgery recovery in cardiac patients, pulmonary rehabilitation, and activity counseling in diabetic patients, among others. Unfortunately, the data generated by wearable devices is seldom integrated into programmatic self-management chronic disease regimens. In addition, there is lack of evidence supporting sustained use or effects on health outcomes, as studies have primarily focused on establishing the feasibility of monitoring activity and the association of measured activity with short-term benefits. Monitoring devices can make a direct and real-time impact on self-management, but the validity and reliability of measurements need to be established. In order for patients to become engaged in wearable data gathering, key patient-centered issues relating to usefulness in care, motivation, the safety and privacy of information, and clinical integration need to be addressed. Because the successful usage of wearables requires an ability to comprehend and utilize personal health data, the user experience should account for individual differences in numeracy skills and apply evidence-based behavioral science principles to promote continued engagement. Activity monitoring has the potential to engage patients as advocates in their personalized care, as well as offer health care providers real world assessments of their patients' daily activity patterns. This potential will be realized as the voice of the chronic disease patients is accounted for in the design of devices, measurements are validated against existing clinical assessments, devices become part of the treatment 'prescription', behavior

  6. Care team identification in the electronic health record: A critical first step for patient-centered communication.

    Science.gov (United States)

    Dalal, Anuj K; Schnipper, Jeffrey L

    2016-05-01

    Patient-centered communication is essential to coordinate care and safely progress patients from admission through discharge. Hospitals struggle with improving the complex and increasingly electronic conversation patterns among care team members, patients, and caregivers to achieve effective patient-centered communication across settings. Accurate and reliable identification of all care team members is a precursor to effective patient-centered communication and ideally should be facilitated by the electronic health record. However, the process of identifying care team members is challenging, and team lists in the electronic health record are typically neither accurate nor reliable. Based on the literature and on experience from 2 initiatives at our institution, we outline strategies to improve care team identification in the electronic health record and discuss potential implications for patient-centered communication. Journal of Hospital Medicine 2016;11:381-385. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

  7. Ontario pharmacists practicing in family health teams and the patient-centered medical home.

    Science.gov (United States)

    Dolovich, Lisa

    2012-04-01

    The patient-centered medical home (PCMH) approach continues to gather momentum in the United States and Canada as a broad approach to reform the delivery of the complete primary care system. The family health team (FHT) model implemented in Ontario, Canada, best mirrors the PCMH approach of the United States. The integration of pharmacists as key members of the health care team providing on-site, in-office coordinated care to FHT patients was included from the start of planning the FHT model and represents a substantial opportunity for pharmacists to realize their professional vision. Several research projects in Canada and elsewhere have contributed to providing evidence to support the integration of pharmacists into primary care practice sites. Two major research programs, the Seniors Medication Assessment Research Trial (SMART) cluster randomized controlled trial and the Integrating Family Medicine and Pharmacy to Advance Primary Care Therapeutics (IMPACT) multipronged demonstration project made substantial contributions to evidence-informed policy decisions supporting the integration of pharmacists into FHTs. These projects can provide useful information to support the integration of pharmacists into the PCMH and to encourage further research to better measure the effect of the pharmacist from the holistic patient-centered perspective.

  8. What do health coaches do? Direct observation of health coach activities during medical and patient-health coach visits at 3 federally qualified health centers.

    Science.gov (United States)

    Johnson, Christopher; Saba, George; Wolf, Jessica; Gardner, Heather; Thom, David H

    2018-05-01

    To examine activities of health coaches during patient medical visits and when meeting one-on-one with patients at 3 urban federally qualified health centers. Encounters were videotaped and transcribed. Data was analyzed using a matrix analysis approach that allowed a priori identification of expected categories of activity, based on the health coach training model and previously developed conceptual framework, which were modified based on activities observed. A total of 10 medical visits (patient, clinician and health coach), and 8 patient-coach visits were recorded. We identified 9 categories common to both medical and patient-coach visits and 2 categories unique to the medical visit. While observed activities were generally consistent with expected categories, some activities were observed infrequently or not at all. We also observed additional activity categories, including information gathering and personal conversation. The average amount of time spent on some categories of coaching activities differed substantially between medical visits and patient-coach visits. Health coaching activities observed differed in several respects to those expected, and differed between medical visits and coaching only visits. These results provide insights into health coaching behaviors that can be used to inform training and improve utilization of health coaches in practice. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. User-centered Design Groups to Engage Patients and Caregivers with a Personalized Health IT Tool

    Science.gov (United States)

    Maher, Molly; Kaziunas, Elizabeth; Ackerman, Mark; Derry, Holly; Forringer, Rachel; Miller, Kristen; O’Reilly, Dennis; An, Larry C.; Tewari, Muneesh; Hanauer, David A.; Choi, Sung Won

    2015-01-01

    Health information technology (IT) has opened exciting avenues for capturing, delivering and sharing data, and offers the potential to develop cost-effective, patient-focused applications. In recent years, there has been a proliferation of health IT applications such as outpatient portals. Rigorous evaluation is fundamental to ensure effectiveness and sustainability, as resistance to more widespread adoption of outpatient portals may be due to lack of user friendliness. Health IT applications that integrate with the existing electronic health record and present information in a condensed, user-friendly format could improve coordination of care and communication. Importantly, these applications should be developed systematically with appropriate methodological design and testing to ensure usefulness, adoption, and sustainability. Based on our prior work that identified numerous information needs and challenges of HCT, we developed an experimental prototype of a health IT tool, the BMT Roadmap. Our goal was to develop a tool that could be used in the real-world, daily practice of HCT patients and caregivers (users) in the inpatient setting. In the current study, we examined the views, needs, and wants of patients and caregivers in the design and development process of the BMT Roadmap through two user-centered Design Groups, conducted in March 2015 and April 2015, respectively: Design Group I utilized a low-fidelity paper-based prototype and Design Group II utilized a high-fidelity prototype presented to users as a web-app on Apple® iPads. There were 11 caregivers (median age 44, range 34–69 years) and 8 patients (median age 18 years, range 11–24 years) in the study population. The qualitative analyses revealed a wide range of responses helpful in guiding the iterative development of the system. Three important themes emerged from the Design Groups: 1) perception of core features as beneficial (views), 2) alerting the design team to potential issues with the user

  10. Innovation in patient-centered care: lessons from a qualitative study of innovative health care organizations in Washington State

    Directory of Open Access Journals (Sweden)

    Reed Peter

    2012-12-01

    Full Text Available Abstract Background Growing interest in the promise of patient-centered care has led to numerous health care innovations, including the patient-centered medical home, shared decision-making, and payment reforms. How best to vet and adopt innovations is an open question. Washington State has been a leader in health care reform and is a rich laboratory for patient-centered innovations. We sought to understand the process of patient-centered care innovation undertaken by innovative health care organizations – from strategic planning to goal selection to implementation to maintenance. Methods We conducted key-informant interviews with executives at five health plans, five provider organizations, and ten primary care clinics in Washington State. At least two readers of each interview transcript identified themes inductively; final themes were determined by consensus. Results Innovation in patient-centered care was a strategic objective chosen by nearly every organization in this study. However, other goals were paramount: cost containment, quality improvement, and organization survival. Organizations commonly perceived effective chronic disease management and integrated health information technology as key elements for successful patient-centered care innovation. Inertia, resource deficits, fee-for-service payment, and regulatory limits on scope of practice were cited as barriers to innovation, while organization leadership, human capital, and adaptive culture facilitated innovation. Conclusions Patient-centered care innovations reflected organizational perspectives: health plans emphasized cost-effectiveness while providers emphasized health care delivery processes. Health plans and providers shared many objectives, yet the two rarely collaborated to achieve them. The process of innovation is heavily dependent on organizational culture and leadership. Policymakers can improve the pace and quality of patient-centered innovation by setting targets

  11. Understanding Falls Risk and Impacts in Chinese American Older Patients at a Community Health Center.

    Science.gov (United States)

    Huang, Susan; Duong, Thomas; Ieong, Liss; Quach, Thu

    2017-08-01

    While falls are highly prevalent and costly for older adults, little is known about falls for Asian Americans. Using a custom, evidence-based, bilingual fall risk assessment and management tool, our study examined the prevalence of falls among older Chinese-speaking patients at a community health center. We identified the risks for falls and explored an association of fall risk with emergency room (ER) and hospital use in this population. The setting was at a community health center in Oakland, CA. Participants included 839 older Asian American adults (ages 65-80 years) who spoke Cantonese/Mandarin. Primary care clinic staff administered a fall risk assessment and management tool at the time of clinic visits to assess patients' risk factors for falls. Of the total, 173 (20.6%) reported having fallen in the past year, with women comprising a majority (71.7%). 362 patients in the cohort (43.1%) reported fear of falling. For the subset of Medicaid managed care patients (n = 455, 54.3% of total) for whom we were able to obtain ER and hospital utilization data, 31 patients (14.5%) who reported a fall risk had an ER/hospital episode compared to 15 (6.2%) of those who did not self-report fall risks (statistically significant, p cultural competence to focus on Asian American older adults, can help establish the prevalence of falls in this understudied population and effectively identify those at higher risk for falls and subsequent ER/hospital utilization. More research is needed to understand the risk and impacts of falls in understudied populations and identify ways to prevent these costly falls.

  12. 77 FR 47573 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

    Science.gov (United States)

    2012-08-09

    ... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Parts 40 and 46 [REG-136008-11] RIN 1545-BK59 Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes... on issuers of certain health insurance policies and plan sponsors of certain self-insured health...

  13. Mental Health Screening Center

    Science.gov (United States)

    ... Releases & Announcements Public Service Announcements Partnering with DBSA Mental Health Screening Center These online screening tools are not ... you have any concerns, see your doctor or mental health professional. Depression Screening for Adult Depression Screening for ...

  14. Patients' satisfaction regarding family physician's consultation in primary healthcare centers of Ministry of Health, Jeddah

    Directory of Open Access Journals (Sweden)

    Khalid Bawakid

    2017-01-01

    Full Text Available Introduction: The current study aims to assess the level of patients' satisfaction and the factors contributing to patients' satisfaction toward family physicians (FPs consultation, visiting primary healthcare centers (PHCCs working under Ministry of Health, Jeddah. Materials and Methods: In this cross-sectional study conducted in Jeddah from November 1, 2016 to March 1, 2017, we used consultation satisfaction questionnaire and its four subscales with standard cutoffs. These subscales include general satisfaction, professional care, depth of relationship, and length of consultation. Mean scores along with standard deviation of these subscales were measured. Independent sample t-test, ANOVA, and multivariate regression analysis were performed to test the association between satisfaction level and predictors. Results: Overall, patients' satisfaction was 60%. Around 74% of patients were satisfied with the professional care and 58% with the depth of the relationship. Around 60% of patients need more consultation time with the physicians. Knowledge about the presence of FP in the nearest PHCCs was around 70%. Multivariate regression analysis for the overall high satisfaction showed that the most important predictors of this high satisfaction level are regular visits to a particular FP (P < 0.001, distance from the PHCC (P = 0.044 and gender of the patient (P = 0.027. Conclusion: This study concluded that satisfaction with the FP's consultation is acceptable but needs improvement. Lower satisfaction was reported among males, patients living at a distance from PHCC and who had less knowledge about the presence of FP in their nearest PHCC. Such study data are vital for any corrective measures to boost satisfaction in patients attending PHCCs.

  15. Forging stronger partnerships between academic health centers and patient-driven organizations.

    Science.gov (United States)

    Gallin, Elaine K; Bond, Enriqueta; Califf, Robert M; Crowley, William F; Davis, Pamela; Galbraith, Richard; Reece, E Albert

    2013-09-01

    In this article, the authors review the unique role that patient-driven organizations, such as patient advocacy groups and voluntary health organizations (PAG/VHOs), play in translational and clinical research. The importance of fostering collaborations between these organizations and U.S. academic health centers (AHCs) is also discussed. Although both the PAG/VHO community and AHCs are heterogeneous, and although not all organizations are well governed or provide independent, well-researched views, there are many outstanding, well-managed, independent PAG/VHOs in the United States whose missions overlap with those of AHCs. The characteristics of effective PAG/VHOs that would serve as excellent partners for AHCs are discussed, and examples are provided regarding their many contributions, which have included advancing research on rare diseases, recruiting patients for clinical trials, and establishing patient registries and biospecimen banks. The authors present feedback obtained from informal discussions with PAG/VHO staff, as well as a survey of a small sample of organizations, that has identified bureaucratic processes, negotiating intellectual property rights, and institutional review board (IRB) delays as the most problematic areas of interactions with AHCs. Actions are suggested for building effective partnerships between the two sectors and the activities that AHCs should undertake to facilitate their interactions with PAG/VHOs including streamlining contract review and IRB processes and finding ways to better align the incentives motivating academic clinical and translational investigators with the goals of PAG/VHOs. This article is one product of the Clinical Research Forum's Partnering with Patient Advocacy Groups Initiative.

  16. Advancing patient-centered care through transformative educational leadership: a critical review of health care professional preparation for patient-centered care

    Directory of Open Access Journals (Sweden)

    Lévesque MC

    2013-07-01

    Full Text Available Martine C Lévesque,1,2 Richard Bruce Hovey,2,3 Christophe Bedos2,4 1Faculté de médecine, Université de Montréal, Montréal, QC, Canada; 2Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada; 3Faculty of Medicine, University of Calgary, Calgary, AB, Canada; 4Département de médecine sociale et préventive, Faculté de médicine, Université de Montréal, Montréal, QC, Canada Abstract: Following a historical brief on the development of patient-centered care (PCC, we discuss PCC's value and role in counterbalancing the evidence-based movement in health care. We in turn make a case for a philosophical shift in thinking about the PCC concept, one based on a consideration for how knowledge is produced, used, and valued within care provision processes. A “shared epistemology” foundation is presented, defined, and promoted as essential to the authentic and ethical realization of “shared decision making” between patient and health care provider, and, more generally, of PCC. In accordance with these views, this article critically reviews the literature on health care professional education for the development of PCC. We uncover the disturbing ways in which education frequently undermines the development of patient centeredness, despite curricular emphasis on professionalism and ethical PCC. We also establish the need to raise awareness of how dominant approaches to evaluating student or practitioner performance often fail to reinforce or promote patient centeredness. Finally, we identify successful and inspiring cases of teaching and learning experiences that have achieved perspective transformation on PCC and on new ways of providing care. The pertinence of adopting the theoretical foundations of adult transformative learning is argued, and a call to action is proposed to the leadership of health professional educators across all disciplines. Keywords: patient-centered care, health professional

  17. Influence of Human Factor Issues on Patient-Centered mHealth Apps' Impact; Where Do We Stand?

    Science.gov (United States)

    Wildenbos, G A; Peute, L W; Jaspers, M W M

    2016-01-01

    This paper discusses the preliminary results of a literature review on studies published in 2014-2015 concerning patient-centered mHealth applications' (apps) impact. Abstracts were included when they described a mHealth app targeted at patients and reported on the effects of this app on patient care. From a total of 559 potentially relevant articles, 17 papers were finally included. Nine studies reported a positive impact of the patient-centered mHealth app on patient care; 4 of these studies were randomized controlled trials. Measured impacts in the 17 studies focused on improving patients' physical activity, self-efficacy and medication adherence. Human factors issues potentially mediating these effects were discussed in all studies. Transitions in the interaction between healthcare providers and their patients were most often discussed as influencing the impact of the mHealth app. More research is needed, focussing on human issues mediating the effect of patient-centered mHealth apps to precipitate knowledge on the effectiveness of mHealth. This research should preferably be guided by socio-technical models.

  18. Development of an Inventory for Health-Care Office Staff to Self-Assess Their Patient-Centered Cultural Sensitivity

    Directory of Open Access Journals (Sweden)

    Carolyn M. Tucker

    2016-02-01

    Full Text Available Background: Patient-centered culturally sensitive health care (PC-CSHC is a best practice approach for improving health-care delivery to culturally diverse populations and reducing health disparities. Despite patients’ report that cultural sensitivity by health-care office staff is an important aspect of PC-CSHC, the majority of available research on PC-CSHC focuses exclusively on health-care providers. This may be due in part to the paucity of instruments available to assess the cultural sensitivity of health-care office staff. The objective of the present study is to determine the psychometric properties of the Tucker-Culturally Sensitive Health Care Office Staff Inventory-Self-Assessment Form (T-CSHCOSI-SAF. This instrument is designed to enable health-care office staff to self-assess their level of agreement that they display behaviors and attitudes that culturally diverse patients have identified as office staff cultural sensitivity indicators. Methods: A sample of 510 health-care office staff were recruited at 67 health-care sites across the United States. These health-care office staff anonymously completed the T-CSHCOSI-SAF and a demographic data questionnaire. Results and Level of Evidence: Confirmatory factor analyses of the T-CSHCOSI-SAF revealed that this inventory has 2 factors with high internal consistency reliability (Cronbach’s αs= .916 and .912. Conclusion and Implications: The T-CSHCOSI-SAF is a useful inventory for health-care office staff to assess their own level of patient-centered cultural sensitivity. Such self-assessment data can be used in the development and implementation of trainings to promote patient-centered cultural sensitivity of health-care office staff and to help draw the attention of these staff to displaying patient-centered cultural sensitivity.

  19. Health Self-Efficacy Among Populations with Multiple Chronic Conditions: the Value of Patient-Centered Communication.

    Science.gov (United States)

    Finney Rutten, Lila J; Hesse, Bradford W; St Sauver, Jennifer L; Wilson, Patrick; Chawla, Neetu; Hartigan, Danielle B; Moser, Richard P; Taplin, Stephen; Glasgow, Russell; Arora, Neeraj K

    2016-08-01

    Using cross-sectional survey data, we assessed the association between chronic illness burden and health-related self-efficacy, evaluating whether patient-centered communication is associated with self-efficacy and if that relationship varies by chronic illness burden. Data were from the Health Information National Trends Survey, a cross-sectional survey of the US adult population collected in 2012-2013 (n = 3630). Health-related self-efficacy was measured with the item: "Overall, how confident are you about your ability to take good care of your health?" and the prevalence of six chronic conditions and depression/anxiety was assessed. Patient-centered communication was measured as the frequency with which respondents perceived their healthcare providers allowed them to ask questions, gave attention to their emotions, involved them in decisions, made sure they understood how to take care of their health, helped them to deal with uncertainty, and if they felt they could rely on their healthcare providers to take care of their healthcare needs. Health-related self-efficacy was significantly lower among individuals with greater illness burden. In adjusted analysis, individuals who experienced more positive patient-centered communication reported higher levels of self-efficacy (β = 0.26, P self-efficacy were observed among patients reporting more positive patient-centered communication; the observed association was stronger among those with greater chronic illness burden.

  20. Joint principles: Integrating behavioral health care into the patient-centered medical home.

    Science.gov (United States)

    2014-06-01

    The Patient-centered Medical Home (PCMH) is an innovative, improved, and evolving approach to providing primary care that has gained broad acceptance in the United States. The Joint Principles of the PCMH, formulated and endorsed in February 2007, are sound and describe the ideal toward which we aspire. However, there is an element running implicitly through these joint principles that is difficult to achieve yet indispensable to the success of the entire PCMH concept. The incorporation of behavioral health care has not always been included as practices transform to accommodate to the PCMH ideals. This is an alarming development because the PCMH will be incomplete and ineffective without the full incorporation of this element, and retrofitting will be much more difficult than prospectively integrating into the original design of the PCMH. Therefore we offer a complementary set of joint principles that recognizes the centrality of behavioral health care as part of the PCMH. This document follows the order and language of the original joint principles while emphasizing what needs to be addressed to insure incorporation of the essential behavioral elements. It is intended to supplement and not replace the original Joint Principles document, which still stands.

  1. Screening panoramic radiographs in a group of patient visiting a health promotion center

    International Nuclear Information System (INIS)

    Lee, Jae Seo; Kang, Byung Cheol

    2005-01-01

    To report the incidence of radiological findings from screening panoramic radiograph and verify the validity of the panoramic radiography for screening purposes. Six thousand one hundred and sixty panoramic radiographs taken from the patients visiting the Health Promotion Center of CNUH were selected for this retrospective study. Panoramic radiographs were examined into the following pathologic conditions : the presence of periodontal bone loss, dental caries, peri apical radiolucencies, retained roots, impacted supernumerary teeth, impacted third molars, odontoma, cystic lesions other than radicular cyst, sialoliths, and mixed radiolucent-radiopaque lesions. Number of pathologic conditions and Prevalence values were recorded. The prevalence of pathologic conditions were 72.9% of periodontal bone loss, 32.2% of dental caries, 11.9% of peri apical radiolucencies, 10.8% of retained roots, 0.4% of root fracture, 1.0% of impacted supernumerary teeth, 1.0% of impacted third molars, 0.06% of odontoma, 0.08% of cystic lesion other than radicular cyst, 0.2% of prolonged retention of deciduous tooth, 0.1% of sialolith, and 0.04% of mixed radiopaque and radiolucent lesion. Although the panoramic radiograph should not be used to replace intraoral radiographic and clinical examinations, this study showed that many dental pathologic conditions could be detected on panoramic radiographs. The panoramic radiograph might serve as a diagnostic aid in dental health evaluation programs.

  2. Screening panoramic radiographs in a group of patient visiting a health promotion center

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Seo; Kang, Byung Cheol [Chonnam National University College of Medicine, Gwangju (Korea, Republic of)

    2005-12-15

    To report the incidence of radiological findings from screening panoramic radiograph and verify the validity of the panoramic radiography for screening purposes. Six thousand one hundred and sixty panoramic radiographs taken from the patients visiting the Health Promotion Center of CNUH were selected for this retrospective study. Panoramic radiographs were examined into the following pathologic conditions : the presence of periodontal bone loss, dental caries, peri apical radiolucencies, retained roots, impacted supernumerary teeth, impacted third molars, odontoma, cystic lesions other than radicular cyst, sialoliths, and mixed radiolucent-radiopaque lesions. Number of pathologic conditions and Prevalence values were recorded. The prevalence of pathologic conditions were 72.9% of periodontal bone loss, 32.2% of dental caries, 11.9% of peri apical radiolucencies, 10.8% of retained roots, 0.4% of root fracture, 1.0% of impacted supernumerary teeth, 1.0% of impacted third molars, 0.06% of odontoma, 0.08% of cystic lesion other than radicular cyst, 0.2% of prolonged retention of deciduous tooth, 0.1% of sialolith, and 0.04% of mixed radiopaque and radiolucent lesion. Although the panoramic radiograph should not be used to replace intraoral radiographic and clinical examinations, this study showed that many dental pathologic conditions could be detected on panoramic radiographs. The panoramic radiograph might serve as a diagnostic aid in dental health evaluation programs.

  3. Patient-centered innovation in health care organizations: a conceptual framework and case study application.

    Science.gov (United States)

    Hernandez, Susan E; Conrad, Douglas A; Marcus-Smith, Miriam S; Reed, Peter; Watts, Carolyn

    2013-01-01

    Patient-centered innovation is spreading at the federal and state levels. A conceptual framework can help frame real-world examples and extract systematic learning from an array of innovative applications currently underway. The statutory, economic, and political environment in Washington State offers a special contextual laboratory for observing the interplay of these factors. We propose a framework for understanding the process of initiating patient-centered innovations-particularly innovations addressing patient-centered goals of improved access, continuity, communication and coordination, cultural competency, and family- and person-focused care over time. The framework to a case study of a provider organization in Washington State actively engaged in such innovations was applied in this article. We conducted a selective review of peer-reviewed evidence and theory regarding determinants of organizational change. On the basis of the literature review and the particular examples of patient-centric innovation, we developed a conceptual framework. Semistructured key informant interviews were conducted to illustrate the framework with concrete examples of patient-centered innovation. The primary determinants of initiating patient-centered innovation are (a) effective leadership, with the necessary technical and professional expertise and creative skills; (b) strong internal and external motivation to change; (c) clear and internally consistent organizational mission; (d) aligned organizational strategy; (e) robust organizational capability; and (f) continuous feedback and organizational learning. The internal hierarchy of actors is important in shaping patient-centered innovation. External financial incentives and government regulations also significantly shape innovation. Patient-centered care innovation is a complex process. A general framework that could help managers and executives organize their thoughts around innovation within their organization is presented.

  4. Hypertension and hyperlipidemia management in patients treated at community health centers.

    Science.gov (United States)

    Kirchhoff, Anne C; Drum, Melinda L; Zhang, James X; Schlichting, Jennifer; Levie, Jessica; Harrison, James F; Lippold, Susan A; Schaefer, Cynthia T; Chin, Marshall H

    2008-01-01

    OBJECTIVE: Community health centers (HCs) provide care for millions of medically underserved Americans with disproportionate burdens of hypertension and hyperlipidemia. For both conditions, treatment guidelines recently became more stringent and quality improvement (QI) efforts have intensified. We assessed hypertension and hyperlipidemia management in HCs during this time of guideline revision and increased QI efforts. DESIGN: Cross-sectional chart review. SETTING AND PARTICIPANTS: Eleven Midwestern HCs for 2000 and 9 for 2002 provided audit data from 2,976 randomly chosen patients with hypertension and/or hyperlipidemia. MEASUREMENT: Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VI/VII) and National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP III) guidelines were used to assess management of these conditions. RESULTS: Hypertension (2000, N=808; 2002, N=692) and hyperlipidemia (2000, N=774; 2002, N=702) outcomes improved for specific clinical subgroups. Hypertensive patients with 1 or more cardiovascular risk factors demonstrated significant improvement (34% vs. 45% controlled at risk factors (39% vs. 58% controlled at risk groups; however, ongoing QI is necessary.

  5. Impact of Patient-centered eHealth Applications on Patient Outcomes: A Review on the Mediating Influence of Human Factor Issues.

    Science.gov (United States)

    Wildenbos, G A; Peute, L W; Jaspers, M W M

    2016-11-10

    To examine the evidence of the impact of patient- centered eHealth applications on patient care and to analyze if and how reported human factor issues mediated the outcomes. We searched PubMed (2014-2015) for studies evaluating the impact of patient-centered eHealth applications on patient care (behavior change, self-efficacy, and patient health-related outcomes). The Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model was used as a guidance framework to identify the reported human factors possibly impacting the effectiveness of an eHealth intervention. Of the 348 potentially relevant papers, 10 papers were included for data analysis. None of the 10 papers reported a negative impact of the eHealth intervention. Seven papers involved a randomized controlled trial (RCT) study. Six of these RCTs reported a positive impact of the eHealth intervention on patient care. All 10 papers reported on human factor issues possibly mediating effects of patient-centered eHealth. Human factors involved patient characteristics, perceived social support, and (type of) interaction between patient and provider. While the amount of patient-centered eHealth interventions increases, many questions remain as to whether and to what extent human factors mediate their use and impact. Future research should adopt a formal theory-driven approach towards human factors when investigating those factors' influence on the effectiveness of these interventions. Insights could then be used to better tailor the content and design of eHealth solutions according to patient user profiles, so as to enhance eHealth interventions impact on patient behavior, self-efficacy, and health-related outcomes.

  6. Impacts of Initial Transformation to a Patient-Centered Medical Home on Diabetes Outcomes in Federally Qualified Health Centers in Florida.

    Science.gov (United States)

    Kinsell, Heidi S; Hall, Allyson G; Harman, Jeffrey S; Tewary, Sweta; Brickman, Andrew

    2017-10-01

    Federally qualified health centers (FQHCs) in Florida see large numbers of vulnerable patients with diabetes. Patient-centered medical home (PCMH) models can lead to improvements in health for patients with chronic conditions and cost savings for providers. Therefore, FQHCs are increasingly moving to PCMH models of care. The study objective was to examine the effects of initial transformation to a level 3 National Committee for Quality Assurance (NCQA) certified PCMH in 2011, on clinical diabetes outcomes among 27 clinic sites from a network of FQHCs in Florida. We used de-identified, longitudinal electronic health record (EHR) data from 2010-2012 and multivariate logistic regression to analyze the effects of initial transformation on the odds of having well-controlled HbA1c, body mass index (BMI), and blood pressure (BP) among vulnerable patients with diabetes. Models controlled for clustering by year, patient, and organizational characteristics. Overall, transformation to a PCMH was associated with 19% greater odds of having well-controlled HbA1c values with no statistically significant impact on BMI or BP. Subanalyses showed transformation had less of an effect on BP for African American patients and HbA1c control for Medicare enrollees but a greater effect on weight control for patients older than 35 years. Transformation to a PCMH in FQHCs appears to improve the health of vulnerable patients with diabetes, with less improvement for subsets of patients. Future research should seek to understand the heterogeneous effects of patient-centered transformation on various subgroups.

  7. Internet Use Frequency and Patient-Centered Care: Measuring Patient Preferences for Participation Using the Health Information Wants Questionnaire

    Science.gov (United States)

    Wang, Mo; Feldman, Robert; Zhou, Le

    2013-01-01

    Background The Internet is bringing fundamental changes to medical practice through improved access to health information and participation in decision making. However, patient preferences for participation in health care vary greatly. Promoting patient-centered health care requires an understanding of the relationship between Internet use and a broader range of preferences for participation than previously measured. Objective To explore (1) whether there is a significant relationship between Internet use frequency and patients’ overall preferences for obtaining health information and decision-making autonomy, and (2) whether the relationships between Internet use frequency and information and decision-making preferences differ with respect to different aspects of health conditions. Methods The Health Information Wants Questionnaire (HIWQ) was administered to gather data about patients’ preferences for the (1) amount of information desired about different aspects of a health condition, and (2) level of decision-making autonomy desired across those same aspects. Results The study sample included 438 individuals: 226 undergraduates (mean age 20; SD 2.15) and 212 community-dwelling older adults (mean age 72; SD 9.00). A significant difference was found between the younger and older age groups’ Internet use frequencies, with the younger age group having significantly more frequent Internet use than the older age group (younger age group mean 5.98, SD 0.33; older age group mean 3.50, SD 2.00; t 436=17.42, PInternet use frequency was positively related to the overall preference rating (γ=.15, PInternet users preferred significantly more information and decision making than infrequent Internet users. The relationships between Internet use frequency and different types of preferences varied: compared with infrequent Internet users, frequent Internet users preferred more information but less decision making for diagnosis (γ=.57, PInternet users in their preferences

  8. Validation of a patient-centered culturally sensitive health care office staff inventory.

    Science.gov (United States)

    Tucker, Carolyn M; Wall, Whitney; Marsiske, Michael; Nghiem, Khanh; Roncoroni, Julia

    2015-09-01

    Research suggests that patient-perceived culturally sensitive health care encompasses multiple components of the health care delivery system including the cultural sensitivity of front desk office staff. Despite this, research on culturally sensitive health care focuses almost exclusively on provider behaviors, attitudes, and knowledge. This is due in part to the paucity of instruments available to assess the cultural sensitivity of front desk office staff. Thus, the objective of the present study is to determine the psychometric properties of the pilot Tucker-Culturally Sensitive Health Care Office Staff Inventory-Patient Form (T-CSHCOSI-PF), which is an instrument designed to enable patients to evaluate the patient-defined cultural sensitivity of their front desk office staff. A sample of 1648 adult patients was recruited by staff at 67 health care sites across the United States. These patients anonymously completed the T-CSHCOSI-PF, a demographic data questionnaire, and a patient satisfaction questionnaire. Findings Confirmatory factor analyses of the TCSHCOSI-PF revealed that this inventory has two factors with high internal consistency reliability and validity (Cronbach's αs=0.97 and 0.95). It is concluded that the T-CSHCOSI-PF is a psychometrically strong and useful inventory for assessing the cultural sensitivity of front desk office staff. This inventory can be used to support culturally sensitive health care research, evaluate the job performance of front desk office staff, and aid in the development of trainings designed to improve the cultural sensitivity of these office staff.

  9. Seroprevalance of leptospirosis in patients with fever visited Vaysian Health Center ,Khoramabad, summer 1385

    Directory of Open Access Journals (Sweden)

    gholamreza Talei

    2007-10-01

    Full Text Available Talei GR1, Sheikhian A2,Mousavi Z3 1. Assistant professor, Department of Microbiology, Faculty of medicine, Lorestan University medical sciences 2. Assistant professor, Department of Immunology, Faculty of medicine, Lorestan University medical sciences 3. B.Sc of laboratory sciences, Lorestan University medical sciences Abstract Background: Leptospirosis is known to be an emerging infection and the most common zoonosiss of the world. The etiological agent of the disease is spirochetes, Leptospira interogans which infect more than 160 differ rent mammalian species including rodents, cattle, dogs and wild mammals. Clinical syndrome may vary from influenza – like syndrome with fever, headache and myalgia to sever Weils syndrome with jaundice, renal dysfunction and hemorrhagic diathesis. Human infection occurs accidentally through contact with contaminated water or animal materials. There are reports of high prevalence of leptospirosis in rice farm workers, probably acquired during work in paddy. Also there was evidence of leptospirosis in the Lorestan province. In this study, serum IgG and IgM antibody response to leptospira was examined in adult patients who visited Vaysian Health Centre during Shahrivar and October 1384,during the season of paddies. work in slug in Materials and methods: About 8 patients visited the Health Center during the season who were examined for clinical symptoms and then a questionnaire was filled. About 5 ml of blood sample was taken, the serum was separated and freezed before being examined by ELISA thechnique.Serion Classic Leptospira IgG/IgM ELISA (Germany was used and the results were calculated according to the instruction. Results: From 80 patient who participated in this study, 39 (48.8% had IgG antibody to leptospira and 41 (51.2% were negative. From IgG positive patients,28 (35% were IgM positive and 11(65% were negative . Of the people who had antibody to leptospira 30 (76.92% were male and 9 (23.08% were

  10. USU Patient Simulation Center

    Data.gov (United States)

    Federal Laboratory Consortium — he National Capital Area (NCA) Medical Simulation Center is a state-of-the-art training facility located near the main USU campus. It uses simulated patients (i.e.,...

  11. Mobile Health to Maintain Continuity of Patient-Centered Care for Chronic Kidney Disease: Content Analysis of Apps.

    Science.gov (United States)

    Lee, Ying-Li; Cui, Yan-Yan; Tu, Ming-Hsiang; Chen, Yu-Chi; Chang, Polun

    2018-04-20

    Chronic kidney disease (CKD) is a global health problem with a high economic burden, which is particularly prevalent in Taiwan. Mobile health apps have been widely used to maintain continuity of patient care for various chronic diseases. To slow the progression of CKD, continuity of care is vital for patients' self-management and cooperation with health care professionals. However, the literature provides a limited understanding of the use of mobile health apps to maintain continuity of patient-centered care for CKD. This study identified apps related to the continuity of patient-centered care for CKD on the App Store, Google Play, and 360 Mobile Assistant, and explored the information and frequency of changes in these apps available to the public on different platforms. App functionalities, like patient self-management and patient management support for health care professionals, were also examined. We used the CKD-related keywords "kidney," "renal," "nephro," "chronic kidney disease," "CKD," and "kidney disease" in traditional Chinese, simplified Chinese, and English to search 3 app platforms: App Store, Google Play, and 360 Mobile Assistant. A total of 2 reviewers reached consensus on coding guidelines and coded the contents and functionalities of the apps through content analysis. After coding, Microsoft Office Excel 2016 was used to calculate Cohen kappa coefficients and analyze the contents and functionalities of the apps. A total of 177 apps related to patient-centered care for CKD in any language were included. On the basis of their functionality and content, 67 apps were recommended for patients. Among them, the most common functionalities were CKD information and CKD self-management (38/67, 57%), e-consultation (17/67, 25%), CKD nutrition education (16/67, 24%), and estimated glomerular filtration rate (eGFR) calculators (13/67, 19%). In addition, 67 apps were recommended for health care professionals. The most common functionalities of these apps were

  12. User Interfaces for Patient-Centered Communication of Health Status and Care Progress

    Science.gov (United States)

    Wilcox-Patterson, Lauren

    2013-01-01

    The recent trend toward patients participating in their own healthcare has opened up numerous opportunities for computing research. This dissertation focuses on how technology can foster this participation, through user interfaces to effectively communicate personal health status and care progress to hospital patients. I first characterize the…

  13. Text Simplification Using Consumer Health Vocabulary to Generate Patient-Centered Radiology Reporting: Translation and Evaluation.

    Science.gov (United States)

    Qenam, Basel; Kim, Tae Youn; Carroll, Mark J; Hogarth, Michael

    2017-12-18

    Radiology reporting is a clinically oriented form of documentation that reflects critical information for patients about their health care processes. Realizing its importance, many medical institutions have started providing radiology reports in patient portals. The gain, however, can be limited because of medical language barriers, which require a way for customizing these reports for patients. The open-access, collaborative consumer health vocabulary (CHV) is a terminology system created for such purposes and can be the basis of lexical simplification processes for clinical notes. The aim of this study was to examine the comprehensibility and suitability of CHV in simplifying radiology reports for consumers. This was done by characterizing the content coverage and the lexical similarity between the terms in the reports and the CHV-preferred terms. The overall procedure was divided into the following two main stages: (1) translation and (2) evaluation. The translation process involved using MetaMap to link terms in the reports to CHV concepts. This is followed by replacing the terms with CHV-preferred terms using the concept names and sources table (MRCONSO) in the Unified Medical Language System (UMLS) Metathesaurus. In the second stage, medical terms in the reports and general terms that are used to describe medical phenomena were selected and evaluated by comparing the words in the original reports with the translated ones. The evaluation includes measuring the content coverage, investigating lexical similarity, and finding trends in missing concepts. Of the 792 terms selected from the radiology reports, 695 of them could be mapped directly to CHV concepts, indicating a content coverage of 88.5%. A total of 51 of the concepts (53%, 51/97) that could not be mapped are names of human anatomical structures and regions, followed by 28 anatomical descriptions and pathological variations (29%, 28/97). In addition, 12 radiology techniques and projections represented

  14. Access to patient-centered medical home among Ohio's Children with Special Health Care Needs.

    Science.gov (United States)

    Conrey, Elizabeth J; Seidu, Dazar; Ryan, Norma J; Chapman, Dj Sam

    2013-06-01

    Medical homes deliver primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective. Children with special health care needs (CSHCN) require a wide range of support to maintain health, making medical home access particularly important. We sought to understand independent risk factors for lacking access. We analyzed Ohio, USA data from the National Survey of Children with Special Health Care Needs (2005-2006). Among CSHCN, 55.6% had medical home access. The proportion achieving each medical home component was highest for having a personal doctor/nurse and lowest for receiving coordinated care, family-centered care and referrals. Specific subsets of CSHCN were significantly and independently more likely to lack medical home access: Hispanic (AOR=3.08), moderate/high severity of difficulty (AOR=2.84), and any public insurance (AOR=1.60). Efforts to advance medical home access must give special attention to these CSHCN populations and improvements must be made to referral access, family-centered care, and care coordination.

  15. Human factors in computing systems: focus on patient-centered health communication at the ACM SIGCHI conference.

    Science.gov (United States)

    Wilcox, Lauren; Patel, Rupa; Chen, Yunan; Shachak, Aviv

    2013-12-01

    Health Information Technologies, such as electronic health records (EHR) and secure messaging, have already transformed interactions among patients and clinicians. In addition, technologies supporting asynchronous communication outside of clinical encounters, such as email, SMS, and patient portals, are being increasingly used for follow-up, education, and data reporting. Meanwhile, patients are increasingly adopting personal tools to track various aspects of health status and therapeutic progress, wishing to review these data with clinicians during consultations. These issues have drawn increasing interest from the human-computer interaction (HCI) community, with special focus on critical challenges in patient-centered interactions and design opportunities that can address these challenges. We saw this community presenting and interacting at the ACM SIGCHI 2013, Conference on Human Factors in Computing Systems, (also known as CHI), held April 27-May 2nd, 2013 at the Palais de Congrès de Paris in France. CHI 2013 featured many formal avenues to pursue patient-centered health communication: a well-attended workshop, tracks of original research, and a lively panel discussion. In this report, we highlight these events and the main themes we identified. We hope that it will help bring the health care communication and the HCI communities closer together. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  16. Quality assured health care in certified breast centers and improvement of the prognosis of breast cancer patients.

    Science.gov (United States)

    Beckmann, Matthias W; Brucker, Cosima; Hanf, Volker; Rauh, Claudia; Bani, Mayada R; Knob, Stefanie; Petsch, Sabrina; Schick, Stefan; Fasching, Peter A; Hartmann, Arndt; Lux, Michael P; Häberle, Lothar

    2011-01-01

    Increasing effort has been put in the implementation and certification of breast centers in order to establish standardized, quality assured health care for breast cancer patients. The aim of this analysis was to investigate whether patients treated in certified breast centers (CBC) have a favorable prognosis as compared to patients treated outside of certified breast treatment units. The data of 3,940 patients with invasive nonmetastatic breast cancer were analyzed with regard to differences in patient and tumor characteristics and crude overall survival according to diagnosis in or outside CBC in Middle Franconia, Germany. Patient, tumor, and follow-up data were obtained from the clinical cancer registry. Patients in CBC were younger, and had lower disease stages and lower grading. Independent of the effects of these variables on overall survival, being treated at a CBC added to the prediction of overall survival. Patients treated at a CBC had a hazard ratio of 0.70 (95% confidence interval 0.52-0.93) in the adjusted Cox model. Independent from common prognostic factors, diagnosis and treatment of breast cancer at a CBC improves the prognosis of patients. It can be hypothesized that this effect is mediated through quality assured health care provided by the certification process. Copyright © 2011 S. Karger AG, Basel.

  17. Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient-provider communication.

    Science.gov (United States)

    Lin, Sue C; McKinley, Duane; Sripipatana, Alek; Makaroff, Laura

    2017-11-01

    Colorectal cancer (CRC) screening rates are low among underserved populations. High-quality patient-physician communication potentially influences patients' willingness to undergo CRC screening. Community health centers (HCs) provide comprehensive primary health care to underserved populations. This study's objectives were to ascertain national CRC screening rates and to explore the relations between sociodemographic characteristics and patient-provider communication on the receipt of CRC screening among HC patients. Using 2014 Health Center Patient Survey data, bivariate and multivariate analyses examined the association of sociodemographic variables (sex, race/ethnicity, age, geography, preferred language, household income, insurance, and employment status) and patient-provider communication with the receipt of CRC screening. Patients between the ages of 65 and 75 years (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.33-4.64) and patients not in the labor force (aOR, 2.32; 95% CI, 1.37-3.94) had higher odds of receiving CRC screening, whereas patients who were uninsured (aOR, 0.33; 95% CI, 0.18-0.61) and patients who were non-English-speaking (aOR, 0.42; 95% CI, 0.18-0.99) had lower odds. Patient-provider communication was not associated with the receipt of CRC screening. The CRC screening rate for HC patients was 57.9%, whereas the rate was 65.1% according to the 2012 Behavioral Risk Factor Surveillance System and 58.2% according to the 2013 National Health Interview Survey. The high ratings of patient-provider communication, regardless of the screening status, suggest strides toward a patient-centered medical home practice transformation that will assist in a positive patient experience. Addressing the lack of insurance, making culturally and linguistically appropriate patient education materials available, and training clinicians and care teams in cultural competency are critical for increasing future CRC screening rates. Cancer 2017

  18. Development of a Community-Based Palliative Care Model for Advance Cancer Patients in Public Health Centers in Busan, Korea.

    Science.gov (United States)

    Kim, Sook-Nam; Choi, Soon-Ock; Shin, Seong Hoon; Ryu, Ji-Sun; Baik, Jeong-Won

    2017-07-01

    A feasible palliative care model for advance cancer patients is needed in Korea with its rapidly aging population and corresponding increase in cancer prevalence. This study describes the process involved in the development of a community-based palliative care (CBPC) model implemented originally in a Busan pilot project. The model development included steps I and II of the pilot project, identification of the service types, a survey exploring the community demand for palliative care, construction of an operational infrastructure, and the establishment of a service delivery system. Public health centers (including Busan regional cancer centers, palliative care centers, and social welfare centers) served as the regional hubs in the development of a palliative care model. The palliative care project included the provision of palliative care, establishment of a support system for the operations, improvement of personnel capacity, development of an educational and promotional program, and the establishment of an assessment system to improve quality. The operational infrastructure included a service management team, provision teams, and a support team. The Busan Metropolitan City CBPC model was based on the principles of palliative care as well as the characteristics of public health centers that implemented the community health projects. The potential use of the Busan CBPC model in Korea should be explored further through service evaluations.

  19. The Correlation Of Knowledge And Education Level Of The Patients With The Gastritis Incident At Sindangbarang Public Health Center Cianjur

    Directory of Open Access Journals (Sweden)

    Drs. Oktoruddin Harun

    2017-02-01

    Full Text Available Gastritis is usually regarded as a thing paltry but gastritis was the beginning of a a disease that can be big problem for us. Based on the previous research at Public Health Center sindangbarang cianjur District were found scene gastritis from 10 patients 7 had less knowledgeable 1 respondents had knowledge cased and 2 respondents had good of knowledge. It is suspected that the incidence of gastritis has to do with knowledge and education level of the patients. The purpose of this research is to identify corelation betwen knowledge and education level of the patients outpatient with the gastritis at Public Health Center sindangbarang cianjur District. Research methodology used survey analytic correlative with design cross sectional .Data analyzed by univariat and bivariat with statistics chi square test. Population in this research were out patients Public Health Center sindangbarag. The sample 120 respondents with total of sampling. The results of the study were corelation knowledge of to gastritis incident based on the analysis of bivariat by using test chi-square computerized the results of statistical corel tests obtained p value 0.013 0.05 so H0 rejected. While relations education level with the gastritis incident based on the results of the analysis bivariat test chi-square use computerized obtained the results of statistical tests obtained p value 0.0001 0.05 so H0 rejected it could be concluded a significant between knowledge and the level of education with the gastritis incident corelation at Public Health Center sindangbarang cianjur District it is advised that need to effort to promotional and preventive especially with regard to knowledge of gastritis as information about gastritis and counseling on a preventive manner gastritis that can reduce or prevent disease gastritis.

  20. Person-centered osteopathic practice: patients' personality (body, mind, and soul) and health (ill-being and well-being).

    Science.gov (United States)

    Fahlgren, Elin; Nima, Ali A; Archer, Trevor; Garcia, Danilo

    2015-01-01

    Background. Osteopathic philosophy and practice are congruent with the biopsychosocial model, a patient-centered approach when treating disease, and the view of the person as a unity (i.e., body, mind, and soul). Nevertheless, a unity of being should involve a systematic person-centered understanding of the patient's personality as a biopsychosociospiritual construct that influences health (i.e., well-being and ill-being). We suggest Cloninger's personality model, comprising temperament (i.e., body) and character (i.e., mind and soul), as a genuine paradigm for implementation in osteopathic practice. As a first step, we investigated (1) the relationships between personality and health among osteopathic patients, (2) differences in personality between patients and a control group, and (3) differences in health within patients depending on the presenting problem and gender. Method. 524 osteopathic patients in Sweden (age mean = 46.17, SD = 12.54, 388 females and 136 males) responded to an online survey comprising the Temperament and Character Inventory and measures of health (well-being: life satisfaction, positive affect, harmony in life, energy, and resilience; ill-being: negative affect, anxiety, depression, stress, and dysfunction and suffering associated to the presenting problem). We conducted two structural equation models to investigate the association personality-health; graphically compared the patients' personality T-scores to those of the control group and compared the mean raw scores using t-tests; and conducted two multivariate analyses of variance, using age as covariate, to compare patients' health in relation to their presenting problem and gender. Results. The patients' personality explained the variance of all of the well-being (R (2) between .19 and .54) and four of the ill-being (R (2) between .05 and .43) measures. Importantly, self-transcendence, the spiritual aspect of personality, was associated to high levels of positive emotions and

  1. Clinic Workload, the Quality of Staff Relationships and Diabetes Management in Community Health Centers Catering to Latino and Chinese Patients.

    Science.gov (United States)

    Vargas Bustamante, Arturo; Martinez, Ana; Chen, Xiao; Rodriguez, Hector P

    2017-06-01

    We examine whether workplace climate-quality of staff relationships (QSR) and manageable clinic workload (MCW) are related to better patient care experiences and diabetes care in community health centers (CHCs) catering to Latino and Chinese patients. Patient experience surveys of adult patients with type 2 diabetes and workplace climate surveys of clinicians and staff from CHCs were included in an analytic sample. Comparisons of means analyses examine patient and provider characteristics. The associations of QSR, MCW and the diabetes care management were examined using regression analyses. Diabetes care process were more consistently provided in CHCs with high quality staff relations and more manageable clinic workload, but HbA1c, LDL cholesterol, and blood pressure outcomes were no different between clinics with high vs. low QSR and MCW. Focusing efforts on improvements in practice climate may lead to more consistent provision of important processes of diabetes care for these patients.

  2. Patient-centered boundary mechanisms to foster intercultural partnerships in health care: a case study in Guatemala.

    Science.gov (United States)

    Hitziger, Martin; Berger Gonzalez, Mónica; Gharzouzi, Eduardo; Ochaíta Santizo, Daniela; Solis Miranda, Regina; Aguilar Ferro, Andrea Isabel; Vides-Porras, Ana; Heinrich, Michael; Edwards, Peter; Krütli, Pius

    2017-08-08

    Up to one half of the population in Africa, Asia and Latin America has little access to high-quality biomedical services and relies on traditional health systems. Medical pluralism is thus in many developing countries the rule rather than the exception, which is why the World Health Organization is calling for intercultural partnerships to improve health care in these regions. They are, however, challenging due to disparate knowledge systems and lack of trust that hamper understanding and collaboration. We developed a collaborative, patient-centered boundary mechanism to overcome these challenges and to foster intercultural partnerships in health care. To assess its impact on the quality of intercultural patient care in a medically pluralistic developing country, we conducted and evaluated a case study. The case study took place in Guatemala, since previous efforts to initiate intercultural medical partnerships in this country were hampered by intense historical and societal conflicts. It was designed by a team from ETH Zurich's Transdisciplinarity Lab, the National Cancer Institute of Guatemala, two traditional Councils of Elders and 25 Mayan healers from the Kaqchikel and Q'eqchi' linguistic groups. It was implemented from January 2014 to July 2015. Scientists and traditional political authorities collaborated to facilitate workshops, comparative diagnoses and patient referrals, which were conducted jointly by biomedical and traditional practitioners. The traditional medical practices were thoroughly documented, as were the health-seeking pathways of patients, and the overall impact was evaluated. The boundary mechanism was successful in discerning barriers of access for indigenous patients in the biomedical health system, and in building trust between doctors and healers. Learning outcomes included a reduction of stereotypical attitudes towards traditional healers, improved biomedical procedures due to enhanced self-reflection of doctors, and improved

  3. Psychological Well Being In Type 2 Diabetes Mellitus Patients In Mulyorejo Public Health Center Surabaya

    Directory of Open Access Journals (Sweden)

    Rr Dian Tristiana

    2016-11-01

    Full Text Available Introduction: Living with chronic diseases such as Diabetes mellitus type 2 will make patients experience change or imbalance include biological, psychological, social and spiritual. One of psychology aspects in patients with Diabetes mellitus type 2 is psychological well being (PWB. Emotional response of type 2 DM patients since the early diagnosis to begin undergoing the treatment will be different for each person. Type 2 DM patients need a good transition process to achieve well being state. The transition from a healthy to a diseased condition is needed for the successful self care management of type 2 DM patients. The purpose of this research was to explore the description of PWB in patients of type 2 Diabetes mellitus in six aspects of PWB and PWB facilitate and inhibitor factors in type 2 DM patients. Methods: This research used qualitative design research with case studies approach. The subject of research was seven participants who met the inclusion criteria. Data collection was done by structured interview and observation. Data analysis was done by thematic analysis. Result and Analysis: This study generated 14 themes. The result showed that the process of type 2 DM patients subjected to the process of transition from a healthy condition into ill condition. The transition process started with cyclic lose response which influence type 2 DM patient to self control and make a right decision-making to self care. Self-control would make type 2 DM patients able to adapt and engage with new experiences that become a new habit for type 2 DM patients and will facilitate type 2 DM patients in adapting to the internal and external environment and make type 2 DM patients have a positive hope in their life. Discuss and conclusion: finding in this study would hopefully be beneficial for professional health staff to make assessment about PWB in type 2 DM patients, nurse hopefully can assist patients in transition with the condition of type 2 DM. Need

  4. Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use.

    Science.gov (United States)

    Jones, Audrey L; Cochran, Susan D; Leibowitz, Arleen; Wells, Kenneth B; Kominski, Gerald; Mays, Vickie M

    2015-12-01

    The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS). Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics. A total of 2,358 adults, aged 18-64 years, met the criteria for serious psychological distress and reported on their usual provider and practice characteristics. We defined "usual provider" as a primary care provider/practice, and "PCMH provider" as a usual provider that delivered accessible, comprehensive, patient-centered care as determined by patient self-reporting. The dependent variable, MHS, included self-reported mental health visits to a primary care provider or mental health specialist, counseling, and psychiatric medication treatment over a period of 1 year. Participants with a usual provider were significantly more likely than those with no usual provider to have experienced a primary care mental health visit (marginal effect [ME] = 8.5, 95 % CI = 3.2-13.8) and to have received psychiatric medication (ME = 15.5, 95 % CI = 9.4-21.5). Participants with a PCMH were additionally more likely than those with no usual provider to visit a mental health specialist (ME = 7.6, 95 % CI = 0.7-14.4) and receive mental health counseling (ME = 8.5, 95 % CI = 1.5-15.6). Among those who reported having had any type of mental health visit, participants with a PCMH were more likely to have received mental health counseling than those with only a usual provider (ME = 10.0, 95 % CI

  5. Physical activity counseling intervention at a federally qualified health center: improves autonomy-supportiveness, but not patients' perceived competence.

    Science.gov (United States)

    Carroll, Jennifer K; Fiscella, Kevin; Epstein, Ronald M; Sanders, Mechelle R; Winters, Paul C; Moorhead, S Anne; van Osch, Liesbeth; Williams, Geoffrey C

    2013-09-01

    To assess the effect of a pilot intervention to promote clinician-patient communication about physical activity on patient ratings of their perceived competence for physical activity and their clinicians' autonomy-supportiveness. Family medicine clinicians (n=13) at two urban community health centers were randomized to early or delayed (8 months later) communication training groups. The goal of the training was to teach the 5As (Ask, Advise, Agree, Assist, Arrange) for physical activity counseling. Outcome measures were changes in patient perceptions of autonomy support (modified Health Care Climate Questionnaire, mHCCQ) and perceived competence (Perceived Competence Scale for physical activity, PCS) completed via surveys at baseline, post-intervention and six-month follow-up. Patients (n=326) were mostly female (70%) and low income. Using a generalized estimating equations model (GEE) with patients nested within clinician, patient perceived autonomy support increased at post-intervention compared to baseline (mean HCCQ scores 3.68-4.06, p=0.03). There was no significant change in patient perceived competence for physical activity. A clinician-directed intervention increased patient perceptions of clinician autonomy support but not patient perceived competence for physical activity. Clinicians working with underserved populations can be taught to improve their autonomy supportiveness, according to patient assessments of their clinicians. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  6. Use of Community Health Workers and Patient Navigators to Improve Cancer Outcomes Among Patients Served by Federally Qualified Health Centers: A Systematic Literature Review.

    Science.gov (United States)

    Roland, Katherine B; Milliken, Erin L; Rohan, Elizabeth A; DeGroff, Amy; White, Susan; Melillo, Stephanie; Rorie, William E; Signes, Carmita-Anita C; Young, Paul A

    2017-01-01

    Introduction: In the United States, disparities in cancer screening, morbidity, and mortality are well documented, and often are related to race/ethnicity and socioeconomic indicators including income, education, and healthcare access. Public health approaches that address social determinants of health have the greatest potential public health benefit, and can positively impact health disparities. As public health interventions, community health workers (CHWs), and patient navigators (PNs) work to address disparities and improve cancer outcomes through education, connecting patients to and navigating them through the healthcare system, supporting patient adherence to screening and diagnostic services, and providing social support and linkages to financial and community resources. Clinical settings, such as federally qualified health centers (FQHCs) are mandated to provide care to medically underserved communities, and thus are also valuable in the effort to address health disparities. We conducted a systematic literature review to identify studies of cancer-related CHW/PN interventions in FQHCs, and to describe the components and characteristics of those interventions in order to guide future intervention development and evaluation. Method: We searched five databases for peer-reviewed CHW/PN intervention studies conducted in partnership with FQHCs with a focus on cancer, carried out in the United States, and published in English between January 1990 and December 2013. Results: We identified 24 articles, all reporting positive outcomes of CHW/PNs interventions in FQHCs. CHW/PN interventions most commonly promoted breast, cervical, or colorectal cancer screening and/or referral for diagnostic resolution. Studies were supported largely through federal funding. Partnerships with academic institutions and community-based organizations provided support and helped develop capacity among FQHC clinic leadership and community members. Discussion: Both the FQHC system and CHW

  7. School-Based Health Centers

    Science.gov (United States)

    ... care group, such as a community health center, hospital, or health department. A few are run by the school district itself. Centers often get money from charities and the government so they can give care ...

  8. A needs assessment of health information technology for improving care coordination in three leading patient-centered medical homes.

    Science.gov (United States)

    Richardson, Joshua E; Vest, Joshua R; Green, Cori M; Kern, Lisa M; Kaushal, Rainu

    2015-07-01

    We investigated ways that patient-centered medical homes (PCMHs) are currently using health information technology (IT) for care coordination and what types of health IT are needed to improve care coordination. A multi-disciplinary team of researchers conducted semi-structured telephone interviews with 28 participants from 3 PCMHs in the United States. Participants included administrators and clinicians from PCMHs, electronic health record (EHR) and health information exchange (HIE) representatives, and policy makers. Participants identified multiple barriers to care coordination using current health IT tools. We identified five areas in which health IT can improve care coordination in PCMHs: 1) monitoring patient populations, 2) notifying clinicians and other staff when specific patients move across care settings, 3) collaborating around patients, 4) reporting activities, and 5) interoperability. To accomplish these tasks, many participants described using homegrown care coordination systems separate from EHRs. The participants in this study have resources, experience, and expertise with using health IT for care coordination, yet they still identified multiple areas for improvement. We hypothesize that focusing health IT development in the five areas we identified can enable more effective care coordination. Key findings from this work are that homegrown systems apart from EHRs are currently used to support care coordination and, also, that reporting tools are key components of care coordination. New health IT that enables monitoring, notifying, collaborating, reporting, and interoperability would enhance care coordination within PCMHs beyond what current health IT enables. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  9. Service line structure and decision-maker attention in three health systems: Implications for patient-centered care.

    Science.gov (United States)

    Louis, Christopher J; Clark, Jonathan R; Gray, Barbara; Brannon, Diane; Parker, Victoria

    2017-06-15

    Scholars have noted a disconnect between the level at which structure is typically examined (the organization) and the level at which the relevant coordination takes place (service delivery). Accordingly, our understanding of the role structure plays in care coordination is limited. In this article, we explore service line structure, with an aim of advancing our understanding of the role service line structure plays in producing coordinated, patient-centered care. We do so by giving special attention to the cognitive roots of patient-centeredness. Our exploratory study relied on comparative case studies of the breast cancer service lines in three health systems. Nonprobability discriminative snowball sampling was used to identify the final sample of key informants. We employed a grounded approach to analyzing and interpreting the data. We found substantial variation across the three service lines in terms of their structure. We also found corresponding variation across the three case sites in terms of where informant attention was primarily focused in the process of coordinating care. Drawing on the attention-based view of the firm, our results draw a clear connection between structural characteristics and the dominant focus of attention (operational tactics, provider roles and relationships, or patient needs and engagement) in health care service lines. Our exploratory results suggest that service line structures influence attention in two ways: (a) by regulating the type and intensity of the problems facing service line participants and (b) by encouraging (or discouraging) a shared purpose around patient needs. Patient-centered attention-a precursor to coordinated, patient-centered care-depends on the internal choices organizations make around service line structure. Moreover, a key task for organizational and service line leaders is to structure service lines to create a context that minimizes distractions and enables care providers to focus their attention on

  10. The impact of health literacy, patient-centered communication and shared decision-making on patients' satisfaction with care received in German primary care practices.

    Science.gov (United States)

    Altin, Sibel Vildan; Stock, Stephanie

    2016-08-30

    Findings on the association between health literacy skills and patient-reported outcomes such as satisfaction with health care delivery are scarce. We explored the extent to which subjective health literacy skills and the perception of the application of patient-centered communication and shared decision-making are associated with patient's satisfaction with care received by their general practitioner (GP). A nationwide cross sectional survey was administered in a random sample of 1125 German adults. A binary logistic regression model controlling for demographics and health status was used to examine the independent contributions of predictor variables (i.e. subjective health literacy, shared decision-making, patient-centered communication) on satisfaction with care received by the GP. Respondents with sufficient health literacy skills were 2.06 times as likely (95 % [CI]: 1.002-4.264) and those who were involved in shared decision-making by their GP were 4.02 times as likely (95 % [CI]: 1.849-8.744) to be satisfied with care received by their GP. Respondents who experienced that their GP explained things in an easy to understand way (OR: 4.44; 95 % [CI]: 1.817-10.869), knew important things about their medical history (OR: 3.46; 95 % [CI]: 1.502-7.994) and spent enough time with them, also reported to be more satisfied (OR: 3.12; 95 % [CI]: 1.410-6.905). German adults having sufficient subjective health literacy skills and experiencing a more patient-centered relationship with their GP are more likely to be satisfied with care. These findings are important for health care organizations aiming to respond to health literacy needs of patients.

  11. Intestinal parasitosis and anaemia among patients in a Health Center, North Ethiopia.

    Science.gov (United States)

    Alemu, Megbaru; Kinfe, Birhane; Tadesse, Desalegn; Mulu, Wondemagegn; Hailu, Tadesse; Yizengaw, Endalew

    2017-11-28

    The aim of this cross-sectional study was to determine the magnitude of intestinal parasitosis and anaemia in a Health Center, North Ethiopia. A total of 427 outpatients were enrolled and the median age of the participants was 22 years. The prevalence of intestinal parasitosis was 143 (33.5%). Age, place of residence and occupation were significantly associated with intestinal parasitosis. When we see parasite specific factors, significant associations were observed for source of drinking water (P = 0.02), age (P intestinal parasite -infected and non-infected participants was 10.7 and 7.0%, respectively. Study participants infected with S. stercoralis and hookworm were more likely to develop anaemia than the non- infected ones; AOR (adjusted odds ratio) = 5.3, 95% CI (1.01-27.4); P = 0.028 and AOR = 11.1, 95% CI (3.36-36.9); P = 0.000, respectively.

  12. A survey of factors associated with the utilization of community health centers for managing hypertensive patients in Chengdu, China.

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    Yun Chai

    Full Text Available BACKGROUND: For decades the development of community health services has been emphasized in China to cope with the growing burden of chronic diseases by providing basic medical services. This survey aims at investigating factors associated with the use of Community Health Centers (CHCs for the management of hypertensive patients in Chengdu, China. METHODS: We used a systematic sampling method to select 2,030 patients with hypertension or diabetes registered in 29 CHCs in Chengdu in 2007. Researchers interviewed patients who consented to participate at their home. This paper reports findings from the survey of 1,716 hypertensive patients with completed questionnaires. Univariate analyses and multiple logistic regression analyses were conducted to explore factors influencing the use of CHCs for the management of hypertensive patients. RESULTS: 81.4% of hypertensive patients regularly used CHCs for hypertension monitoring and treatment in Chengdu. Univariate analyses indicated that use of CHCs was associated with the education level, occupation, types of medical insurance, Body Mass Index(BMI, patients' knowledge on hypertension, awareness of CHCs functions, satisfaction of the service of CHCs. Multiple regression analyses found that use of CHCs was positively associated with the following factors: the Urban Resident Basic Medical Insurance(URBMI, knowledge on blood pressure, awareness of the sites in CHCs to measure blood pressure, awareness of having to take life-long antihypertensive medicine once the treatment started, awareness of the health records registration in CHCs, regular follow up, improved convenience of seeing doctor. Patients with professional job were less likely to use the services of CHCs. CONCLUSIONS: The use of CHCs for hypertension management could be increased by improving residents' knowledge on the monitoring and treatment of hypertension, and the awareness of CHCs functions. The CHCs could play an important role in

  13. Marketing and Community Mental Health Centers.

    Science.gov (United States)

    Ferniany, Isaac W.; Garove, William E.

    1983-01-01

    Suggests that a marketing approach can be applied to community mental health centers. Marketing is a management orientation of providing services for, not to, patients in a systematic manner, which can help mental health centers improve services, strengthen community image, achieve financial independence and aid in staff recruitment. (Author)

  14. Quality of life of pulmonary TB patients after intensive phase treatmentin the health centers of Medan city, Indonesia

    Science.gov (United States)

    Wahyuni, A. S.; Soeroso, N.; Harahap, J.; Amelia, R.; Alona, I.

    2018-03-01

    Tuberculosis (TB) is one of the chronic diseases that has become a long major health problem in the world, as well as in Indonesia. TB treatment takes a long time (6-9 months) to cover both intensive and advanced phases. TB patients experience significant disruptions in their social life, exposed to stigma and discrimination. The purpose of this study was to determine the quality of life of TB patients after two months of TB intensive treatment phase. We conducted a quantitative study through cross-sectional design. This research recruited 100 TB patients aged > 18 years old and Category I with AFB(+) result. We involved patients from 7 Health Centers in Medan City. We utilised SF 36 instrument to assess the patients quality of lifein the interview. To analyse the collected data, we performed Independent t-analysis. The result of this study was that the quality of life of TB patients who had undergone initial treatment phase wasina low category with a score of 63.9. The two best-measured aspects of quality of life among the eight dimensions assessed in the instrument were pain and physical function.

  15. Developing a Shared Patient-Centered, Web-Based Medication Platform for Type 2 Diabetes Patients and Their Health Care Providers: Qualitative Study on User Requirements.

    Science.gov (United States)

    Bernhard, Gerda; Mahler, Cornelia; Seidling, Hanna Marita; Stützle, Marion; Ose, Dominik; Baudendistel, Ines; Wensing, Michel; Szecsenyi, Joachim

    2018-03-27

    Information technology tools such as shared patient-centered, Web-based medication platforms hold promise to support safe medication use by strengthening patient participation, enhancing patients' knowledge, helping patients to improve self-management of their medications, and improving communication on medications among patients and health care professionals (HCPs). However, the uptake of such platforms remains a challenge also due to inadequate user involvement in the development process. Employing a user-centered design (UCD) approach is therefore critical to ensure that user' adoption is optimal. The purpose of this study was to identify what patients with type 2 diabetes mellitus (T2DM) and their HCPs regard necessary requirements in terms of functionalities and usability of a shared patient-centered, Web-based medication platform for patients with T2DM. This qualitative study included focus groups with purposeful samples of patients with T2DM (n=25), general practitioners (n=13), and health care assistants (n=10) recruited from regional health care settings in southwestern Germany. In total, 8 semistructured focus groups were conducted. Sessions were audio- and video-recorded, transcribed verbatim, and subjected to a computer-aided qualitative content analysis. Appropriate security and access methods, supported data entry, printing, and sending information electronically, and tracking medication history were perceived as the essential functionalities. Although patients wanted automatic interaction checks and safety alerts, HCPs on the contrary were concerned that unspecific alerts confuse patients and lead to nonadherence. Furthermore, HCPs were opposed to patients' ability to withhold or restrict access to information in the platform. To optimize usability, there was consensus among participants to display information in a structured, chronological format, to provide information in lay language, to use visual aids and customize information content, and align

  16. Frequency and Clinical Manifestations of Scabies in Suspected Patients Referred to Health Centers of Kashan, Central Iran (2010 - 2014

    Directory of Open Access Journals (Sweden)

    Sima Rasti

    2017-02-01

    Full Text Available Background Scabies is one of the most common itching contagious skin disorder in the world. The agent of disease is Sarcoptes scabiei. Objectives This study was conducted to determine the frequency and clinical manifestations of S. scabies in suspected patients referred to health centers of Kashan during 2010 - 2014. Methods This cross-sectional study was performed on 129 patients suspected to Sarcoptes scabiei. The demographic and clinical symptoms for each of patients were recorded in questionnaire by interview. A deep skin scrap was prepared and wet smear were prepared using 10% KOH. By observation of each form of Sarcoptes was identified as positive sample. The data were recorded in Spss. ver 16.5 and analyzed by X2 and fisher exact tests. Results The results of this study showed that 28 (21.7 % were Sarcoptes positive. The frequency of sarcoptes was higher in males (23% than females (20.6%. The difference was not statistically significant. The most cases were isolated in spring and winter. Sarcoptes infestation was the most in elderly and patients undergone dialysis. There is significant difference between disease and age group and underlying disease (P = 0.03, P = 0.014; respectively. Erosion or pustule was the most clinical signs in positive cases. Conclusions The results of study showed that the rate of scabies infestation in Kashan is relatively high, and the most cases were in elderly patients. Health education to increase awareness of the families for prevention of scabies was recommended.

  17. Dental Health Status of Schizophrenic Patients in the Chronic Psychiatric Care Center in the Province of Chaharmahal va Bakhtiyary

    Directory of Open Access Journals (Sweden)

    Masoud Nik-Farjam

    2011-07-01

    Full Text Available Objective: Schizophrenia is a chronic disease . Schizophrenic patients are unable in personal fuction and self care such as dental health. Especially, side effects of anti– psych otic drugs cause some dental problems in the patient . Also dental problems may lead to some disease , so it is necessary to play full attention to dental health condition in schizophrenic patients. The aim of study was assessing the dental health status of schizophrenic patients confined in chronic psychiatric care center on Chaharmahal & Bakhtiyari. Materials & Methods: This survey is an analytical descriptive and cross-sectional study, 123 schizophrenic patients are assessed in 2008. The data was collected through interview, (using the Scale for the assessment of positive and negative symptom (SAPS and SANS, Decayed, Missed, Filled Teeth index (DMFT, Gingival index and demographic questionnaire. Quantities analysis of data was undertaken by using X 2, Man vetney test and Pearson r test . Results: The mean of DMFT was 19.43±7.71. There was a significant correlation between age, smoking history and cigarettes per day, oral hygiene condition and other negative symptoms and average DMFT (P&le0.05. Also there was a significant correlation between the severity of periodentitis and sex, history of smoking, number of smoked cigarettes per day, previous hospital admission and average of negative and positive symptoms. No significant correlation between the severity of periodentitis and mean DMFT (P&le0.05 was seen. Conclusion: Results of the study demonstrated that dental health of people with schizophrenia is poor.

  18. Center for Environmental Health Sciences

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    Federal Laboratory Consortium — The primary research objective of the Center for Environmental Health Sciences (CEHS) at the University of Montana is to advance knowledge of environmental impacts...

  19. Evaluating organizational change in health care: the patient-centered hospital model.

    Science.gov (United States)

    Fiorio, Carlo V; Gorli, Mara; Verzillo, Stefano

    2018-02-08

    An increasing number of hospitals react to recent demographic, epidemiological and managerial challenges moving from a traditional organizational model to a Patient-Centered (PC) hospital model. Although the theoretical managerial literature on the PC hospital model is vast, quantitative evaluations of the performance of hospitals that moved from the traditional to the PC organizational structure is scarce. However, quantitative analysis of effects of managerial changes is important and can provide additional argument in support of innovation. We take advantage of a quasi-experimental setting and of a unique administrative data set on the population of hospital discharge charts (HDCs) over a period of 9 years of Lombardy, the richest and one of the most populated region of Italy. During this period three important hospitals switched to the PC model in 2010, whereas all the others remained with the functional organizational model. This allowed us to develop a difference-in-difference analysis of some selected measures of efficiency and effectiveness for PC hospitals focusing on the "between-variability" of the 25 major diagnostic categories (MDCs) in each hospital and estimating a difference-in-difference model. We contribute to the literature that addresses the evaluation of healthcare and hospital change by providing a quantitative estimation of efficiency and effectiveness changes following to the implementation of the PC hospital model. Results show that both efficiency and effectiveness have significantly increased in the average MDC of PC hospitals, thus confirming the need for policy makers to invest in new organizational models close to the principles of PC hospital structures. Although an organizational change towards the PC model can be a costly process, implying a rebalancing of responsibilities and power among hospital personnel (e.g. medical and nursing staff), our results suggest that changing towards a PC model can be worthwhile in terms of both

  20. The impact of ED nurse manager leadership style on staff nurse turnover and patient satisfaction in academic health center hospitals.

    Science.gov (United States)

    Raup, Glenn H

    2008-10-01

    Nurse managers with effective leadership skills are an essential component to the solution for ending the nursing shortage. Empirical studies of existing ED nurse manager leadership styles and their impact on key nurse management outcomes such as staff nurse turnover and patient satisfaction have not been performed. The specific aims of this study were to determine what types of leadership styles were used by ED nurse managers in academic health center hospitals and examine their influence on staff nurse turnover and patient satisfaction. ED nurse managers were asked to complete the Multifactor Leadership Questionnaire and a 10-item researcher defined nurse manager role and practice demographics survey. Completed surveys (15 managers and 30 staff nurses) representing 15 out of 98 possible U.S. academic health centers were obtained. Fisher's exact test with 95% confidence intervals were used to analyze the data. The sample percentage of managers who exhibited Transformational leadership styles and demographic findings of nurse manager age, total years experience and length of time in current position matched current reports in the literature. A trend of lower staff nurse turnover with Transformational leadership style compared to non-Trasformational leadership styles was identified. However, the type of leadership style did not appear to have an effect on patient satisfaction. The ED is an ever-changing, highly regulated, critical-care environment. Effective ED nurse manager leadership strategies are vital to maintaining the standards of professional emergency nursing practice to create an environment that can produce management outcomes of decreased staff nurse turnover, thereby enhancing staff nurse retention and potentially impacting patient satisfaction.

  1. Assessment of nutritional status in cancer patients in Osijek health area center.

    Science.gov (United States)

    Ebling, Barbara; Brumnić, Vesna; Rendić-Miocević, Zrinka; Gmajnić, Rudika; Pribić, Sanda; Juretić, Antonio; Ebling, Zdravko; Muha, Ivana

    2014-03-01

    The aim of this research was to perform the nutritional screening and clinical assessment of malnutrition and of cachexia as well as the need for enteral nutritional support. We used an international questionnaire for nutrition screening and clinical assessment of malnutrition. 103 cancer patients participated in the research. The results indicate that 80patients (78%) have recently unintentionally lost weight in the last six months. Of those 80 patients 12 (15%) have lost more than 15 kilograms. Three patients (3%) suffer from hunger because of their inability to eat. Presence of multiple (3 or more) symptoms (nausea, vomiting, diarrhea or anorexia) was reported by 11 patients (11%). Severe work dysfunction was found in 28 patients (27%). 14 patients (14%) experience significant loss of musculature (musculus quadriceps femoris, musculus deltoideus). The obtained results indicate that 15patients (14%) are severely, and 39 patients (38%) are moderately undernourished. This survey confirmed the significance of nutritional screening in cancer patients, as it detected 30 patients (29%) who required introduction of enteral nutrition.

  2. Patient-Centered Research

    Science.gov (United States)

    Shridharani, KV; Yuen, W; Huang, D; Pan, C

    2000-01-01

    PURPOSE Complementary and Alternative Medicine (CAM) can be defined as medical practices not taught widely at US medical schools or generally available at US hospitals. National studies suggest that between 30–40% of the general US population use CAM. These users tend to be more educated, have higher incomes, and are more likely to be between the ages of 30–49. However, to date, no study has documented the use of CAM among the homebound population, patients who are usually elderly, debilitated, and have less access to medical care. We studied the use of alternative therapies in homebound patients of the Mount Sinai Visiting Doctors Program serving the inner city of New York. METHODS Eligibility for the study was limited to patients who are in the Visiting Doctors Program, and whose mini-mental status exam score was greater than 20 or who were deemed competent to complete the survey by their primary care provider. Participant's CAM use was assessed by a survey administered by an interviewer at the patient's home. RESULTS Forty-nine consecutive, eligible patients were interviewed and a survey completed. Among the respondents, 84% were women, the mean age was 78.6 (STD = 14.1). Respondents were 51% Caucasian, 27% African-American, 14% Hispanic and 8% other. On rating their own health, 69% rated it as poor to fair, 22% rated it as good, and 8% rated it as very good to excellent. Sixty-nine percent of the respondents reported using one or more CAM in the past 12 months. Commonly used CAM included: vitamins/minerals (33%) [excluding MVI, calcium], spiritual healing (27%), and herbal remedies (20%). Spiritual healing included prayer and faith healing. The most common herbal remedies were garlic, ginger, and chamomile tea. Among CAM users, their main sources of information about CAM came from their own physicians (32%), family/friends/co-workers (18%), and newspaper/radio/TV (18%). CONCLUSION The use of CAM in this elderly, debilitated, homebound population was

  3. A consumer health record for supporting the patient-centered management of chronic diseases

    NARCIS (Netherlands)

    de Clercq, Paul A.; Hasman, Arie; Wolffenbuttel, Bruce H. R.

    2003-01-01

    OBJECTIVES: To design and implement a shareable consumer health record system to investigate whether the system can assist in the management of chronic diseases. METHODS: A toolkit was designed for constructing the consumer health record system in an evolutionary way. An ethnographic-like approach

  4. A consumer health record for supporting the patient-centered management of chronic diseases

    NARCIS (Netherlands)

    Clercq, de P.A.; Hasman, A.; Wolffenbuttel, B.H.R.

    2003-01-01

    Objectives : To design and implement a shareable consumer health record system to investigate whether the system can assist in the management of chronic diseases. Methods : A toolkit was designed for constructing the consumer health record system in an evolutionary way. An ethnographic-like approach

  5. A consumer health record for supporting the patient-centered management of chronic diseases

    NARCIS (Netherlands)

    De Clercq, Paul A; Hasman, Arie; Wolffenbuttel, Bruce H R

    Objectives : To design and implement a shareable consumer health record system to investigate whether the system can assist in the management of chronic diseases. Methods : A toolkit was designed for constructing the consumer health record system in an evolutionary way. An ethnographic-like approach

  6. [A Retrospective Series of 77 Pediatric Patients with Vertigo at a National Center for Child Health and Development].

    Science.gov (United States)

    Goto, Fumiyuki; Suzuki, Noriomi; Hara, Mariko; Tsuchihashi, Nana; Morimoto, Noriko

    2015-07-01

    The evaluation and management of vertigo in children varies among institutional and medical specialties. The aim of this study was to describe the characteristics of vertigo in children presenting at a national pediatric center. Patients vertigo to the department of otolaryngology at a national center for child health and development from April 2004 to October 2009 were included (N = 77; 42 males and 35 females; average age, 8.7 ± 3.4 years) in this study. The most common diagnoses were vestibular migraine (VM; N = 21), benign paroxysmal vertigo (BPV; N =16), unilateral vestibulopathy (N = 12), and psychogenic vertigo (N = 8). Significant differences were observed in the frequency of the diagnoses between children aged older and younger than 7 years: BPV was most common in children vertigo attack with a digital camera or cellular phone can be useful because observing the nystagmus recorded on the video is helpful for making a diagnosis. Furthermore, the parents are participating in their child's care by attempting to record the attack, strengthening the relationship between the parents and the child. The incidence of psychogenic vertigo is low (less than 10%). Therefore, although physicians have recently tended to define the disorder as psychogenic when no objective abnormality is found in a patient, making a diagnosis of psychogenic vertigo is not recommended. Because vertigo can sometimes make a child anxious, delivering the correct diagnosis and treatment at the early stage is important for preventing anxiety in affected children.

  7. User-Centered Design Groups to Engage Patients and Caregivers with a Personalized Health Information Technology Tool.

    Science.gov (United States)

    Maher, Molly; Kaziunas, Elizabeth; Ackerman, Mark; Derry, Holly; Forringer, Rachel; Miller, Kristen; O'Reilly, Dennis; An, Larry C; Tewari, Muneesh; Hanauer, David A; Choi, Sung Won

    2016-02-01

    Health information technology (IT) has opened exciting avenues for capturing, delivering and sharing data, and offers the potential to develop cost-effective, patient-focused applications. In recent years, there has been a proliferation of health IT applications such as outpatient portals. Rigorous evaluation is fundamental to ensure effectiveness and sustainability, as resistance to more widespread adoption of outpatient portals may be due to lack of user friendliness. Health IT applications that integrate with the existing electronic health record and present information in a condensed, user-friendly format could improve coordination of care and communication. Importantly, these applications should be developed systematically with appropriate methodological design and testing to ensure usefulness, adoption, and sustainability. Based on our prior work that identified numerous information needs and challenges of HCT, we developed an experimental prototype of a health IT tool, the BMT Roadmap. Our goal was to develop a tool that could be used in the real-world, daily practice of HCT patients and caregivers (users) in the inpatient setting. Herein, we examined the views, needs, and wants of users in the design and development process of the BMT Roadmap through user-centered Design Groups. Three important themes emerged: 1) perception of core features as beneficial (views), 2) alerting the design team to potential issues with the user interface (needs); and 3) providing a deeper understanding of the user experience in terms of wider psychosocial requirements (wants). These findings resulted in changes that led to an improved, functional BMT Roadmap product, which will be tested as an intervention in the pediatric HCT population in the fall of 2015 (ClinicalTrials.govNCT02409121). Copyright © 2016 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  8. Outcomes in Child Health: Exploring the Use of Social Media to Engage Parents in Patient-Centered Outcomes Research.

    Science.gov (United States)

    Dyson, Michele P; Shave, Kassi; Fernandes, Ricardo M; Scott, Shannon D; Hartling, Lisa

    2017-03-16

    With the rapid growth of technology and its improved accessibility globally, social media is gaining an increasingly important role in health care. Patients are frequently engaging with social media to access information, share content, and interact with others in online health communities. However, the use of social media as a stakeholder engagement strategy has been minimally explored, and effective methods for involving participants in research on the identification of patient-centered outcomes remain unknown. The aim of this study was to evaluate the process of using social media to engage parents in identifying patient-centered outcomes, using acute respiratory infections in children as an example to gauge feasibility. We conducted a process evaluation of a two-phase Web-based strategy to engage parents in research on patient-centered outcomes. In the first phase, we developed a website and study-specific Facebook and Twitter accounts to recruit parents to complete a Web-based survey identifying patient-centered outcomes. In the second phase, we used Facebook to host discussion with parents based on the survey results. The reach of social media as an engagement strategy and the characteristics of the population recruited were assessed. During the first phase, there were 5027 visits to the survey site, 110 participants completed the survey, 553 unique users visited the study website (675 visits), the Facebook page received 104 likes, and the Twitter account gained 52 followers over the 14-week study period. Most survey respondents identified Facebook (51.8%, 57/110) or a friend (45.5%, 50/110) as their source of referral. It was found that 70.0% (77/110) of respondents resided in Canada, in urban centers (92.7%, 102/110), and 88.2% (97/110) had a college or university degree or higher. The median year of birth was 1978 and 90.0% (99/110) were female. Most survey responses (88.2%, 97/110) were completed during the first month of the study. In the second phase, 4

  9. Prevalence of Substance Use Among Patients of Community Health Centers in East Los Angeles and Tijuana.

    Science.gov (United States)

    Gelberg, Lillian; Natera Rey, Guillermina; Andersen, Ronald M; Arroyo, Miriam; Bojorquez-Chapela, Ietza; Rico, Melvin W; Vahidi, Mani; Yacenda-Murphy, Julia; Arangua, Lisa; Serota, Martin

    2017-02-23

    Given the increased use of psychoactive substances on the United States-Mexico border, a binational study (Tijuana, Mexico-Los Angeles, USA) was conducted to identify the prevalence of substance use in primary care settings. To compare the prevalence and characteristics of patients at risk for substance use disorders in Tijuana and East Los Angeles (LA) community clinics with special attention paid to drug use. This was an observational, cross-sectional, analytical study, comparing substance use screening results from patients in Tijuana and LA. The settings were 2 community clinics in LA and 6 in Tijuana. Participants were 2,507 adult patients in LA and 2,890 in Tijuana eligible for WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) screening during March-October 2013. Patients anonymously self-administered the WHO ASSIST on a tablet PC in the clinic waiting rooms. Of eligible patients, 96.4% completed the ASSIST in Tijuana and 88.7% in LA (mean 1.34 minutes and 4.20 minutes, respectively). The prevalence of patients with moderate-to-high substance use was higher in LA than Tijuana for each substance: drugs 19.4% vs. 5.7%, alcohol 15.2% vs. 6.5%, tobacco 20.4% vs. 16.2%. LA patients born in Mexico had 2x the odds and LA patients born in the United States had 6x the odds of being a moderate-to-high drug user compared to Tijuana patients born in Mexico. Moderate-to-high drug use is higher in LA than in Tijuana but rates are sufficiently high in both to suggest that screening for drug use (along with alcohol and tobacco use) should be integrated into routine primary care of community clinics in both cities.

  10. Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters.

    Science.gov (United States)

    Street, Richard L; Liu, Lin; Farber, Neil J; Chen, Yunan; Calvitti, Alan; Zuest, Danielle; Gabuzda, Mark T; Bell, Kristin; Gray, Barbara; Rick, Steven; Ashfaq, Shazia; Agha, Zia

    2014-09-01

    The computer with the electronic health record (EHR) is an additional 'interactant' in the medical consultation, as clinicians must simultaneously or in alternation engage patient and computer to provide medical care. Few studies have examined how clinicians' EHR workflow (e.g., gaze, keyboard activity, and silence) influences the quality of their communication, the patient's involvement in the encounter, and conversational control of the visit. Twenty-three primary care providers (PCPs) from USA Veterans Administration (VA) primary care clinics participated in the study. Up to 6 patients per PCP were recruited. The proportion of time PCPs spent gazing at the computer was captured in real time via video-recording. Mouse click/scrolling activity was captured through Morae, a usability software that logs mouse clicks and scrolling activity. Conversational silence was coded as the proportion of time in the visit when PCP and patient were not talking. After the visit, patients completed patient satisfaction measures. Trained coders independently viewed videos of the interactions and rated the degree to which PCPs were patient-centered (informative, supportive, partnering) and patients were involved in the consultation. Conversational control was measured as the proportion of time the PCP held the floor compared to the patient. The final sample included 125 consultations. PCPs who spent more time in the consultation gazing at the computer and whose visits had more conversational silence were rated lower in patient-centeredness. PCPs controlled more of the talk time in the visits that also had longer periods of mutual silence. PCPs were rated as having less effective communication when they spent more time looking at the computer and when there was more periods of silence in the consultation. Because PCPs increasingly are using the EHR in their consultations, more research is needed to determine effective ways that they can verbally engage patients while simultaneously

  11. Predictors of health-related quality of life in neurosurgical brain tumor patients: focus on patient-centered perspective.

    Science.gov (United States)

    Bunevicius, Adomas; Tamasauskas, Sarunas; Deltuva, Vytenis; Tamasauskas, Arimantas; Radziunas, Andrius; Bunevicius, Robertas

    2014-02-01

    In brain tumor (BT) patients, the association between health-related quality of life (HRQoL) and psychological characteristics remains largely unknown. We evaluated the association of personality traits, clinical factors, psychological distress symptoms, and cognitive state with HRQoL in BT patients. On admission for BT surgery, 200 patients (69 % women; age 55.8 ± 14.5 years) were evaluated for HRQoL (SF-36 scale), Big-Five personality traits (Ten-Item Personality Inventory), psychological distress symptoms (Hospital Anxiety and Depression Scale or HADS), cognitive function (Mini-Mental State Examination or MMSE) and clinical characteristics, including functional status (Barthel index or BI). The most common BT diagnoses were meningioma (39 %) and high-grade glioma (18 %). Only factors significantly associated with SF-36 domains in univariable regression analyses were included in their respective multivariable models and predicted from 6 %-49 % of the total variance of SF-36 scores. Greater TIPI emotional stability score was independently associated with greater SF-36 emotional well-being (β = 0.23, p emotional well-being score (β = 0.13, p = 0.02). HADS-anxiety and HADS-depression scores were the strongest independent determinants of all, except physical functioning, SF-36 scores (β-values range from 0.14 to 0.56; p values ≤ 0.03). BI score was the strongest independent determinant of SF-36 physical functioning score (β = 0.36, p emotional well-being and social functioning SF-36 scores. Consciousness and emotional stability should be considered important personality-related determinants of HRQoL in BT patients. Psychological distress, functional disability, and cognitive impairment are also important predictors of HRQoL.

  12. Reinventing the academic health center.

    Science.gov (United States)

    Kirch, Darrell G; Grigsby, R Kevin; Zolko, Wayne W; Moskowitz, Jay; Hefner, David S; Souba, Wiley W; Carubia, Josephine M; Baron, Steven D

    2005-11-01

    Academic health centers have faced well-documented internal and external challenges over the last decade, putting pressure on organizational leaders to develop new strategies to improve performance while simultaneously addressing employee morale, patient satisfaction, educational outcomes, and research growth. In the aftermath of a failed merger, new leaders of The Pennsylvania State University College of Medicine and Milton S. Hershey Medical Center encountered a climate of readiness for a transformational change. In a case study of this process, nine critical success factors are described that contributed to significant performance improvement: performing a campus-wide cultural assessment and acting decisively on the results; making values explicit and active in everyday decisions; aligning corporate structure and governance to unify the academic enterprise and health system; aligning the next tier of administrative structure and function; fostering collaboration and accountability-the creation of unified campus teams; articulating a succinct, highly focused, and compelling vision and strategic plan; using the tools of mission-based management to realign resources; focusing leadership recruitment on organizational fit; and "growing your own" through broad-based leadership development. Outcomes assessment data for academic, research, and clinical performance showed significant gains between 2000 and 2004. Organizational transformation as a result of the nine factors is possible in other institutional settings and can facilitate a focus on crucial quality initiatives.

  13. A Topic Diathesis In Hereditary Ichthyosis Patients Attending A Tertiary Health Care Center In Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Al-Akloby Omar M Al-Amro

    2004-01-01

    Full Text Available The occurrence of atopic diathesis in hereditary ichthyosis (HI has not been documented in Saudi patients. The atopic manifestations in histopathologically confirmed HI patients attending the dermatology clinic of king Fahad Hospital of the University at Al-Khobar city, Saudi Arabia is discussed in this study. From the dermatology OPD logbook, all Saudi patients with confirmed HI seen between January 1990 to December 1995 were included in the study. The findings regarding atopic manifestations were extracted into data collection forms and analyzed. During the 5 year study period, 10,455 new cases were seen in our dermatology OPD. Of these, 61 had hereditary icthyosis, with 37 males and 24 females with a male to female ratio of 1.5:1. Thus, the frequency of HI among Saudi hospital attendees was 6 per 1000 new cases. The type of HI was ichthyosis vulgaris in 25 (41% patients, X-linked recessive ichthyosis in 11 (18%, lamellar ichthyosis in 4(7%, bullous ichthyosiform erythroderma in 2 (3% and nonbullous ichthyosiform erythroderma was seen in 19 (31%. Generalized pruritus was present in 49 (80% cases, atopic dermatitis in , elevated serum IgE level was noted in 27 and bronchial asthma in 3 cases. Dandruff was reported in 24 cases, keratosis pilaris in15, recurrent skin infection in 7. Combination of hereditary ichthyosis, generalized pruritus and high serum IGE level was reported in 27 (44.3% patient.

  14. The Effect of Electronic Health Record Use and Patient-Centered Communication on Cancer Screening Behavior: An Analysis of the Health Information National Trends Survey.

    Science.gov (United States)

    Totzkay, Daniel; Silk, Kami J; Sheff, Sarah E

    2017-07-01

    The present study used the 2013 Health Information National Trends Survey (N = 3185) to examine the effects of patient-centered communication (PCC) and the use of electronic health records (EHRs) on the likelihood of patients receiving a recommended screening for cancer (i.e., mammogram, PSA test). Self-determination theory, a framework of self-initiated extrinsic behaviors, was applied to test mediation models of PCC and EHR use, respectively, through patient activation. The results demonstrated that PCC and EHR use predicted cancer screening (mediated through patient activation), but only for women recommended for biannual mammograms. The aforementioned relationship was not found for men who are recommended for prostate cancer screening. PCC and EHRs do appear to facilitate a patient's ability to take care of their own health, but only under certain circumstances. It was additionally found that men were more likely to report higher degrees of physician PCC when their physicians maintained an EHR, whereas women reported no difference. Future research should examine more nuanced personality factors that affect the perception of PCC in the presence of EHRs and the relationship between men's activation and likelihood of receiving a cancer screen.

  15. Patient-Centered Medical Home Features and Health Care Expenditures of Medicare Beneficiaries with Chronic Disease Dyads.

    Science.gov (United States)

    Philpot, Lindsey M; Stockbridge, Erica L; Padrón, Norma A; Pagán, José A

    2016-06-01

    Three out of 4 Medicare beneficiaries have multiple chronic conditions, and managing the care of this growing population can be complex and costly because of care coordination challenges. This study assesses how different elements of the patient-centered medical home (PCMH) model may impact the health care expenditures of Medicare beneficiaries with the most prevalent chronic disease dyads (ie, co-occurring high cholesterol and high blood pressure, high cholesterol and heart disease, high cholesterol and diabetes, high cholesterol and arthritis, heart disease and high blood pressure). Data from the 2007-2011 Medical Expenditure Panel Survey suggest that increased access to PCMH features may differentially impact the distribution of health care expenditures across health care service categories depending on the combination of chronic conditions experienced by each beneficiary. For example, having no difficulty contacting a provider after regular hours was associated with significantly lower outpatient expenditures for beneficiaries with high cholesterol and diabetes (n = 635; P = 0.038), but it was associated with significantly higher inpatient expenditures for beneficiaries with high blood pressure and high cholesterol (n = 1599; P = 0.015), and no significant differences in expenditures in any category for beneficiaries with high blood pressure and heart disease (n = 1018; P > 0.05 for all categories). However, average total health care expenditures are largely unaffected by implementing the PCMH features considered. Understanding how the needs of Medicare beneficiaries with multiple chronic conditions can be met through the adoption of the PCMH model is important not only to be able to provide high-quality care but also to control costs. (Population Health Management 2016;19:206-211).

  16. Glycemic control among patients with type 2 diabetes at a primary health care center in Oman.

    Science.gov (United States)

    Al Balushi, Khalid A; Al-Haddabi, Mahmod; Al-Zakwani, Ibrahim; Al Za'abi, Mohammed

    2014-10-01

    To determine the status of blood sugar control by using fasting blood sugar (FBS) of ≤6.1 mmol/l and glycosyted hemoglobin A1c (HbAc1) of Oman. The overall mean age of the cohort was 53±12 years (range: 24-91) with females representing 60% (n=106) of the study sample. The study found that only 9.6% (n=17) and 35% (n=62) of the patients attained optimal FBS and HbAc1 levels, respectively. Higher HbA1c was significantly associated with higher diastolic BP (84 versus 80 mm Hg; p=0.006), higher total cholesterol (5.2 versus 4.7 mmol/l; p=0.002) and higher low-density lipoprotein cholesterol (3.8 versus 3.0 mmol/l; p=0.034). The results demonstrated poor glycemic control in Oman type 2 diabetic patients comparable to local and global studies especially in those hypertensive and dyslipidemic patients. Implementation of early and aggressive management of diabetes mellitus at the primary care setting is warranted. Copyright © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  17. Patients' preferences for patient-centered communication

    DEFF Research Database (Denmark)

    Lau, Sofie Rosenlund; Christensen, Søren Troels; Andreasen T., Jesper

    2013-01-01

    To investigate patients' preferences for patient-centered communication (PCC) in the encounter with healthcare professionals in an outpatient department in rural Sierra Leone.......To investigate patients' preferences for patient-centered communication (PCC) in the encounter with healthcare professionals in an outpatient department in rural Sierra Leone....

  18. National Center for Health Statistics

    Science.gov (United States)

    ... Submit Search the CDC National Center for Health Statistics Note: Javascript is disabled or is not supported ... Survey of Family Growth Vital Records National Vital Statistics System National Death Index Vital Statistics Rapid Release ...

  19. School Health Centers

    Science.gov (United States)

    Gordon, Douglas

    2010-01-01

    Maintaining student health, safety, and welfare is a primary goal for any K-12 school system. If a child becomes sick, is injured, or seems in any other way incapacitated at school, it is the understood responsibility that the school will provide care and, if necessary, contact the parents and direct the child to outside treatment. Beyond that…

  20. Health Services OutPatient Experience questionnaire: factorial validity and reliability of a patient-centered outcome measure for outpatient settings in Italy

    Directory of Open Access Journals (Sweden)

    Coluccia A

    2014-09-01

    Full Text Available Anna Coluccia, Fabio Ferretti, Andrea PozzaDepartment of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, University of Siena, Siena, ItalyPurpose: The patient-centered approach to health care does not seem to be sufficiently developed in the Italian context, and is still characterized by the biomedical model. In addition, there is a lack of validated outcome measures to assess outpatient experience as an aspect common to a variety of settings. The current study aimed to evaluate the factorial validity, reliability, and invariance across sex of the Health Services OutPatient Experience (HSOPE questionnaire, a short ten-item measure of patient-centeredness for Italian adult outpatients. The rationale for unidimensionality of the measure was that it could cover global patient experience as a process common to patients with a variety of diseases and irrespective of the phase of treatment course.Patients and methods: The HSOPE was compiled by 1,532 adult outpatients (51% females, mean age 59.22 years, standard deviation 16.26 receiving care in ten facilities at the Santa Maria alle Scotte University Hospital of Siena, Italy. The sample represented all the age cohorts. Twelve percent were young adults, 57% were adults, and 32% were older adults. Exploratory and confirmatory factor analyses were conducted to evaluate factor structure. Reliability was evaluated as internal consistency using Cronbach’s α. Factor invariance was assessed through multigroup analyses.Results: Both exploratory and confirmatory analyses suggested a clearly defined unidimensional structure of the measure, with all the ten items having salient loadings on a single factor. Internal consistency was excellent (α=0.95. Indices of model fit supported a single-factor structure for both male and female outpatient groups. Young adult outpatients had significantly lower scores on perceived patient-centeredness relative to older adults. No

  1. Needs Assessment for Creating a Patient-Centered, Community-Engaged Health Program for Homeless Pregnant Women

    Directory of Open Access Journals (Sweden)

    Tegan Ake

    2018-01-01

    Full Text Available Purpose: Women who experience homelessness during pregnancy have poorer birth outcomes than the general population. This exploratory research describes the needs assessment of homeless women currently living at a shelter in Milwaukee, Wisconsin, to identify unmet needs related to maternal and infant perinatal health as the first step in designing a mutually beneficial patient-centered service-learning program for medical students to address these needs. Methods: Two 1-hour focus groups were held at a shelter for women who are homeless and/or victims of domestic violence. A total of 13 women participated in each session; four medical students and a physician served as facilitators and scribes at each session. The facilitators alternated asking predetermined open- and close-ended questions, followed by discussion among participants. Questions elicited experiences during pregnancy, what went well, what women living in the shelter struggled with, and what support they wished for but did not have. Scribes captured the conversation through hand-written notes and used content analysis in order of frequency. Results: Thirteen themes were identified. The 5 most frequently identified themes were a need for pregnancy education, access/transportation, baby care, advocacy, and material necessities. Participating shelter residents and the medical students expressed interest in working with one another and forming a long-term partnership with the shelter. Conclusions: Results of this needs assessment will inform the creation of a new shelter-based medical education program that will meet homeless women’s needs while preparing medical students for patient-centered, community-responsive care.

  2. Nursing perception of the impact of medication carts on patient safety and ergonomics in a teaching health care center.

    Science.gov (United States)

    Rochais, Élise; Atkinson, Suzanne; Bussières, Jean-François

    2013-04-01

    In our Quebec (Canada) University Hospital Center, 68 medication carts have been implemented as part of a nationally funded project on drug distribution technologies. There are limited data published about the impact of medication carts in point-of-care units. Our main objective was to assess nursing staff's perception and satisfaction of medication carts on patient safety and ergonomics. Quantitative and qualitative cross-sectional study. Data were gathered from a printed questionnaire administered to nurses and an organized focus group composed of nurses and pharmacists. A total of 195 nurses completed the questionnaire. Eighty percent of the nurses agreed that medication carts made health care staff's work easier and 64% agreed that it helped to reduce medication incidents/accidents. Only 27% and 43% agreed that carts' location reduces the risk of patients' interruptions and colleagues' interruptions, respectively. A total of 17 suggestions were extracted from the focus group (n = 7 nurses; n = 3 pharmacist) and will be implemented in the next year. This descriptive study confirms the positive perception and satisfaction of nurses exposed to medication carts. However, interruptions are a major concern and source of dissatisfaction. The focus group has revealed many issues which will be improved.

  3. Assessment of perceived health status in hypertensive and diabetes mellitus patients at primary health centers in Oman

    Directory of Open Access Journals (Sweden)

    Ahmed Al-Mandhari

    2011-01-01

    Conclusions: The presence of both diseases was associated with lower physical scores of perceived health status. Health status was also affected by various demographic and clinical characteristics. However, the results should be interpreted in light of the study′s limitations.

  4. Enhancing mHealth Technology in the Patient-Centered Medical Home Environment to Activate Patients With Type 2 Diabetes: A Multisite Feasibility Study Protocol.

    Science.gov (United States)

    Gimbel, Ronald; Shi, Lu; Williams, Joel E; Dye, Cheryl J; Chen, Liwei; Crawford, Paul; Shry, Eric A; Griffin, Sarah F; Jones, Karyn O; Sherrill, Windsor W; Truong, Khoa; Little, Jeanette R; Edwards, Karen W; Hing, Marie; Moss, Jennie B

    2017-03-06

    The potential of mHealth technologies in the care of patients with diabetes and other chronic conditions has captured the attention of clinicians and researchers. Efforts to date have incorporated a variety of tools and techniques, including Web-based portals, short message service (SMS) text messaging, remote collection of biometric data, electronic coaching, electronic-based health education, secure email communication between visits, and electronic collection of lifestyle and quality-of-life surveys. Each of these tools, used alone or in combination, have demonstrated varying degrees of effectiveness. Some of the more promising results have been demonstrated using regular collection of biometric devices, SMS text messaging, secure email communication with clinical teams, and regular reporting of quality-of-life variables. In this study, we seek to incorporate several of the most promising mHealth capabilities in a patient-centered medical home (PCMH) workflow. We aim to address underlying technology needs and gaps related to the use of mHealth technology and the activation of patients living with type 2 diabetes. Stated differently, we enable supporting technologies while seeking to influence patient activation and self-care activities. This is a multisite phased study, conducted within the US Military Health System, that includes a user-centered design phase and a PCMH-based feasibility trial. In phase 1, we will assess both patient and provider preferences regarding the enhancement of the enabling technology capabilities for type 2 diabetes chronic care management. Phase 2 research will be a single-blinded 12-month feasibility study that incorporates randomization principles. Phase 2 research will seek to improve patient activation and self-care activities through the use of the Mobile Health Care Environment with tailored behavioral messaging. The primary outcome measure is the Patient Activation Measure scores. Secondary outcome measures are Summary of

  5. Statement of the American Psychological Association in response to the "joint principles: integrating behavioral health care into the patient-centered medical home".

    Science.gov (United States)

    Anderson, Norman B; Belar, Cynthia D; Cubic, Barbara A; Garrison, Ellen G; Johnson, Suzanne Bennett; Kaslow, Nadine J

    2014-06-01

    Comments on the article "Joint principles: Integrating behavioral health care into the patient-centered medical home" (see record 2014-24217-011), presented by the Working Party Group on Integrated Behavioral Healthcare. The American Psychological Association (APA) shares concerns about the lack of reference to behavioral health care in the original 2007 Joint Principles of the Patient-Centered Medical Home for which this new document is intended to supplement but not replace. The decision to support the supplemental Joint Principles was not an easy one for APA, as there is one area of significant concern. That concern is related to the use of the term "physician-directed medical practice"

  6. Implementation of the patient-centered medical home in the Veterans Health Administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use.

    Science.gov (United States)

    Nelson, Karin M; Helfrich, Christian; Sun, Haili; Hebert, Paul L; Liu, Chuan-Fen; Dolan, Emily; Taylor, Leslie; Wong, Edwin; Maynard, Charles; Hernandez, Susan E; Sanders, William; Randall, Ian; Curtis, Idamay; Schectman, Gordon; Stark, Richard; Fihn, Stephan D

    2014-08-01

    In 2010, the Veterans Health Administration (VHA) began implementing the patient-centered medical home (PCMH) model. The Patient Aligned Care Team (PACT) initiative aims to improve health outcomes through team-based care, improved access, and care management. To track progress and evaluate outcomes at all VHA primary care clinics, we developed and validated a method to assess PCMH implementation. To create an index that measures the extent of PCMH implementation, describe variation in implementation, and examine the association between the implementation index and key outcomes. We conducted an observational study using data on more than 5.6 million veterans who received care at 913 VHA hospital-based and community-based primary care clinics and 5404 primary care staff from (1) VHA clinical and administrative databases, (2) a national patient survey administered to a weighted random sample of veterans who received outpatient care from June 1 to December 31, 2012, and (3) a survey of all VHA primary care staff in June 2012. Composite scores were constructed for 8 core domains of PACT: access, continuity, care coordination, comprehensiveness, self-management support, patient-centered care and communication, shared decision making, and team-based care. Patient satisfaction, rates of hospitalization and emergency department use, quality of care, and staff burnout. Fifty-three items were included in the PACT Implementation Progress Index (Pi2). Compared with the 87 clinics in the lowest decile of the Pi2, the 77 sites in the top decile exhibited significantly higher patient satisfaction (9.33 vs 7.53; P hospitalization rates for ambulatory care-sensitive conditions (4.42 vs 3.68 quarterly admissions for veterans 65 years or older per 1000 patients; P < .001), and lower emergency department use (188 vs 245 visits per 1000 patients; P < .001). The extent of PCMH implementation, as measured by the Pi2, was highly associated with important outcomes for both

  7. Patient Satisfaction with Kimbrough Ambulatory Care Center

    Science.gov (United States)

    1997-02-01

    few are going to opt to change health plans. 14. SUBJECT TERMS PATIENT SATISFACTION; CONSUMER SATISFACTION; SURVEY 15. NUMBER OF PAGES 57 16...to address is overall patient satisfaction with Kimbrough’s current health care system. I surveyed customers on: how satisfied or dissatisfied they...research project was designed to determine how satisfied customers are with Kimbrough Ambulatory Care Center. A patient satisfaction survey developed by

  8. Patient-Centered Research

    Science.gov (United States)

    Wicki, J; Perneger, TV; Junod, AF; Bounameaux, H; Perrier, A

    2000-01-01

    PURPOSE We aimed to develop a simple standardized clinical score to stratify emergency ward patients with clinically suspected PE into groups with a high, intermediate, or low probability of PE, in order to improve and simplify the diagnostic approach. METHODS Analysis of a database of 1090 consecutive patients admitted to the emergency ward for suspected PE, in whom diagnosis of PE was ruled in or out by a standard diagnostic algorithm. Logistic regression was used to predict clinical parameters associated with PE. RESULTS 296 out of 1090 patients (27%) were found to have PE. The optimal estimate of clinical probability was based on eight variables: recent surgery, previous thromboembolic event, older age, hypocapnia, hypoxemia, tachycardia, band atelectasis or elevation of a hemidiaphragm on chest X-ray. A probability score was calculated by adding points assigned to these variables. A cut-off score of 4 best identified patients with low probability of PE. 486 patients (49%) had a low clinical probability of PE (score 9). CONCLUSION This clinical score, based on easily available and objective variables, provides a standardized assessment of the clinical probability of PE. Applying this score to emergency ward patients suspected of PE could allow a more efficient diagnostic process.

  9. 76 FR 17139 - Health Center Program

    Science.gov (United States)

    2011-03-28

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Health Center Program AGENCY: Health Resources and Services Administration, HHS. ACTION: Notice of Noncompetitive... Improvement Project (CIP) from Saint Vincent's Catholic Medical Centers (SVCMC) of New York, current grantee...

  10. Factors associated with daily consumption of sugar-sweetened beverages among adult patients at four federally qualified health centers, Bronx, New York, 2013.

    Science.gov (United States)

    Kristal, Ross B; Blank, Arthur E; Wylie-Rosett, Judith; Selwyn, Peter A

    2015-01-08

    Consumption of sugar-sweetened beverages (SSBs) is associated with cardiovascular disease risk factors. This study examined the relationships between SSB consumption and demographic, health behavior, health service, and health condition characteristics of adult patients of a network of federally qualified health centers (FQHCs) in a low-income, urban setting. Validated, standardized self-reported health behavior questions were incorporated into the electronic health record (EHR) and asked of patients yearly, at 4 FQHCs. We conducted cross-sectional analysis of EHR data collected in 2013 from 12,214 adult patients by using logistic regression. Forty percent of adult patients consumed 1 or more SSBs daily. The adjusted odds ratios indicated that patients who consumed more than 1 SSB daily were more likely to be aged 18 to 29 years versus age 70 or older, current smokers versus never smoking, eating no servings of fruits and/or vegetables daily or 1 to 4 servings daily versus 5 or more servings daily, and not walking or biking more than 10 blocks in the past 30 days. Patients consuming 1 or more servings of SSBs daily were less likely to speak Spanish than English, be women than men, be diagnosed with type 2 diabetes versus no diabetes, and be diagnosed with hypertension versus no hypertension. SSB consumption differed by certain demographic characteristics, health behaviors, and health conditions. Recording SSB intake and other health behaviors data in the EHR could help clinicians in identifying and counseling patients to promote health behavior changes. Future studies should investigate how EHR data on patient health behavior can be used to improve the health of patients and communities.

  11. Improving the provision of language services at an academic medical center: ensuring high-quality health communication for limited-English-proficient patients.

    Science.gov (United States)

    Standiford, Connie J; Nolan, Elizabeth; Harris, Michelle; Bernstein, Steven J

    2009-12-01

    To evaluate and improve the provision of language services at an academic medicine center caring for a diverse population including many limited-English-proficient (LEP) patients. The authors performed a prospective observational study between November 2006 and December 2008 evaluating the provision of language services at the University of Michigan Health System. The primary performance measures were (1) screening patients for their preferred language for health care, (2) assessing the proportion of LEP patients receiving language services from a qualified language services provider, and (3) assessing whether there were any disparities in diabetes care for LEP patients compared with English-speaking patients. The proportion of patients screened for preferred language increased from 59% to 96% with targeted inventions, such as training staff to capture preferred language for health care and correcting prior inaccurate primary language data entry. The proportion of LEP outpatients with a qualified language services provider increased from 19% to 83% through the use of staff and contract interpreters, over-the-phone interpreting and bilingual providers. There were no systematic differences in diabetes quality performance measures between LEP and English-proficient patients. Academic medical centers should measure their provision of language services and compare quality and safety data (e.g., performance measures and adverse events) between LEP and English-speaking patients to identify disparities in care. Leadership support and ongoing training are needed to ensure language-specific services are embedded into clinical care to meet the needs of our diverse patient populations.

  12. Perspectives on quality mental health care from Brazilian and Cape Verdean outpatients: implications for effective patient-centered policies and models of care.

    Science.gov (United States)

    De Jesus, Maria; Earl, Tara R

    2014-01-01

    Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care.

  13. Meaningful use in the safety net: a rapid ethnography of patient portal implementation at five community health centers in California.

    Science.gov (United States)

    Ackerman, Sara L; Sarkar, Urmimala; Tieu, Lina; Handley, Margaret A; Schillinger, Dean; Hahn, Kenneth; Hoskote, Mekhala; Gourley, Gato; Lyles, Courtney

    2017-09-01

    US health care institutions are implementing secure websites (patient portals) to achieve federal Meaningful Use (MU) certification. We sought to understand efforts to implement portals in "safety net" health care systems that provide services for low-income populations. Our rapid ethnography involved visits at 4 California safety net health systems and in-depth interviews at a fifth. Visits included interviews with clinicians and executives ( n  = 12), informal focus groups with front-line staff ( n  = 35), observations of patient portal sign-up procedures and clinic work, review of marketing materials and portal use data, and a brief survey ( n  = 45). Our findings demonstrate that the health systems devoted considerable effort to enlisting staff support for portal adoption and integrating portal-related work into clinic routines. Although all health systems had achieved, or were close to achieving, MU benchmarks, patients faced numerous barriers to portal use and our participants were uncertain how to achieve and sustain "meaningful use" as defined by and for their patients. Health systems' efforts to achieve MU certification united clinic staff under a shared ethos of improved quality of care. However, MU's assumptions about patients' demand for electronic access to health information and ability to make use of it directed clinics' attention to enrollment and message routing rather than to the relevance and usability of a tool that is minimally adaptable to the safety net context. We found a mismatch between MU-based metrics of patient engagement and the priorities and needs of safety net patient populations. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  14. How to integrate the electronic health record and patient-centered communication into the medical visit: a skills-based approach.

    Science.gov (United States)

    Duke, Pamela; Frankel, Richard M; Reis, Shmuel

    2013-01-01

    Implementation of the electronic health record (EHR) has changed the dynamics of doctor-patient communication. Physicians train to use EHRs from a technical standpoint, giving only minimal attention to integrating the human dimensions of the doctor-patient relationship into the computer-accompanied medical visit. This article reviews the literature and proposes a model to help clinicians, residents, and students improve physician-patient communication while using the EHR. We conducted a literature search on use of communication skills when interfacing with the EHR. We observed an instructional gap and developed a model using evidence-based communication skills. This model integrates patient-centered interview skills and aims to empower physicians to remain patient centered while effectively using EHRs. It may also serve as a template for future educational and practice interventions for use of the EHR in the examination room.

  15. Academic Medical Centers as digital health catalysts.

    Science.gov (United States)

    DePasse, Jacqueline W; Chen, Connie E; Sawyer, Aenor; Jethwani, Kamal; Sim, Ida

    2014-09-01

    Emerging digital technologies offer enormous potential to improve quality, reduce cost, and increase patient-centeredness in healthcare. Academic Medical Centers (AMCs) play a key role in advancing medical care through cutting-edge medical research, yet traditional models for invention, validation and commercialization at AMCs have been designed around biomedical initiatives, and are less well suited for new digital health technologies. Recently, two large bi-coastal Academic Medical Centers, the University of California, San Francisco (UCSF) through the Center for Digital Health Innovation (CDHI) and Partners Healthcare through the Center for Connected Health (CCH) have launched centers focused on digital health innovation. These centers show great promise but are also subject to significant financial, organizational, and visionary challenges. We explore these AMC initiatives, which share the following characteristics: a focus on academic research methodology; integration of digital technology in educational programming; evolving models to support "clinician innovators"; strategic academic-industry collaboration and emergence of novel revenue models. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Patient-centered blood management.

    Science.gov (United States)

    Hohmuth, Benjamin; Ozawa, Sherri; Ashton, Maria; Melseth, Richard L

    2014-01-01

    Transfusions are common in hospitalized patients but carry significant risk, with associated morbidity and mortality that increases with each unit of blood received. Clinical trials consistently support a conservative over a liberal approach to transfusion. Yet there remains wide variation in practice, and more than half of red cell transfusions may be inappropriate. Adopting a more comprehensive approach to the bleeding, coagulopathic, or anemic patient has the potential to improve patient care. We present a patient-centered blood management (PBM) paradigm. The 4 guiding principles of effective PBM that we present include anemia management, coagulation optimization, blood conservation, and patient-centered decision making. PBM has the potential to decrease transfusion rates, decrease practice variation, and improve patient outcomes. PBM's value proposition is highly aligned with that of hospital medicine. Hospitalists' dual role as front-line care providers and quality improvement leaders make them the ideal candidates to develop, implement, and practice PBM. © 2013 Society of Hospital Medicine.

  17. The Community Health Applied Research Network (CHARN) Data Warehouse: a Resource for Patient-Centered Outcomes Research and Quality Improvement in Underserved, Safety Net Populations.

    Science.gov (United States)

    Laws, Reesa; Gillespie, Suzanne; Puro, Jon; Van Rompaey, Stephan; Quach, Thu; Carroll, Joseph; Weir, Rosy Chang; Crawford, Phil; Grasso, Chris; Kaleba, Erin; McBurnie, Mary Ann

    2014-01-01

    The Community Health Applied Research Network, funded by the Health Resources and Services Administration, is a research network comprising 18 Community Health Centers organized into four Research Nodes (each including an academic partner) and a data coordinating center. The network represents more than 500,000 diverse safety net patients across 11 states. The primary objective of this paper is to describe the development and implementation process of the CHARN data warehouse. The methods involved regulatory and governance development and approval, development of content and structure of the warehouse and processes for extracting the data locally, performing validation, and finally submitting data to the data coordinating center. Version 1 of the warehouse has been developed. Tables have been added, the population and the years of electronic health records (EHR) have been expanded for Version 2. It is feasible to create a national, centralized data warehouse with multiple Community Health Center partners using different EHR systems. It is essential to allow sufficient time: (1) to develop collaborative, trusting relationships among new partners with varied technology, backgrounds, expertise, and interests; (2) to complete institutional, business, and regulatory review processes; (3) to identify and address technical challenges associated with diverse data environments, practices, and resources; and (4) to provide continuing data quality assessments to ensure data accuracy.

  18. [Patients and quality of primary health care services. Survey of practitioners at the Bahía de Cádiz and La Janda health centers].

    Science.gov (United States)

    Hernán García, M; Gutiérrez Cuadra, J L; Lineros González, C; Ruiz Barbosa, C; Rabadán Asensio, A

    2002-10-31

    To report the opinions of practitioners at health centers on dimensions of quality that affect user satisfaction. Cross-sectional study of focus groups (FG). Bahía de Cádiz and La Janda health centers in southwestern Spain. We studied 4 FG whose participants were staff members of the two health centers: FG1, physicians; FG2, user satisfaction service staff; FG3, social workers; FG4, nurses. The groups were based on the different functions of staff at the two centers. The analysis was based on variables in the SERCAL model (an adaptation of the SERVQUAL model for the Spanish health care system) of opinions regarding service quality: access, comfort (tangibles), personalized service (courtesy), competence, and loyalty. The data were analyzed with version N-Vivo of the NUDIST program. All dimensions of the theoretical model were identified by practitioners as constructs of users' perceptions of service quality. Users' and practitioners' views contrasted with and complemented each other to generate a model that could be validated. Access, personalized service and problem-solving (responsiveness) were key variables. Practitioners' opinions provided information of use in improving the quality model. Differences in opinion between users and practitioners merit further study based on an understanding of these groups' values and interests, and on the care provision context. Practitioners identified access, personalized service and problem-solving as features that influenced users' opinions of the quality of the health center.

  19. BMT Roadmap: A User-Centered Design Health Information Technology Tool to Promote Patient-Centered Care in Pediatric Hematopoietic Cell Transplantation.

    Science.gov (United States)

    Runaas, Lyndsey; Hanauer, David; Maher, Molly; Bischoff, Evan; Fauer, Alex; Hoang, Tiffany; Munaco, Anna; Sankaran, Roshun; Gupta, Rahael; Seyedsalehi, Sajjad; Cohn, Amy; An, Larry; Tewari, Muneesh; Choi, Sung Won

    2017-05-01

    Health information technology (HIT) has great potential for increasing patient engagement. Pediatric hematopoietic cell transplantation (HCT) is a setting ripe for using HIT but in which little research exists. "BMT Roadmap" is a web-based application that integrates patient-specific information and includes several domains: laboratory results, medications, clinical trial details, photos of the healthcare team, trajectory of transplant process, and discharge checklist. BMT Roadmap was provided to 10 caregivers of patients undergoing first-time HCT. Research assistants performed weekly qualitative interviews throughout the patient's hospitalization and at discharge and day 100 to assess the impact of BMT Roadmap. Rigorous thematic analysis revealed 5 recurrent themes: emotional impact of the HCT process itself; critical importance of communication among patients, caregivers, and healthcare providers; ways in which BMT Roadmap was helpful during inpatient setting; suggestions for improving BMT Roadmap; and other strategies for organization and management of complex healthcare needs that could be incorporated into BMT Roadmap. Caregivers found the tool useful and easy to use, leading them to want even greater access to information. BMT Roadmap was feasible, with no disruption to inpatient care. Although this initial study is limited by the small sample size and single-institution experience, these initial findings are encouraging and support further investigation. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  20. Clinical quality performance in U.S. health centers.

    Science.gov (United States)

    Shi, Leiyu; Lebrun, Lydie A; Zhu, Jinsheng; Hayashi, Arthur S; Sharma, Ravi; Daly, Charles A; Sripipatana, Alek; Ngo-Metzger, Quyen

    2012-12-01

    To describe current clinical quality among the nation's community health centers and to examine health center characteristics associated with performance excellence. National data from the 2009 Uniform Data System. Health centers reviewed patient records and reported aggregate data to the Uniform Data System. Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance. Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well. Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients. © Health Research and Educational Trust.

  1. Patterns of care in patients with cervical cancer 2012. Results of a survey among German radiotherapy departments and out-patient health care centers

    International Nuclear Information System (INIS)

    Marnitz, S.; Rauer, A.; Budach, V.; Koehler, C.; Schneider, A.; Mangler, M.; Tsunoda, A.

    2014-01-01

    Platinum-based primary or adjuvant chemoradiation is the treatment of choice for patients with cervical cancer. However, despite national guidelines and international recommendations, many aspects in diagnosis, therapy, and follow-up of patients with cervical cancer are not based on valid data. To evaluate the current patterns of care for patients with cervical cancer in Germany, a questionnaire with 25 items was sent to 281 radiooncologic departments and out-patient health care centers. The response rate was 51 %. While 87 % of institutions treat 0-25 patients/year, 12 % treat between 26 and 50 and only 1 % treat more than 50 patients/year. In 2011, the stage distribution of 1,706 treated cervical cancers were IB1, IB2, IIA, IIB, IIIA/IIIB, and IV in 11, 12, 11, 22, 28, and 16 %, respectively. CT (90 %) and MRI (86 %) are mainly used as staging procedures in contrast to PET-CT with 14 %. Interestingly, 27 % of institutions advocate surgical staging prior to chemoradiation. In the majority of departments 3D-based (70 %) and intensity-modulated radiotherapy (76 %) are used for percutaneous radiation, less frequently volumetric arc techniques (26 %). Nearly all colleagues (99.3 %) apply conventional fractioning of 1.8-2 Gy for external-beam radiotherapy, in 19 % combined with a simultaneous integrated boost. Cisplatinum mono is used as a radiosensitizer with 40 mg/m 2 weekly by 90 % of radiooncologists. For boost application in the primary treatment, HDR (high-dose rate) brachytherapy is the dominant technique (84 %). In patients after radical hysterectomy pT1B1/1B2, node negative and resection in sound margins adjuvant chemoradiation is applied due to the occurrence of 1-4 other risk factors in 16-97 %. There is a broad spectrum of recommended primary treatment strategies in stages IIB and IVA. Results of the survey underline the leading role but also differences in the use of chemoradiation in the treatment of cervical cancer patients in Germany. (orig.) [de

  2. Patterns of clozapine and other antipsychotics prescriptions in patients with treatment-resistant schizophrenia in community mental health centers in São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Ana Stella de Azevedo Silveira

    2015-12-01

    Full Text Available Abstract Background Despite of its global underuse, clozapine is still the golden standard antipsychotic for patients with treatment-resistant schizophrenia (TRS. Objective To evaluate the patterns of clozapine and other antipsychotic drugs prescription in TRS in community mental health centers in São Paulo, Brazil. Methods A multiple-choice questionnaire was applied to fifteen psychiatrists at five centers inquiring about patients’ clinical condition, adherence to oral treatment and current antipsychotic treatment. History of previous and current antipsychotic treatment was collected through medical chart review. Results Out of 442 schizophrenia patients, 103 (23.3% fulfilled the criteria for TRS. Fifty-eight patients (56.3% were receiving polypharmacy; 30 (29.1% were on atypical antipsychotic monotherapy, 14 (13.6% were on typical antipsychotic monotherapy, 25 (24.3% were taking depot antipsychotic medication and only 22 (21.4% were receiving clozapine. Discussion As well as in other parts of the world, many TRS patients (78.6% receive other drugs instead of clozapine in São Paulo, the best evidence-based medication for patients with TRS. The government should make every effort to provide medical training and the equipment and logistic support to adequately serve those who could benefit from clozapine treatment at the community health centers.

  3. Critical thinking in patient centered care.

    Science.gov (United States)

    Mitchell, Shannon H; Overman, Pamela; Forrest, Jane L

    2014-06-01

    Health care providers can enhance their critical thinking skills, essential to providing patient centered care, by use of motivational interviewing and evidence-based decision making techniques. The need for critical thinking skills to foster optimal patient centered care is being emphasized in educational curricula for health care professions. The theme of this paper is that evidence-based decision making (EBDM) and motivational interviewing (MI) are tools that when taught in health professions educational programs can aid in the development of critical thinking skills. This paper reviews the MI and EBDM literature for evidence regarding these patient-centered care techniques as they relate to improved oral health outcomes. Comparisons between critical thinking and EBDM skills are presented and the EBDM model and the MI technique are briefly described followed by a discussion of the research to date. The evidence suggests that EBDM and MI are valuable tools; however, further studies are needed regarding the effectiveness of EBDM and MI and the ways that health care providers can best develop critical thinking skills to facilitate improved patient care outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. [Communication center in public health].

    Science.gov (United States)

    George, W; Grimminger, F; Krause, B

    2002-06-01

    The Communications Center's portfolio covers areas such as marketing, contacts, distribution of information, sales activities and collection of bills by telephone (encashment). A special emphasis is Customer Care Management (Customer Relationship Management) to the patient and his caregivers (relatives), the customers, especially the physicians who send their patients to the hospital and the hospital doctor. By providing communication centers, the hospital would be able to improve the communication with the G.P.s, and identify the wishes and requirements more accurately and easily from the beginning. Dealing effectively with information and communication is already also of special importance for hospital doctors today. One can assume that the demands on doctors in this respect will become even more complex in the future. Doctors who are involved in scientific research are of course fully aware of the growing importance of the Internet with its new information and communication channels. Therefore analysing the current situation, the demands on a future information management system can be formulated: A system that will help doctors to avoid dealing with little goal-oriented information and thus setting up effective communication channels; an information system which is multi-media oriented towards the interests and needs of the patients and patient's relatives and which is further developed continually and directly by those involved.

  5. Applying User-Centered Design Methods to the Development of an mHealth Application for Use in the Hospital Setting by Patients and Care Partners.

    Science.gov (United States)

    Couture, Brittany; Lilley, Elizabeth; Chang, Frank; DeBord Smith, Ann; Cleveland, Jessica; Ergai, Awatef; Katsulis, Zachary; Benneyan, James; Gershanik, Esteban; Bates, David W; Collins, Sarah A

    2018-04-01

     Developing an optimized and user-friendly mHealth application for patients and family members in the hospital environment presents unique challenges given the diverse patient population and patients' various states of well-being.  This article describes user-centered design methods and results for developing the patient and family facing user interface and functionality of MySafeCare, a safety reporting tool for hospitalized patients and their family members.  Individual and group usability sessions were conducted with specific testing scenarios for participants to follow to test the usability and functionality of the tool. Participants included patients, family members, and Patient and Family Advisory Council (PFAC) members. Engagement rounds were also conducted on study units and lessons learned provided additional information to the usability work. Usability results were aligned with Nielsen's Usability Heuristics.  Eleven patients and family members and 25 PFAC members participated in usability testing and over 250 patients and family members were engaged during research team rounding. Specific themes resulting from the usability testing sessions influenced the changes made to the user interface design, workflow functionality, and terminology.  User-centered design should focus on workflow functionality, terminology, and user interface issues for mHealth applications. These themes illustrated issues aligned with four of Nielsen's Usability Heuristics: match between system and the real world, consistency and standards, flexibility and efficiency of use, and aesthetic and minimalist design. We identified workflow and terminology issues that may be specific to the use of an mHealth application focused on safety and used by hospitalized patients and their families. Schattauer GmbH Stuttgart.

  6. Endoscopic evaluation of upper abdominal symptoms in adult patients, Saudi Aramco-Ai Hasa Health Center, Saudi Arabia.

    Science.gov (United States)

    Nkrumah, K N

    2002-01-01

    Upper oesophago-gastro-duodenoscopies (UGI endoscopies) were performed on adult patients who attended Saudi Aramco Health Centre at Al Hasa, Saudi Arabia, between June 1986 and December 1993, with complaint of upper abdominal pain. During this period, three hundred and fifteen (315) patients were examined. Sixty one percent were females and the rest males. Peptic ulcer disease including gastritis was the most common diagnosis made. Helicobacter pylori-like organisms were documented historically in biopsy samples in 113 of 178 (63%) patients. Nearly all were associated with gastritis; no organisms were reported in normal histology specimens. This confirms the association of this organism with gastritis. Gastric cancer suspected radiologically were not confirmed endoscopically or histologically. It is important to endoscope and biopsy for histology suspected gastric cancer and ulcer; a negative result may save the patient from unnecessary surgery, ideally all normal looking gastric mucosa should be biopsied so that histological gastritis is not missed.

  7. Safety and Efficacy in Early Insulin Initiation as Comprehensive Therapy for Patients with Type 2 Diabetes in Primary Health Care Centers

    Directory of Open Access Journals (Sweden)

    Agung Pranoto

    2015-04-01

    Full Text Available Aim: to analyze the safety and efficacy of early insulin initiation therapy for patients with type 2 diabetes mellitus (T2DM in primary health care provided by general practitioners (GPs in Surabaya, East Java, Indonesia. Methods: pre-post study of ninety nine diabetic patients without previous insulin treatment with HbA1c levels >8% were involved in this study. The study was conducted in 10 primary health care centers in Surabaya between October 2011 to June 2012. Each patient received insulin therapy for 12 weeks. Laboratory examination was performed for each patient including fasting plasma glucose (FPG, 2 hours post-prandial plasma glucose (2hPPG and HbA1c examination before and after the study. Self monitoring blood glucose (SMBG examination was conducted in order to adjust the insulin dose and prevent the incidence of hypoglycemia. Data was statistically analyzed using paired-T test. Results: FPG level was decreased from baseline data (209 mg/dL to 152.07 mg/dL at the end of the study (Δ56.93 mg/dl; p=0.0001. The average of 2hPPG level was also decreased from 313.00 mg/dl to 220.72 mg/dL (Δ 92.28 mg/dL; p=0.0001. HbA1c was reduced from 11.60% at baseline to 8.95% at the end of study (Δ 2.65%; p=0.0001. Hypoglycemia was found in 6 patients (6.06% in this study, but all events were mild and did not need to be admitted to hospital. Conclusion: the safety of insulin therapy iniatiation might be provided by GPs at primary health centers with significant efficacy and minimal side effects. Key words: insulin, general practioner, primary health center.

  8. Community health centers and primary care access and quality for chronically-ill patients - a case-comparison study of urban Guangdong Province, China.

    Science.gov (United States)

    Shi, Leiyu; Lee, De-Chih; Liang, Hailun; Zhang, Luwen; Makinen, Marty; Blanchet, Nathan; Kidane, Ruth; Lindelow, Magnus; Wang, Hong; Wu, Shaolong

    2015-11-30

    Reform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the 'gate-keeper' CHC model, or the hospital-owned CHC models, was most effective in enhancing access to and quality of care for patients with chronic illness. The case-comparison design was used to study nine health care organizations in Guangzhou, Dongguan, and Shenzhen cities within Guangdong province, China. 560 patients aged 50 or over with hypertension or diabetes who visited either CHCs or hospitals in these three cities were surveyed by using face-to-face interviews. Bivariate analyses were performed to compare quality and value of care indicators among subjects from the three cities. Multivariate analyses were used to assess the association between type of primary care delivery and quality as well as value of chronic care after controlling for patients' demographic and health status characteristics. Patients from all three cities chose their current health care providers primarily out of concern for quality of care (both provider expertise and adequate medical equipment), patient-centered care, and insurance plan requirement. Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators. Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics. The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity. However, coordination suffered due to seemingly duplicating primary care outpatients at the hospital setting. Significant associations between types of health care facilities and quality of care were also observed such that patients from CHCs were more likely to be satisfied with traveling time and follow-up care by

  9. [Health centers: history and future prospects.].

    Science.gov (United States)

    Colin, Marie-Pierre; Acker, Dominique

    2009-03-29

    Health houses and health centers are often hailed as specifically modern forms of medical practice in mobile healthcare provision. Yet the concept of health center emerged in the seventeenth century. The founding principles of these institutions were to promote access to good-quality universal healthcare and to practice a form of healthcare that treated patients in their globality (i.e. within their social and environmental context) based on public healthcare measures. Though they constitute a response to a specific healthcare project, healthcare centers face a number of specific difficulties that pose a challenge to their durability and development. Payment per consultation is ill-adapted to the remuneration of their services, and methods of remuneration that may be applicable to independent medical practitioners do not apply in the context of health centers, which may struggle to survive without the support of territorial collectivities (i.e. regional and local authorities) or associations. Health houses face similar difficulties in terms of their structural expenses. Expectations are high for trying out new methods of remuneration. The perspective and experience of healthcare centers will likely prove to be essential in this context. Their future needs to be envisaged alongside health houses and medical hubs. The growth of precarity and the increasing difficulties affecting access to healthcare provision need to be taken into account. The choice of the specific type of structure will depend on local realities, on the political will of regional authorities and on the specific projects of healthcare professionals. Yet whatever solution is envisaged, it will not be possible without public funding.

  10. 76 FR 1441 - Health Center Program

    Science.gov (United States)

    2011-01-10

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Health Center Program AGENCY: Health Resources and Services Administration, HHS. ACTION: Notice of Noncompetitive... for Services (IDS) and a portion of the Capital Improvement Project (CIP) from Saint Vincent's...

  11. Center for Maritime Safety and Health Studies

    Data.gov (United States)

    Federal Laboratory Consortium — Established in November 2015, the Center for Maritime Safety and Health Studies (CMSHS) promotes safety and health for all maritime workers, including those employed...

  12. Integrating community health workers into a patient-centered medical home to support disease self-management among Vietnamese Americans: lessons learned.

    Science.gov (United States)

    Wennerstrom, Ashley; Bui, Tap; Harden-Barrios, Jewel; Price-Haywood, Eboni G

    2015-01-01

    There is evidence that patient-centered medical homes (PCMHs) and community health workers (CHWs) improve chronic disease management. There are few models for integrating CHWs into PCMHs in order to enhance disease self-management support among diverse populations. In this article, we describe how a community-based nonprofit agency, a PCMH, and academic partners collaborated to develop and implement the Patient Resource and Education Program (PREP). We employed CHWs as PCMH care team members to provide health education and support to Vietnamese American patients with uncontrolled diabetes and/or hypertension. We began by conducting focus groups to assess patient knowledge, desire for support, and availability of community resources. Based on findings, we developed PREP with CHW guidance on cultural tailoring of educational materials and methods. CHWs received training in core competencies related to self-management support principles and conducted the 4-month intervention for PCMH patients. Throughout the program, we conducted process evaluation through structured team meetings and patient satisfaction surveys. We describe successes and challenges associated with PREP delivery including patient recruitment, structuring/documenting visits, and establishing effective care team integration, work flow, and communication. Strategies for mitigating these issues are presented, and we make recommendations for other PCMHs seeking to integrate CHWs into care teams. © 2014 Society for Public Health Education.

  13. Effect of a Patient-Centered Communication Intervention on Oncologist-Patient Communication, Quality of Life, and Health Care Utilization in Advanced Cancer

    Science.gov (United States)

    Epstein, Ronald M.; Duberstein, Paul R.; Fenton, Joshua J.; Fiscella, Kevin; Hoerger, Michael; Tancredi, Daniel J.; Xing, Guibo; Gramling, Robert; Mohile, Supriya; Franks, Peter; Kaesberg, Paul; Plumb, Sandy; Cipri, Camille S.; Street, Richard L.; Shields, Cleveland G.; Back, Anthony L.; Butow, Phyllis; Walczak, Adam; Tattersall, Martin; Venuti, Alison; Sullivan, Peter; Robinson, Mark; Hoh, Beth; Lewis, Linda; Kravitz, Richard L.

    2018-01-01

    IMPORTANCE Observational studies demonstrate links between patient-centered communication, quality of life (QOL), and aggressive treatments in advanced cancer, yet few randomized clinical trials (RCTs) of communication interventions have been reported. OBJECTIVE To determine whether a combined intervention involving oncologists, patients with advanced cancer, and caregivers would promote patient-centered communication, and to estimate intervention effects on shared understanding, patient-physician relationships, QOL, and aggressive treatments in the last 30 days of life. DESIGN, SETTING, AND PARTICIPANTS Cluster RCT at community- and hospital-based cancer clinics in Western New York and Northern California; 38 medical oncologists (mean age 44.6 years; 11 (29%) female) and 265 community-dwelling adult patients with advanced nonhematologic cancer participated (mean age, 64.4 years, 146 [55.0%] female, 235 [89%] white; enrolled August 2012 to June 2014; followed for 3 years); 194 patients had participating caregivers. INTERVENTIONS Oncologists received individualized communication training using standardized patient instructors while patients received question prompt lists and individualized communication coaching to identify issues to address during an upcoming oncologist visit. Both interventions focused on engaging patients in consultations, responding to emotions, informing patients about prognosis and treatment choices, and balanced framing of information. Control participants received no training. MAIN OUTCOMES AND MEASURES The prespecified primary outcome was a composite measure of patient-centered communication coded from audio recordings of the first oncologist visit following patient coaching (intervention group) or enrollment (control). Secondary outcomes included the patient-physician relationship, shared understanding of prognosis, QOL, and aggressive treatments and hospice use in the last 30 days of life. RESULTS Data from 38 oncologists (19 randomized

  14. A translation table for patient-centered comparative effectiveness research: guidance to improve the value of research for clinical and health policy decision-making.

    Science.gov (United States)

    Tunis, Sean R; Messner, Donna A; Mohr, Penny; Gliklich, Richard E; Dubois, Robert W

    2012-05-01

    This article provides background and context for a series of papers stemming from a collaborative effort by Outcome Sciences, Inc., the National Pharmaceutical Council and the Center for Medical Technology Policy to use a stakeholder-driven process to develop a decision tool to select appropriate methods for comparative effectiveness research. The perceived need and origins of the 'translation table' concept for method selection are described and the legislative history and role of the Patient-Centered Outcomes Research Institute are reviewed. The article concludes by stressing the significance of this effort for future health services and clinical research, and the importance of consulting end-users--patients, providers, payers and policy-makers--in the process of defining research questions and approaches to them.

  15. Patient-centered medical homes for patients with disabilities.

    Science.gov (United States)

    Hernandez, Brigida; Damiani, Marco; Wang, T Arthur; Driscoll, Carolyn; Dellabella, Peter; LePera, Nicole; Mentari, Michael

    2015-01-01

    The patient-centered medical home is an innovative approach to improve health care outcomes. To address the unique needs of patients with intellectual and developmental disabilities (IDDs), a large health care provider reevaluated the National Committee for Quality Assurance's 6 medical home standards: (a) enhance access and continuity, (b) identify and manage patient populations, (c) plan and manage care, (d) provide self-care and community support, (e) track and coordinate care, and (f) measure and improve performance. This article describes issues to consider when serving patients with IDDs.

  16. Academic health centers in competitive markets.

    Science.gov (United States)

    Reuter, J; Gaskin, D

    1997-01-01

    Academic health center (AHC) hospitals and other major teaching hospitals have funded a portion of their academic missions through patient care revenues. Using all-payer state discharge data, this DataWatch presents information on how these institutions are being affected by market changes. Although AHCs are not as successful as other hospitals are in attracting managed care patients, competitive pressures had not eroded AHCs' financial status as of 1994. However, increasing enrollment in managed care and potential changes in both Medicare and Medicaid suggest that pressure on the financing of these institutions' social missions will continue to grow over time.

  17. A Qualitative Study of Factors That Influence Contraceptive Choice among Adolescent School-Based Health Center Patients.

    Science.gov (United States)

    Hoopes, Andrea J; Gilmore, Kelly; Cady, Janet; Akers, Aletha Y; Ahrens, Kym R

    2016-06-01

    Long-acting reversible contraceptive (LARC) methods can prevent teen pregnancy yet remain underutilized by adolescents in the United States. Pediatric providers are well positioned to discuss LARCs with adolescents, but little is known about how counseling should occur in pediatric primary care settings. We explored adolescent womens' attitudes and experiences with LARCs to inform the development of adolescent-centered LARC counseling strategies. Qualitative analysis of one-on-one interviews. Participants were recruited from 2 urban school-based, primary care centers. Thirty adolescent women aged 14-18 years, diverse in race/ethnicity, and sexual experience. Interviews were audio-recorded, transcribed, and coded using inductive and deductive coding. Major themes were identified to integrate LARC-specific adolescent preferences into existing counseling approaches. Participants (mean age, 16.2 years; range, 14-18 years) represented a diverse range of racial and/or ethnic identities. Half (15/30) were sexually active and 17% (5/30) reported current or past LARC use. Five themes emerged regarding key factors that influence LARC choice, including: (1) strong preferences about device-specific characteristics; (2) previous exposure to information about LARCs from peers, family members, or health counseling sessions; (3) knowledge gaps about LARC methods that affect informed decision-making; (4) personal circumstances or experiences that motivate a desire for effective and/or long-acting contraception; and (5) environmental constraints and supports that might influence adolescent access to LARCs. We identified 5 factors that influence LARC choice among adolescent women and propose a framework for incorporating these factors into contraceptive counseling services in pediatric primary care settings. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  18. Patient Experience Assessment is a Requisite for Quality Evaluation: A Discussion of the In-Center Hemodialysis Consumer Assessment of Health Care Providers and Systems (ICH CAHPS) Survey.

    Science.gov (United States)

    Cavanaugh, Kerri L

    2016-01-01

    Patient experience surveys provide a critical and unique perspective on the quality of patient-centered healthcare delivery. These surveys provide a mechanism to systematically express patients' voice on topics valued by patients to make decisions about choices in care. They also provide an assessment to healthcare organizations about their service that cannot be obtained from any other source. Regulatory agencies have mandated the assessment of patients' experience as part of healthcare value based purchasing programs and weighted the results to account for up to 30% of the total scoring. This is a testimony to the accepted importance of this metric as a fundamental assessment of quality. After more than a decade of rigorous research, there is a significant body of growing evidence supporting specifically the validity and use of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, including a version specific to in-center hemodialysis (ICH CAHPS). This review will focus on the ICH CAHPS survey including a review of its development, content, administration, and also a discussion of common criticisms. Although it is suggested that the survey assesses activities and experiences that are not modifiable by the healthcare organization (or the dialysis facility in our case) emerging evidence suggests otherwise. Dialysis providers have an exclusive opportunity to lead the advancement of understanding the implications and serviceability of the evaluation of the patient experience in health care. © 2016 Wiley Periodicals, Inc.

  19. Do Ask, Do Tell: High Levels of Acceptability by Patients of Routine Collection of Sexual Orientation and Gender Identity Data in Four Diverse American Community Health Centers

    Science.gov (United States)

    Cahill, Sean; Singal, Robbie; Grasso, Chris; King, Dana; Mayer, Kenneth; Baker, Kellan; Makadon, Harvey

    2014-01-01

    Background The Institute of Medicine and The Joint Commission have recommended asking sexual orientation and gender identity (SOGI) questions in clinical settings and including such data in Electronic Health Records (EHRs). This is increasingly viewed as a critical step toward systematically documenting and addressing health disparities affecting lesbian, gay, bisexual, and transgender (LGBT) people. The U.S. government is currently considering whether to include SOGI data collection in the Stage 3 guidelines for the incentive program promoting meaningful use of EHR. However, some have questioned whether acceptable standard measures to collect SOGI data in clinical settings exist. Methods In order to better understand how a diverse group of patients would respond if SOGI questions were asked in primary care settings, 301 randomly selected patients receiving primary care at four health centers across the U.S. were asked SOGI questions and then asked follow-up questions. This sample was mainly heterosexual, racially diverse, and geographically and regionally broad. Results There was a strong consensus among patients surveyed about the importance of asking SOGI questions. Most of the LGBT respondents thought that the questions presented on the survey allowed them to accurately document their SOGI. Most respondents—heterosexual and LGBT—answered the questions, and said that they would answer such questions in the future. While there were some age-related differences, respondents of all ages overwhelmingly expressed support for asking SOGI questions and understood the importance of providers' knowing their patients' SOGI. Conclusions Given current deliberations within national health care regulatory bodies and the government's increased attention to LGBT health disparities, the finding that patients can and will answer SOGI questions has important implications for public policy. This study provides evidence that integrating SOGI data collection into the meaningful

  20. Epidemiologic Features and Prognosis of Patients Who Was Diagnosed Having Type 2 Diabetes Mellitus and Applied to a Community Health Center

    Directory of Open Access Journals (Sweden)

    Sevilay Hindistan

    2009-08-01

    Full Text Available AIM: The study was designed to investigate the prognosis and the epidemiologic features of people who was diagnosed having type 2 DM and Applied to the Community Health Center. METHOD: This study which was carried out at Catak Health Branch of Trabzon Erdogdu Health Center in April, May, and June in 2008 is a descriptive and cross-sectional field study. All of the patients with Type 2 DM diagnosis who came to the Health Center for routine control (55 people were involved in the study. The aim of the study was explained to each participant in the study and their oral consent was taken. As the data collection instrument, diabetes surveillance form which includes of socio-demographic features, risk factors, blood sugar diagnosis criteria, body mass index, chronic complications and foot examination was used. Diabetes surveillance form was shaped by modifying the diabetes diagnosis form which was structured by Erdogan and Nahcivan (1999. The data obtained were evaluated through number and percentage distribution, mean, chi square test, correlation and variant analyses techniques. RESULTS: Age mean of the patients was 59.4±10.7 and 85.5% of them was female. Average diagnosis age was 53.2±12.5, average diabetes year was 6,6±6,6. 45.5% of the patients were obese, 12.7% of them morbid obese and diabetes history in the family was about 54.5%. It was found that 56.3% patients had blood glucose level was 140 mg/dl and 54.5% of the patients’ HbA1c level were higher than 7%. When lipid parameter levels of the patients were examined, it was seen that HDL cholesterol level was (E<35,K<45 for 52.7% of the patients and that was lower than the target treatment level; LDL cholesterol level was 100mg/dl for 76.4%; and total cholesterol level was higher than 200 mg/dl 49.1% of the patients. A statistically significant positive correlation was found between diabetes year of the patients and HbA1c level (r=0.291, p=0.031. 8.6 had % neuropathy, 1.7% of them had

  1. Defining the medical imaging requirements for a rural health center

    CERN Document Server

    2017-01-01

    This book establishes the criteria for the type of medical imaging services that should be made available to rural health centers, providing professional rural hospital managers with information that makes their work more effective and efficient. It also offers valuable insights into government, non-governmental and religious organizations involved in the planning, establishment and operation of medical facilities in rural areas. Rural health centers are established to prevent patients from being forced to travel to distant urban medical facilities. To manage patients properly, rural health centers should be part of regional and more complete systems of medical health care installations in the country on the basis of a referral and counter-referral program, and thus, they should have the infrastructure needed to transport patients to urban hospitals when they need more complex health care. The coordination of all the activities is only possible if rural health centers are led by strong and dedicated managers....

  2. Nursing perception of the impact of automated dispensing cabinets on patient safety and ergonomics in a teaching health care center.

    Science.gov (United States)

    Rochais, Elise; Atkinson, Suzanne; Guilbeault, Mélanie; Bussières, Jean-François

    2014-04-01

    To evaluate how nursing staff felt about the impact of automated dispensing cabinets (ADCs) on the safe delivery of health care and workplace ergonomics. To identify the main issues involved in the use of this technology and to describe the corrective measures implemented. Cross-sectional descriptive study with quantitative and qualitative components. A questionnaire that consisted of 33 statements about ADC was distributed from May 24 to June 3, 2011. A total of 172 (46%) of 375 nurses completed the questionnaire. Nursing staff considered the introduction of ADC made their work easier (level of agreement of 90%), helped to safely provide patients with care (91%), and helped to reduce medication incidents/accidents (81%). Nursing staff was particularly satisfied by the narcotic drugs management with the ADCs. Nursing staff were not satisfied with the additional delays in the preparation and administration of a medication dose and the inability to prevent a medication from being administered when stopped on the medication administration record (48%). The nursing staff members were satisfied with the use of ADC and believed it made their work easier, promoted safe patient care, and were perceived to reduce medication incidents/accidents.

  3. Association of perceived neighborhood characteristics, socioeconomic status and rural residency with health outcomes in Egyptian patients with systemic lupus erythematosus: one center study.

    Science.gov (United States)

    Abdul-Sattar, Amal B; Abou El Magd, Sahar

    2017-12-01

    To investigate the role of perceived neighborhood characteristics, socioeconomic status (SES) and rural residency in influencing the health status outcome of Egyptian patients with systemic lupus erythematosus (SLE). Eighty patients affected with SLE were consecutively included in this a single-center cross-sectional study from July, 2011 to July, 2013. Outcome measures included the Systemic Lupus Activity Questionnaire (SLAQ) score, the Medical Outcomes Study Short Form-36 Health Survey physical functioning score and Center for Epidemiologic Studies-Depression (CES-D score of ≥ 19 points). Multivariate logistic regression analyses were conducted. Results from multivariate logistic regression analyses, a separate adjusted model of each perceived neighborhood characteristic, indicate associations of worse perceived social cohesion with higher SLAQ scores (P socioeconomic status and rural residency with health status outcomes, the results found association of poor socioeconomic status with the three health status outcome measures and association between rural residency and depression symptoms. Individuals had increased odds of depressive symptoms if they perceived worse neighborhood social cohesion (odds ratio [OR]: 2.14; CI: 1.42-2.80), if they perceived worse neighborhood safety (OR: 1.64; CI: 1.02-2.40) and if they perceived worse neighborhood aesthetic characteristics (OR: 2.79; CI: 1.84-3.38). Study findings indicate that poor socioeconomic status, rural residency and perceived neighborhood characteristics are associated with depression; worse perceived neighborhood aesthetics and safety are associated with lower SF-36 physical functioning, and worse neighborhood social cohesion is associated with higher disease activity among patients with SLE. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  4. Contributions of COPD, asthma, and ten comorbid conditions to health care utilization and patient-centered outcomes among US adults with obstructive airway disease

    Directory of Open Access Journals (Sweden)

    Murphy TE

    2017-08-01

    Full Text Available Terrence E Murphy,1 Gail J McAvay,1 Heather G Allore,1 Jason A Stamm,2 Paul F Simonelli2 1Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA; 2Department of Internal Medicine, Section of Thoracic Medicine, Geisinger Medical Center, Danville, PA, USA Background: Among persons with obstructive airway disease, the relative contributions of chronic obstructive pulmonary disease (COPD, asthma, and common comorbid conditions to health care utilization and patient-centered outcomes (PCOs have not been previously reported.Methods: We followed a total of 3,486 persons aged ≥40 years with COPD, asthma, or both at baseline, from the Medical Expenditure Panel Survey (MEPS cohorts enrolled annually from 2008 through 2012 for 1 year. MEPS is a prospective observational study of US households recording self-reported COPD, asthma, and ten medical conditions: angina, arthritis, cancer, coronary heart disease, cognitive impairment, diabetes, hypertension, lung cancer, myocardial infarction, and stroke/transient ischemic attack. We studied the separate contributions of these conditions to health care utilization (all-cause and respiratory disease hospitalization, any emergency department [ED] visit, and six or more outpatient visits and PCOs (seven or more days spent in bed due to illness, incident loss of mobility, and incident decline in self-perceived health.Results: COPD made the largest contributions to all-cause and respiratory disease hospitalization and ED visits, while arthritis made the largest contribution to outpatient health care. Arthritis and COPD, respectively, made the greatest contributions to the PCOs.Conclusion: COPD made the largest and second largest contributions to health care utilization and PCOs among US adults with obstructive airway disease. The twelve medical conditions collectively accounted for between 52% and 61% of the health care utilization outcomes and between 53

  5. Early predictors of health-related quality of life outcomes in polytrauma patients with spine injuries: a level 1 trauma center study.

    Science.gov (United States)

    Tee, J W; Chan, C H P; Gruen, R L; Fitzgerald, M C B; Liew, S M; Cameron, P A; Rosenfeld, J V

    2014-02-01

    Study Design Retrospective review on clinical-quality trauma registry prospective data. Objective To identify early predictors of suboptimal health status in polytrauma patients with spine injuries. Methods A retrospective review on a prospective cohort was performed on spine-injured polytrauma patients with successful discharge from May 2009 to January 2011. The Short Form 12-Questionnaire Health Survey (SF-12) was used in the health status assessment of these patients. Univariate and multivariate logistic regression models were applied to investigate the effects of the Injury Severity Score, age, blood sugar level, vital signs, brain trauma severity, comorbidities, coagulation profile, spine trauma-related neurologic status, and spine injury characteristics of the patients. Results The SF-12 had a 52.3% completion rate from 915 patients. The patients who completed the SF-12 were younger, and there were fewer patients with severe spinal cord injuries (American Spinal Injury Association classifications A, B, and C). Other comparison parameters were satisfactorily matched. Multivariate logistic regression revealed five early predictive factors with statistical significance (p ≤ 0.05). They were (1) tachycardia (odds ratio [OR] = 1.88; confidence interval [CI] = 1.11 to 3.19), (2) hyperglycemia (OR = 2.65; CI = 1.51 to 4.65), (3) multiple chronic comorbidities (OR = 2.98; CI = 1.68 to 5.26), and (4) thoracic spine injuries (OR = 1.54; CI = 1.01 to 2.37). There were no independent early predictive factors identified for suboptimal mental health-related qualify of life outcomes. Conclusion Early independent risk factors predictive of suboptimal physical health status identified in a level 1 trauma center in polytrauma patients with spine injuries were tachycardia, hyperglycemia, multiple chronic medical comorbidities, and thoracic spine injuries. Early spine trauma risk factors were shown not to predict suboptimal mental

  6. Telltale signs of patient-centered diagnosis.

    Science.gov (United States)

    Millenson, Michael L

    2014-01-01

    A best-selling book from the mid-1980s was entitled, All I Really Need to Know I Learned in Kindergarten. Some doctors may similarly feel that well-worn epigrams from Hippocrates, Osler and others have told them all they really need to know about patient-centered care. The problem is that aphorisms and action are not one and the same. The workup for patient-centered diagnosis takes work, and there are telltale signs along the way. Effective patient engagement requires training and practice. It means incorporating patient-generated data into the diagnostic process. And it means being sensitive to new economic constraints on patients. Ensuring that diagnostic processes and decisions meet the test of patient-centeredness poses a challenge. The new criteria do not replace the professional obligation of beneficence; rather they add an additional obligation of power sharing. While that is neither simple nor easy, it promises better care for patients, a more satisfying clinical encounter and a better health care system for all.

  7. 75 FR 2549 - Health Center Program

    Science.gov (United States)

    2010-01-15

    ... Program AGENCY: Health Resources and Services Administration, HHS ACTION: Notice of Noncompetitive Replacement Award to Regional Health Care Affiliates. SUMMARY: The Health Resources and Services Administration (HRSA) will be transferring Health Center Program (section 330 of the Public Health Service Act...

  8. Patterns of care in patients with cervical cancer 2012. Results of a survey among German radiotherapy departments and out-patient health care centers

    Energy Technology Data Exchange (ETDEWEB)

    Marnitz, S.; Rauer, A.; Budach, V. [Charite Universitaetsmedizin, Department of Radiooncology, Berlin (Germany); Koehler, C.; Schneider, A.; Mangler, M. [Charite Universitaetsmedizin, Department of Gynecology, Berlin (Germany); Tsunoda, A. [Barretos Cancer Centre, Department of Gynecologic Oncology, Barretos (Brazil)

    2014-01-15

    Platinum-based primary or adjuvant chemoradiation is the treatment of choice for patients with cervical cancer. However, despite national guidelines and international recommendations, many aspects in diagnosis, therapy, and follow-up of patients with cervical cancer are not based on valid data. To evaluate the current patterns of care for patients with cervical cancer in Germany, a questionnaire with 25 items was sent to 281 radiooncologic departments and out-patient health care centers. The response rate was 51 %. While 87 % of institutions treat 0-25 patients/year, 12 % treat between 26 and 50 and only 1 % treat more than 50 patients/year. In 2011, the stage distribution of 1,706 treated cervical cancers were IB1, IB2, IIA, IIB, IIIA/IIIB, and IV in 11, 12, 11, 22, 28, and 16 %, respectively. CT (90 %) and MRI (86 %) are mainly used as staging procedures in contrast to PET-CT with 14 %. Interestingly, 27 % of institutions advocate surgical staging prior to chemoradiation. In the majority of departments 3D-based (70 %) and intensity-modulated radiotherapy (76 %) are used for percutaneous radiation, less frequently volumetric arc techniques (26 %). Nearly all colleagues (99.3 %) apply conventional fractioning of 1.8-2 Gy for external-beam radiotherapy, in 19 % combined with a simultaneous integrated boost. Cisplatinum mono is used as a radiosensitizer with 40 mg/m{sup 2} weekly by 90 % of radiooncologists. For boost application in the primary treatment, HDR (high-dose rate) brachytherapy is the dominant technique (84 %). In patients after radical hysterectomy pT1B1/1B2, node negative and resection in sound margins adjuvant chemoradiation is applied due to the occurrence of 1-4 other risk factors in 16-97 %. There is a broad spectrum of recommended primary treatment strategies in stages IIB and IVA. Results of the survey underline the leading role but also differences in the use of chemoradiation in the treatment of cervical cancer patients in Germany. (orig

  9. Malaria helminth co-infections and their contribution for aneamia in febrile patients attending Azzezo health center, Gondar, Northwest Ethiopia: a cross sectional study.

    Science.gov (United States)

    Alemu, Abebe; Shiferaw, Yitayal; Ambachew, Aklilu; Hamid, Halima

    2012-10-01

    To assess the prevalence of malaria helminth co-infections and their contribution for aneamia in febrile patients attending Azzezo health center, Gondar, Northwest Ethiopia. A cross section study was conducted among febrile patients attending Azezo health center from February-March 30, 2011. Convenient sampling technique was used to select 384 individuals. Both capillary blood and stool were collected. Giemsa stained thick and thin blood film were prepared for identification of Plasmodium species and stool sample was examined by direct wet mount and formalin-ether concentration technique for detection of intestinal helminthes parasites. Haemoglobin concentration was determined using a portable haemoglobin spectrophotometer, Hemocue Hb 201 analyzer. Out of 384 febrile patients examined for malaria parasites, 44 (11.5%) individuals were positive for malaria parasites, of which Plasmodium vivax accounted for 75.0% (33), Plasmodium falciparum for 20.5% (9) infectious, whereas two person (4.5%) had mixed species infection. Prevalence of malaria was higher in males (28) when compared with prevalence in females (16). More than half (207, 53.9%) of study participants had one or more infection. Prevalence was slightly higher in females (109, 52.7%) than in males (98, 47.3%). About helminths, Ascaris lumbricoides was the predominant isolate (62.1%) followed by hookworms (18.4%). Only 22 participants were co-infected with malaria parasite and helminths and co-infection with Ascaris lumbricoides was predominant (45.0%). The prevalence of anemia was 10.9% and co-infection with Plasmodium and helminth parasites was significantly associated with (Pparasitic infections is very crucial to improve health of the affected communities in economically developing countries. Copyright © 2012 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

  10. Health Social Media and Patient-Centered Care: Buzz or Evidence? Findings from the Section "Education and Consumer Health Informatics" of the 2015 Edition of the IMIA Yearbook.

    Science.gov (United States)

    Staccini, P; Fernandez-Luque, L

    2015-08-13

    To summarize the 2014 state of the art in the areas related to consumer health informatics and social media. We conducted a systematic review of articles published in 2014 in PubMed with a predefined set of queries. We identified 439 articles relevant for the review. The two section editors independently screened those papers taking into account their relevance to the topics covered by the section. In a second step, they jointly selected the 20 most representative papers as candidate best papers. Candidate best papers were then submitted for full review and scoring by external reviewers. Based on the scoring, section editors together with the IMIA Yearbook editorial board selected the four best papers published in 2014 in consumer health informatics. Helping patients acquire a healthier lifestyle is a crucial part of patient empowerment. In this line of work, new studies are exploring the efficacy of online health interventions for patient behavioral change. The special case of smoking cessation for consumers with low socio-economic status is particularly noticeable. Another study has explored how an online intervention can reduce the anxiety of women who experience an abnormal mammography. The team of PatientsLikeMe has studied how online support groups could play a role in the quality of life of organ transplant recipients. The patient perspective of online forums' users is also analyzed in the domain of anticoagulation therapy. Online health interventions, many of them using social media, have confirmed their potential to impact consumer behavioral change. However, there are still many methodological issues that need to be addressed in order to prove cost-effectiveness.

  11. National Center for Environmental Health

    Science.gov (United States)

    ... R S T U V W X Y Z # Environmental Health Topics Emergency and Environmental Health Services Chemical Weapons Elimination Environmental Health Services Healthy Homes Healthy Places – Community ...

  12. Integrative medicine and patient-centered care.

    Science.gov (United States)

    Maizes, Victoria; Rakel, David; Niemiec, Catherine

    2009-01-01

    Integrative medicine has emerged as a potential solution to the American healthcare crisis. It provides care that is patient centered, healing oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches originating from conventional and alternative medicine. Initially driven by consumer demand, the attention integrative medicine places on understanding whole persons and assisting with lifestyle change is now being recognized as a strategy to address the epidemic of chronic diseases bankrupting our economy. This paper defines integrative medicine and its principles, describes the history of complementary and alternative medicine (CAM) in American healthcare, and discusses the current state and desired future of integrative medical practice. The importance of patient-centered care, patient empowerment, behavior change, continuity of care, outcomes research, and the challenges to successful integration are discussed. The authors suggest a model for an integrative healthcare system grounded in team-based care. A primary health partner who knows the patient well, is able to addresses mind, body, and spiritual needs, and coordinates care with the help of a team of practitioners is at the centerpiece. Collectively, the team can meet all the health needs of the particular patient and forms the patient-centered medical home. The paper culminates with 10 recommendations directed to key actors to facilitate the systemic changes needed for a functional healthcare delivery system. Recommendations include creating financial incentives aligned with health promotion and prevention. Insurers are requested to consider the total costs of care, the potential cost effectiveness of lifestyle approaches and CAM modalities, and the value of longer office visits to develop a therapeutic relationship and stimulate behavioral change. Outcomes research to track the effectiveness of integrative models must be funded, as well as feedback and dissemination strategies

  13. 75 FR 48853 - National Health Center Week, 2010

    Science.gov (United States)

    2010-08-11

    ... communities by conducting outreach and education, ensuring patients can communicate with their providers, and... information technology systems, and meet their critical care needs. The reforms in the landmark new health.... Community health centers are at the heart of a modern, reformed health care system in America. We must...

  14. Achieving excellence in community health centers: implications for health reform.

    Science.gov (United States)

    Gurewich, Deborah; Capitman, John; Sirkin, Jenna; Traje, Diana

    2012-02-01

    Existing studies tell us little about care quality variation within the community health center (CHC) delivery system. They also tell us little about the organizational conditions associated with CHCs that deliver especially high quality care. The purpose of this study was to examine the operational practices associated with a sample of high performing CHCs. Qualitative case studies of eight CHCs identified as delivering high-quality care relative to other CHCs were used to examine operational practices, including systems to facilitate care access, manage patient care, and monitor performance. Four common themes emerged that may contribute to high performance. At the same time, important differences across health centers were observed, reflecting differences in local environments and CHC capacity. In the development of effective, community-based models of care, adapting care standards to meet the needs of local conditions may be important.

  15. Electronic health record training in undergraduate medical education: bridging theory to practice with curricula for empowering patient- and relationship-centered care in the computerized setting.

    Science.gov (United States)

    Wald, Hedy S; George, Paul; Reis, Shmuel P; Taylor, Julie Scott

    2014-03-01

    While electronic health record (EHR) use is becoming state-of-the-art, deliberate teaching of health care information technology (HCIT) competencies is not keeping pace with burgeoning use. Medical students require training to become skilled users of HCIT, but formal pedagogy within undergraduate medical education (UME) is sparse. How can medical educators best meet the needs of learners while integrating EHRs into medical education and practice? How can they help learners preserve and foster effective communication skills within the computerized setting? In general, how can UME curricula be devised for skilled use of EHRs to enhance rather than hinder provision of effective, humanistic health care?Within this Perspective, the authors build on recent publications that "set the stage" for next steps: EHR curricula innovation and implementation as concrete embodiments of theoretical underpinnings. They elaborate on previous calls for maximizing benefits and minimizing risks of EHR use with sufficient focus on physician-patient communication skills and for developing core competencies within medical education. The authors describe bridging theory into practice with systematic longitudinal curriculum development for EHR training in UME at their institution, informed by Kern and colleagues' curriculum development framework, narrative medicine, and reflective practice. They consider this innovation within a broader perspective-the overarching goal of empowering undergraduate medical students' patient- and relationship-centered skills while effectively demonstrating HCIT-related skills.

  16. Prevalence of Sexual Violence and its Association with Depression among Male and Female Patients with Risky Drug Use in Urban Federally Qualified Health Centers.

    Science.gov (United States)

    Bone, Curtis W; Goodfellow, Amelia M; Vahidi, Mani; Gelberg, Lillian

    2018-02-01

    Sexual violence (SV) is common; however, the prevalence of SV and its long term sequela vary geographically and among subpopulations within the USA. As such, the aims of this study are the following: (1) to determine the prevalence of SV, (2) to identify correlates of SV, and (3) to determine if SV is associated with depression among male and female risky drug users in urban Federally Qualified Health Centers (FQHCs) in Los Angeles. This study includes adult patients of five urban FQHCs who self-reported risky drug use. We identified survivors of SV and those experiencing depression through survey questions that queried, before or after age 18, "Were you ever sexually assaulted, molested or raped?" and with the RAND Mental Health Index (MHI-5). We utilized Pearson's chi-square tests to assess predictors of SV and logistic regression to assess for an association between SV and depression. Data collection took place from February 2011 to November 2012. Of the 334 study patients, 49% of females and 25% of males reported surviving SV. Exposure to SV, (both before 18 years of age and after 18 years of age) was the strongest predictor of depression among men and women in this study (OR 4.7, p < 0.05). These data demonstrate that sexual violence is prevalent in this urban FQHC population and is strongly associated with depression. Providers should consider screening both men and women with risky drug use for SV while health systems should continue to align mental health and primary care services to appropriately care for these extremely vulnerable patients. Trial Registration Clinical Trials. gov ID NCT01942876, Protocol ID DESPR DA022445, http://www.clinicaltrials.gov.

  17. CMS Innovation Center Health Care Innovation Awards

    Science.gov (United States)

    Berry, Sandra H.; Concannon, Thomas W.; Morganti, Kristy Gonzalez; Auerbach, David I.; Beckett, Megan K.; Chen, Peggy G.; Farley, Donna O.; Han, Bing; Harris, Katherine M.; Jones, Spencer S.; Liu, Hangsheng; Lovejoy, Susan L.; Marsh, Terry; Martsolf, Grant R.; Nelson, Christopher; Okeke, Edward N.; Pearson, Marjorie L.; Pillemer, Francesca; Sorbero, Melony E.; Towe, Vivian; Weinick, Robin M.

    2013-01-01

    Abstract The Center for Medicare and Medicaid Innovation within the Centers for Medicare & Medicaid Services (CMS) has funded 108 Health Care Innovation Awards, funded through the Affordable Care Act, for applicants who proposed compelling new models of service delivery or payment improvements that promise to deliver better health, better health care, and lower costs through improved quality of care for Medicare, Medicaid, and Children's Health Insurance Program enrollees. CMS is also interested in learning how new models would affect subpopulations of beneficiaries (e.g., those eligible for Medicare and Medicaid and complex patients) who have unique characteristics or health care needs that could be related to poor outcomes. In addition, the initiative seeks to identify new models of workforce development and deployment, as well as models that can be rapidly deployed and have the promise of sustainability. This article describes a strategy for evaluating the results. The goal for the evaluation design process is to create standardized approaches for answering key questions that can be customized to similar groups of awardees and that allow for rapid and comparable assessment across awardees. The evaluation plan envisions that data collection and analysis will be carried out on three levels: at the level of the individual awardee, at the level of the awardee grouping, and as a summary evaluation that includes all awardees. Key dimensions for the evaluation framework include implementation effectiveness, program effectiveness, workforce issues, impact on priority populations, and context. The ultimate goal is to identify strategies that can be employed widely to lower cost while improving care. PMID:28083297

  18. Medical Waste Management in Community Health Centers.

    Science.gov (United States)

    Tabrizi, Jafar Sadegh; Rezapour, Ramin; Saadati, Mohammad; Seifi, Samira; Amini, Behnam; Varmazyar, Farahnaz

    2018-02-01

    Non-standard management of medical waste leads to irreparable side effects. This issue is of double importance in health care centers in a city which are the most extensive system for providing Primary Health Care (PHC) across Iran cities. This study investigated the medical waste management standards observation in Tabriz community health care centers, northwestern Iran. In this triangulated cross-sectional study (qualitative-quantitative), data collecting tool was a valid checklist of waste management process developed based on Iranian medical waste management standards. The data were collected in 2015 through process observation and interviews with the health center's staff. The average rate of waste management standards observance in Tabriz community health centers, Tabriz, Iran was 29.8%. This case was 22.8% in dimension of management and training, 27.3% in separating and collecting, 31.2% in transport and temporary storage, and 42.9% in sterilization and disposal. Lack of principal separation of wastes, inappropriate collecting and disposal cycle of waste and disregarding safety tips (fertilizer device performance monitoring, microbial cultures and so on) were among the observed defects in health care centers supported by quantitative data. Medical waste management was not in a desirable situation in Tabriz community health centers. The expansion of community health centers in different regions and non-observance of standards could predispose to incidence the risks resulted from medical wastes. So it is necessary to adopt appropriate policies to promote waste management situation.

  19. Planning for the Mercy Center for Breast Health.

    Science.gov (United States)

    Olivares, V Ed

    2002-01-01

    During the last months of 2000, administrators at the Mercy San Juan Medical Center in Carmichael, Calif., convened a steering committee to plan the Mercy Center for Breast Health. The Steering Committee was composed of the director of ancillary and support services, the oncology clinical nurse specialist, the RN manager of the oncology nursing unit, the RN surgery center manager, and me, the manager of imaging services. The committee was responsible for creating a new business with five specific objectives: to position the Center as a comprehensive diagnostic and resource center for women; to generate physician referrals to the Breast Center through various vehicles; to create awareness of the Breast Center's capabilities among area radiologists; to create awareness of the Breast Center among employees of six sister facilities; to create "brand awareness" for the Mercy Center for Breast Health among referring physicians and patients who could use competing centers in the area. The Steering Committee's charter was to design a center with a feminine touch and ambience and to provide a "one-stop shopping" experience for patients. A major component of the Breast Center is the Dianne Haselwood Resource Center, which provides patients with educational support and information. The Steering Committee brought its diverse experience and interests to bear on arranging for equipment acquisition, information and clerical systems, staffing, clinic office design, patient care and marketing. Planning the Mercy Center for Breast Health has been a positive challenge that brought together many elements of the organization and people from different departments and specialties to create a new business venture. Our charge now is to grow and to live up to our vision of offering complete breast diagnostic, education and support services in one location.

  20. Mortality predictors of HIV-infected patients on antiretroviral therapy in Debre Tabor General Hospital and Woreta Health Center, South Gondar Zone, Northwest Ethiopia

    Directory of Open Access Journals (Sweden)

    Mekonnen Assefa Ahunie

    2017-02-01

    Full Text Available Objective: To investigate the mortality predictors of HIV-infected individuals who were receiving antiretroviral treatment. Methods: Data were extracted from medical records of 698 antiretroviral therapy (ART users enrolled at Debre Tabor General Hospital and Woreta Health Center from January 2005 to June 2014 and sociodemographic, clinical and ART-related data were collected. Mortality was compared by using time-to-event Kaplan-Meier method and log rank test and Cox regression analysis were used to identify the predictors of mortality. Results: The overall mortality rate was 1.5 per 100 persons per year. Ambulatory and bedridden patients had four- and seven-fold higher risk of death [adjusted hazard ratio (HR = 4.2, 95% confidence interval (CI: 1.7–10.7 and adjusted HR = 6.5, 95% CI: 2.0–20.7, respectively] as compared to those patients who had worked functional status. Patients who had poor antiretroviral drug adherence had five times higher risk of death (adjusted HR = 5.1, 95% CI: 1.6–16.3 than patients who had good antiretroviral adherence. Conclusions: Mortality rate was highly observed in the early phase of antiretroviral treatment. Poor ART adherence, being ambulatory and bedridden functional status was independent predictors of mortality.

  1. Contributions of COPD, asthma, and ten comorbid conditions to health care utilization and patient-centered outcomes among US adults with obstructive airway disease.

    Science.gov (United States)

    Murphy, Terrence E; McAvay, Gail J; Allore, Heather G; Stamm, Jason A; Simonelli, Paul F

    2017-01-01

    Among persons with obstructive airway disease, the relative contributions of chronic obstructive pulmonary disease (COPD), asthma, and common comorbid conditions to health care utilization and patient-centered outcomes (PCOs) have not been previously reported. We followed a total of 3,486 persons aged ≥40 years with COPD, asthma, or both at baseline, from the Medical Expenditure Panel Survey (MEPS) cohorts enrolled annually from 2008 through 2012 for 1 year. MEPS is a prospective observational study of US households recording self-reported COPD, asthma, and ten medical conditions: angina, arthritis, cancer, coronary heart disease, cognitive impairment, diabetes, hypertension, lung cancer, myocardial infarction, and stroke/transient ischemic attack. We studied the separate contributions of these conditions to health care utilization (all-cause and respiratory disease hospitalization, any emergency department [ED] visit, and six or more outpatient visits) and PCOs (seven or more days spent in bed due to illness, incident loss of mobility, and incident decline in self-perceived health). COPD made the largest contributions to all-cause and respiratory disease hospitalization and ED visits, while arthritis made the largest contribution to outpatient health care. Arthritis and COPD, respectively, made the greatest contributions to the PCOs. COPD made the largest and second largest contributions to health care utilization and PCOs among US adults with obstructive airway disease. The twelve medical conditions collectively accounted for between 52% and 61% of the health care utilization outcomes and between 53% and 68% of the PCOs. Cognitive impairment, diabetes, hypertension, and stroke also made significant contributions.

  2. Indoor Temperatures in Patient Waiting Rooms in Eight Rural Primary Health Care Centers in Northern South Africa and the Related Potential Risks to Human Health and Wellbeing

    Directory of Open Access Journals (Sweden)

    Caradee Y. Wright

    2017-01-01

    Full Text Available Increased temperatures affect human health and vulnerable groups including infants, children, the elderly and people with pre-existing diseases. In the southern African region climate models predict increases in ambient temperature twice that of the global average temperature increase. Poor ventilation and lack of air conditioning in primary health care clinics, where duration of waiting time may be as long as several hours, pose a possible threat to patients seeking primary health care. Drawing on information measured by temperature loggers installed in eight clinics in Giyani, Limpopo Province of South Africa, we were able to determine indoor temperatures of waiting rooms in eight rural primary health care facilities. Mean monthly temperature measurements inside the clinics were warmer during the summer months of December, January and February, and cooler during the autumn months of March, April and May. The highest mean monthly temperature of 31.4 ± 2.7 °C was recorded in one clinic during February 2016. Maximum daily indoor clinic temperatures exceeded 38 °C in some clinics. Indoor temperatures were compared to ambient (outdoor temperatures and the mean difference between the two showed clinic waiting room temperatures were higher by 2–4 °C on average. Apparent temperature (AT incorporating relative humidity readings made in the clinics showed ‘realfeel’ temperatures were >4 °C higher than measured indoor temperature, suggesting a feeling of ‘stuffiness’ and discomfort may have been experienced in the waiting room areas. During typical clinic operational hours of 8h00 to 16h00, mean ATs fell into temperature ranges associated with heat–health impact warning categories of ‘caution’ and ‘extreme caution’.

  3. Indoor Temperatures in Patient Waiting Rooms in Eight Rural Primary Health Care Centers in Northern South Africa and the Related Potential Risks to Human Health and Wellbeing.

    Science.gov (United States)

    Wright, Caradee Y; Street, Renée A; Cele, Nokulunga; Kunene, Zamantimande; Balakrishna, Yusentha; Albers, Patricia N; Mathee, Angela

    2017-01-06

    Increased temperatures affect human health and vulnerable groups including infants, children, the elderly and people with pre-existing diseases. In the southern African region climate models predict increases in ambient temperature twice that of the global average temperature increase. Poor ventilation and lack of air conditioning in primary health care clinics, where duration of waiting time may be as long as several hours, pose a possible threat to patients seeking primary health care. Drawing on information measured by temperature loggers installed in eight clinics in Giyani, Limpopo Province of South Africa, we were able to determine indoor temperatures of waiting rooms in eight rural primary health care facilities. Mean monthly temperature measurements inside the clinics were warmer during the summer months of December, January and February, and cooler during the autumn months of March, April and May. The highest mean monthly temperature of 31.4 ± 2.7 °C was recorded in one clinic during February 2016. Maximum daily indoor clinic temperatures exceeded 38 °C in some clinics. Indoor temperatures were compared to ambient (outdoor) temperatures and the mean difference between the two showed clinic waiting room temperatures were higher by 2-4 °C on average. Apparent temperature (AT) incorporating relative humidity readings made in the clinics showed 'realfeel' temperatures were >4 °C higher than measured indoor temperature, suggesting a feeling of 'stuffiness' and discomfort may have been experienced in the waiting room areas. During typical clinic operational hours of 8h00 to 16h00, mean ATs fell into temperature ranges associated with heat-health impact warning categories of 'caution' and 'extreme caution'.

  4. A 10-year analysis of the oral squamous cell carcinoma profile in patients from public health centers in Uruguay

    Directory of Open Access Journals (Sweden)

    Maria Laura Cosetti OLIVEIRA

    2015-01-01

    Full Text Available The aim of this study was to evaluate the demographic, clinical, and therapeutic characteristics and predictive factors of poor prognosis in patients with primary oral squamous cell carcinoma (OSCC in Uruguay. Medical records of patients with the diagnosis of primary OSCC treated between 2000 and 2010 in Uruguayan public hospitals were selected. Data on demographic characteristics, risk factors, clinical features, treatment, and outcome were collected. Associations of independent variables with outcomes were assessed using Pearson chi-squared and Fisher's tests. Of 200 patients with OSCC, 79.4% were men (3.8:1 male:female ratio, with a mean age of 60.75 ± 11.26 years. Tobacco and alcohol consumption were reported by 85.3% and 63.5% of patients, respectively. The most commonly affected location was the tongue (42.5%, with lesions exhibiting ulcerous aspects in 87.9% of cases and pain at the time of diagnosis in 70.4% of cases. One hundred sixty-one (82.1% patients had advanced-stage (III/IV OSCC. Surgery was the most common treatment option, and the overall 5-year survival rate was 58.5%. Univariate analysis showed that the predictors of poor prognosis were clinical aspect, size, regional metastasis, clinical stage, and treatment. In Uruguay, OSCC is diagnosed late, which is associated with a low survival rate. Educational and preventive measures and investment to improve early diagnosis should be undertaken.

  5. Art and community health: lessons from an urban health center.

    Science.gov (United States)

    Siegel, Wilma Bulkin; Bartley, Mary Anne

    2004-01-01

    Staff at a nurse-managed urban health center conducted a series of art sessions to benefit the community. The authors believe the program's success clearly communicated the relationship between art and community health. As a result of the success of the sessions, plans are in the works to make art a permanent part of the health center's services.

  6. The Breast Health Center at Women & Infants Hospital: origin, philosophy, and features.

    Science.gov (United States)

    Falkenberry, S S; Chung, M; Legare, R; Strenger, R; Wallace, D; Phillips, G; Morry, S; Marchant, D J; Cady, B

    2000-04-01

    The Breast Health Center, a component of the program in Women's Oncology at Women & Infants Hospital, is a multidisciplinary center devoted to the treatment and study of benign and malignant breast diseases. The philosophy, structure, and function of The Breast Health Center are described along with its specific components. The Breast Health Center's three fundamental missions of patient care, education, and research are discussed.

  7. Patient Workload Profile: National Naval Medical Center (NNMC), Bethesda, MD.

    Science.gov (United States)

    1980-06-01

    AD-A09a 729 WESTEC SERVICES NC SAN DIEGOCA0S / PATIENT WORKLOAD PROFILE: NATIONAL NAVAL MEDICAL CENTER NNMC),- ETC(U) JUN 80 W T RASMUSSEN, H W...provides site workload data for the National Naval Medical Center (NNMC) within the following functional support areas: Patient Appointment...on managing medical and patient data, thereby offering the health care provider and administrator more powerful capabilities in dealing with and

  8. More Than a Text Message: Dismantling Digital Triggers to Curate Behavior Change in Patient-Centered Health Interventions.

    Science.gov (United States)

    Muench, Frederick; Baumel, Amit

    2017-05-26

    Digital triggers such as text messages, emails, and push alerts are designed to focus an individual on a desired goal by prompting an internal or external reaction at the appropriate time. Triggers therefore have an essential role in engaging individuals with digital interventions delivered outside of traditional health care settings, where other events in daily lives and fluctuating motivation to engage in effortful behavior exist. There is an emerging body of literature examining the use of digital triggers for short-term action and longer-term behavior change. However, little attention has been given to understanding the components of digital triggers. Using tailoring as an overarching framework, we separated digital triggers into 5 primary components: (1) who (sender), (2) how (stimulus type, delivery medium, heterogeneity), (3) when (delivered), (4) how much (frequency, intensity), and (5) what (trigger's target, trigger's structure, trigger's narrative). We highlighted key considerations when tailoring each component and the pitfalls of ignoring common mistakes, such as alert fatigue and habituation. As evidenced throughout the paper, there is a broad literature base from which to draw when tailoring triggers to curate behavior change in health interventions. More research is needed, however, to examine differences in efficacy based on component tailoring, to best use triggers to facilitate behavior change over time, and to keep individuals engaged in physical and mental health behavior change efforts. Dismantling digital triggers into their component parts and reassembling them according to the gestalt of one's change goals is the first step in this development work. ©Frederick Muench, Amit Baumel. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.05.2017.

  9. NASA Human Health and Performance Center (NHHPC)

    Science.gov (United States)

    Davis, Jeffery R.

    2010-01-01

    This slide presentation reviews the purpose, potential members and participants of the NASA Human Health and Performance Center (NHHPC). Included in the overview is a brief description of the administration and current activities of the NHHPC.

  10. Job satisfaction survey among health centers staff

    OpenAIRE

    Shahnazi, Hossein; Daniali, Seyede Shahrbanoo; Sharifirad, Gholamreza

    2014-01-01

    Background: Due to the importance of health care organizations with significant responsibility for prevention and care, assessment of job satisfaction among health care staff is essential. Quality of health services will be decreased provided they are not satisfied. Materials and Methods: This study was a cross-sectional analysis of health care staff in Khomeinishahr (centers, buildings, and networks) If they had at least 6 months work experience, they could enter the study. Data included a t...

  11. Effectiveness of an intervention in groups of family caregivers of dependent patients for their application in primary health centers. Study protocol

    Directory of Open Access Journals (Sweden)

    Pérez-Arechaederra Diana

    2010-09-01

    Full Text Available Abstract Background Although Primary Health Care (PHC Teams are used to deal with prevention and treatment of sanitary problems in adults with chronic diseases, they usually have a lack of experience in development of psychotherapeutic interventions. However, these interventions are the ones that achieve better results to reduce symptomatology and improve emotional state of caregivers. The study aims to evaluate the effectiveness of an intervention of psychotherapy in improving the mental health and Quality of life of caregivers. This intervention is based on theoretical approaches to care adjusted to cognitive theory, in order to be applied in primary health care centres. Methods/Design This is multicentre clinical trials study, randomized in two parallel groups, carry out in two PHC, Study population: 150 caregivers will be included by consecutive sampling and they will be randomized the half to experimental group and the other half to control group. They provide mostly all the assistance to care-dependent familiars receiving attention in PHC Centers. Measurements: Each caregiver will be evaluated on a personal interview. The caregivers' assessment protocol: 1 Assessment of different socio-demographic related to care, and caregiver's personal situation. 2Care-dependent individuals will also be assessed by Barthel Index and Pfeiffer Questionnaire (SPMSQ. 3Change in caregivers will be the principal measure: family function (Family APGAR Questionnaire, burden short questionnaire (Short Zarit Burden Interview, quality of life (Ruiz & Baca: 1993 Questionnaire, the Duke-UNK Functional Social Support Questionnaire, the General Health Questionnaire-12, and changes in Dysfunctional Thoughts about caring. 4 Intervention implementation measures will also be assessed. Intervention: A psychotherapeutic intervention will be 8 sessions of 90 minutes in groups. This intervention has been initially developed for family caregivers of patients with dementia

  12. Trends in internet search activity, media coverage, and patient-centered health information after the FDA safety communications on surgical mesh for pelvic organ prolapse.

    Science.gov (United States)

    Stone, Benjamin V; Forde, James C; Levit, Valerie B; Lee, Richard K; Te, Alexis E; Chughtai, Bilal

    2016-11-01

    In July 2011, the US Food and Drug Administration (FDA) issued a safety communication regarding serious complications associated with surgical mesh for pelvic organ prolapse, prompting increased media and public attention. This study sought to analyze internet search activity and news article volume after this FDA warning and to evaluate the quality of websites providing patient-centered information. Google Trends™ was utilized to evaluate search engine trends for the term "pelvic organ prolapse" and associated terms between 1 January 2004 and 31 December 2014. Google News™ was utilized to quantify the number of news articles annually under the term "pelvic organ prolapse." The search results for the term "pelvic organ prolapse" were assessed for quality using the Health On the Net Foundation (HON) certification. There was a significant increase in search activity from 37.42 in 2010 to 57.75 in 2011, at the time of the FDA communication (p = 0.021). No other annual interval had a statistically significant increase in search activity. The single highest monthly search activity, given the value of 100, was August 2011, immediately following the July 2011 notification, with the next highest value being 98 in July 2011. Linear regression analysis of news articles per year since the FDA communication revealed r 2  = 0.88, with a coefficient of 186. Quality assessment demonstrated that 42 % of websites were HON-certified, with .gov sites providing the highest quality information. Although the 2011 FDA safety communication on surgical mesh was associated with increased public and media attention, the quality of relevant health information on the internet remains of poor quality. Future quality assurance measures may be critical in enabling patients to play active roles in their own healthcare.

  13. [Fact-finding survey on regional healthcare services for patients with epilepsy based on a questionnaire administered to public health centers in Japan].

    Science.gov (United States)

    Fujii, Masami; Ishimaru, Yasutaka; Takahashi, Hiroyuki; Egami, Hirofumi; Nishida, Hideki; Oka, Shinji; Shirabe, Komei

    2015-01-01

    Epilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizures. The prevalence of epilepsy is about 1%, and its incidence is increasing with the aging population. In addition to their medical problems, epilepsy patients face many social problems, including schooling, working, and maintaining their driver's licenses. However, these problems are not fully recognized by the regional healthcare centers (HCCs), and the inadequacy of collaboration between medical services, healthcare, and welfare is sometimes pointed out. Under these circumstances, this fact-finding survey was administered in the form of a questionnaire to HCCs across the nation for the purpose of improving the support system and educational activities for epilepsy in Japan. A mail-back survey on regional healthcare services for epilepsy patients was sent out to 490 HCCs across the nation. Public health nurses (PHNs) responded to the self-completed questionnaire on behalf of each HCC. The questionnaire was comprised of the presence or absence of consultations on epilepsy, content of the consultations, and holding of workshops, lectures, or conferences in the community covered by the HCC. We obtained responses from 347 HCCs (response rate 71%). Seventy-three percent of the PHNs had experience with consultations regarding the medical and healthcare issues associated with epilepsy. However, only 10% of the PHNs responded that they could provide appropriate consultation for these issues. The content of the consultations mainly included medical services, clinical symptoms of epilepsy, and anxieties about their social life and their future. Workshops, lectures, or conferences on epilepsy were held for residents or health and welfare professionals in only 8% of the communities. This percentage is lower than those (21-70%) for other intractable or mental disorders that are mainly managed by HCCs (Prestrictions. To improve these situations, regional education programs for

  14. Patient Care Coordinator | Center for Cancer Research

    Science.gov (United States)

    blood diseases and conditions; parasitic infections; rheumatic and inflammatory diseases; and rare and neglected diseases. CMRP’s collaborative approach to clinical research and the expertise and dedication of staff to the continuation and success of the program’s mission has contributed to improving the overall standards of public health on a global scale. The Clinical Monitoring Research Program (CMRP) provides comprehensive, dedicated clinical research, study coordination, and administrative support to the National Cancer Institute’s (NCI’s), Center for Cancer Research (CCR), Urologic Oncology Branch (UOB) located at the National Institutes of Health (NIH) in Bethesda, Maryland. KEY ROLES/RESPONSIBILITIES - THIS POSITION IS CONTINGENT UPON FUNDING APPROVAL The Patient Care Coordinator III (PCC III) provides administrative services, as well as patient care coordination. Responsibilities will include: Communicates with various clinical administrative support offices/clinics/diagnostic centers concerning scheduling of patient appointments, new and existing work scopes and clinical protocols (Surgery, X-ray, etc.). Consults with the patient, chooses the appropriate appointment, and enters ID and demographic data supplied by patient to secure an appointment in order to update clinic and physician schedules. Composes correspondence on various administrative issues including patient letters and notices to the patient’s home and physicians. Provides patients with information about their appointments, including medical materials the patient will need to bring, dates and times, clinic information, hospital maps and appropriate travel and hotel information. Arranges Admission Travel Voucher (ATV) travel, including lodging, meals and direct bill requests and enters data in the ATV system daily. Obtains up-to-date patient records and other pertinent information prior to patient appointments or admission. Maintains a roster of all patients and tracks their appointments

  15. Public Health Nursing: Public Health Centers

    Science.gov (United States)

    Misuse and Addiction Prevention Finance & Management Services Health Care Services Juvenile Justice , Alaska 99752 Phone: 442-7144 Fax: 442-7292 e-mail: Josephine Oke, Program Manager [back to top] North Phone: 852-0270 Fax: 852-2855 email: Andrey Boskhomdzhiev [back to top] Municipality of Anchorage P.O

  16. The Examination of The Outdoors of Family Health-Care Center: A Case Study In Çanakkale City Center

    OpenAIRE

    SAĞLIK, Alper; KELKİT, Abdullah

    2017-01-01

    The gardens of the health-care centers are areas of fear, anxiety and stress based. In the process of the treatment of patients, these areas have psychological, physical and social significance. For this reason, health-care center gardens should be designed to help treatment of patients. Well designed gardens are important for elimination of adverse effects of clinical environments on patients and helping patients to stay away from the stress by ensuring their socia...

  17. Kennedy Space Center environmental health program

    International Nuclear Information System (INIS)

    Marmaro, G.M.; Cardinale, M.A.; Summerfield, B.R.; Tipton, D.A.

    1992-01-01

    The Kennedy Space Center's environmental health organization is responsible for programs which assure its employees a healthful workplace under diverse and varied working conditions. These programs encompass the disciplines of industrial hygiene, radiation protection (health physics), and environmental sanitation/pollution control. Activities range from the routine, such as normal office work, to the highly specialized, such as the processing of highly toxic and hazardous materials

  18. Center for the Advancement of Health

    Science.gov (United States)

    ... More Prepared Patient Blogs » WHAT IS PATIENT ENGAGEMENT? HEALTH BEHAVIOR NEWS Urban Parks and Trails Are Cost-Effective Ways to Promote Exercise December 8, 2014 Military Culture Enables Tobacco Use ...

  19. Health Services Cost Analyzing in Tabriz Health Centers 2008

    Directory of Open Access Journals (Sweden)

    Massumeh gholizadeh

    2015-08-01

    Full Text Available Background and objectives : Health Services cost analyzing is an important management tool for evidence-based decision making in health system. This study was conducted with the purpose of cost analyzing and identifying the proportion of different factors on total cost of health services that are provided in urban health centers in Tabriz. Material and Methods : This study was a descriptive and analytic study. Activity Based Costing method (ABC was used for cost analyzing. This cross–sectional survey analyzed and identified the proportion of different factors on total cost of health services that are provided in Tabriz urban health centers. The statistical population of this study was comprised of urban community health centers in Tabriz. In this study, a multi-stage sampling method was used to collect data. Excel software was used for data analyzing. The results were described with tables and graphs. Results : The study results showed the portion of different factors in various health services. Human factors by 58%, physical space 8%, medical equipment 1.3% were allocated with high portion of expenditures and costs of health services in Tabriz urban health centers. Conclusion : Based on study results, since the human factors included the highest portion of health services costs and expenditures in Tabriz urban health centers, balancing workload with staff number, institutionalizing performance-based management and using multidisciplinary staffs may lead to reduced costs of services. ​

  20. Effects of Rational-Emotive Therapy, Rational Role Reversal, and Rational-Emotive Imagery on the Emotional Adjustment of Community Mental Health Center Patients.

    Science.gov (United States)

    Lipsky, Marc J.; And Others

    1980-01-01

    Results showed that rational-emotive therapy (RET), with the addition of rational role reversal, produced significantly better results than did relaxation training and support or no contact. This was the first study to demonstrate the efficacy of RET with multisymptomatic applicants to a community mental health center. (Author/BEF)

  1. Implementing Patient Family-Centered Care Grand Rounds Using Patient/Family Advisor Narratives

    Directory of Open Access Journals (Sweden)

    Maureen B Fagan DNP, MHA, FNP-BC

    2015-11-01

    Full Text Available With the emerging trend of patient family–centered care in health care, it is essential that physicians be exposed to patient and family perspectives of care during medical education and training. Grand Rounds provides an ideal format for physicians to learn about patient family–centered care. At Brigham and Women’s Hospital, we sought to bring the voice of the patient to Patient Family–Centered Grand Rounds in order to expose clinicians to rich narratives describing the medical care received by patients/families and to ultimately change physician practice to reflect patient family–centered principles. We conducted a clinician survey and found promising results indicating that patient/family narratives can be effective at educating physicians about patient family–centered care.

  2. Diabetes Stories: Use of Patient Narratives of Diabetes to Teach Patient-Centered Care

    Science.gov (United States)

    Kumagai, Arno K.; Murphy, Elizabeth A.; Ross, Paula T.

    2009-01-01

    A critical component to instituting compassionate, patient-centered diabetes care is the training of health care providers. Our institution developed the Family Centered Experience (FCE), a comprehensive 2-year preclinical program based on longitudinal conversations with patients about living with chronic illness. The goal of the FCE is to explore…

  3. Utilization of maternal health services in rural primary health centers ...

    African Journals Online (AJOL)

    Utilization of maternal health services in rural primary health centers in Sub- Saharan Africa. ... their pregnancies were normal during antenatal care visits, hostile attitude of health workers, poverty and mode of payment. Majority of the PHCs provided antenatal, normal delivery, and post natal services. Rural mothers lacked ...

  4. Prevalence and associated factors of hepatitis C virus infection among renal disease patients on maintenance hemodialysis in three health centers in Aden, Yemen: A cross sectional study

    Directory of Open Access Journals (Sweden)

    Khadija Aman

    2015-01-01

    Full Text Available We aimed to assess the prevalence and factors associated with positive anti-hepatitis C virus (HCV antibodies among patients on maintenance hemodialysis (HD in three centers in Aden, Yemen. The data from 219 patients and their records over the period between 2000-2013, was extracted and analyzed. The mean ± SD age of the patients was 47.08 ± 13.9 years; 74.4% of them were married and 14.6% were employed. The prevalence of validated anti-HCV-positive cases was 40.2% (95%CI 33.64%-46.73%. The mean ± SD duration on HD of all the patients was 35.09 ± 38 months. On bivariate analysis, the duration on HD and attending more than one center for HD associated significantly with anti-HCV positivity (P <0.05. On multivariate fully adjusted Poisson regression modelling, controlled for age, Patients attending more than one center and those who underwent HD for longer durations were more likely to be positive for anti- HCV antibodies [P = 0.004, adjusted prevalence rate ratio (APRR = 1.87, 95% confidence interval (CI: 1.22-2.88; P = 0.0005, APRR = 1.01, 95% CI: 1.00-1.02. In this study sample, the prevalence of HCV was significant. Patients attending more than one center and those who underwent HD for longer durations were found to be more likely to contract HCV. Enhancing existing infection control measures and allocating more resources to HD centers therefore warrants consideration.

  5. Prevalence and associated factors of hepatitis C virus infection among renal disease patients on maintenance hemodialysis in three health centers in Aden, Yemen: a cross sectional study.

    Science.gov (United States)

    Aman, Khadija; Al-Dubai, Sami AbdoRadman; Aman, Reema; Hawash, Aamenah; Alshagga, Mustafa; Kassim, Saba

    2015-03-01

    We aimed to assess the prevalence and factors associated with positive anti-hepatitis C virus (HCV) antibodies among patients on maintenance hemodialysis (HD) in three centers in Aden, Yemen. The data from 219 patients and their records over the period between 2000-2013, was extracted and analyzed. The mean ± SD age of the patients was 47.08 ± 13.9 years; 74.4% of them were married and 14.6% were employed. The prevalence of validated anti-HCV-positive cases was 40.2% (95%CI 33.64%-46.73%). The mean ± SD duration on HD of all the patients was 35.09 ± 38 months. On bivariate analysis, the duration on HD and attending more than one center for HD associated significantly with anti-HCV positivity (P <0.05). On multivariate fully adjusted Poisson regression modelling, controlled for age, Patients attending more than one center and those who underwent HD for longer durations were more likely to be positive for anti- HCV antibodies [P = 0.004, adjusted prevalence rate ratio (APRR) = 1.87, 95% confidence interval (CI): 1.22-2.88; P = 0.0005, APRR = 1.01, 95% CI: 1.00-1.02. In this study sample, the prevalence of HCV was significant. Patients attending more than one center and those who underwent HD for longer durations were found to be more likely to contract HCV. Enhancing existing infection control measures and allocating more resources to HD centers therefore warrants consideration.

  6. Shared Decision Making and Effective Physician-Patient Communication: The Quintessence of Patient-Centered Care

    Directory of Open Access Journals (Sweden)

    Huy Ming Lim

    2015-03-01

    Full Text Available The Institute of Medicine’s (IOM 2001 landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century, identified patient-centeredness as one of the fundamental attributes of quality health care, alongside safety, effectiveness, timeliness, efficiency, and equity. The IOM defined patient-centeredness as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” This concept of patient-centered care represents a paradigm shift from the traditional disease-oriented and physician-centered care, grounding health care in the subjective experience of illness and the needs and preferences of individual patients rather than the evaluation and treatment of diseases which emphasizes on leveraging clinical expertise and evidence derived from population-based studies. Regrettably, despite the ubiquitous talk about patient-centered care in modern health care, shared decision-making and effective physician-patient communication—the two cruxes of patient-centered care—are yet to become the norms. Strategies to promote and enhance shared decision-making and effective communication between clinicians and patients should be rigorously implemented to establish a health care system that truly values patients as individuals and turn the rhetoric of patient-centered care into reality.

  7. The role of health centers in preventive care provision

    Directory of Open Access Journals (Sweden)

    Shemetova G.N.

    2017-12-01

    Full Text Available Aim: to assess the importance of the Centers of Health in the organization and provision of preventive care to the population, in the early detection of risk factors for the development of chronic non-communicable diseases and the development of a healthy lifestyle. Material and Methods. On the basis of the Health Center of Engels Center for Medical Prevention in the Saratov Region, the detection of risk factors for 2011-2015 was analyzed according to statistical reporting (form No. 68 and health cards (form025-CZ/y of 207 patients. To assess the satisfaction of visitors with the work of the Center, a specially developed questionnaire was conducted, which included 22 questions that characterize the patient profile, his attitude to the organization and the results of the survey, and the motivation to modify the way of life. Results. The study confirmed the important role of the Centers of Health in the organization and provision of preventive care to the population, the formation of a healthy lifestyle and the early detection of diseases and risk factors for their development. Conclusion. Only joint efforts of medical institutions, authorities, educational organizations, mass media can lead to the formation of the population's responsibility for their health and readiness to modify the way of life.

  8. Nurse-midwives in federally funded health centers: understanding federal program requirements and benefits.

    Science.gov (United States)

    Carter, Martha

    2012-01-01

    Midwives are working in federally funded health centers in increasing numbers. Health centers provide primary and preventive health care to almost 20 million people and are located in every US state and territory. While health centers serve the entire community, they also serve as a safety net for low-income and uninsured individuals. In 2010, 93% of health center patients had incomes below 200% of the Federal Poverty Guidelines, and 38% were uninsured. Health centers, including community health centers, migrant health centers, health care for the homeless programs, and public housing primary care programs, receive grant funding and enjoy other benefits due to status as federal grantees and designation as federally qualified health centers. Clinicians working in health centers are also eligible for financial and professional benefits because of their willingness to serve vulnerable populations and work in underserved areas. Midwives, midwifery students, and faculty working in, or interacting with, health centers need to be aware of the regulations that health centers must comply with in order to qualify for and maintain federal funding. This article provides an overview of health center regulations and policies affecting midwives, including health center program requirements, scope of project policy, provider credentialing and privileging, Federal Tort Claims Act malpractice coverage, the 340B Drug Pricing Program, and National Health Service Corps scholarship and loan repayment programs. © 2012 by the American College of Nurse-Midwives.

  9. 42 CFR 124.515 - Compliance alternative for community health centers, migrant health centers and certain National...

    Science.gov (United States)

    2010-10-01

    ..., migrant health centers and certain National Health Service Corps sites. 124.515 Section 124.515 Public... Unable To Pay § 124.515 Compliance alternative for community health centers, migrant health centers and... migrant health center under section 329 of the Act is in substantial compliance with the terms and...

  10. The Evolving Academic Health Center: Challenges and Opportunities for Psychiatry

    Science.gov (United States)

    Mirin, Steven; Summergrad, Paul

    2011-01-01

    Objective: Regardless of the outcome of current efforts at healthcare reform, the resources that academic health centers need--to provide care for increasingly complex patient populations, support clinical innovation, grow the clinical enterprise, and carry out their research and teaching missions--are in jeopardy. This article examines the value…

  11. Holistic Health Care for the Medically Uninsured: The Church Health Center of Memphis

    OpenAIRE

    Morris, G. Scott

    2015-01-01

    The Church Health Center (CHC) in Memphis was founded in 1987 to provide quality, affordable health care for working, uninsured people and their families. With numerous, dedicated financial supporters and health care volunteers, CHC has become the largest faith-based health care organization of its type nationally, serving >61,000 patients. CHC embraces a holistic approach to health by promoting wellness in every dimension of life. It offers on-site services including medical care, dentistry,...

  12. St. Luke's Medical Center: technologizing health care

    International Nuclear Information System (INIS)

    Tumanguil, S.S.

    1994-01-01

    The computerization of the St. Luke's Medical Center improved the hospital administration and management, particularly in nuclear medicine department. The use of computer-aided X-ray simulator machine and computerized linear accelerator machine in diagnosing and treating cancer are the most recent medical technological breakthroughs that benefited thousands of Filipino cancer patients. 4 photos

  13. A multi-center study on the attitudes of Malaysian emergency health care staff towards allowing family presence during resuscitation of adult patients

    OpenAIRE

    Sheng, Chew Keng; Lim, Chee Kean; Rashidi, Ahmad

    2010-01-01

    Abstracts Background The practice of allowing family members to witness on-going active resuscitation has been gaining ground in many developed countries since it was first introduced in the early 1990s. In many Asian countries, the acceptability of this practice has not been well studied. Aim We conducted a multi-center questionnaire study to determine the attitudes of health care professionals in Malaysia towards family presence to witness ongoing medical procedures during resuscitation. Me...

  14. Health services at the Kennedy Space Center

    Science.gov (United States)

    Ferguson, E. B.; Humbert, P.; Long, I. D.; Tipton, D. A.

    1992-01-01

    Comprehensive occupational health services are provided to approximately 17,000 workers at the Kennedy Space Center and an additional 6000 on Cape Canaveral Air Force Station. These areas cover about 120,000 acres encompassing part of the Merritt Island Wild Life Refuge and wetlands which are the habitat of numerous endangered and protected species of wildlife. The services provided at the Kennedy Space Center optimally assure a safe and healthy working environment for the employees engaged in the preparation and launching of this country's Space Shuttle and other important space exploration programs.

  15. Consumerism: forcing medical practices toward patient-centered care.

    Science.gov (United States)

    Ozmon, Jeff

    2007-01-01

    Consumerism has been apart of many industries over the years; now consumerism may change the way many medical practices deliver healthcare. With the advent of consumer-driven healthcare, employers are shifting the decision-making power to their employees. Benefits strategies like health savings accounts and high-deductible insurance plans now allow the patients to control how and where they spend their money on medical care. Practices that seek to attract the more affluent and informed consumers are beginning to institute patient-centered systems designs that invite patients to actively participate in their healthcare. This article will outline the changes in the healthcare delivery system facing medical practices, the importance of patient-centered care, and six strategies to implement to change toward more patient-centered care.

  16. Patient-centered communication in digital medical encounters.

    Science.gov (United States)

    Alpert, Jordan M; Dyer, Karen E; Lafata, Jennifer Elston

    2017-10-01

    Patients are increasingly using the secure messaging function available through online patient portals to communicate with their health care providers, yet little is known about the characteristics of conversations that occur. The goal of this study is to describe the types of messages initiated by patients communicating via patient portals and to assess whether providers employ patient-centered strategies in their electronic responses. A total of 193 messages from 58 message threads between patients and providers were collected during a one-week period in a large health care system. Content analysis of patient messages was conducted and deductive analysis of provider responses was employed for two types of patient-centered communication, provider use of supportive talk and partnership building. Patients sent nearly double the number of messages compared to providers (65% versus 35%). Patient messages expressed concern, sought medical solutions and requested assistance with administrative tasks. Over half (53.4%) of provider replies did not contain language reflective of either partnership building or supportive talk. Partnership building language and supportive talk occurred at lower rates than documented in the literature on in-person encounters. This may represent a lost opportunity to strengthen the patient-provider relationship. As secure messaging is increasingly utilized as a form of patient-provider communication, it is important to understand how aspects of this communication channel, including the patient-centeredness of the language used by providers, impact patient-provider relationships and patient outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Quality and Electronic Health Records in Community Health Centers

    Science.gov (United States)

    Lesh, Kathryn A.

    2014-01-01

    Adoption and use of health information technology, the electronic health record (EHR) in particular, has the potential to help improve the quality of care, increase patient safety, and reduce health care costs. Unfortunately, adoption and use of health information technology has been slow, especially when compared to the adoption and use of…

  18. Integration of pharmacists into a patient-centered medical home.

    Science.gov (United States)

    Scott, Mollie Ashe; Hitch, Bill; Ray, Lisa; Colvin, Gaye

    2011-01-01

    To define the joint principles of the patient-centered medical home (PCMH) and describe the integration of pharmacists into a PCMH. Family medicine residency training program in North Carolina from 2001 to 2011. Mountain Area Health Education Family Health Center is a family medicine residency training program that is part of the North Carolina Area Health Education Center system. The goal of the organization is to train and retain health care students and residents. The practice is recognized as a level III PCMH by the National Committee for Quality Assurance (NCQA) and seeks to provide quality, safe, patient-centered care according to the joint principles of PCMH. Pharmacists, nurses, nutritionists, care managers, Spanish translators, and behavioral medicine specialists work collaboratively with physicians to provide seamless, comprehensive care. The Department of Pharmacotherapy is embedded in the family medicine clinic. Three pharmacists and two pharmacy residents are involved in providing direct patient care services, ensuring access to community resources, assisting patients with transitions of care, providing interprofessional education, and participating in continuous quality improvement initiatives. The pharmacists serve as clinical pharmacist practitioners and provide medication therapy management services in a pharmacotherapy clinic, anticoagulation clinics, and an osteoporosis clinic and via an inpatient family medicine service. Multiple learners such as student pharmacists, pharmacy residents, and family medicine residents rotate through the various pharmacy clinics to learn about pharmacotherapeutic principles and the role of the pharmacist in PCMH. PCMH is a comprehensive, patient-centered, team-based approach to population management in the primary care setting. Pharmacists play a vital role in PCMH and make fundamental contributions to patient care across health care settings. Such innovations in the ambulatory care setting create a unique niche

  19. Accelerated Adoption of Advanced Health Information Technology in Beacon Community Health Centers.

    Science.gov (United States)

    Jones, Emily; Wittie, Michael

    2015-01-01

    To complement national and state-level HITECH Act programs, 17 Beacon communities were funded to fuel community-wide use of health information technology to improve quality. Health centers in Beacon communities received supplemental funding. This article explores the association between participation in the Beacon program and the adoption of electronic health records. Using the 2010-2012 Uniform Data System, trends in health information technology adoption among health centers located within and outside of Beacon communities were explored using differences in mean t tests and multivariate logistic regression. Electronic health record adoption was widespread and rapidly growing in all health centers, especially quality improvement functionalities: structured data capture, order and results management, and clinical decision support. Adoption lagged for functionalities supporting patient engagement, performance measurement, care coordination, and public health. The use of advanced functionalities such as care coordination grew faster in Beacon health centers, and Beacon health centers had 1.7 times higher odds of adopting health records with basic safety and quality functionalities in 2010-2012. Three factors likely underlie these findings: technical assistance, community-wide activation supporting health information exchange, and the layering of financial incentives. Additional technical assistance and community-wide activation is needed to support the use of functionalities that are currently lagging. © Copyright 2015 by the American Board of Family Medicine.

  20. Protocol for a nationwide survey of primary health care in China: the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) MPP (Million Persons Project) Primary Health Care Survey.

    Science.gov (United States)

    Su, Meng; Zhang, Qiuli; Lu, Jiapeng; Li, Xi; Tian, Na; Wang, Yun; Yip, Winnie; Cheng, Kar Keung; Mensah, George A; Horwitz, Ralph I; Mossialos, Elias; Krumholz, Harlan M; Jiang, Lixin

    2017-08-28

    China has pioneered advances in primary health care (PHC) and public health for a large and diverse population. To date, the current state of PHC in China has not been subjected to systematic assessments. Understanding variations in primary care services could generate opportunities for improving the structure and function of PHC. This paper describes a nationwide PHC study (PEACE MPP Primary Health Care Survey) conducted across 31 provinces in China. The study leverages an ongoing research project, the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project (MPP). It employs an observational design with document acquisition and abstraction and in-person interviews. The study will collect data and original documents on the structure and financing of PHC institutions and the adequacy of the essential medicines programme; the education, training and retention of the PHC workforce; the quality of care; and patient satisfaction with care. The study will provide a comprehensive assessment of current PHC services and help determine gaps in access and quality of care. All study instruments and documents will be deposited in the Document Bank as an open-access source for other researchers. The central ethics committee at the China National Centre for Cardiovascular Disease (NCCD) approved the study. Written informed consent has been obtained from all patients. Findings will be disseminated in future peer reviewed papers, and will inform strategies aimed at improving the PHC in China. NCT02953926. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. HEALTH EDUCATION TO PROMOTE HEALTHY AGING WITH ELDERLY PATIENTS AT A REFERRAL CENTER FOR SOCIAL ASSISTANCE (CRAS IN SINOP-MT

    Directory of Open Access Journals (Sweden)

    J. O. Iori

    2017-02-01

    Full Text Available Nursing care for the elderly should aim to promote elderly health and reduction of foreseeable risk factors, as well as value and institute measures to the greatest possible degree of autonomy and independence in the elderly in relation to his life and especially about his Cheers. With this view, we carried out a study with 16 members aged from Linkages Strengthening Group of a Social Assistance Reference Center (CRAS, the municipality of Sinop - MT, to enhance understanding of the elderly as the promotion of health through education about risk and protective factors of the most common diseases and health problems among the elderly. We used the action research as a methodological reasons, because this means turning the subject both at the level of thought and in action. The results of this research showed a female predominance in the participation of older age groups, increased participation of older widows with education of 01 years to 04 years. The perception of the elderly as the educational activity performed was satisfactory, reporting that the dynamics of the talks were good, important and promoted new information. It was also found through most of the elderly respondents reported the need for health education activities for this audience. It is concluded that the elderly incorporated into their daily health promotion measures learned in the educational activity, with improvements in quality of life. As well, the need to implement more health education programs for the elderly aimed at promoting healthy aging.

  2. A Record Linkage Protocol for a Diabetes Registry at Ethnically Diverse Community Health Centers

    OpenAIRE

    Maizlish, Neil A.; Herrera, Linda

    2005-01-01

    Community health centers serve ethnically diverse populations that may pose challenges for record linkage based on name and date of birth. The objective was to identify an optimal deterministic algorithm to link patient encounters and laboratory results for hemoglobin A1c testing and examine its variability by health center site, patient ethnicity, and other variables. Based on data elements of last name, first name, date of birth, gender, and health center site, matches with ≥50% to < 100% o...

  3. [Effectiveness of support for asbestos health consultation in health centers].

    Science.gov (United States)

    Nagamatsu, Yasuko

    2011-09-01

    In this research, we aimed to evaluate the support for asbestos health consultation in health centers. In this exploratory descriptive study, a self-administered original questionnaire was developed and used. Among all 517 health centers, valid responses were returned from 323 (62.5%) consenting centers. Consultations in the previous year ranged from 0-108 cases, with a facility median of 3.0 cases. Among staff members, 86.4% did not receive training and 35.4% had never used the manual. Workplaces that use asbestos within their jurisdiction were recognized by 39.2% of staff members, and 16.7% of these members always supported consultants psychologically. The staff members were not confident about asbestos health consultation: 71.2% for general questions, 76.2% for questions about asbestos-related diseases, and 76.4% for questions about risk of asbestos-related diseases; 51.4% were not confident about the Asbestos-Related Health Damage Relief System. Health center staff members who were significantly more confident were those who had more staff to work with; dealt with many consultations in the previous year; recognized the workplaces using asbestos within their jurisdiction; often used the manual and often psychologically supported consultants. According to the covariance structure analysis model, the 'use of support systems' consisting of 'the use of manual', 'training attendance' and 'recognition of workplaces that use asbestos' positively affected the frequency of psychological support (peffective in building the confidence of health center staff in relation to asbestos health consultation, although the use of these support systems was low.

  4. National Center for Disaster Medicine and Public Health

    Data.gov (United States)

    Federal Laboratory Consortium — The National Center for Disaster Medicine and Public Health (NCDMPH) is an academic center tasked with leading federal, and coordinating national, efforts to develop...

  5. [Patient-centered medicine for tuberculosis medical services].

    Science.gov (United States)

    Fujita, Akira; Narita, Tomoyo

    2012-12-01

    The 2011 edition of Specific Guiding Principles for Tuberculosis Prevention calls for a streamlined medical services system capable of providing medical care that is customized to the patient's needs. The new 21st Century Japanese version of the Directly Observed Treatment Short Course (DOTS) expands the indication of DOTS to all tuberculosis (TB) patients in need of treatment. Hospital DOTS consists of comprehensive, patient-centered support provided by a DOTS care team. For DOTS in the field, health care providers should select optimal administration support based on patient profiles and local circumstances. In accordance with medical fee revisions for 2012, basic inpatient fees have been raised and new standards for TB hospitals have been established, the result of efforts made by the Japanese Society for Tuberculosis and other associated groups. It is important that the medical care system be improved so that patients can actively engage themselves as a member of the team, for the ultimate goal of practicing patient-centered medicine. We have organized this symposium to explore the best ways for practicing patient-centered medicine in treating TB. It is our sincere hope that this symposium will lead to improved medical treatment for TB patients. 1. Providing patient-centered TB service via utilization of collaborative care pathway: Akiko MATSUOKA (Hiroshima Prefectural Tobu Public Health Center) We have been using two types of collaborative care pathway as one of the means of providing patient-centered TB services since 2008. The first is the clinical pathway, which is mainly used by TB specialist doctors to communicate with local practitioners on future treatment plan (e.g. medication and treatment duration) of patients. The clinical pathway was first piloted in Onomichi district and its use was later expanded to the whole of Hiroshima prefecture. The second is the regional care pathway, which is used to share treatment progress, test results and other

  6. It can't hurt to ask; a patient-centered quality of service assessment of health canada's medical cannabis policy and program

    Science.gov (United States)

    2012-01-01

    Background In 2001 Health Canada responded to a series of Ontario court decisions by creating the Marihuana Medical Access Division (MMAD) and the Marihuana Medical Access Regulations (MMAR). Although Health Canada has conducted a small number of stakeholder consultations, the federal government has never polled federally authorized cannabis patients. This study is an attempt to learn more about patient needs, challenges and experiences with the MMAD. Methods Launched in the spring of 2007, Quality of Service Assessment of Health Canada's Medical Cannabis Policy and Program pairs a 50 question online survey addressing the personal experiences of patients in the federal cannabis program with 25 semi-guided interviews. Data gathering for this study took place from April 2007 to Jan. 2008, eventually garnering survey responses from 100 federally-authorized users, which at the time represented about 5% of the patients enrolled in Health Canada's program. This paper presents the results of the survey portion of the study. Results 8% of respondents report getting their cannabis from Health Canada, while 66% grow it for themselves. >50% report that they frequent compassion clubs or dispensaries, which remain illegal and unregulated in Canada. 81% of patients would chose certified organic methods of cultivation; >90% state that not all strains are equally effective at relieving symptoms, and 97% would prefer to obtain cannabis from a source where multiple strains are available. Of the 48 patients polled that had tried the Health Canada cannabis supply, >75% rank it as either "1" or "2" on a scale of 1-10 (with "1" being "very poor", and 10 being "excellent"). Discussion 72% of respondents report they are either "somewhat" or "totally unsatisfied" with Canada's medical cannabis program. These survey results and relevant court decisions suggest that the MMAR are not meeting the needs of most of the nation's medical cannabis patient community. It is hoped this research will

  7. It can't hurt to ask; a patient-centered quality of service assessment of health canada's medical cannabis policy and program

    Directory of Open Access Journals (Sweden)

    Lucas Philippe

    2012-01-01

    Full Text Available Abstract Background In 2001 Health Canada responded to a series of Ontario court decisions by creating the Marihuana Medical Access Division (MMAD and the Marihuana Medical Access Regulations (MMAR. Although Health Canada has conducted a small number of stakeholder consultations, the federal government has never polled federally authorized cannabis patients. This study is an attempt to learn more about patient needs, challenges and experiences with the MMAD. Methods Launched in the spring of 2007, Quality of Service Assessment of Health Canada's Medical Cannabis Policy and Program pairs a 50 question online survey addressing the personal experiences of patients in the federal cannabis program with 25 semi-guided interviews. Data gathering for this study took place from April 2007 to Jan. 2008, eventually garnering survey responses from 100 federally-authorized users, which at the time represented about 5% of the patients enrolled in Health Canada's program. This paper presents the results of the survey portion of the study. Results 8% of respondents report getting their cannabis from Health Canada, while 66% grow it for themselves. >50% report that they frequent compassion clubs or dispensaries, which remain illegal and unregulated in Canada. 81% of patients would chose certified organic methods of cultivation; >90% state that not all strains are equally effective at relieving symptoms, and 97% would prefer to obtain cannabis from a source where multiple strains are available. Of the 48 patients polled that had tried the Health Canada cannabis supply, >75% rank it as either "1" or "2" on a scale of 1-10 (with "1" being "very poor", and 10 being "excellent". Discussion 72% of respondents report they are either "somewhat" or "totally unsatisfied" with Canada's medical cannabis program. These survey results and relevant court decisions suggest that the MMAR are not meeting the needs of most of the nation's medical cannabis patient community. It is

  8. A conceptual framework for patient-centered fertility treatment.

    Science.gov (United States)

    Duthie, Elizabeth A; Cooper, Alexandra; Davis, Joseph B; Schoyer, Katherine D; Sandlow, Jay; Strawn, Estil Y; Flynn, Kathryn E

    2017-09-07

    Patient-centered care is a pillar of quality health care and is important to patients experiencing infertility. In this study we used empirical, in-depth data on couples' experiences of infertility treatment decision making to inform and revise a conceptual framework for patient-centered fertility treatment that was developed based on health care professionals' conceptualizations of fertility treatment, covering effectiveness, burden, safety, and costs. In this prospective, longitudinal mixed methods study, we collected data from both members (separately) of 37 couples who scheduled an initial consult with a reproductive specialist. Data collection occurred 1 week before the initial consultation, 1 week after the initial consultation, and then roughly 2, 4, 8, and 12 months later. Data collection included semi-structured qualitative interviews, self-reported questionnaires, and medical record review. Interviews were recorded, transcribed, and content analyzed in NVivo. A single coder analyzed all transcripts, with > 25% of transcripts coded by a second coder to ensure quality control and consistency. Content analysis of the interview transcripts revealed 6 treatment dimensions: effectiveness, physical and emotional burden, time, cost, potential risks, and genetic parentage. Thus, the revised framework for patient-centered fertility treatment retains much from the original framework, with modification to one dimension (from safety to potential risks) and the addition of two dimensions (time and genetic parentage). For patients and their partners making fertility treatment decisions, tradeoffs are explicitly considered across dimensions as opposed to each dimension being considered on its own. Patient-centered fertility treatment should account for the dimensions of treatment that patients and their partners weigh when making decisions about how to add a child to their family. Based on the lived experiences of couples seeking specialist medical care for

  9. Rationale and study design of a patient-centered intervention to improve health status in chronic heart failure: The Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) randomized trial.

    Science.gov (United States)

    Bekelman, David B; Allen, Larry A; Peterson, Jamie; Hattler, Brack; Havranek, Edward P; Fairclough, Diane L; McBryde, Connor F; Meek, Paula M

    2016-11-01

    While contemporary heart failure management has led to some improvements in morbidity and mortality, patients continue to report poor health status (i.e., burdensome symptoms, impaired function, and poor quality of life). The Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) trial is a NIH-funded, three-site, randomized clinical trial that examines the effect of the CASA intervention compared to usual care on the primary outcome of patient-reported health status at 6months in patients with heart failure and poor health status. The CASA intervention involves a nurse who works with patients to treat symptoms (e.g., shortness of breath, fatigue, pain) using disease-specific and palliative approaches, and a social worker who provides psychosocial care targeting depression and adjustment to illness. The intervention uses a collaborative care team model of health care delivery and is structured and primarily phone-based to enhance reproducibility and scalability. This article describes the rationale and design of the CASA trial, including several decision points: (1) how to design a patient-centered intervention to improve health status; (2) how to structure the intervention so that it is reproducible and scalable; and (3) how to systematically identify outpatients with heart failure most likely to need and benefit from the intervention. The results should provide valuable information to providers and health systems about the use of team care to manage symptoms and provide psychosocial care in chronic illness. Published by Elsevier Inc.

  10. Coordinated Management of Academic Health Centers.

    Science.gov (United States)

    Balser, Jeffrey R; Stead, William W

    2017-01-01

    Academic health centers (AHCs) are the nation's primary resource for healthcare discovery, innovation, and training. US healthcare revenue growth has declined sharply since 2009, and is forecast to remain well below historic levels for the foreseeable future. As the cost of education and research at nearly all AHCs is heavily subsidized through large transfers from clinical care margins, our institutions face a mounting crisis. Choices centering on how to increase the cost-effectiveness of the AHC enterprise require unprecedented levels of alignment to preserve an environment that nurtures creativity. Management processes require governance models that clarify decision rights while harnessing the talents and the intellectual capital of a large, diverse enterprise to nimbly address unfamiliar organizational challenges. This paper describes key leadership tactics aimed at propelling AHCs along this journey - one that requires from all leaders a commitment to resilience, optimism, and willingness to embrace change.

  11. Patient satisfaction in Dental Healthcare Centers.

    Science.gov (United States)

    Ali, Dena A

    2016-01-01

    This study aimed to (1) measure the degree of patient satisfaction among the clinical and nonclinical dental services offered at specialty dental centers and (2) investigate the factors associated with the degree of overall satisfaction. Four hundred and ninety-seven participants from five dental centers were recruited for this study. Each participant completed a self-administered questionnaire to measure patient satisfaction with clinical and nonclinical dental services. Analysis of variance, t-tests, a general linear model, and stepwise regression analysis was applied. The respondents were generally satisfied, but internal differences were observed. The exhibited highest satisfaction with the dentists' performance, followed by the dental assistants' services, and the lowest satisfaction with the center's physical appearance and accessibility. Females, participants with less than a bachelor's degree, and younger individuals were more satisfied with the clinical and nonclinical dental services. The stepwise regression analysis revealed that the coefficient of determination (R (2)) was 40.4%. The patient satisfaction with the performance of the dentists explained 42.6% of the overall satisfaction, whereas their satisfaction with the clinical setting explained 31.5% of the overall satisfaction. Additional improvements with regard to the accessibility and physical appearance of the dental centers are needed. In addition, interventions regarding accessibility, particularly when booking an appointment, are required.

  12. Patient guardians as an instrument for person centered care.

    Science.gov (United States)

    Basu, Lopa; Frescas, Ruben; Kiwelu, Humphrey

    2014-05-08

    Person-centered care involves keeping the person at the center of the care planning and decision-making process. While the theory behind person-centered care is commonly shared, its application in healthcare settings is more challenging. In a number of African countries, a lesson emerges involving the application of person-centered care through the use of patient guardians. Patient guardians, often family or close friends, act as an extension of the patient's hospital care team. Medical teams engage with these self-designated individuals who invest their time and efforts in the care of the patient. More importantly, the guardian continues this role and relationship when the patient is released from the hospital to return home. Healthcare workers view patient guardians as a valuable resource. In a structured manner, guardians become stewards of information regarding topics such as hand hygiene and infection control. The knowledge gained can help the recovering patient upon discharge and potentially spread the information to others in the community. Further study of this model may show clear applicability to help improve health literacy in underserved settings in both low-income and high-income countries.

  13. Campus Health Centers' Lack of Information Regarding Providers: A Content Analysis of Division-I Campus Health Centers' Provider Websites.

    Science.gov (United States)

    Perrault, Evan K

    2018-07-01

    Campus health centers are a convenient, and usually affordable, location for college students to obtain health care. Staffed by licensed and trained professionals, these providers can generally offer similar levels of care that providers at off-campus clinics can deliver. Yet, previous research finds students may forgo this convenient, on-campus option partially because of a lack of knowledge regarding the quality of providers at these campus clinics. This study sought to examine where this information deficit may come from by analyzing campus health centers' online provider information. All Division-I colleges or universities with an on-campus health center, which had information on their websites about their providers (n = 294), had their providers' online information analyzed (n = 2,127 providers). Results revealed that schools commonly offer professional information (e.g., provider specialties, education), but very little about their providers outside of the medical context (e.g., hobbies) that would allow a prospective student patient to more easily relate. While 181 different kinds of credentials were provided next to providers' names (e.g., MD, PA-C, FNP-BC), only nine schools offered information to help students understand what these different credentials meant. Most schools had information about their providers within one-click of the homepage. Recommendations for improving online information about campus health center providers are offered.

  14. Patient centered integrated clinical resource management.

    Science.gov (United States)

    Hofdijk, Jacob

    2011-01-01

    The impact of funding systems on the IT systems of providers has been enormous and have prevented the implementation of designs to focused on the health issue of patients. The paradigm shift the Dutch Ministry of Health has taken in funding health care has a remarkable impact on the orientation of IT systems design. Since 2007 the next step is taken: the application of the funding concept on chronic diseases using clinical standards as the norm. The focus on prevention involves the patient as an active partner in the care plan. The impact of the new dimension in funding has initiated a process directed to the development of systems to support collaborative working and an active involvement of the patient and its informal carers. This national approach will be presented to assess its international potential, as all countries face the long term care crisis lacking resources to meet the health needs of the population.

  15. The Patient-Centered Medical Home Neighbor: A Critical Concept for a Redesigned Healthcare Delivery System

    Science.gov (United States)

    2011-01-25

    Sharing Knowledge: Achieving Breakthrough Performance 2010 Military Health System Conference The Patient -Centered Medical Home Neighbor: A Critical...DATE 25 JAN 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE The Patient -Centered Medical Home Neighbor: A...Conference What is the Patient -Centered Medical Home?  …a vision of health care as it should be  …a framework for organizing systems of care at both the

  16. A multi-center study on the attitudes of Malaysian emergency health care staff towards allowing family presence during resuscitation of adult patients.

    Science.gov (United States)

    Sheng, Chew Keng; Lim, Chee Kean; Rashidi, Ahmad

    2010-08-21

    The practice of allowing family members to witness on-going active resuscitation has been gaining ground in many developed countries since it was first introduced in the early 1990s. In many Asian countries, the acceptability of this practice has not been well studied. We conducted a multi-center questionnaire study to determine the attitudes of health care professionals in Malaysia towards family presence to witness ongoing medical procedures during resuscitation. Using a bilingual questionnaire (in Malay and English language), we asked our respondents about their attitudes towards allowing family presence (FP) as well as their actual experience of requests from families to be allowed to witness resuscitations. Multiple logistic regression was used to analyze the association between the many variables and a positive attitude towards FP. Out of 300 health care professionals who received forms, 270 responded (a 90% response rate). Generally only 15.8% of our respondents agreed to allow relatives to witness resuscitations, although more than twice the number (38.5%) agreed that relatives do have a right to be around during resuscitation. Health care providers are significantly more likely to allow FP if the procedures are perceived as likely to be successful (e.g., intravenous cannulation and blood taking as compared to chest tube insertion). Doctors were more than twice as likely as paramedics to agree to FP (p-value = 0.002). This is probably due to the Malaysian work culture in our health care systems in which paramedics usually adopt a 'follow-the-leader' attitude in their daily practice. The concept of allowing FP is not well accepted among our Malaysian health care providers.

  17. Oral health in Brazil - Part II: Dental Specialty Centers (CEOs

    Directory of Open Access Journals (Sweden)

    Vinícius Pedrazzi

    2008-08-01

    Full Text Available The concepts of health promotion, self-care and community participation emerged during the 1970s and, since then, their application has grown rapidly in the developed world, showing evidence of effectiveness. In spite of this, a major part of the population in the developing countries still has no access to specialized dental care such as endodontic treatment, dental care for patients with special needs, minor oral surgery, periodontal treatment and oral diagnosis. This review focuses on a program of the Brazilian Federal Government named CEOs (Dental Specialty Centers, which is an attempt to solve the dental care deficit of a population that is suffering from oral diseases and whose oral health care needs have not been addressed by the regular programs offered by the SUS (Unified National Health System. Literature published from 2000 to the present day, using electronic searches by Medline, Scielo, Google and hand-searching was considered. The descriptors used were Brazil, Oral health, Health policy, Health programs, and Dental Specialty Centers. There are currently 640 CEOs in Brazil, distributed in 545 municipal districts, carrying out dental procedures with major complexity. Based on this data, it was possible to conclude that public actions on oral health must involve both preventive and curative procedures aiming to minimize the oral health distortions still prevailing in developing countries like Brazil.

  18. Prevalence of opportunistic intestinal parasitic infection among HIV infected patients who are taking antiretroviral treatment at Jimma Health Center, Jimma, Ethiopia.

    Science.gov (United States)

    Zeynudin, A; Hemalatha, K; Kannan, S

    2013-02-01

    One of the major health problems among HIV sero-positive patients are superimposed infections due to the deficient immunity. Furthermore, intestinal parasitic (IP) infections, which are also one of the basic health problems in tropical regions, are common in these patients. Infection by opportunistic pathogens, including various forms of intestinal parasites has been the hall mark of HIV since the beginning of the epidemic. To study the prevalence of opportunistic intestinal parasitic infection among HIV patients who are taking antiretroviral treatment (ART) in Jimma, Ethiopia. Patient samples were diagnosed by examination of single stool specimen which was examined as fresh wet mounts, formal-ether concentration technique and modified Ziehl-Neelsen staining technique. Data was obtained from 91 study subjects selected by convenience sampling method. The overall prevalence of intestinal parasitic infections was found to be 39.56%. Eight types of intestinal parasites was identified, the most dominant being, Ascaris lumbricoides, 21.67%, Entamoeba histolytica, 15% and Cryptosporidium parvum 13.33%. The prevalence of opportunistic parasite was 15.38%, the prevalence of non-opportunistic parasite was 20.87% and the prevalence of both opportunistic and non opportunistic was 3.29%. The study indicated that intestinal parasites were still a problem in the study area. Data also showed that among the predisposing factors, habit of hand washing before meal, usage of latrine and duration after treatment was statistically associated with intestinal parasitic infections.

  19. Trends in Mental Health and Substance Abuse Services at the Nation’s Community Health Centers: 1998–2003

    Science.gov (United States)

    Druss, Benjamin G.; Bornemann, Thomas; Fry-Johnson, Yvonne W.; McCombs, Harriet G.; Politzer, Robert M.; Rust, George

    2006-01-01

    Objective. We examined trends in delivery of mental health and substance abuse services at the nation’s community health centers. Methods. Analyses used data from the Health Resources and Services Administration (HRSA), Bureau of Primary Care’s (BPHC) 1998 and 2003 Uniform Data System, merged with county-level data. Results. Between 1998 and 2003, the number of patients diagnosed with a mental health/substance abuse disorder in community health centers increased from 210 000 to 800 000. There was an increase in the number of patients per specialty mental health/substance abuse treatment provider and a decline in the mean number of patient visits, from 7.3 visits per patient to 3.5 by 2003. Although most community health centers had some on-site mental health/substance abuse services, centers without on-site services were more likely to be located in counties with fewer mental health/substance abuse clinicians, psychiatric emergency rooms, and inpatient hospitals. Conclusions. Community health centers are playing an increasingly central role in providing mental health/substance abuse treatment services in the United States. It is critical both to ensure that these centers have adequate resources for providing mental health/substance abuse care and that they develop effective linkages with mental health/substance abuse clinicians in the communities they serve. PMID:17008573

  20. Comparison of optimal cardiovascular risk factor management in patients with Type 2 diabetes who attended urban medical health center with those attended a tertiary care center: Experiences from Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Sedighe Moradi

    2016-01-01

    Conclusions: Both centers have failure in target achievement in some risk factors; however, the inability of the primary care center in controlling hyperlipidemia in comparison with the tertiary center is a serious warning to provide training about managing dyslipidemia in these centers.

  1. 78 FR 9055 - National Center for Health Statistics (NCHS), Classifications and Public Health Data Standards...

    Science.gov (United States)

    2013-02-07

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics (NCHS), Classifications and Public Health Data Standards Staff, Announces the..., Medical Systems Administrator, Classifications and Public Health Data Standards Staff, NCHS, 3311 Toledo...

  2. The economics of patient-centered care.

    Science.gov (United States)

    David, Guy; Saynisch, Philip A; Smith-McLallen, Aaron

    2018-05-01

    The Patient-Centered Medical Home (PCMH) is a widely-implemented model for improving primary care, emphasizing care coordination, information technology, and process improvements. However, its treatment as an undifferentiated intervention in policy evaluation obscures meaningful variation in implementation. This heterogeneity leads to contracting inefficiencies between insurers and practices and may account for mixed evidence on its success. Using a novel dataset we group practices into meaningful implementation clusters and then link these clusters with detailed patient claims data. We find implementation choice affects performance, suggesting that generally-unobserved features of primary care reorganization influence patient outcomes. Reporting these features may be valuable to insurers and their members. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. Violence against health workers in Family Medicine Centers

    Science.gov (United States)

    Al-Turki, Nouf; Afify, Ayman AM; AlAteeq, Mohammed

    2016-01-01

    Background Health care violence is a significant worldwide problem with negative consequences on both the safety and well-being of health care workers as well as workplace activities. Reports examining health care violence in Saudi Arabia are limited and the results are conflicting. Objective To estimate the prevalence and determine the demographic and occupational characteristics associated with workplace violence in primary care centers in Riyadh, Saudi Arabia. Methods A cross-sectional study included 270 health care workers in 12 family medicine centers in Riyadh during November and December 2014. A structured self-administered questionnaire was used to estimate the frequency, timing, causes, reactions, and consequences of workplace violence plus participants’ demographic and occupational data. Results A total 123 health care workers (45.6%) experienced some kind of violence over 12 months prior to the study. These included physical (6.5%) and nonphysical violence (99.2%), including verbal violence (94.3%) and intimidation (22.0%). Offenders were patients (71.5%) in the majority of cases, companions (20.3%), or both (3.3%). Almost half (48.0%) of health care workers who experienced violence did nothing, 38.2% actively reported the event, and 13.8% consulted a colleague. A significant association of workplace violence was found with working multiple shifts, evening or night shift, and lack of an encouraging environment to report violence. Conclusion Workplace violence is still a significant problem in primary care centers. The high frequency of violence together with underreporting may indicate the inefficiency of the current safety program. More safety programs and training activities for health care workers, efficient reporting system, and zero tolerance policies need to be implemented to minimize workplace violence against health workers. PMID:27330300

  4. Violence against health workers in Family Medicine Centers.

    Science.gov (United States)

    Al-Turki, Nouf; Afify, Ayman Am; AlAteeq, Mohammed

    2016-01-01

    Health care violence is a significant worldwide problem with negative consequences on both the safety and well-being of health care workers as well as workplace activities. Reports examining health care violence in Saudi Arabia are limited and the results are conflicting. To estimate the prevalence and determine the demographic and occupational characteristics associated with workplace violence in primary care centers in Riyadh, Saudi Arabia. A cross-sectional study included 270 health care workers in 12 family medicine centers in Riyadh during November and December 2014. A structured self-administered questionnaire was used to estimate the frequency, timing, causes, reactions, and consequences of workplace violence plus participants' demographic and occupational data. A total 123 health care workers (45.6%) experienced some kind of violence over 12 months prior to the study. These included physical (6.5%) and nonphysical violence (99.2%), including verbal violence (94.3%) and intimidation (22.0%). Offenders were patients (71.5%) in the majority of cases, companions (20.3%), or both (3.3%). Almost half (48.0%) of health care workers who experienced violence did nothing, 38.2% actively reported the event, and 13.8% consulted a colleague. A significant association of workplace violence was found with working multiple shifts, evening or night shift, and lack of an encouraging environment to report violence. Workplace violence is still a significant problem in primary care centers. The high frequency of violence together with underreporting may indicate the inefficiency of the current safety program. More safety programs and training activities for health care workers, efficient reporting system, and zero tolerance policies need to be implemented to minimize workplace violence against health workers.

  5. Job satisfaction survey among health centers staff.

    Science.gov (United States)

    Shahnazi, Hossein; Daniali, Seyede Shahrbanoo; Sharifirad, Gholamreza

    2014-01-01

    Due to the importance of health care organizations with significant responsibility for prevention and care, assessment of job satisfaction among health care staff is essential. Quality of health services will be decreased provided they are not satisfied. This study was a cross-sectional analysis of health care staff in Khomeinishahr (centers, buildings, and networks) If they had at least 6 months work experience, they could enter the study. Data included a two-part questionnaire with a standardized questionnaire, demographic variables, and Smith job descriptive index, which is a questionnaire with six domains. Reliability was obtained for each domain and its validity was reported 0.93. The results showed an overall satisfaction score averages 43.55 ± 12.8 (from 100). Job satisfaction score was not significantly different between the sexes. However, within the current attitude toward job satisfaction, men scores was better than women (P = 0.001). Highest score in job satisfaction was related to relationships with colleagues and lowest score was related to the income, benefits, and job promotion. The more the years of work, the less the job satisfaction was. The attitude toward the current job had a direct relationship with income (P = 0.01). There was a significant inverse relationship between educational level and job satisfaction in domains promotion, income, and benefits (P = 0.01). The staff with higher education levels was less satisfied with income and job promotion qualification. Managers should focus on job qualification to increase job satisfaction and improve the quality of work.

  6. 78 FR 42788 - School-Based Health Center Program

    Science.gov (United States)

    2013-07-17

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration School-Based... Gadsden County. SUMMARY: HRSA will be transferring a School-Based Health Center Capital (SBHCC) Program... support the expansion of services at school-based health centers will continue. SUPPLEMENTARY INFORMATION...

  7. Outcomes of antiretroviral treatment: a comparison between hospitals and health centers in Ethiopia.

    Science.gov (United States)

    Balcha, Taye T; Jeppsson, Anders

    2010-01-01

    the objective of this study was to compare the outcomes of antiretroviral therapy (ART) between hospital and health center levels in Ethiopia. medical records of 1709 ART patients followed for 24 months at 2 hospitals and 3 health centers in the Oromia region of Ethiopia were reviewed. Noted outcomes of ART were currently alive and on treatment; lost to follow-up (LTFU); transferred out (TO); and died (D). of 1709 HIV-positive patients started on ART between September 2006 and February 2007, 1044 (61%) remained alive and were on treatment after 24-month follow-up. In all, 835 (57%) of ART patients at hospitals and 209 (83%) at health centers were retained in the program. Of those who were alive and receiving ART, 79% of patients at health centers and 72% at hospitals were clinically or immunologically improving. In addition, 331 (23%) patients at hospitals were LFTU as compared to 24 (10%) of patients at health centers (relative risk [RR] at 95% confidence interval [CI]: .358 [.231-.555]). While 11% was the mortality rate at hospitals, 5% of patients at health centers also died (RR at 95% CI: .360 [.192-.673]). antiretroviral therapy at health centers was associated with more favorable outcomes than at hospitals.

  8. An analysis of patient-provider secure messaging at two Veterans Health Administration medical centers: message content and resolution through secure messaging.

    Science.gov (United States)

    Shimada, Stephanie L; Petrakis, Beth Ann; Rothendler, James A; Zirkle, Maryan; Zhao, Shibei; Feng, Hua; Fix, Gemmae M; Ozkaynak, Mustafa; Martin, Tracey; Johnson, Sharon A; Tulu, Bengisu; Gordon, Howard S; Simon, Steven R; Woods, Susan S

    2017-09-01

    We sought to understand how patients and primary care teams use secure messaging (SM) to communicate with one another by analyzing secure message threads from 2 Department of Veterans Affairs facilities. We coded 1000 threads of SM communication sampled from 40 primary care teams. Most threads (94.5%) were initiated by patients (90.4%) or caregivers (4.1%); only 5.5% were initiated by primary care team members proactively reaching out to patients. Medication renewals and refills (47.2%), scheduling requests (17.6%), medication issues (12.9%), and health issues (12.7%) were the most common patient-initiated requests, followed by referrals (7.0%), administrative issues (6.5%), test results (5.4%), test issues (5.2%), informing messages (4.9%), comments about the patient portal or SM (4.1%), appreciation (3.9%), self-reported data (2.8%), life issues (1.5%), and complaints (1.5%). Very few messages were clinically urgent (0.7%) or contained other potentially challenging content. Message threads were mostly short (2.7 messages), comprising an average of 1.35 discrete content types. A substantial proportion of issues (24.2%) did not show any evidence of being resolved through SM. Time to response and extent of resolution via SM varied by message content. Proactive SM use by teams varied, but was most often for test results (32.7%), medication-related issues (21.8%), medication renewals (16.4%), or scheduling issues (18.2%). The majority of messages were transactional and initiated by patients or caregivers. Not all content categories were fully addressed over SM. Further education and training for both patients and clinical teams could improve the quality and efficiency of SM communication. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the United States.

  9. Improving Pain Care with Project ECHO in Community Health Centers.

    Science.gov (United States)

    Anderson, Daren; Zlateva, Ianita; Davis, Bennet; Bifulco, Lauren; Giannotti, Tierney; Coman, Emil; Spegman, Douglas

    2017-10-01

    Pain is an extremely common complaint in primary care, and patient outcomes are often suboptimal. This project evaluated the impact of Project ECHO Pain videoconference case-based learning sessions on knowledge and quality of pain care in two Federally Qualified Health Centers. Quasi-experimental, pre-post intervention, with comparison group. Two large, multisite federally qualified health centers in Connecticut and Arizona. Intervention (N = 10) and comparison (N = 10) primary care providers. Primary care providers attended 48 weekly Project ECHO Pain sessions between January and December 2013, led by a multidisciplinary pain specialty team. Surveys and focus groups assessed providers' pain-related knowledge and self-efficacy. Electronic health record data were analyzed to evaluate opioid prescribing and specialty referrals. Compared with control, primary care providers in the intervention had a significantly greater increase in pain-related knowledge and self-efficacy. Providers who attended ECHO were more likely to use formal assessment tools and opioid agreements and refer to behavioral health and physical therapy compared with control providers. Opioid prescribing decreased significantly more among providers in the intervention compared with those in the control group. Pain is an extremely common and challenging problem, particularly among vulnerable patients such as those cared for at the more than 1,200 Federally Qualified Health Centers in the United States. In this study, attendance at weekly Project ECHO Pain sessions not only improved knowledge and self-efficacy, but also altered prescribing and referral patterns, suggesting that knowledge acquired during ECHO sessions translated into practice changes. © 2017 American Academy of Pain Medicine.

  10. Patient-Centered Tools for Medication Information Search.

    Science.gov (United States)

    Wilcox, Lauren; Feiner, Steven; Elhadad, Noémie; Vawdrey, David; Tran, Tran H

    2014-05-20

    Recent research focused on online health information seeking highlights a heavy reliance on general-purpose search engines. However, current general-purpose search interfaces do not necessarily provide adequate support for non-experts in identifying suitable sources of health information. Popular search engines have recently introduced search tools in their user interfaces for a range of topics. In this work, we explore how such tools can support non-expert, patient-centered health information search. Scoping the current work to medication-related search, we report on findings from a formative study focused on the design of patient-centered, medication-information search tools. Our study included qualitative interviews with patients, family members, and domain experts, as well as observations of their use of Remedy, a technology probe embodying a set of search tools. Post-operative cardiothoracic surgery patients and their visiting family members used the tools to find information about their hospital medications and were interviewed before and after their use. Domain experts conducted similar search tasks and provided qualitative feedback on their preferences and recommendations for designing these tools. Findings from our study suggest the importance of four valuation principles underlying our tools: credibility, readability, consumer perspective, and topical relevance.

  11. Barriers to Providing Health Education During Primary Care Visits at Community Health Centers: Clinical Staff Insights.

    Science.gov (United States)

    Alicea-Planas, Jessica; Pose, Alix; Smith, Linda

    2016-04-01

    The rapid increase of diverse patients living in the US has created a different set of needs in healthcare, with the persistence of health disparities continuing to challenge the current system. Chronic disease management has been discussed as a way to improve health outcomes, with quality patient education being a key component. Using a community based participatory research framework, this study utilized a web-based survey and explored clinical staff perceptions of barriers to providing patient education during primary care visits. With a response rate of nearly 42 %, appointment time allotment seemed to be one of the most critical factors related to the delivery of health education and should be considered key. The importance of team-based care and staff training were also significant. Various suggestions were made in order to improve the delivery of quality patient education at community health centers located in underserved areas.

  12. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design.

    Science.gov (United States)

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary

    2016-01-01

    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile.

  13. Center for Devices and Radiological Health Publications Index, August 1988

    International Nuclear Information System (INIS)

    1988-08-01

    This is the first Publications Index to be published by the Center for Devices and Radiological Health. Previous indexes, titled 'Bureau of Radiological Health Publications Index', were published before the Center was formed in 1982 through the merger of the Bureau of Radiological Health and the Bureau of Medical Devices; the last of these indexes was published in October 1980. The 1988 edition contains records of medical device and radiological health documents authored or published by the Center from 1978 through 1986. It should not be considered all-inclusive since those documents for which bibliographic information was not available have been excluded. The Publications Index is being distributed to Center staff, state radiological health programs, and libraries on the Center's publication mailing list. The Center plans to update and publish the Index every other year to provide a convenient record of published Center documents

  14. Patient-centered care requires a patient-oriented workflow model.

    Science.gov (United States)

    Ozkaynak, Mustafa; Brennan, Patricia Flatley; Hanauer, David A; Johnson, Sharon; Aarts, Jos; Zheng, Kai; Haque, Saira N

    2013-06-01

    Effective design of health information technology (HIT) for patient-centered care requires consideration of workflow from the patient's perspective, termed 'patient-oriented workflow.' This approach organizes the building blocks of work around the patients who are moving through the care system. Patient-oriented workflow complements the more familiar clinician-oriented workflow approaches, and offers several advantages, including the ability to capture simultaneous, cooperative work, which is essential in care delivery. Patient-oriented workflow models can also provide an understanding of healthcare work taking place in various formal and informal health settings in an integrated manner. We present two cases demonstrating the potential value of patient-oriented workflow models. Significant theoretical, methodological, and practical challenges must be met to ensure adoption of patient-oriented workflow models. Patient-oriented workflow models define meaningful system boundaries and can lead to HIT implementations that are more consistent with cooperative work and its emergent features.

  15. The potential of crowdsourcing to improve patient-centered care.

    Science.gov (United States)

    Weiner, Michael

    2014-01-01

    Crowdsourcing (CS) is the outsourcing of a problem or task to a crowd. Although patient-centered care (PCC) may aim to be tailored to an individual's needs, the uses of CS for generating ideas, identifying values, solving problems, facilitating research, and educating an audience represent powerful roles that can shape both allocation of shared resources and delivery of personalized care and treatment. CS can often be conducted quickly and at relatively low cost. Pitfalls include bias, risks of research ethics, inadequate quality of data, inadequate metrics, and observer-expectancy effect. Health professionals and consumers in the US should increase their attention to CS for the benefit of PCC. Patients' participation in CS to shape health policy and decisions is one way to pursue PCC itself and may help to improve clinical outcomes through a better understanding of patients' perspectives. CS should especially be used to traverse the quality-cost curve, or decrease costs while preserving or improving quality of care.

  16. 42 CFR 491.10 - Patient health records.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Patient health records. 491.10 Section 491.10...: Conditions for Certification; and FQHCs Conditions for Coverage § 491.10 Patient health records. (a) Records... systematically organized. (3) For each patient receiving health care services, the clinic or center maintains a...

  17. A Multidimensional Data Warehouse for Community Health Centers.

    Science.gov (United States)

    Kunjan, Kislaya; Toscos, Tammy; Turkcan, Ayten; Doebbeling, Brad N

    2015-01-01

    Community health centers (CHCs) play a pivotal role in healthcare delivery to vulnerable populations, but have not yet benefited from a data warehouse that can support improvements in clinical and financial outcomes across the practice. We have developed a multidimensional clinic data warehouse (CDW) by working with 7 CHCs across the state of Indiana and integrating their operational, financial and electronic patient records to support ongoing delivery of care. We describe in detail the rationale for the project, the data architecture employed, the content of the data warehouse, along with a description of the challenges experienced and strategies used in the development of this repository that may help other researchers, managers and leaders in health informatics. The resulting multidimensional data warehouse is highly practical and is designed to provide a foundation for wide-ranging healthcare data analytics over time and across the community health research enterprise.

  18. The concurrent validity of the Problem Oriented Screening Instrument for Teenagers (POSIT) substance use/abuse subscale in adolescent patients in an urban federally qualified health center.

    Science.gov (United States)

    Kelly, Sharon M; O'Grady, Kevin E; Gryczynski, Jan; Mitchell, Shannon Gwin; Kirk, Arethusa; Schwartz, Robert P

    2017-01-01

    The Problem Oriented Screening Instrument for Teenagers (POSIT) substance use/abuse subscale has been validated with high school students, adolescents with criminal justice involvement, and adolescent substance use treatment samples using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R and DSM-IV. This study examines the concurrent validity of the POSIT's standard 17-item substance use/abuse subscale and a revised, shorter 11-item version using DSM-5 substance use disorder diagnoses. Adolescents (N = 525; 93% African American, 55% female) 12-17 years of age awaiting primary care appointments at a Federally Qualified Health Center in Baltimore, Maryland completed the 17-item POSIT substance use/abuse subscale and items from a modified World Mental Health Composite International Diagnostic Interview corresponding to DSM-5 alcohol use disorder (AUD) and cannabis use disorder (CUD). Receiver operating characteristic curves, sensitivities, and specificities were examined with DSM-5 AUD, CUD, and a diagnosis of either or both disorders for the standard and revised subscales using risk cutoffs of either 1 or 2 POSIT "yes" responses. For the 17-item subscale, sensitivities were generally high using either cutoff (range: 0.79-1.00), although a cutoff of 1 was superior (sensitivities were 1.00 for AUD, CUD, and for either disorder). Specificities were also high using either cutoff (range: 0.81-0.95) but were higher using a cutoff of 2. For the 11-item subscale, a cutoff of 1 yielded higher sensitivities than a cutoff of 2 (ranges for 1 and 2: 0.96-1.00 and 0.79-0.86, respectively). Specificities for this subscale were higher using a cutoff of 2 (ranges for 1 and 2: 0.82-0.89 and 0.89-0.96, respectively). Findings suggest that the POSIT's substance use/abuse subscale is a potentially useful tool for screening adolescents in primary care for AUD or CUD using a cutoff of 1 or 2. The briefer, revised subscale may be preferable to the standard subscale in

  19. Area health education centers and health science library services.

    Science.gov (United States)

    West, R T; Howard, F H

    1977-07-01

    A study to determine the impact that the Area Health Education Center type of programs may have on health science libraries was conducted by the Extramural Programs, National Library of Medicine, in conjunction with a contract awarded by the Bureau of Health Manpower, Health Resources Administration, to develop an inventory of the AHEC type of projects in the United States. Specific study tasks included a review of these programs as they relate to library and information activities, on-site surveys on the programs to define their needs for library services and information, and a categorization of library activities. A major finding was that health science libraries and information services are generally not included in AHEC program planning and development, although information and information exchange is a fundamental part of the AHEC type of programs. This study suggests that library inadequacies are basically the result of this planning failure and of a lack of financial resources; however, many other factors may be contributory. The design and value of library activities for these programs needs explication.

  20. Design of the Violence and Stress Assessment (ViStA) study: a randomized controlled trial of care management for PTSD among predominantly Latino patients in safety net health centers.

    Science.gov (United States)

    Meredith, Lisa S; Eisenman, David P; Green, Bonnie L; Kaltman, Stacey; Wong, Eunice C; Han, Bing; Cassells, Andrea; Tobin, Jonathan N

    2014-07-01

    Posttraumatic stress disorder (PTSD) is a common problem in primary care. Although effective treatments are available, little is known about whether such treatments are effective within the context of Federally Qualified Health Centers (FQHCs) that serve as national "safety nets" for providing primary care for low income and underinsured patients. The Violence and Stress Assessment (ViStA) study is the first randomized controlled trial (RCT) to test the impact of a care management intervention for treating PTSD in FQHCs. To develop a PTSD management intervention appropriate for lower resource FQHCs and the predominantly Latino patients they serve, formative work was conducted through a collaborative effort between researchers and an FQHC practice-based research network. This article describes how FQHC stakeholders were convened to review, assess, and prioritize evidence-based strategies for addressing patient, clinician, and system-level barriers to care. This multi-component care management intervention incorporates diagnosis with feedback, patient education and activation; navigation and linkage to community resources; clinician education and medication guidance; and structured cross-disciplinary communication and continuity of care, all facilitated by care managers with FQHC experience. We also describe the evaluation design of this five-year RCT and the characteristics of the 404 English or Spanish speaking patients enrolled in the study and randomized to either the intervention or to usual care. Patients are assessed at baseline, six months, and 12 months to examine intervention effectiveness on PTSD, other mental health symptoms, health-related quality-of-life, health care service use; and perceived barriers to care and satisfaction with care. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Violence against health workers in Family Medicine Centers

    Directory of Open Access Journals (Sweden)

    Al-Turki N

    2016-05-01

    Full Text Available Nouf Al-Turki,1 Ayman AM Afify,1 Mohammed AlAteeq2 1Family Medicine Department, Prince Sultan Military Medical City, 2Department of Family Medicine and PHC, King Abdul-Aziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia Background: Health care violence is a significant worldwide problem with negative consequences on both the safety and well-being of health care workers as well as workplace activities. Reports examining health care violence in Saudi Arabia are limited and the results are conflicting.Objective: To estimate the prevalence and determine the demographic and occupational characteristics associated with workplace violence in primary care centers in Riyadh, Saudi Arabia.Methods: A cross-sectional study included 270 health care workers in 12 family medicine centers in Riyadh during November and December 2014. A structured self-administered questionnaire was used to estimate the frequency, timing, causes, reactions, and consequences of workplace violence plus participants’ demographic and occupational data.Results: A total 123 health care workers (45.6% experienced some kind of violence over 12 months prior to the study. These included physical (6.5% and nonphysical violence (99.2%, including verbal violence (94.3% and intimidation (22.0%. Offenders were patients (71.5% in the majority of cases, companions (20.3%, or both (3.3%. Almost half (48.0% of health care workers who experienced violence did nothing, 38.2% actively reported the event, and 13.8% consulted a colleague. A significant association of workplace violence was found with working multiple shifts, evening or night shift, and lack of an encouraging environment to report violence.Conclusion: Workplace violence is still a significant problem in primary care centers. The high frequency of violence together with underreporting may indicate the inefficiency of the current safety program. More safety programs and training activities for health care

  2. Evaluations of treatment efficacy of depression from perspective of both patients' symptoms and general sense of mental health and wellbeing: A large scale, multi-centered, longitudinal study in China.

    Science.gov (United States)

    Zeng, Qingzhi; Wang, Wei Chun; Fang, Yiru; Mellor, David; Mccabe, Marita; Byrne, Linda; Zuo, Sai; Xu, Yifeng

    2016-07-30

    Relying on the absence, presence of level of symptomatology may not provide an adequate indication of the effects of treatment for depression, nor sufficient information for the development of treatment plans that meet patients' needs. Using a prospective, multi-centered, and observational design, the present study surveyed a large sample of outpatients with depression in China (n=9855). The 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Remission Evaluation and Mood Inventory Tool (REMIT) were administered at baseline, two weeks later and 4 weeks, to assess patients' self-reported symptoms and general sense of mental health and wellbeing. Of 9855 outpatients, 91.3% were diagnosed as experiencing moderate to severe depression. The patients reported significant improvement over time on both depressive symptoms and general sense after 4-week treatment. The effect sizes of change in general sense were lower than those in symptoms at both two week and four week follow-up. Treatment effects on both general sense and depressive symptomatology were associated with demographic and clinical factors. The findings indicate that a focus on both general sense of mental health and wellbeing in addition to depressive symptomatology will provide clinicians, researchers and patients themselves with a broader perspective of the status of patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. University of Washington Center for Child Environmental Health Risks Research

    Data.gov (United States)

    Federal Laboratory Consortium — The theme of the University of Washington based Center for Child Environmental Health Risks Research (CHC) is understanding the biochemical, molecular and exposure...

  4. Investigating Medication Errors in Educational Health Centers of Kermanshah

    Directory of Open Access Journals (Sweden)

    Mohsen Mohammadi

    2015-08-01

    Full Text Available Background and objectives : Medication errors can be a threat to the safety of patients. Preventing medication errors requires reporting and investigating such errors. The present study was conducted with the purpose of investigating medication errors in educational health centers of Kermanshah. Material and Methods: The present research is an applied, descriptive-analytical study and is done as a survey. Error Report of Ministry of Health and Medical Education was used for data collection. The population of the study included all the personnel (nurses, doctors, paramedics of educational health centers of Kermanshah. Among them, those who reported the committed errors were selected as the sample of the study. The data analysis was done using descriptive statistics and Chi 2 Test using SPSS version 18. Results: The findings of the study showed that most errors were related to not using medication properly, the least number of errors were related to improper dose, and the majority of errors occurred in the morning. The most frequent reason for errors was staff negligence and the least frequent was the lack of knowledge. Conclusion: The health care system should create an environment for detecting and reporting errors by the personnel, recognizing related factors causing errors, training the personnel and create a good working environment and standard workload.

  5. Using public health detailing and a family-centered ecological approach to promote patient-provider-parent action for reducing childhood obesity.

    Science.gov (United States)

    Sealy, Yvette M; Zarcadoolas, Christina; Dresser, Michelle; Wedemeyer, Laura; Short, Leslie; Silver, Lynn

    2012-04-01

    This paper describes the research and development of the Obesity in Children Action Kit, a paper-based chronic disease management tool of the Public Health Detailing Program (PHD) at the New York City (NYC) Department of Health and Mental Hygiene (DOHMH). It also describes PHD's process for developing the Obesity in Children detailing campaign (targeting healthcare providers working with children aged 2-18) and its results, during which the Action Kit materials were a focal point. The campaign goals were to impact healthcare provider clinical behaviors, improve the health literacy of parents and children, instigate patient-provider-parent dialogue, and change family practices to prevent obesity. Qualitative research methods consisted of healthcare provider in-depth interviews and parent focus groups to aid campaign development. Evaluation of the Obesity in Children campaign included self-reported data on uptake and usage of clinical tools and action steps of matched assessments from 237 healthcare provider initial and follow-up visits, material stock counts, and DOHMH representative qualitative visit excerpts. Key themes identified in parent focus groups were concerns about childhood diabetes and high blood pressure, awareness of cultural pressure and our "supersize" culture, frustration with family communication around overweight and obesity, lack of knowledge about food quality and portion size, economic pressures, and the availability of healthy and nutritious foods. During the Obesity in Children campaign, six representatives reached 161 practices with 1,588 one-on-one interactions, and an additional 461 contacts were made through group presentations. After these interactions, there was a significant increase in the percentage of physicians self-reported use of key recommended practices: Use of BMI percentile-for-age to assess for overweight or obesity at every visit increased from 77% to 88% (p families to set realistic goals increased from 64% to 86% (p

  6. 78 FR 10610 - TRICARE; Demonstration Project for Participation in Maryland Multi-Payer Patient Centered Medical...

    Science.gov (United States)

    2013-02-14

    ... National Committee on Quality Assurance Patient Centered Medical Home (PPC-PCMH) recognition criteria... quality improvements. TMA Defense Health Cost Assessment and Evaluation (DHCAPE) staff will calculate... Maryland Multi-Payer Patient Centered Medical Home Program (MMPCMHP) Demonstration AGENCY: Department of...

  7. Impact of a Patient-Centered Medical Home on Access, Quality, and Cost

    Science.gov (United States)

    2013-02-01

    Effec- tiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communica- tion, and customer service...reduced health care costs. The patient -centered medical home (PCMH) concept is “an approach to providing comprehensive primary care [in] a health care... patient at the right place and right time” is vital to the appro- priate utilization of health care services across a broad spec- trum of patient needs

  8. Factors Affecting Sexual History Taking in a Health Center Serving Homeless Persons.

    Science.gov (United States)

    Sowicz, Timothy Joseph; Bradway, Christine K

    2018-03-01

    Low rates of documentation of sexual histories have been reported and research on sexual history taking (SHT) has focused on the content of, barriers to collecting, and interventions to improve documentation of sexual histories. Absent from this literature is an understanding of the contextual factors affecting SHT. To address this gap, a focused ethnography of one health center was conducted. Data were collected through observations of health care encounters and interviews with health care providers (HCPs). No SHT was observed and this was likely influenced by patients' characteristics, communication between patients and HCPs, the prioritization of patients' basic needs, and time constraints imposed upon encounters. Given that the health center studied serves patients experiencing homelessness, behavioral health concerns, and opioid use disorder, findings illuminate areas for future inquiry into a patient population affected by social as well as physiologic determinants of health and potentially at high risk for adverse sexual health outcomes.

  9. Federally qualified health center dental clinics: financial information.

    Science.gov (United States)

    Bailit, Howard L; Devitto, Judy; Myne-Joslin, Ronnie; Beazoglou, Tryfon; McGowan, Taegan

    2013-01-01

    Federally Qualified Health Center (FQHC) dental clinics are a major component of the dental safety net system, providing care to 3.75 million patients annually. This study describes the financial and clinical operations of a sample of FQHCs. In cooperation with the National Network for Oral Health Access, FQHC dental clinics that could provide 12 months of electronic dental record information were asked to participate in the study. Based on data from 28 dental clinics (14 FQHCs), 50 percent of patients were under 21 years of age. The primary payers were Medicaid (72.4 percent) and sliding-scale/self-pay patients (17.5 percent). Sites averaged 3.1 operatories, 0.66 dental hygienists, and 1.9 other staff per dentist. Annually, each FTE dentist and hygienist provided 2,801 and 2,073 patient visits, respectively. Eighty percent of services were diagnostic, preventive, and restorative. Patient care accounted for 82 percent of revenues, and personnel (64.2 percent) and central administration (13.4 percent) accounted for most expenses. Based on a small convenience sample of FQHC dental clinics, this study presents descriptive data on their clinical and financial operations. Compared with data from the UDS (Uniform Data System) report, study FQHCs were larger in terms of space, staff, and patients served. However, there was substantial variation among clinics for almost all measures. As the number and size of FQHC dental clinics increase, the Health Resources and Services Administration needs to provide them access to comparative data that they can use to benchmark their operations. © 2013 American Association of Public Health Dentistry.

  10. Recruiting community health centers into pragmatic research: Findings from STOP CRC.

    Science.gov (United States)

    Coronado, Gloria D; Retecki, Sally; Schneider, Jennifer; Taplin, Stephen H; Burdick, Tim; Green, Beverly B

    2016-04-01

    Challenges of recruiting participants into pragmatic trials, particularly at the level of the health system, remain largely unexplored. As part of Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC), we recruited eight separate community health centers (consisting of 26 individual safety net clinics) into a large comparative effectiveness pragmatic study to evaluate methods of raising the rates of colorectal cancer screening. In partnership with STOP CRC's advisory board, we defined criteria to identify eligible health centers and applied these criteria to a list of health centers in Washington, Oregon, and California affiliated with Oregon Community Health Information Network, a 16-state practice-based research network of federally sponsored health centers. Project staff contacted centers that met eligibility criteria and arranged in-person meetings of key study investigators with health center leadership teams. We used the Consolidated Framework for Implementation Research to thematically analyze the content of discussions during these meetings to identify major facilitators of and barriers to health center participation. From an initial list of 41 health centers, 11 met the initial inclusion criteria. Of these, leaders at three centers declined and at eight centers (26 clinic sites) agreed to participate (73%). Participating and nonparticipating health centers were similar with respect to clinic size, percent Hispanic patients, and percent uninsured patients. Participating health centers had higher proportions of Medicaid patients and higher baseline colorectal cancer screening rates. Common facilitators of participation were perception by center leadership that the project was an opportunity to increase colorectal cancer screening rates and to use electronic health record tools for population management. Barriers to participation were concerns of center leaders about ability to provide fecal testing to and assure follow-up of

  11. Department of Defense, Deployment Health Clinical Center

    Science.gov (United States)

    ... general public of trends in mental health and mental health care within the Military Health System Get The Numbers Real Warriors Campaign Real Warriors Campaign A multimedia public awareness campaign designed to combat the stigma associated with ...

  12. National Maternal and Child Oral Health Resource Center

    Science.gov (United States)

    ... State Offices Search the Organizations Database Center for Oral Health Systems Integration and Improvement (COHSII) COHSII is a ... needs of the MCH population. Brush Up on Oral Health This monthly newsletter provides Head Start staff with ...

  13. Blood glucose control in diabetes patients seen in primary health care centers Controle glicêmico em pacientes diabéticos atendidos em centros de atenção primária à saúde

    Directory of Open Access Journals (Sweden)

    Maria Cecília F Assunção

    2005-04-01

    Full Text Available OBJECTIVE: To identify factors associated to poor glycemic control among diabetic patients seen at primary health care centers. METHODS: A cross-sectional study was carried out in a sample of 372 diabetic patients attending 32 primary health care centers in southern Brazil. Data on three hierarchical levels of health unit infrastructure, medical care and patient characteristics were collected. RESULTS: The frequency of poor glycemic control was 50.5%. Multivariate analysis (multilevel method showed that patients with body mass indexes below 27 kg/m², patients on oral hypoglycemic agents or insulin, and patients diagnosed as diabetic over five years prior to the interview were more likely to present poor glycemic control when compared to their counterparts. CONCLUSIONS: Given the hierarchical data structuring, all associations found suggest that factors associated to hyperglycemia are related to patient-level characteristics.OBJETIVO: Identificar fatores associados à falta de controle glicêmico em pacientes diabéticos atendidos em centros de atenção primária à saúde. MÉTODOS: Estudo transversal em amostra de 372 pacientes diabéticos atendidos nos 32 centros de atenção primária de uma cidade do sul do Brasil. Foram coletados dados ordenados em três níveis hierárquicos: estrutura das unidades de saúde, características do processo do cuidado médico e pacientes diabéticos. RESULTADOS: A freqüência de falta de controle glicêmico foi de 50,5%. A análise multivariada (método multinível mostrou que pacientes com Índice de Massa Corporal abaixo de 27 kg/m², em tratamento medicamentoso e com mais de cinco anos de diagnóstico de diabetes, tiveram maior probabilidade de apresentar hiperglicemia quando comparados a seus pares. CONCLUSÕES: Considerando a estrutura hierárquica dos dados, todas as associações encontradas sugerem que os fatores associados à hiperglicemia são relacionados a características dos pacientes.

  14. Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need

    Directory of Open Access Journals (Sweden)

    Faul, Mark

    2014-11-01

    Full Text Available Introduction: The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care.   Methods: We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443. The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions (“trauma center need” as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need.     Results: Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need.  Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Conclusion: Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the

  15. 78 FR 49357 - National Health Center Week, 2013

    Science.gov (United States)

    2013-08-14

    ... America A Proclamation Community health centers play a critical role in providing affordable, high-quality... people living in the United States depends on their services. They are an important source of jobs in... extend our thanks to the women and men who operate America's health centers. NOW, THEREFORE, I, BARACK...

  16. The Community Mental Health Center as a Matrix Organization.

    Science.gov (United States)

    White, Stephen L.

    1978-01-01

    This article briefly reviews the literature on matrix organizational designs and discusses the ways in which the matrix design might be applied to the special features of a community mental health center. The phases of one community mental health center's experience in adopting a matrix organizational structure are described. (Author)

  17. Rewards and challenges of community health center practice.

    Science.gov (United States)

    Cole, Allison M; Chen, Frederick M; Ford, Paul A; Phillips, William R; Stevens, Nancy G

    2014-04-01

    More than 1100 community health centers (CHCs) in the United States provide primary care to 20 million underserved patients annually. CHCs have struggled to recruit and retain qualified physicians. To understand physicians' work experiences in CHCs and identify major sources of satisfaction and dissatisfaction. Using purposeful sampling, we conducted semistructured interviews with 12 family physicians practicing in CHCs. Interview questions assessed physicians' experiences in CHCs and sources of satisfaction and dissatisfaction. Interview notes were coded and analyzed by 2 investigators using a grounded theory approach to identify key themes. Though family physicians feel tremendous satisfaction from care of underserved patients, they are frustrated with the overwhelming workload they experience. Family physicians also report poor administrative management while working in CHCs. Implementation of the Affordable Care Act, which relies on expansion of CHC services, may be adversely affected by family physicians' frustrations with CHC practice. Further research to explore and potentially improve the CHC work environment may be needed.

  18. Qualitative Methods in Patient-Centered Outcomes Research.

    Science.gov (United States)

    Vandermause, Roxanne; Barg, Frances K; Esmail, Laura; Edmundson, Lauren; Girard, Samantha; Perfetti, A Ross

    2017-02-01

    The Patient-Centered Outcomes Research Institute (PCORI), created to fund research guided by patients, caregivers, and the broader health care community, offers a new research venue. Many (41 of 50) first funded projects involved qualitative research methods. This study was completed to examine the current state of the science of qualitative methodologies used in PCORI-funded research. Principal investigators participated in phenomenological interviews to learn (a) how do researchers using qualitative methods experience seeking funding for, implementing and disseminating their work; and (b) how may qualitative methods advance the quality and relevance of evidence for patients? Results showed the experience of doing qualitative research in the current research climate as "Being a bona fide qualitative researcher: Staying true to research aims while negotiating challenges," with overlapping patterns: (a) researching the elemental, (b) expecting surprise, and (c) pushing boundaries. The nature of qualitative work today was explicitly described and is rendered in this article.

  19. Optimizing health care delivery by integrating workplaces, homes, and communities: how occupational and environmental medicine can serve as a vital connecting link between accountable care organizations and the patient-centered medical home.

    Science.gov (United States)

    McLellan, Robert K; Sherman, Bruce; Loeppke, Ronald R; McKenzie, Judith; Mueller, Kathryn L; Yarborough, Charles M; Grundy, Paul; Allen, Harris; Larson, Paul W

    2012-04-01

    In recent years, the health care reform discussion in the United States has focused increasingly on the dual goals of cost-effective delivery and better patient outcomes. A number of new conceptual models for health care have been advanced to achieve these goals, including two that are well along in terms of practical development and implementation-the patient-centered medical home (PCMH) and accountable care organizations (ACOs). At the core of these two emerging concepts is a new emphasis on encouraging physicians, hospitals, and other health care stakeholders to work more closely together to better coordinate patient care through integrated goals and data sharing and to create team-based approaches that give a greater role to patients in health care decision-making. This approach aims to achieve better health outcomes at lower cost. The PCMH model emphasizes the central role of primary care and facilitation of partnerships between patient, physician, family, and other caregivers, and integrates this care along a spectrum that includes hospitals, specialty care, and nursing homes. Accountable care organizations make physicians and hospitals more accountable in the care system, emphasizing organizational integration and efficiencies coupled with outcome-oriented, performance-based medical strategies to improve the health of populations. The ACO model is meant to improve the value of health care services, controlling costs while improving quality as defined by outcomes, safety, and patient experience. This document urges adoption of the PCMH model and ACOs, but argues that in order for these new paradigms to succeed in the long term, all sectors with a stake in health care will need to become better aligned with them-including the employer community, which remains heavily invested in the health outcomes of millions of Americans. At present, ACOs are largely being developed as a part of the Medicare and Medicaid systems, and the PCMH model is still gathering

  20. Health literacy and patient portals.

    Science.gov (United States)

    Gu, Yulong; Orr, Martin; Warren, Jim

    2015-06-01

    Health literacy has been described as the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Improving health literacy may serve to promote concordance with therapy, engage patients in their own health care, and improve health outcomes. Patient portal technology aims at enabling patients and families to have easy access to key information in their own medical records and to communicate with their health care providers electronically. However, there is a gap in our understanding of how portals will improve patient outcome. The authors believe patient portal technology presents an opportunity to improve patient concordance with prescribed therapy, if adequate support is provided to equip patients (and family/carers) with the knowledge needed to utilise the health information available via the portals. Research is needed to understand what a health consumer will use patient portals for and how to support a user to realise the technology's potential.

  1. Holistic Health Care for the Medically Uninsured: The Church Health Center of Memphis.

    Science.gov (United States)

    Morris, G Scott

    2015-11-05

    The Church Health Center (CHC) in Memphis was founded in 1987 to provide quality, affordable health care for working, uninsured people and their families. With numerous, dedicated financial supporters and health care volunteers, CHC has become the largest faith-based health care organization of its type nationally, serving >61,000 patients. CHC embraces a holistic approach to health by promoting wellness in every dimension of life. It offers on-site services including medical care, dentistry, optometry, counseling, social work, and nutrition and fitness education, to promote wellness in every dimension of life. A 2012 economic analysis estimated that a $1 contribution to the CHC provided roughly $8 in health services. The CHC has trained >1200 Congregational Health Promoters to be health leaders and is conducting research on the effectiveness of faith community nurses partnering with congregations to assist in home care for patients recently discharged from Memphis hospitals. The MEMPHIS Plan, CHC's employer-sponsored health care plan for small business and the self-employed, offers uninsured people in lower-wage jobs access to quality, affordable health care. The CHC also conducts replications workshops several times a year to share their model with leaders in other communities. The Institute for Healthcare Improvement (IHI) recently completed a case study that concluded: "The CHC is one of a very few organizations successfully embodying all three components of the IHI Triple Aim by improving population health outcomes, enhancing the individual's health care experience, and controlling costs. All three have been part of the Center's DNA since its inception, and as a transforming force in the community, the model is well worth national attention."

  2. Introducing sexual orientation and gender identity into the electronic health record: one academic health center's experience.

    Science.gov (United States)

    Callahan, Edward J; Sitkin, Nicole; Ton, Hendry; Eidson-Ton, W Suzanne; Weckstein, Julie; Latimore, Darin

    2015-02-01

    Many U.S. populations experience significant health disparities. Increasing health care providers' awareness of and education about sexual orientation (SO) and gender identity (GI) diversity could help reduce health disparities among lesbian, gay, bisexual, and transgender (LGBT) patients. The authors share the University of California, Davis, Health System's (UCDHS's) experience as it became the first U.S. academic health center to formally introduce patient SO/GI demographic data into its electronic health record (EHR) as a step toward reducing LGBT health disparities. Adding these data to the EHR initially met with resistance. The authors, members of the UCDHS Task Force for Inclusion of SO/GI in the EHR, viewed this resistance as an invitation to educate leaders, providers, and staff about LGBT health disparities and to expose providers to techniques for discussing SO/GI with patients. They describe the strategies they employed to effect institutional culture change, including involvement of senior leadership, key informant interviews, educational outreach via grand rounds and resident workshops, and creation of a patient safety net through inviting providers to self-identify as welcoming LGBT patients. The ongoing cultural change process has inspired spin-off projects contributing to an improved climate for LGBT individuals at UCDHS, including an employee organization supporting SO/GI diversity, support for and among LGBT medical learners through events and listservs, development and implementation of an LGBT health curriculum, and creation of peer navigator programs for LGBT patients with cancer. The authors reflect on lessons learned and on institutional pride in and commitment to providing quality care for LGBT patients.

  3. Promoting Ecological Health Resilience for Minority Youth: Enhancing Health Care Access through the School Health Center.

    Science.gov (United States)

    Clauss-Ehlers, Caroline C. C.

    2003-01-01

    Discusses the demographic realities of children of color in the U.S., with a focus on health care needs and access issues that have an enormous influence on health status. An ecologic model is presented that incorporates cultural values and community structures into the school health center. (Contains 50 references.) (GCP)

  4. An International Standard Set of Patient-Centered Outcome Measures After Stroke

    NARCIS (Netherlands)

    Salinas, J. (Joel); Sprinkhuizen, S.M. (Sara M.); Ackerson, T. (Teri); Bernhardt, J. (Julie); Davie, C. (Charlie); George, M.G. (Mary G.); Gething, S. (Stephanie); Kelly, A.G. (Adam G.); Lindsay, P. (Patrice); Liu, L. (Liping); Martins, S.C.O. (Sheila C.O.); Morgan, L. (Louise); B. Norrving (Bo); Ribbers, G.M. (Gerard M.); Silver, F.L. (Frank L.); Smith, E.E. (Eric E.); Williams, L.S. (Linda S.); Schwamm, L.H. (Lee H.)

    2015-01-01

    markdownabstract__BACKGROUND AND PURPOSE:__ Value-based health care aims to bring together patients and health systems to maximize the ratio of quality over cost. To enable assessment of healthcare value in stroke management, an international standard set of patient-centered stroke outcome measures

  5. Promoting cancer screening within the patient centered medical home.

    Science.gov (United States)

    Sarfaty, Mona; Wender, Richard; Smith, Robert

    2011-01-01

    While consensus has grown that primary care is the essential access point in a high-performing health care system, the current model of primary care underperforms in both chronic disease management and prevention. The Patient Centered Medical Home model (PCMH) is at the center of efforts to reinvent primary care practice, and is regarded as the most promising approach to addressing the burden of chronic disease, improving health outcomes, and reducing health spending. However, the potential for the medical home to improve the delivery of cancer screening (and preventive services in general) has received limited attention in both conceptualization and practice. Medical home demonstrations to date have included few evidence-based preventive services in their outcome measures, and few have evaluated the effect of different payment models. Decreasing use of hospitals and emergency rooms and an emphasis on improving chronic care represent improvements in effective delivery of healthcare, but leave opportunities for reducing the burden of cancer untouched. Data confirm that what does or does not happen in the primary care setting has a substantial impact on cancer outcomes. Insofar as cancer is the leading cause of death before age 80, the PCMH model must prioritize adherence to cancer screening according to recommended guidelines, and systems, financial incentives, and reimbursements must be aligned to achieve that goal. This article explores capacities that are needed in the medical home model to facilitate the integration of cancer screening and other preventive services. These capacities include improved patient access and communication, health risk assessments, periodic preventive health exams, use of registries that store cancer risk information and screening history, ability to track and follow up on tests and referrals, feedback on performance, and payment models that reward cancer screening. Copyright © 2011 American Cancer Society, Inc.

  6. Strategies to improve chronic disease management in seven metro Boston community health centers.

    Science.gov (United States)

    Ndumele, Chima D; Russell, Beverley E; Ayanian, John Z; Landon, Bruce E; Keegan, Thomas; O'Malley, A James; Hicks, Leroi S

    2009-01-01

    The Community, Health Center, and Academic Medicine Partnership Project (CHAMPP) is a partnership between medical researchers, community health centers (CHCs), and a community advisory committee focused on reducing cardiovascular morbidity related to hypertension and diabetes for non-Hispanic Black and Hispanic populations in Boston, Massachusetts. We conducted site visits at seven participating CHCs, located in Boston. The visits were to solicit health center staff opinions about site-specific barriers and enabling factors for optimum preventative cardiovascular care for racial/ethnic minority patients receiving hypertension and diabetes care at their centers. Site visits included a tour of each health center and a series of directed interviews with center personnel. Site visit notes were reviewed to identify themes that emerged during the course of each site visit. A summary matrix was developed for each health center, which included information regarding the most salient and persistent themes of the visit. Site visits uncovered several patient-, provider-, CHC-, and community-based factors that either facilitate or hinder optimal care of chronic disease patients. Commonly referenced barriers included the need for improved patient adherence to provider recommendations; insufficient time for providers to address complex health issues presented by patients and the need for a broader range of healthier food options in surrounding communities. Interactive patient groups and community health workers (CHWs) have been well received when implemented. Recommendations included adopting case management as a part of usual care for chronic disease patients; additionally, widespread implementation of CHWs may to provide a platform for more comprehensive care for patients.

  7. An analytics approach to designing patient centered medical homes.

    Science.gov (United States)

    Ajorlou, Saeede; Shams, Issac; Yang, Kai

    2015-03-01

    Recently the patient centered medical home (PCMH) model has become a popular team based approach focused on delivering more streamlined care to patients. In current practices of medical homes, a clinical based prediction frame is recommended because it can help match the portfolio capacity of PCMH teams with the actual load generated by a set of patients. Without such balances in clinical supply and demand, issues such as excessive under and over utilization of physicians, long waiting time for receiving the appropriate treatment, and non-continuity of care will eliminate many advantages of the medical home strategy. In this paper, by using the hierarchical generalized linear model with multivariate responses, we develop a clinical workload prediction model for care portfolio demands in a Bayesian framework. The model allows for heterogeneous variances and unstructured covariance matrices for nested random effects that arise through complex hierarchical care systems. We show that using a multivariate approach substantially enhances the precision of workload predictions at both primary and non primary care levels. We also demonstrate that care demands depend not only on patient demographics but also on other utilization factors, such as length of stay. Our analyses of a recent data from Veteran Health Administration further indicate that risk adjustment for patient health conditions can considerably improve the prediction power of the model.

  8. 42 CFR 405.2462 - Payment for rural health clinic and Federally qualified health center services.

    Science.gov (United States)

    2010-10-01

    ... integral and subordinate part of a hospital, skilled nursing facility or home health agency participating... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for rural health clinic and Federally qualified health center services. 405.2462 Section 405.2462 Public Health CENTERS FOR MEDICARE & MEDICAID...

  9. Deployment Health Centers Review, 2016-2017

    Science.gov (United States)

    2017-08-21

    the short and long-term adverse effects of military service on the physical and mental health of veterans. We recommend that the DHB continue to...adverse effects of military service on the physical and mental health of veterans” by expanding on current clinical, surveillance, and research efforts...the ability to identify, treat, and minimize the short- and long-term adverse effects of military service on the mental and physical health of

  10. South Florida Health Care Centers | NSU

    Science.gov (United States)

    diagnosed with autism spectrum disorder. Optometric Care Complete range of personalized eye care delays or symptoms on the autism spectrum. Support services are also available for families with a child Segal Center provides programs for early childhood, parenting, and autism. Institutes Distance Education

  11. Naval Health Research Center 1985 Annual Report

    Science.gov (United States)

    1985-01-01

    strengthening programs for the entire crew. Aerobic programs for select populations (e.g., overweight personnel), however, were found on 20% of the...Institute, Lima Detachment, Peru (Command) 25-26 UCOR R. Kallal, CUP W. J. Lambert, & M. Nave, Naval Data Services Center, Bethesda, Maryland (Dr

  12. Impact on Seniors of the Patient-Centered Medical Home: Evidence from a Pilot Study

    Science.gov (United States)

    Fishman, Paul A.; Johnson, Eric A.; Coleman, Kathryn; Larson, Eric B.; Hsu, Clarissa; Ross, Tyler R.; Liss, David; Tufano, James; Reid, Robert J.

    2012-01-01

    Purpose: To assess the impact on health care cost and quality among seniors of a patient-centered medical home (PCMH) pilot at Group Health Cooperative, an integrated health care system in Washington State. Design and Methods: A prospective before-and-after evaluation of the experience of seniors receiving primary care services at 1 pilot clinic…

  13. Burnout of Physicians Working in Primary Health Care Centers under Ministry of Health Jeddah, Saudi Arabia.

    Science.gov (United States)

    Bawakid, Khalid; Abdulrashid, Ola; Mandoura, Najlaa; Shah, Hassan Bin Usman; Ibrahim, Adel; Akkad, Noura Mohammad; Mufti, Fauad

    2017-11-25

    Introduction The levels of physicians' job satisfaction and burnout directly affect their professionalism, punctuality, absenteeism, and ultimately, patients' care. Despite its crucial importance, little is known about professional burnout of the physicians in Saudi Arabia. The objectives of this research are two-fold: (1) To assess the prevalence of burnout in physicians working in primary health care centers under Ministry of Health; and (2) to find the modifiable factors which can decrease the burnout ratio. Methodology Through a cross-sectional study design, a representative sample of the physicians working in primary health care centers (PHCCs) Jeddah (n=246) was randomly selected. The overall burnout level was assessed using the validated abbreviated Maslach burnout inventory (aMBI) questionnaire. It measures the overall burnout prevalence based on three main domains i.e., emotional exhaustion, depersonalization, and personal accomplishment. Independent sample T-test, analysis of variance (ANOVA), and multivariate regression analysis were performed using Statistical Package for the Social Sciences (SPSS Version 22, IBM, Armonk, NY). Results Overall, moderate to high burnout was prevalent in 25.2% of the physicians. Emotional exhaustion was noted in 69.5%. Multivariate regression analysis showed that patient pressure/violence (p burnout. The patient's pressure/violence was the only significant independent predictor of overall burnout. Conclusion Emotional exhaustion is the most prominent feature of overall burnout in the physicians of primary health care centers. The main reasons include patient's pressure/violence, unorganized patient flow, less cooperative colleague doctors, fewer support services at the PHCCs, more paperwork, and less cooperative colleagues. Addressing these issues could lead to a decrease in physician's burnout.

  14. Seeking Humanizing Care in Patient-Centered Care Process: A Grounded Theory Study.

    Science.gov (United States)

    Cheraghi, Mohammad Ali; Esmaeili, Maryam; Salsali, Mahvash

    Patient-centered care is both a goal in itself and a tool for enhancing health outcomes. The application of patient-centered care in health care services globally however is diverse. This article reports on a study that sought to introduce patient-centered care. The aim of this study is to explore the process of providing patient-centered care in critical care units. The study used a grounded theory method. Data were collected on 5 critical care units in Tehran University of Medical Sciences. Purposive and theoretical sampling directed the collection of data using 29 semistructured interviews with 27 participants (nurses, patients, and physician). Data obtained were analyzed according to the analysis stages of grounded theory and constant comparison to identify the concepts, context, and process of the study. The core category of this grounded theory is "humanizing care," which consisted of 4 interrelated phases, including patient acceptance, purposeful patient assessment and identification, understanding patients, and patient empowerment. A core category of humanizing care integrated the theory. Humanizing care was an outcome and process. Patient-centered care is a dynamic and multifaceted process provided according to the nurses' understanding of the concept. Patient-centered care does not involve repeating routine tasks; rather, it requires an all-embracing understanding of the patients and showing respect for their values, needs, and preferences.

  15. Chronic Childhood Trauma, Mental Health, Academic Achievement, and School-Based Health Center Mental Health Services

    OpenAIRE

    Larson, S; Chapman, S; Spetz, J; Brindis, CD

    2017-01-01

    Children and adolescents exposed to chronic trauma have a greater risk for mental health disorders and school failure. Children and adolescents of minority racial/ethnic groups and those living in poverty are at greater risk of exposure to trauma and less likely to have access to mental health services. School-based health centers (SBHCs) may be one strategy to decrease health disparities.Empirical studies between 2003 and 2013 of US pediatric populations and of US SBHCs were included if rese...

  16. Patient-centered medical home cyberinfrastructure current and future landscape.

    Science.gov (United States)

    Finkelstein, Joseph; Barr, Michael S; Kothari, Pranav P; Nace, David K; Quinn, Matthew

    2011-05-01

    The patient-centered medical home (PCMH) is an approach that evolved from the understanding that a well-organized, proactive clinical team working in a tandem with well-informed patients is better able to address the preventive and disease management needs in a guideline-concordant manner. This approach represents a fundamental shift from episodic acute care models and has become an integral part of health reform supported on a federal level. The major aspects of PCMH, especially pertinent to its information infrastructure, have been discussed by an expert panel organized by the Agency for Healthcare Research and Quality at the Informatics for Consumer Health Summit. The goal of this article is to summarize the panel discussions along the four major domains presented at the summit: (1) PCMH as an Evolving Model of Healthcare Delivery; (2) Health Information Technology (HIT) Applications to Support the PCMH; (3) Current HIT Landscape of PCMH: Challenges and Opportunities; and (4) Future HIT Landscape of PCMH: Federal Initiatives on Health Informatics, Legislation, and Standardization. Copyright © 2011 American Journal of Preventive Medicine. All rights reserved.

  17. Assessing Patient-Centered Communication in Cancer Care: Stakeholder Perspectives

    Science.gov (United States)

    Mazor, Kathleen M.; Gaglio, Bridget; Nekhlyudov, Larissa; Alexander, Gwen L.; Stark, Azadeh; Hornbrook, Mark C.; Walsh, Kathleen; Boggs, Jennifer; Lemay, Celeste A.; Firneno, Cassandra; Biggins, Colleen; Blosky, Mary Ann; Arora, Neeraj K.

    2013-01-01

    Purpose: Patient-centered communication is critical to quality cancer care. Effective communication can help patients and family members cope with cancer, make informed decisions, and effectively manage their care; suboptimal communication can contribute to care breakdowns and undermine clinician-patient relationships. The study purpose was to explore stakeholders' views on the feasibility and acceptability of collecting self-reported patient and family perceptions of communication experiences while receiving cancer care. The results were intended to inform the design, development, and implementation of a structured and generalizable patient-level reporting system. Methods: This was a formative, qualitative study that used semistructured interviews with cancer patients, family members, clinicians, and leaders of health care organizations. The constant comparative method was used to identify major themes in the interview transcripts. Results: A total of 106 stakeholders were interviewed. Thematic saturation was achieved. All stakeholders recognized the importance of communication and endorsed efforts to improve communication during cancer care. Patients, clinicians, and leaders expressed concerns about the potential consequences of reports of suboptimal communication experiences, such as damage to the clinician-patient relationship, and the need for effective improvement strategies. Patients and family members would report good communication experiences in order to encourage such practices. Practical and logistic issues were identified. Conclusion: Patient reports of their communication experiences during cancer care could increase understanding of the communication process, stimulate improvements, inform interventions, and provide a basis for evaluating changes in communication practices. This qualitative study provides a foundation for the design and pilot testing of such a patient reporting system. PMID:23943884

  18. Comparing Performance of Public and Cooperative Health Centers

    Directory of Open Access Journals (Sweden)

    Mostafa Farahbakhsh

    2012-04-01

    Full Text Available Background: Health cooperatives in similar structure of health network in Iran, give primary health cares to defined population with supervisory of public sector. Materials and method: This study compares health system performance between public (PHC and cooperative (CHC health centers. Results: Client's satisfaction was 4.14 in CHC and 3.9 in PHC in 5 point Likert scale. The mean for daily health services of CHC and PHC were 110.8 and 85 respectively. Conclusion: Health cooperatives are appropriate strategy for downsizing of government in health sector

  19. Insuring the uninsured: potential impact of Health Care Reform Act of 2010 on trauma centers.

    Science.gov (United States)

    Shafi, Shahid; Ogola, Gerald; Fleming, Neil; Rayan, Nadine; Kudyakov, Rustam; Barnes, Sunni A; Ballard, David J

    2012-11-01

    Viability of trauma centers is threatened by cost of care provided to patients without health insurance. The health care reform of 2010 is likely to benefit trauma centers by mandating universal health insurance by 2014. However, the financial benefit of this mandate will depend on the reimbursement provided. The study hypothesis was that compensation for the care of uninsured trauma patients at Medicare or Medicaid rates will lead to continuing losses for trauma centers. Financial data for first hospitalization were obtained from an urban Level I trauma center for 3 years (n = 6,630; 2006-2008) and linked with clinical information. Patients were grouped into five payments categories: commercial (29%), Medicaid (8%), Medicare (20%), workers' compensation (6%), and uninsured (37%). Prediction models for costs and payments were developed for each category using multiple regression models, adjusting for patient demographics, injury characteristics, complications, and survival. These models were used to predict payments that could be expected if uninsured patients were covered by different insurance types. Results are reported as net margin per patient (payments minus total costs) for each insurance type, with 95% confidence intervals, discounted to 2008 dollar values. Patients were typical for an urban trauma center (median age of 43 years, 66% men, 82% blunt, 5% mortality, and median length of stay 4 days). Overall, the trauma center lost $5,655 per patient, totaling $37.5 million over 3 years. These losses were encountered for patients without insurance ($14,343), Medicare ($4,838), and Medicaid ($15,740). Patients with commercial insurance were profitable ($5,295) as were those with workers' compensation ($6,860). Payments for the care of the uninsured at Medicare/Medicaid levels would lead to continued losses at $2,267 to $4,143 per patient. The health care reforms of 2010 would lead to continued losses for trauma centers if uninsured are covered with Medicare

  20. Development of a Decision Aid for Cardiopulmonary Resuscitation Involving Intensive Care Unit Patients' and Health Professionals' Participation Using User-Centered Design and a Wiki Platform for Rapid Prototyping: A Research Protocol

    Science.gov (United States)

    Heyland, Daren Keith; Ebell, Mark H; Dupuis, Audrey; Lavoie-Bérard, Carole-Anne; Légaré, France; Archambault, Patrick Michel

    2016-01-01

    Background Cardiopulmonary resuscitation (CPR) is an intervention used in cases of cardiac arrest to revive patients whose heart has stopped. Because cardiac arrest can have potentially devastating outcomes such as severe neurological deficits even if CPR is performed, patients must be involved in determining in advance if they want CPR in the case of an unexpected arrest. Shared decision making (SDM) facilitates discussions about goals of care regarding CPR in intensive care units (ICUs). Patient decision aids (DAs) are proven to support the implementation of SDM. Many patient DAs about CPR exist, but they are not universally implemented in ICUs in part due to lack of context and cultural adaptation. Adaptation to local context is an important phase of implementing any type of knowledge tool such as patient DAs. User-centered design supported by a wiki platform to perform rapid prototyping has previously been successful in creating knowledge tools adapted to the needs of patients and health professionals (eg, asthma action plans). This project aims to explore how user-centered design and a wiki platform can support the adaptation of an existing DA for CPR to the local context. Objective The primary objective is to use an existing DA about CPR to create a wiki-based DA that is adapted to the context of a single ICU and tailorable to individual patient’s risk factors while employing user-centered design. The secondary objective is to document the use of a wiki platform for the adaptation of patient DAs. Methods This study will be conducted in a mixed surgical and medical ICU at Hôtel-Dieu de Lévis, Quebec, Canada. We plan to involve all 5 intensivists and recruit at least 20 alert and oriented patients admitted to the ICU and their family members if available. In the first phase of this study, we will observe 3 weeks of daily interactions between patients, families, intensivists, and other allied health professionals. We will specifically observe 5 dyads of

  1. Medicaid Expansion And Grant Funding Increases Helped Improve Community Health Center Capacity.

    Science.gov (United States)

    Han, Xinxin; Luo, Qian; Ku, Leighton

    2017-01-01

    Through the expansion of Medicaid eligibility and increases in core federal grant funding, the Affordable Care Act (ACA) sought to increase the capacity of community health centers to provide primary care to low-income populations. We examined the effects of the ACA Medicaid expansion and changes in federal grant levels on the centers' numbers of patients, percentages of patients by type of insurance, and numbers of visits from 2012 to 2015. In the period after expansion (2014-15), health centers in expansion states had a 5 percent higher total patient volume, larger shares of Medicaid patients, smaller shares of uninsured patients, and increases in overall visits and mental health visits, compared to centers in nonexpansion states. Increases in federal grant funding levels were associated with increases in numbers of patients and of overall, medical, and preventive service visits. If federal grant levels are not sustained after 2017, there could be marked reductions in health center capacity in both expansion and nonexpansion states. Project HOPE—The People-to-People Health Foundation, Inc.

  2. Pediatrics Education in an AHEC Setting: Preparing Students to Provide Patient Centered Medicine

    Science.gov (United States)

    Evans, Steven Owens

    2012-01-01

    Patient centered medicine is a paradigm of health care that seeks to treat the whole person, rather than only the illness. The physician must understand the patient as a whole by considering the patient's individual needs, social structure, socioeconomic status, and educational background. Medical education includes ways to train students in this…

  3. Envisioning a social-health information exchange as a platform to support a patient-centered medical neighborhood: a feasibility study.

    Science.gov (United States)

    Nguyen, Oanh Kieu; Chan, Connie V; Makam, Anil; Stieglitz, Heather; Amarasingham, Ruben

    2015-01-01

    Social determinants directly contribute to poorer health, and coordination between healthcare and community-based resources is pivotal to addressing these needs. However, our healthcare system remains poorly equipped to address social determinants of health. The potential of health information technology to bridge this gap across the delivery of healthcare and social services remains unrealized. We conducted in-depth, in-person interviews with 50 healthcare and social service providers to determine the feasibility of a social-health information exchange (S-HIE) in an urban safety-net setting in Dallas County, Texas. After completion of interviews, we conducted a town hall meeting to identify desired functionalities for a S-HIE. We conducted thematic analysis of interview responses using the constant comparative method to explore perceptions about current communication and coordination across sectors, and barriers and enablers to S-HIE implementation. We sought participant confirmation of findings and conducted a forced-rank vote during the town hall to prioritize potential S-HIE functionalities. We found that healthcare and social service providers perceived a need for improved information sharing, communication, and care coordination across sectors and were enthusiastic about the potential of a S-HIE, but shared many technical, legal, and ethical concerns around cross-sector information sharing. Desired technical S-HIE functionalities encompassed fairly simple transactional operations such as the ability to view basic demographic information, visit and referral data, and medical history from both healthcare and social service settings. A S-HIE is an innovative and feasible approach to enabling better linkages between healthcare and social service providers. However, to develop S-HIEs in communities across the country, policy interventions are needed to standardize regulatory requirements, to foster increased IT capability and uptake among social service agencies

  4. Patient-centered pharmacovigilance: A review

    African Journals Online (AJOL)

    centered pharmacovigilance ... (DOAJ), African Journal Online, Bioline International, Open-J-Gate and Pharmacy Abstracts .... claimed a relationship between duration of drug usage and ..... prescribed physicians were completely safe, and.

  5. Health professionals' job satisfaction and associated factors at public health centers in West Ethiopia.

    Science.gov (United States)

    Deriba, Beyazin Kebede; Sinke, Shimele Ololo; Ereso, Berhane Megersa; Badacho, Abebe Sorsa

    2017-05-30

    Human resources are vital for delivering health services, and health systems cannot function effectively without sufficient numbers of skilled, motivated, and well-supported health workers. Job satisfaction of health workers is important for motivation and efficiency, as higher job satisfaction improves both employee performance and patient satisfaction. Even though several studies have addressed job satisfaction among healthcare professionals in different part of the world, there are relatively few studies on healthcare professionals' job satisfaction in Ethiopia. A facility-based cross-sectional study was conducted among health professionals working in health centers in April 2015 using self-administered structured questionnaires. All 322 health professionals working in 23 randomly selected public health centers were included. Factor scores were computed for the identified items by varimax rotation to represent satisfaction. Multivariate linear regression analysis was performed, and the effect of independent variables on the regression factor score quantified. Three hundred eight respondents participated with a response rate of 95.56%. The overall level of job satisfaction was 41.46%. Compensation (benefits) (beta 0.448 [95% CI 0.341 to 0.554]), recognition by management (beta 0.132 [95% CI 0.035 to 0.228]), and opportunity for development (beta 0.123 [95% CI 0.020 to 0.226]) were associated with job satisfaction. A unit increase in salary and incentives and recognition by management scores resulted in 0.459 (95% CI 0.356 to 0.561) and 0.156 (95% CI 0.065 to 0.247) unit increases in job satisfaction scores, respectively. The overall level of job satisfaction in health professionals was low. Salary and incentives, recognition by management, developmental opportunities, and patient appreciation were strong predictors of job satisfaction.

  6. Patient-centered care in Parkinson's disease

    NARCIS (Netherlands)

    Eijk, M. van der

    2015-01-01

    Patient centeredness means providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions’.The concept assumes that both physicians and patients are experts; physicians in diagnostic and

  7. University of Illinois at Chicago Health Policy Center - Funding

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1991-2015. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. Funding Data, Appropriations...

  8. San Joaquin Valley Aerosol Health Effects Research Center (SAHERC)

    Data.gov (United States)

    Federal Laboratory Consortium — At the San Joaquin Valley Aerosol Health Effects Center, located at the University of California-Davis, researchers will investigate the properties of particles that...

  9. Tri-Service Center for Oral Health Studies (TSCOHS)

    Data.gov (United States)

    Federal Laboratory Consortium — The Tri-Service Center for Oral Health Studies (TSCOHS), a service of the Postgraduate Dental College, is chartered by the Department of Defense TRICARE Management...

  10. Plan for radiological security at a university health center

    International Nuclear Information System (INIS)

    Huiaman Mendoza, G.M.; Sanchez Riojas, M.M.; Felix JImenez, D.

    1998-01-01

    This work shows a radiological security plan applied to a Basic Radiological Service at a university health center. Factors taken into account were installation designs, equipment operation parameters, work procedures, image system and responsibilities

  11. Making Value-Based Payment Work for Academic Health Centers.

    Science.gov (United States)

    Miller, Harold D

    2015-10-01

    Under fee-for-service payment systems, physicians and hospitals can be financially harmed by delivering higher-quality, more efficient care. The author describes how current "value-based purchasing" initiatives fail to address the underlying problems in fee-for-service payment and can be particularly problematic for academic health centers (AHCs). Bundled payments, warranties, and condition-based payments can correct the problems with fee-for-service payments and enable physicians and hospitals to redesign care delivery without causing financial problems for themselves. However, the author explains several specific actions that are needed to ensure that payment reforms can be a "win-win-win" for patients, purchasers, and AHCs: (1) disconnecting funding for teaching and research from payment for service delivery, (2) providing predictable payment for essential hospital services, (3) improving the quality and efficiency of care at AHCs, and (4) supporting collaborative relationships between AHCs and community providers by allowing each to focus on their unique strengths and by paying AHC specialists to assist community providers in diagnosis and treatment. With appropriate payment reforms and a commitment by AHCs to redesign care delivery, medical education, and research, AHCs could provide the leadership needed to improve care for patients, lower costs for health care purchasers, and maintain the financial viability of both AHCs and community providers.

  12. Utilization of Mental Health Services in School-Based Health Centers

    Science.gov (United States)

    Bains, Ranbir M.; Cusson, Regina; White-Frese, Jesse; Walsh, Stephen

    2017-01-01

    Background: We summarize utilization patterns for mental health services in school-based health centers. Methods: Administrative data on school-based health center visits in New Haven, Connecticut were examined for the 2007-2009 school years. Relative frequencies of mental health visits by age were calculated as a percentage of all visits and were…

  13. 75 FR 56549 - National Center for Health Statistics (NCHS), Classifications and Public Health Data Standards...

    Science.gov (United States)

    2010-09-16

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics (NCHS), Classifications and Public Health Data Standards Staff, Announces the... Public Health Data Standards Staff, NCHS, 3311 Toledo Road, Room 2337, Hyattsville, Maryland 20782, e...

  14. 75 FR 39265 - National Center for Health Statistics (NCHS), Classifications and Public Health Data Standards...

    Science.gov (United States)

    2010-07-08

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics (NCHS), Classifications and Public Health Data Standards Staff, Announces the... Prevention, Classifications and Public Health Data Standards, 3311 Toledo Road, Room 2337, Hyattsville, MD...

  15. 78 FR 53148 - National Center for Health Statistics (NCHS), Classifications and Public Health Data Standards...

    Science.gov (United States)

    2013-08-28

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics (NCHS), Classifications and Public Health Data Standards Staff, Announces the... Administrator, Classifications and Public Health Data Standards Staff, NCHS, 3311 Toledo Road, Room 2337...

  16. 78 FR 24756 - Health Center Program

    Science.gov (United States)

    2013-04-26

    ...'s funded section 330 grant application. Genesee County Community Mental Health (GCCMH)--now Genesee... operations of the grant program since its award in June 2012. On January 1, 2013, the State of Michigan... care services on the County of Genesee's behalf and has indicated an ability to continue operations...

  17. Investigation of the effects of group discussion on the empowerment of patients with hypertension who were referred to two health centers in Tehran in 1390

    Directory of Open Access Journals (Sweden)

    Nasrin Kheibar

    2014-04-01

    Results: The average age of the subjects was 54 ± 8.4 years and 34.4% of the participants had a history of hypertension for 5 years. Group discussions could lead to improve the average empowerment of individuals (P=0.04. Furthermore, among all the aspects of empowerment, group discussions had the greatest impact on the perception and sensitivity levels (P=0.001 and P=0.02 respectively. Conclusion: In patients with hypertension, group discussions can lead to increased perception and sensitivity levels and also enhance the ability of individuals to control their lifestyles.

  18. Medicine as a corporate enterprise, patient welfare centered profession, or patient welfare centered professional enterprise?

    Science.gov (United States)

    Singh, Ajai; Singh, Shakuntala

    2005-11-01

    enterprise or remain a patient welfare centered profession. A third approach involves an eclectic resolution of the two. Such amount of patient welfare as also ensures profit, and such amount of profit as also ensures patient welfare is to be forwarded. For, profit, without patient welfare, is blind. And patient welfare, without profit, is lame. According to this approach, medicine becomes a patient welfare centered professional enterprise.The various ramifications of each of these approaches are discussed in this monograph.

  19. Opportunities for social workers in the patient centered medical home.

    Science.gov (United States)

    Hawk, Mary; Ricci, Edmund; Huber, George; Myers, Marcella

    2015-01-01

    The Patient Centered Medical Home (PCMH) has been hailed as one method of improving chronic care outcomes in the United States. A number of studies have underscored the importance of the social work role within the PCMH, yet little existing research explores the social worker as a driver of improved patient care. The Pennsylvania Chronic Care Initiative was created with a primary goal of increasing the number of practices that were recognized as PCMH by the National Committee for Quality Assurance. This article describes findings from in-depth qualitative interviews with representatives from seven primary care practices, in which the authors examined barriers and facilitators to implementation of the initiative. Barriers to implementation included small practice size, payer-driven care, not having a strong physician champion, variability within patient populations, and high implementation costs. Facilitators included having a social worker coordinate behavioral health services, clinical nurse case managers, preexisting models of outcomes-driven care, and being part of an integrated health delivery and financing system. Recommendations strengthening the role of medical social workers in primary care practices are discussed.

  20. NHRC (Naval Health Research Center) Report 1982.

    Science.gov (United States)

    1982-01-01

    tryplophan 25 )" I and after placebo, assigned in a counter- balanced order. L-tryptophan significantly reduced sleep latency without altering nap...Occupational Influ- ences on Quality of Worklife " (Bruder/Butler/LA Johnson) LCDR Butler: "Patient Reaction to Family Practice and Nonfamily Practice

  1. What is patient-centered care really? Voices of Hispanic prenatal patients.

    Science.gov (United States)

    Bergman, Alicia A; Connaughton, Stacey L

    2013-01-01

    Variations in patient-centered care (PCC) models and approaches contribute to ambiguity in how PCC is understood and defined, especially with regard to meeting the needs of diverse patient populations. One of the biggest challenges of putting PCC into practice is knowing what elements are the most important to patients. This qualitative study privileges patients' voices and adds a cultural dimension to existing health communication research on PCC through an empirical investigation of 48 Hispanic prenatal care patients' understandings and expectations of PCC. Semistructured interviews with 48 patients revealed five key themes in order of frequency: (a) una relación amable (a friendly relationship), (b) la atencion médica efectiva (effective medical care), (c) Español hablado (the Spanish language spoken), (d) comprensión de la información (understanding of information), and (e) eliminación del racismo (elimination of racism). The themes reflected several different assumptions and expectations with regard to PCC as compared to those espoused in many of the existing models and frameworks, such as the extent to which friendly interpersonal behaviors (e.g., smiling, making eye contact, displaying patience, and engaging in formal greetings, introductions, and farewells) were critical to patient satisfaction with the health care experience. Not only did patients feel better understood, but accompanied by friendly behaviors, information was viewed as more believable and accurate, and thus more patient-centered. The findings suggest that implementing culturally sensitive PCC approaches to caring for Hispanic prenatal care patients can include training health care staff on the importance of displaying friendly communicative behaviors such as smiling.

  2. Clinical study of burn patients requiring admission: A single center experience at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences

    Directory of Open Access Journals (Sweden)

    Donkupar Khongwar

    2016-01-01

    Full Text Available Background: Although burns are a major problem in health care, a lot of the variation in risk factors exists from region to region which if uncovered correctly could help take effective prevention measures. Aims and Objectives: To assess the 3-year (January 2012 to January 2015 epidemiology of burn injuries admitted to our hospital (primary objective and to find areas of improvement in burn care (secondary objective. Materials and Methods: After obtaining ethical approval data were obtained from the medical record section regarding age, sex, residence, occupation, marital status, socioeconomic status, dates of admission and discharge, circumstances regarding the place, intent, cause, and source of heat. Clinical assessment was done using Wallace's “Rule of Nine” in adult and “Lund and Browder” chart in the pediatric age groups. The interrelationships between clinical and epidemiological variables with burn injury were studied. Results: An increasing trend in the admission rates of burn victims noted in last 3 years males (55.47% outnumbered females (44.52%. The most common age group affected is older children, adolescents, and young adults (between 11 and 30 years. Flame (38.3% and scald (25.3% burns contributed to most of the injuries. Females (52.30% are the major victim of flame burns. Electrical and chemical burns affected only the males suggesting work-related injuries. Trunk (30.8% is the most severely affected site in all cases. Depression (6.8% and power line workers (4.7% seem to be important risk factors in our study. Inability to complete treatment (26.7% was a major concern in our study. Conclusions: This study highlights the need for proper burn care that could be provided at the primary health-care level. The majority of burns were accidental in nature in school going children, young adults, and females. Flame and scald burns were the most common cause. Preventive measures directed toward burn safety and first aid measures

  3. Johnson Space Center Health and Medical Technical Authority

    Science.gov (United States)

    Fogarty, Jennifer A.

    2010-01-01

    1.HMTA responsibilities: a) Assure program/project compliance with Agency health and medical requirements at identified key decision points. b) Certify that programs/projects comply with Agency health and medical requirements prior to spaceflight missions. c) Assure technical excellence. 2. Designation of applicable NASA Centers for HMTA implementation and Chief Medical Officer (CMO) appointment. 3. Center CMO responsible for HMTA implementation for programs and projects at the center. JSC HMTA captured in "JSC HMTA Implementation Plan". 4. Establishes specifics of dissenting opinion process consistent with NASA procedural requirements.

  4. Addressing health literacy in patient decision aids

    Science.gov (United States)

    2013-01-01

    Background Effective use of a patient decision aid (PtDA) can be affected by the user’s health literacy and the PtDA’s characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess: 1. a) the effects of health literacy / numeracy on selected decision-making outcomes, and b) the effects of interventions designed to mitigate the influence of lower health literacy on decision-making outcomes, and 2. the extent to which existing PtDAs a) account for health literacy, and b) are tested in lower health literacy populations. Methods We reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews. Results Aim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies

  5. Provision of Patient-Centered Transgender Care.

    Science.gov (United States)

    Selix, Nancy W; Rowniak, Stefan

    2016-11-01

    Transgender individuals have unique health care needs and experience health disparities. There is an increased need for transgender health care services and primary care for this underserved population. However, provision of appropriate health care services for transgender persons requires cultural competency and skill on the part of the health care provider, and providers need specific skills to address the needs of this population. A review of the literature was performed by accessing CINAHL, PsycINFO, and PubMed databases. Pertinent research was extracted and reviewed for relevance. References in these publications were reviewed to identify additional publications that address primary prevention, secondary prevention, and tertiary care of transgender individuals. Articles that include prevention, screening, and treatment of health problems of transgender persons were identified. Research on the health needs of the transgender population is limited. Whenever available, research findings that address this unique population should be incorporated into clinical practice. When research evidence is not available to address the unique needs of transgender individuals, research and clinical care guidelines from the general population may be applied for health screening and maintenance. This article provides information about primary care services for transgender individuals and seeks to improve awareness of the health disparities this underserved population experiences. Simple solutions to modify clinical settings to enhance care are provided. © 2016 by the American College of Nurse-Midwives.

  6. A comparison of health behaviors of women in centering pregnancy and traditional prenatal care.

    Science.gov (United States)

    Shakespear, Kaylynn; Waite, Phillip J; Gast, Julie

    2010-03-01

    Researchers sought to determine the difference in health behaviors between women who receive prenatal care via the Centering Pregnancy approach and those involved in traditional prenatal care. Using a cross-sectional design, adult pregnant women (n = 125) were surveyed from at least 28 weeks gestation to delivery. The sample was comprised of primarily white low income women. Using multiple linear regression it was determined that women in Centering Pregnancy had significantly lower index health behavior scores compared with the traditional care group showing that those in Centering Pregnancy reported engaging in fewer health promoting behaviors. Furthermore, no differences were observed for smoking or weight gain behaviors between groups. Additionally, those in Centering Pregnancy reported a lower perceived value of prenatal care. The results of this study suggest that Centering Pregnancy is not adequately aiding its patients in adopting healthy behaviors during pregnancy.

  7. PATIENT-REPORTED OUTCOMES (PROs): PUTTING THE PATIENT PERSPECTIVE IN PATIENT-CENTERED OUTCOMES RESEARCH

    Science.gov (United States)

    Snyder, Claire F.; Jensen, Roxanne E.; Segal, Jodi B.; Wu, Albert W.

    2013-01-01

    Patient-centered outcomes research (PCOR) aims to improve care quality and patient outcomes by providing information that patients, clinicians, and family members need regarding treatment alternatives, and emphasizing patient input to inform the research process. PCOR capitalizes on available data sources and generates new evidence to provide timely and relevant information and can be conducted using prospective data collection, disease registries, electronic medical records, aggregated results from prior research, and administrative claims. Given PCOR’s emphasis on the patient perspective, methods to incorporate patient-reported outcomes (PROs) are critical. PROs are defined by the U.S. Food & Drug Administration as “Any report coming directly from patients… about a health condition and its treatment.” However, PROs have not routinely been collected in a way that facilitates their use in PCOR. Electronic medical records, disease registries, and administrative data have only rarely collected, or been linked to, PROs. Recent technological developments facilitate the electronic collection of PROs and linkage of PRO data, offering new opportunities for putting the patient perspective in PCOR. This paper describes the importance of and methods for using PROs for PCOR. We (1) define PROs; (2) identify how PROs can be used in PCOR, and the critical role of electronic data methods for facilitating the use of PRO data in PCOR; (3) outline the challenges and key unanswered questions that need to be addressed for the routine use of PROs in PCOR; and (4) discuss policy and research interventions to accelerate the integration of PROs with clinical data. PMID:23774513

  8. Health Literacy Innovations in California Community College Health Centers

    Science.gov (United States)

    Armenia, Joanne Elizabeth

    2013-01-01

    Limited health literacy is a national public health problem contributing to adverse health outcomes and increasing healthcare costs. Both health and educational systems are intervention points for improvement; however, there is paucity in empirical research regarding the role of educational systems. This needs assessment study explored health…

  9. Use of qualitative methods and user-centered design to develop customized health information technology tools within federally qualified health centers to keep children insured.

    Science.gov (United States)

    DeVoe, Jennifer; Angier, Heather; Likumahuwa, Sonja; Hall, Jennifer; Nelson, Christine; Dickerson, Kay; Keller, Sara; Burdick, Tim; Cohen, Deborah

    2014-01-01

    Lack of health insurance negatively impacts children's health. Despite federal initiatives to expand children's coverage and accelerate state outreach efforts, millions of US children remain uninsured or experience frequent gaps in coverage. Most current efforts to enroll and retain eligible children in public insurance programs take place outside of the health care system. This study is a partnership between patients' families, medical informaticists, federally qualified health center (FQHC) staff, and researchers to build and test information technology tools to help FQHCs reach uninsured children and those at risk for losing coverage.

  10. Patient and Other Stakeholder Engagement in Patient-Centered Outcomes Research Institute Funded Studies of Patients with Kidney Diseases.

    Science.gov (United States)

    Cukor, Daniel; Cohen, Lewis M; Cope, Elizabeth L; Ghahramani, Nasrollah; Hedayati, S Susan; Hynes, Denise M; Shah, Vallabh O; Tentori, Francesca; Unruh, Mark; Bobelu, Jeanette; Cohen, Scott; Dember, Laura M; Faber, Thomas; Fischer, Michael J; Gallardo, Rani; Germain, Michael J; Ghahate, Donica; Grote, Nancy; Hartwell, Lori; Heagerty, Patrick; Kimmel, Paul L; Kutner, Nancy; Lawson, Susan; Marr, Lisa; Nelson, Robert G; Porter, Anna C; Sandy, Phillip; Struminger, Bruce B; Subramanian, Lalita; Weisbord, Steve; Young, Bessie; Mehrotra, Rajnish

    2016-09-07

    Including target populations in the design and implementation of research trials has been one response to the growing health disparities endemic to our health care system, as well as an aid to study generalizability. One type of community-based participatory research is "Patient Centered-Research", in which patient perspectives on the germane research questions and methodologies are incorporated into the study. The Patient-Centered Outcomes Research Institute (PCORI) has mandated that meaningful patient and stakeholder engagement be incorporated into all applications. As of March 2015, PCORI funded seven clinically-focused studies of patients with kidney disease. The goal of this paper is to synthesize the experiences of these studies to gain an understanding of how meaningful patient and stakeholder engagement can occur in clinical research of kidney diseases, and what the key barriers are to its implementation. Our collective experience suggests that successful implementation of a patient- and stakeholder-engaged research paradigm involves: (1) defining the roles and process for the incorporation of input; (2) identifying the particular patients and other stakeholders; (3) engaging patients and other stakeholders so they appreciate the value of their own participation and have personal investment in the research process; and (4) overcoming barriers and challenges that arise and threaten the productivity of the collaboration. It is our hope that the experiences of these studies will further interest and capacity for incorporating patient and stakeholder perspectives in research of kidney diseases. Copyright © 2016 by the American Society of Nephrology.

  11. The Union Health Center: a working model of clinical care linked to preventive occupational health services.

    Science.gov (United States)

    Herbert, R; Plattus, B; Kellogg, L; Luo, J; Marcus, M; Mascolo, A; Landrigan, P J

    1997-03-01

    As health care provision in the United States shifts to primary care settings, it is vital that new models of occupational health services be developed that link clinical care to prevention. The model program described in this paper was developed at the Union Health Center (UHC), a comprehensive health care center supported by the International Ladies Garment Workers Union (now the Union of Needletrades, Industrial and Textile Employees) serving a population of approximately 50,000 primarily minority, female garment workers in New York City. The objective of this paper is to describe a model occupational medicine program in a union-based comprehensive health center linking accessible clinical care with primary and secondary disease prevention efforts. To assess the presence of symptoms suggestive of occupational disease, a health status questionnaire was administered to female workers attending the UHC for routine health maintenance. Based on the results of this survey, an occupational medicine clinic was developed that integrated direct clinical care with worker and employer education and workplace hazard abatement. To assess the success of this new approach, selected cases of sentinel health events were tracked and a chart review was conducted after 3 years of clinic operation. Prior to initiation of the occupational medicine clinic, 64% (648) of the workers surveyed reported symptoms indicative of occupational illnesses. However, only 42 (4%) reported having been told by a physician that they had an occupational illness and only 4 (.4%) reported having field a workers' compensation claim for an occupational disease. In the occupational medicine clinic established at the UHC, a health and safety specialist acts as a case manager, coordinating worker and employer education as well as workplace hazard abatement focused on disease prevention, ensuring that every case of occupational disease is treated as a potential sentinel health event. As examples of the success

  12. Audit of a diabetic health education program at a large Primary Health Care Center in Asir region.

    Science.gov (United States)

    Al-Khaldi, Y M; Khan, M Y

    2000-09-01

    To evaluate the health education program in a large Primary Health Care Center, to find out the problems faced by the staff and to suggest the practical and relevant solutions. This study was carried out at Wasat Abha Primary Health Care Center, Asir region during 1997. The files of diabetics who attended the center were evaluated for health education topics by using a checklist. The essential structure of diabetic health education program was assessed by using another check list designed by the investigators. Data entry and analysis was carried out through SPSS package. Chi-square test was applied wherever necessary. The total number of diabetics who attended Wasat Abha Primary Health Care Center was 198. The duration of diabetes mellitus was 7.7+5.8 years. Ninety percent of these were married, 50.5% were educated and 79% were employed. Compliance to appointment was good in 60% and poor in 30% of diabetics. About 73% of the diabetics received at least one health education topic while 27% did not receive any health education at all. Only 33% of diabetic patients had adequate health education. Ninety one percent were provided with diabetic identification cards, 80% were explained about diabetes and 77% were educated about the role of diet. Essential structure for diabetes education program was found to be unsatisfactory. Effective diabetic health education program needs the availability of all essential structures, community participation and integration of the government and private sectors. The deficiencies in the structures and the process of health education programs in our practice are almost universal to other Primary Health Care Centers in the Asir region. Providing the Primary Health Care Centers with all essential structures and annual auditing are complimentary to a successful diabetic health education program.

  13. 75 FR 12766 - National Center on Minority Health and Health Disparities; Notice of Closed Meetings

    Science.gov (United States)

    2010-03-17

    ... Health and Health Disparities; Notice of Closed Meetings Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel Loan Repayment Program for Health Disparities Research... Review, National Center on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800...

  14. 75 FR 9421 - National Center on Minority Health and Health Disparities; Notice of Closed Meeting

    Science.gov (United States)

    2010-03-02

    ... Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; Loan Repayment Program for Health Disparities Research..., National Center on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda...

  15. Patient-centered care and its effect on outcomes in the treatment of asthma

    Directory of Open Access Journals (Sweden)

    Qamar N

    2011-06-01

    Full Text Available Nashmia Qamar1,*, Andrea A Pappalardo2,*, Vineet M Arora3, Valerie G Press41Pediatric Residency Program, University of Chicago Medical Center, Chicago, IL, USA; 2Internal Medicine-Pediatric Residency Program, University of Chicago Medical Center, Chicago, IL, USA; 3Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA; 4Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA *Drs Qamar and Pappalardo contributed equally to this paperAbstract: Patient-centered care may be pivotal in improving health outcomes for patients with asthma. In addition to increased attention in both research and clinical forums, recent legislation also highlights the importance of patient-centered outcomes research in the Patient Protection and Affordable Care Act. However, whether patient-centered care has been shown to improve outcomes for this population is unclear. To answer this question, we performed a systematic review of the literature that aimed to define current patient-focused management issues, characterize important patient-defined outcomes in asthma control, and identify current and emerging treatments related to patient outcomes and perspectives. We used a parallel search strategy via Medline®, Cochrane Central Register of Controlled Trials, CINAHL® (Cumulative Index to Nursing and Allied Health Literature, and PsycINFO®, complemented with a reference review of key articles that resulted in a total of 133 articles; 58 were interventions that evaluated the effect on patient-centered outcomes, and 75 were descriptive studies. The majority of intervention studies demonstrated improved patient outcomes (44; “positive” results; none showed true harm (0; “negative”; and the remainder were equivocal (14; “neutral”. Key themes emerged relating to patients’ desires for asthma knowledge, preferences for tailored management plans, and

  16. Patient-centered Fertility Care: From Theory to Practice

    Directory of Open Access Journals (Sweden)

    Fatemeh Jafarzadeh-Kenarsari

    2016-07-01

    Full Text Available Background & aim: Healthcare areas, especially fertility care (commonly accompanied with high emotions, as well as long-term and recurring treatment periods could exclusively benefit from patient-centered care (PCC. Despite evident advantages of PCC, this approach has not been practiced as a routine procedure in current clinical environments yet, even in western developed countries. Therefore, this review aimed to evaluate the significance and different aspects of PCC, while emphasizing on patient-centered fertility care, its challenges, and applicable recommendations in this regard. Methods: This narrative review was conducted on 29 relevant medical and clinical papers (published during 1990-2015 collected using various national and international databases (e.g., SID, Magiran, Medlib, Google scholar, Proquest, Pubmed, Wiley, Science direct, and Scopus. Key words and phrases used in this review were “infertility”, “fertility care”, “childlessness”, “patient-centered care”, “patient-centered fertility care” “shared decision-making”, “infertile patient preferences”, and “patient involvement in fertility care”. Results: According to the literature, implementation challenges of patient-centered fertility care were reported as different individual and organizational factors. These factors include lack of professional motivation to change, underestimating the significance of patient-centeredness by healthcare professionals, difficulty in translation of feedback into concrete measures, lack of time and financial resources, insufficient experience of healthcare professionals with regard to identification of needs and preferences of patients, traditional organizational culture, and common misconceptions. Conclusion: Promotion of patient-centered fertility services requires the identification of infertile needs and priorities of individuals, designation of interventional and supportive programs based on sociocultural

  17. Patient-Centered Pain Care Using Artificial Intelligence and Mobile Health Tools: Protocol for a Randomized Study Funded by the US Department of Veterans Affairs Health Services Research and Development Program.

    Science.gov (United States)

    Piette, John D; Krein, Sarah L; Striplin, Dana; Marinec, Nicolle; Kerns, Robert D; Farris, Karen B; Singh, Satinder; An, Lawrence; Heapy, Alicia A

    2016-04-07

    practice, and physical functioning. Outcomes will be measured at 3 and 6 months post recruitment and will include pain-related interference, treatment satisfaction, and treatment dropout. Our primary hypothesis is that AI-CBT will result in pain-related functional outcomes that are at least as good as the standard approach, and that by scaling back the intensity of contact that is not associated with additional gains in pain control, the AI-CBT approach will be significantly less costly in terms of therapy time. The trial is currently in the start-up phase. Patient enrollment will begin in the fall of 2016 and results of the trial will be available in the winter of 2019. This study will evaluate an intervention that increases patients' access to effective CBT pain management services while allowing health systems to maximize program expansion given constrained resources.

  18. Implementing the patient-centered medical home in residency education.

    Science.gov (United States)

    Doolittle, Benjamin R; Tobin, Daniel; Genao, Inginia; Ellman, Matthew; Ruser, Christopher; Brienza, Rebecca

    2015-01-01

    In recent years, physician groups, government agencies and third party payers in the United States of America have promoted a Patient-centered Medical Home (PCMH) model that fosters a team-based approach to primary care. Advocates highlight the model's collaborative approach where physicians, mid-level providers, nurses and other health care personnel coordinate their efforts with an aim for high-quality, efficient care. Early studies show improvement in quality measures, reduction in emergency room visits and cost savings. However, implementing the PCMH presents particular challenges to physician training programs, including institutional commitment, infrastructure expenditures and faculty training. Teaching programs must consider how the objectives of the PCMH model align with recent innovations in resident evaluation now required by the Accreditation Council of Graduate Medical Education (ACGME) in the US. This article addresses these challenges, assesses the preliminary success of a pilot project, and proposes a viable, realistic model for implementation at other institutions.

  19. Measuring the quality of patient-centered care: why patient-reported measures are critical to reliable assessment

    Directory of Open Access Journals (Sweden)

    Tzelepis F

    2015-06-01

    Full Text Available Flora Tzelepis, Robert W Sanson-Fisher, Alison C Zucca, Elizabeth A FradgleyPriority Research Centre for Health Behaviour, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, AustraliaPurpose: The Institute of Medicine (IOM identified patient-centeredness as crucial to quality health care. The IOM endorsed six patient-centeredness dimensions that stipulated that care must be: respectful to patients’ values, preferences, and expressed needs; coordinated and integrated; provide information, communication, and education; ensure physical comfort; provide emotional support; and involve family and friends. Patient-reported measures examine the patient’s perspective and are essential to the accurate assessment of patient-centered care. This article’s objectives are to: 1 use the six IOM-endorsed patient-centeredness dimensions as a framework to outline why patient-reported measures are crucial to the reliable measurement of patient-centered care; and 2 to identify existing patient-reported measures that assess each patient-centered care dimension.Methods: For each IOM-endorsed patient-centeredness dimension, the published literature was searched to highlight the essential role of patients in assessing patient-centered care and informing quality improvement efforts. Existing literature was also searched to identify examples of patient-reported measures that assess each patient-centeredness dimension.Conclusion: Patient-reported measures are arguably the best way to measure patient-centeredness. For instance, patients are best positioned to determine whether care aligns with patient values, preferences, and needs and the Measure of Patient Preferences is an example of a patient-reported measure that does so. Furthermore, only the patient knows whether they received the level of information desired, and if information was understood and can be recalled. Patient-reported measures that examine information provision include

  20. Udenlandske patienter i et distriktspsykiatrisk center

    DEFF Research Database (Denmark)

    Stenager, Elsebeth; Andersen, Kristian Øllegård; Taha, Jihan

    2010-01-01

    INTRODUCTION: Over the last ten years more patients have been referred to the District Psychiatric Centre (DPC) in Odense. We therefore found it relevant to investigate the following in this study: - To register patients with foreign background, who are receiving psychiatric treatment in DPC. - T...

  1. Forging successful academic-community partnerships with community health centers: the California statewide Area Health Education Center (AHEC) experience.

    Science.gov (United States)

    Fowkes, Virginia; Blossom, H John; Mitchell, Brenda; Herrera-Mata, Lydia

    2014-01-01

    Increased access to insurance under the Affordable Care Act will increase demands for clinical services in community health centers (CHCs). CHCs also have an increasingly important educational role to train clinicians who will remain to practice in community clinics. CHCs and Area Health Education Centers (AHECs) are logical partners to prepare the health workforce for the future. Both are sponsored by the Health Resources and Services Administration, and they share a mission to improve quality of care in medically underserved communities. AHECs emphasize the educational side of the mission, and CHCs the service side. Building stronger partnerships between them can facilitate a balance between education and service needs.From 2004 to 2011, the California Statewide AHEC program and its 12 community AHECs (centers) reorganized to align training with CHC workforce priorities. Eight centers merged into CHC consortia; others established close partnerships with CHCs in their respective regions. The authors discuss issues considered and approaches taken to make these changes. Collaborative innovative processes with program leadership, staff, and center directors revised the program mission, developed common training objectives with an evaluation plan, and defined organizational, functional, and impact characteristics for successful AHECs in California. During this planning, centers gained confidence as educational arms for the safety net and began collaborations with statewide programs as well as among themselves. The AHEC reorganization and the processes used to develop, strengthen, and identify standards for centers forged the development of new partnerships and established academic-community trust in planning and implementing programs with CHCs.

  2. 76 FR 40733 - National Institute for Occupational Safety and Health, (NIOSH), World Trade Center Health Program...

    Science.gov (United States)

    2011-07-11

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Institute for Occupational Safety and Health, (NIOSH), World Trade Center Health Program Science/Technical Advisory Committee (WTCHP-STAC) Correction: This notice was published in the Federal Register on June 23...

  3. Evaluating the Sustainability of School-Based Health Centers.

    Science.gov (United States)

    Navarro, Stephanie; Zirkle, Dorothy L; Barr, Donald A

    2017-01-01

    The United States is facing a surge in the number of school-based health centers (SBHCs) owing to their success in delivering positive health outcomes and increasing access to care. To preserve this success, experts have developed frameworks for creating sustainable SBHCs; however, little research has affirmed or added to these models. This research seeks to analyze elements of sustainability in a case study of three SBHCs in San Diego, California, with the purpose of creating a research-based framework of SBHC sustainability to supplement expertly derived models. Using a mixed methods study design, data were collected from interviews with SBHC stakeholders, observations in SBHCs, and SBHC budgets. A grounded theory qualitative analysis and a quantitative budget analysis were completed to develop a theoretical framework for the sustainability of SBHCs. Forty-one interviews were conducted, 6 hours of observations were completed, and 3 years of SBHC budgets were analyzed to identify care coordination, community buy-in, community awareness, and SBHC partner cooperation as key themes of sustainability promoting patient retention for sustainable billing and reimbursement levels. These findings highlight the unique ways in which SBHCs gain community buy-in and awareness by becoming trusted sources of comprehensive and coordinated care within communities and among vulnerable populations. Findings also support ideas from expert models of SBHC sustainability calling for well-defined and executed community partnerships and quality coordinated care in the procurement of sustainable SBHC funding.

  4. An Employee-Centered Care Model Responds to the Triple Aim: Improving Employee Health.

    Science.gov (United States)

    Fox, Kelly; McCorkle, Ruth

    2018-01-01

    Health care expenditures, patient satisfaction, and timely access to care will remain problematic if dramatic changes in health care delivery models are not developed and implemented. To combat this challenge, a Triple Aim approach is essential; Innovation in payment and health care delivery models is required. Using the Donabedian framework of structure, process, and outcome, this article describes a nurse-led employee-centered care model designed to improve consumers' health care experiences, improve employee health, and increase access to care while reducing health care costs for employees, age 18 and older, in a corporate environment.

  5. Centralized Outpatient Education Center for Patients with Diabetes at Walter Reed Army Medical Center

    Science.gov (United States)

    1984-05-16

    rated into the study where appropriate. Interviews with education coordinators from nonmilitary diabetes treatment facilities were evaluated and...personnel were evaluated to determine the acceptance of the concept of an outpatient education center for diabetic patients. 12 The data from the...step was to evaluate the data from 100 outpatients to ascertain the degree of acceptance of an outpatient education center for diabetic patients. The

  6. An HIT Solution for Clinical Care and Disaster Planning: How One health Center in Joplin, MO Survived a Tornado and Avoided a Health Information Disaster.

    Science.gov (United States)

    Shin, Peter; Jacobs, Feygele

    2012-01-01

    Since taking office, President Obama has made substantial investments in promoting the diffusion of health information technology (IT). The objective of the national health IT program is, generally, to enable health care providers to better manage patient care through secure use and sharing of health information. Through the use of technologies including electronic health records, providers can better maintain patient care information and facilitate communication, often improving care outcomes. The recent tornado in Joplin, MO highlights the importance of health information technology in the health center context, and illustrates the importance of secure electronic health information systems as a crucial element of disaster and business continuity planning. This article examines the experience of a community health center in the aftermath of the major tornado that swept through the American Midwest in the spring of 2011, and provides insight into the planning for disaster survival and recovery as it relates to patient records and health center data.

  7. Oral health knowledge of health care workers in special?children?s center

    OpenAIRE

    Wyne, Amjad; Hammad, Nouf; Splieth, Christian

    2015-01-01

    Objective: To determine the oral health knowledge of health care workers in special children?s center. Methods: A self-administered questionnaire was used to collect following information: demographics, oral hygiene practices, importance of fluoride, dental visits, cause of tooth decay, gingival health, and sources of oral health information. The study was conducted at Riyadh Center for Special Children in Riyadh City from December 2013 to May 2014. Results: All 60 health care workers in the ...

  8. Academic health centers and society: an ethical reflection.

    Science.gov (United States)

    Pellegrino, E D

    1999-08-01

    Academic health centers--which combine university, medical school, and hospital--exist to satisfy universal human needs and thus are by definition instruments of social purpose. Their core mission is threefold: to provide medical knowledge that can help relieve and prevent illness and suffering, to supply practitioners able to apply that knowledge wisely, and to serve as sites where optimal use of medical knowledge can be demonstrated and investigated. Maintaining a balance between core mission and responsiveness to social trends is a delicate exercise. Overly close accommodation to such trends can endanger the core mission, as has occurred in the United States with regard to managed care. Society and academic health centers have mutual obligations. Obligations of society include giving academic health centers financial and other support and allowing them sufficient freedom to pursue their mission; obligations of academic medical centers include accepting greater scrutiny by society and providing social criticism on matters relating to health. A task for the future is to discern how academic health centers can be responsive to social needs without being totally subservient to societal desires.

  9. Implementing the patient-centered medical home in complex adaptive systems: Becoming a relationship-centered patient-centered medical home.

    Science.gov (United States)

    Flieger, Signe Peterson

    This study explores the implementation experience of nine primary care practices becoming patient-centered medical homes (PCMH) as part of the New Hampshire Citizens Health Initiative Multi-Stakeholder Medical Home Pilot. The purpose of this study is to apply complex adaptive systems theory and relationship-centered organizations theory to explore how nine diverse primary care practices in New Hampshire implemented the PCMH model and to offer insights for how primary care practices can move from a structural PCMH to a relationship-centered PCMH. Eighty-three interviews were conducted with administrative and clinical staff at the nine pilot practices, payers, and conveners of the pilot between November and December 2011. The interviews were transcribed, coded, and analyzed using both a priori and emergent themes. Although there is value in the structural components of the PCMH (e.g., disease registries), these structures are not enough. Becoming a relationship-centered PCMH requires attention to reflection, sensemaking, learning, and collaboration. This can be facilitated by settings aside time for communication and relationship building through structured meetings about PCMH components as well as the implementation process itself. Moreover, team-based care offers a robust opportunity to move beyond the structures to focus on relationships and collaboration. (a) Recognize that PCMH implementation is not a linear process. (b) Implementing the PCMH from a structural perspective is not enough. Although the National Committee for Quality Assurance or other guidelines can offer guidance on the structural components of PCMH implementation, this should serve only as a starting point. (c) During implementation, set aside structured time for reflection and sensemaking. (d) Use team-based care as a cornerstone of transformation. Reflect on team structures and also interactions of the team members. Taking the time to reflect will facilitate greater sensemaking and learning and

  10. Patient-centered care: the key to cultural competence.

    Science.gov (United States)

    Epner, D E; Baile, W F

    2012-04-01

    Much of the early literature on 'cultural competence' focuses on the 'categorical' or 'multicultural' approach, in which providers learn relevant attitudes, values, beliefs, and behaviors of certain cultural groups. In essence, this involves learning key 'dos and don'ts' for each group. Literature and educational materials of this kind focus on broad ethnic, racial, religious, or national groups, such as 'African American', 'Hispanic', or 'Asian'. The problem with this categorical or 'list of traits' approach to clinical cultural competence is that culture is multidimensional and dynamic. Culture comprises multiple variables, affecting all aspects of experience. Cultural processes frequently differ within the same ethnic or social group because of differences in age cohort, gender, political association, class, religion, ethnicity, and even personality. Culture is therefore a very elusive and nebulous concept, like art. The multicultural approach to cultural competence results in stereotypical thinking rather than clinical competence. A newer, cross cultural approach to culturally competent clinical practice focuses on foundational communication skills, awareness of cross-cutting cultural and social issues, and health beliefs that are present in all cultures. We can think of these as universal human beliefs, needs, and traits. This patient centered approach relies on identifying and negotiating different styles of communication, decision-making preferences, roles of family, sexual and gender issues, and issues of mistrust, prejudice, and racism, among other factors. In the current paper, we describe 'cultural' challenges that arise in the care of four patients from disparate cultures, each of whom has advanced colon cancer that is no longer responding to chemotherapy. We then illustrate how to apply principles of patient centered care to these challenges.

  11. Trends in Publications in Radiology Journals Designated as Relating to Patient-Centered Care.

    Science.gov (United States)

    Rosenkrantz, Andrew B; Rawson, James V

    2017-05-01

    To assess trends in publications in radiology journals designated as dealing with patient-centered care. PubMed was searched for articles in radiology journals for which the article's record referenced patient-centered/patient-centric care. Among these, original research articles were identified and assigned major themes. Trends were assessed descriptively. A total of 115 articles in radiology journals designated as dealing with patient-centered care were identified, including 40 original research articles. The number of articles annually ranged from 0 to 4 in 2000-2008, 5 to 9 in 2010-2012, 14 to 15 in 2013-2014, and 25 in 2015. Only four radiology journals had published more than one of the original research articles. Original research articles' most common themes were: optimization of patients' access to reports and images (n=7); patients' examination experience (5); image evaluation (n=4); radiologists meeting with patients (n=4); improving patients' knowledge of imaging (n=3); examination wait times/efficiency (n=3); examination utilization/appropriateness (n=3); and IT enhancements (n=3). A total of 13 of 40 original research articles solicited opinions from patients. One study involved patients in educating trainees regarding patient-centered care. No study involved patients in system-level decisions regarding health care design and delivery. Articles dealing with patient-centered care in radiology are increasing, though they remain concentrated in a limited number of journals. Though major themes included image/report access, patient experiences, and radiologists meeting with patients, many studies dealt with less clearly patient-centric topics such as examination interpretation, while inclusion of patients in systems design was lacking. Further research in radiology is encouraged to target a broader range of ideals of patient-centered care, such as diversity, autonomy, and compassion, and to incorporate greater patient engagement. Copyright © 2016

  12. Role of the health center in health crisis management, especially in a radiation disaster

    International Nuclear Information System (INIS)

    Kurahashi, Toshiyuki

    2013-01-01

    In a disaster, in particular a radiation disaster, health centers should play an active role in taking advantage of its own expertise. There are various causes of a health crisis; the response to a health crisis is defined according to each cause. However, it should be adequately addressed by assuming the worst case for a health crisis of unknown cause. The role of health centers, in addition to the implementation of appropriate and timely treatment of any health crisis, is prevention of a future health crisis, advanced preparation, and damage recovery; activities during normal times are also important to maintain. Regarding the specific activities of the health center, judgment in the preference of measures to be performed is important. That the information is collected properly based on the idea of risk communication, coordination, and public relations transmission is required also for health centers. (author)

  13. Assessment of the Patient-Centered and Family-Centered Care Experience of Total Joint Replacement Patients Using a Shadowing Technique.

    Science.gov (United States)

    Marcus-Aiyeku, Ulanda; DeBari, Margaret; Salmond, Susan

    2015-01-01

    In 2030, when baby boomers reach 65 years of age and represent 18% of the population, it is anticipated that 67 million adults will have a diagnosis of arthritis increasing the demand for total hip and knee arthroplasty. With the growing emphasis on patient- and family-centered care, the aim of this project was to assess the patient experience of patients and families throughout the entire spectrum of the total joint replacement service line care at a university regional trauma hospital. A shadowing methodology as defined by the Institute for Health Improvement was utilized. Eight patient/family groups undergoing total joint replacements were shadowed. The mapped care experience included time, caregiver, activity, shadower observations, and impressions. Findings revealed inconsistencies in the delivery of patient- and family-centered care. Communication and interactions were predominantly provider-centric, with a focus on care routines versus the patient and family, and anticipation that care would be medically directed.

  14. A 3-stage model of patient-centered communication for addressing cancer patients' emotional distress.

    Science.gov (United States)

    Dean, Marleah; Street, Richard L

    2014-02-01

    To describe pathways through which clinicians can more effectively respond to patients' emotions in ways that contribute to betterment of the patient's health and well-being. A representative review of literature on managing emotions in clinical consultations was conducted. A three-stage, conceptual model for assisting clinicians to more effectively address the challenges of recognizing, exploring, and managing cancer patients' emotional distress in the clinical encounter was developed. To enhance and enact recognition of patients' emotions, clinicians can engage in mindfulness, self-situational awareness, active listening, and facilitative communication. To enact exploration, clinicians can acknowledge and validate emotions and provide empathy. Finally, clinicians can provide information empathetically, identify therapeutic resources, and give referrals and interventions as needed to help lessen patients' emotional distress. This model serves as a framework for future research examining pathways that link clinicians' emotional cue recognition to patient-centered responses exploring a patient's emotional distress to therapeutic actions that contribute to improved psychological and emotional health. Specific communicative and cognitive strategies are presented that can help clinicians better recognize a patient's emotional distress and respond in ways that have therapeutic value. Published by Elsevier Ireland Ltd.

  15. A revisionist view of the integrated academic health center.

    Science.gov (United States)

    Rodin, Judith

    2004-02-01

    Like many academic health centers that had expanded aggressively during the 1990s, the nation's first vertically integrated academic health center, the University of Pennsylvania Health System, was profoundly challenged by the dramatic and unanticipated financial impacts of the Balanced Budget Act of 1997. The author explains why-although Penn's Health System had lost $300 million over two years and its debts threatened to cause serious financial and educational damage to the rest of the University-Penn chose to manage its way out of the financial crisis (instead of selling or spinning off its four hospitals, clinical practices, and possibly even its medical school). A strategy of comprehensive integration has not only stabilized Penn's Health System financially, but strengthened its position of leadership in medical education, research, and health care delivery. The author argues that a strategy of greater horizontal integration offers important strategic advantages to academic health centers. In an era when major social and scientific problems demand broadly multidisciplinary and highly-integrated approaches, such horizontally integrated institutions will be better able to educate citizens and train physicians, develop new approaches to health care policy, and answer pressing biomedical research questions. Institutional cultural integration is also crucial to create new, innovative organizational structures that bridge traditional disciplinary, school, and clinical boundaries.

  16. Evaluating a Sexual Health Patient Education Resource.

    Science.gov (United States)

    Matzo, Marianne; Troup, Sandi; Hijjazi, Kamal; Ferrell, Betty

    2015-01-01

    This article shares the findings of an evaluation of a patient teaching resource for sexual health entitled Everything Nobody Tells You About Cancer Treatment and Your Sex Life: From A to Z, which was accomplished through systematic conceptualization, construction, and evaluation with women diagnosed with breast or gynecologic cancer. This resource, which has evolved from patient-focused research and has been tested in the clinical setting, can be used in patient education and support. Oncology professionals are committed to addressing quality-of-life concerns for patients across the trajectory of illness. Sexuality is a key concern for patients and impacts relationships and overall quality of life. Through careful assessment, patient education, and support, clinicians can ensure that sexuality is respected as an essential part of patient-centered care.

  17. Health Extension in New Mexico: An Academic Health Center and the Social Determinants of Disease

    Science.gov (United States)

    Kaufman, Arthur; Powell, Wayne; Alfero, Charles; Pacheco, Mario; Silverblatt, Helene; Anastasoff, Juliana; Ronquillo, Francisco; Lucero, Ken; Corriveau, Erin; Vanleit, Betsy; Alverson, Dale; Scott, Amy

    2010-01-01

    The Agricultural Cooperative Extension Service model offers academic health centers methodologies for community engagement that can address the social determinants of disease. The University of New Mexico Health Sciences Center developed Health Extension Rural Offices (HEROs) as a vehicle for its model of health extension. Health extension agents are located in rural communities across the state and are supported by regional coordinators and the Office of the Vice President for Community Health at the Health Sciences Center. The role of agents is to work with different sectors of the community in identifying high-priority health needs and linking those needs with university resources in education, clinical service and research. Community needs, interventions, and outcomes are monitored by county health report cards. The Health Sciences Center is a large and varied resource, the breadth and accessibility of which are mostly unknown to communities. Community health needs vary, and agents are able to tap into an array of existing health center resources to address those needs. Agents serve a broader purpose beyond immediate, strictly medical needs by addressing underlying social determinants of disease, such as school retention, food insecurity, and local economic development. Developing local capacity to address local needs has become an overriding concern. Community-based health extension agents can effectively bridge those needs with academic health center resources and extend those resources to address the underlying social determinants of disease. PMID:20065282

  18. Improving the transition of care in patients transferred through the ochsner medical center transfer center.

    Science.gov (United States)

    Amedee, Ronald G; Maronge, Genevieve F; Pinsky, William W

    2012-01-01

    Patient transfers from other hospitals within the Ochsner Health System to the main campus are coordinated through a Transfer Center that was established in fall 2008. We analyzed the transfer process to assess distinct opportunities to enhance the overall transition of patient care. We surveyed internal medicine residents and nocturnists to determine their satisfaction with transfers in terms of safety, efficiency, and usefulness of information provided at the time of transfer. After a kaizen event at which complementary goals for the institution and members of the study team were recognized and implemented, we resurveyed the group to evaluate improvement in the transfer process. The preintervention average satisfaction score was 1.18 (SD=0.46), while the postintervention score was 3.7 (SD=1.01). A t test showed a significant difference in the average scores between the preintervention and postintervention surveys (Pkaizen event), data were collected that facilitated fewer and higher quality handoffs that were performed in less time. In addition, the process resulted in increased awareness of the value of resident participation in institutional quality improvement projects.

  19. Organizational Processes and Patient Experiences in the Patient-centered Medical Home.

    Science.gov (United States)

    Aysola, Jaya; Schapira, Marilyn M; Huo, Hairong; Werner, Rachel M

    2018-06-01

    There is increasing emphasis on the use of patient-reported experience data to assess practice performance, particularly in the setting of patient-centered medical homes. Yet we lack understanding of what organizational processes relate to patient experiences. Examine associations between organizational processes practices adopt to become PCMH and patient experiences with care. We analyzed visit data from patients (n=8356) at adult primary care practices (n=22) in a large health system. We evaluated the associations between practice organizational processes and patient experience using generalized estimating equations (GEE) with an exchangeable correlation structure to account for patient clustering by practice in multivariate models, adjusting for several practice-level and patient-level characteristics. We evaluated if these associations varied by race/ethnicity, insurance type, and the degree of patient comorbidity MEASURES:: Predictors include overall PCMH adoption and adoption of six organizational processes: access and communications, patient tracking and registry, care management, test referral tracking, quality improvement and external coordination. Primary outcome was overall patient experience. In our full sample, overall PCMH adoption score was not significantly associated with patient experience outcomes. However, among subpopulations with higher comorbidities, the overall PCMH adoption score was positively associated with overall patient experience measures [0.2 (0.06, 0.4); P=0.006]. Differences by race/ethnicity and insurance type in associations between specific organizational processes and patient experience were noted. Although some organizational processes relate to patients' experiences with care irrespective of the background of the patient, further efforts are needed to align practice efforts with patient experience.

  20. Burnout of Physicians Working in Primary Health Care Centers under Ministry of Health Jeddah, Saudi Arabia

    Science.gov (United States)

    Bawakid, Khalid; Mandoura, Najlaa; Shah, Hassan Bin Usman; Ibrahim, Adel; Akkad, Noura Mohammad; Mufti, Fauad

    2017-01-01

    Introduction The levels of physicians' job satisfaction and burnout directly affect their professionalism, punctuality, absenteeism, and ultimately, patients' care. Despite its crucial importance, little is known about professional burnout of the physicians in Saudi Arabia. The objectives of this research are two-fold: (1) To assess the prevalence of burnout in physicians working in primary health care centers under Ministry of Health; and (2) to find the modifiable factors which can decrease the burnout ratio. Methodology Through a cross-sectional study design, a representative sample of the physicians working in primary health care centers (PHCCs) Jeddah (n=246) was randomly selected. The overall burnout level was assessed using the validated abbreviated Maslach burnout inventory (aMBI) questionnaire. It measures the overall burnout prevalence based on three main domains i.e., emotional exhaustion, depersonalization, and personal accomplishment. Independent sample T-test, analysis of variance (ANOVA), and multivariate regression analysis were performed using Statistical Package for the Social Sciences (SPSS Version 22, IBM, Armonk, NY). Results Overall, moderate to high burnout was prevalent in 25.2% of the physicians. Emotional exhaustion was noted in 69.5%. Multivariate regression analysis showed that patient pressure/violence (p <0.001), unorganized patients flow to clinics (p=0.021), more paperwork (p<0.001), and less co-operative colleague doctors (p=0.045) were the significant predictors for high emotional exhaustion. A positive correlation was noted between the number of patients per day and burnout. The patient’s pressure/violence was the only significant independent predictor of overall burnout. Conclusion Emotional exhaustion is the most prominent feature of overall burnout in the physicians of primary health care centers. The main reasons include patient’s pressure/violence, unorganized patient flow, less cooperative colleague doctors, fewer

  1. Evacuation of a mental health center during a forest fire in Israel.

    Science.gov (United States)

    Kreinin, Anatoly; Shakera, Tatiana; Sheinkman, Ayala; Levi, Tamar; Tal, Vered; Polakiewicz, Jacob

    2014-08-01

    Tirat Carmel Mental Health Center was successfully evacuated in December 2010 during a ravaging forest fire in the nearby Carmel Mountains. A total of 228 patients were successfully evacuated from the center within 45 minutes. No fatalities or injuries associated with the evacuation occurred. We believe that the efficient functioning of the administrative and medical staff provides a replicable model that can contribute to the level of awareness and readiness of hospital staff members for natural and manmade disasters.

  2. Implementing health management information systems: measuring success in Korea's health centers.

    Science.gov (United States)

    Chae, Y M; Kim, S I; Lee, B H; Choi, S H; Kim, I S

    1994-01-01

    This article analyses the effects that the introduction and adoption of a health management information system (HMIS) can have on both the productivity of health center staff as well as on user-satisfaction. The focus is upon the service provided by the Kwonsun Health Center located in Suwon City, Korea. Two surveys were conducted to measure the changes in productivity and adoption (knowledge, persuasion, decision, implementation and confirmation) of health center staff over time. In addition, a third survey was conducted to measure the effects of HMIS on the level of satisfaction perceived by the visitors, by comparing the satisfaction level between the study health center and a similar health center identified as a control. The results suggest that HMIS increased the productivity and satisfaction of the staff but did not increase their persuasion and decision levels; and, that is also succeeded in increasing the levels of visitors' satisfaction with the services provided.

  3. An Evaluation of a Voluntary Academic Medical Center Website Designed to Improve Access to Health Education among Consumers: Implications for E-Health and M-Health

    Science.gov (United States)

    Harris-Hollingsworth, Nicole Rosella

    2012-01-01

    Academic Medical Centers across the United States provide health libraries on their web portals to disseminate health promotion and disease prevention information, in order to assist patients in the management of their own care. However, there is a need to obtain consumer input, consumer satisfaction, and to conduct formal evaluations. The purpose…

  4. Using the "customer service framework" to successfully implement patient- and family-centered care.

    Science.gov (United States)

    Rangachari, Pavani; Bhat, Anita; Seol, Yoon-Ho

    2011-01-01

    Despite the growing momentum toward patient- and family-centered care at the federal policy level, the organizational literature remains divided on its effectiveness, especially in regard to its key dimension of involving patients and families in treatment decisions and safety practices. Although some have argued for the universal adoption of patient involvement, others have questioned both the effectiveness and feasibility of patient involvement. In this article, we apply a well-established theoretical perspective, that is, the Service Quality Model (SQM) (also known as the "customer service framework") to the health care context, to reconcile the debate related to patient involvement. The application helps support the case for universal adoption of patient involvement and also question the arguments against it. A key contribution of the SQM lies in highlighting a set of fundamental service quality determinants emanating from basic consumer service needs. It also provides a simple framework for understanding how gaps between consumer expectations and management perceptions of those expectations can affect the gap between "expected" and "perceived" service quality from a consumer's perspective. Simultaneously, the SQM also outlines "management requirements" for the successful implementation of a customer service strategy. Applying the SQM to the health care context therefore, in addition to reconciling the debate on patient involvement, helps identify specific steps health care managers could take to successfully implement patient- and family-centered care. Correspondingly, the application also provides insights into strategies for the successful implementation of policy recommendations related to patient- and family-centered care in health care organizations.

  5. Effects of Patient-centered Medical Home Transformation on Child Patient Experience.

    Science.gov (United States)

    Harder, Valerie S; Krulewitz, Julianne; Jones, Craig; Wasserman, Richard C; Shaw, Judith S

    2016-01-01

    Patient experience, 1 of 3 aims for improving health care, is rarely included in studies of patient-centered medical home (PCMH) transformation. This study examines the association between patient experience and National Committee on Quality Assurance (NCQA) PCMH transformation. This was a cross-sectional study of parent-reported child patient experience from PCMH and non-PCMH practices. It used randomly sampled experience surveys completed by 2599 patients at 29 pediatric and family medicine PCMH (n = 21) and non-PCMH (n = 8) practices in Vermont from 2011 to 2013. Patient experiences related to child development and prevention were assessed using the Consumer Assessment of Health care Providers and Systems (CAHPS). A 10-point increase in NCQA score at PCMH practices is associated with a 3.1% higher CAHPS child prevention score (P = .004). Among pediatric practices, PCMH recognition is associated with 7.7% (P child development and prevention composite scores, respectively. Among family medicine practices, PCMH recognition is associated with 7.4% (P = .001) and 11.0% (P child development and prevention composite scores, respectively. Our results suggest that PCMH recognition may improve child patient experience at pediatric practices and worsen experience at family medicine practices. These findings warrant further investigation into the differential influence of NCQA PCMH transformation on family medicine and pediatric practices. © Copyright 2016 by the American Board of Family Medicine.

  6. Validity of the Agency for Health Care Research and Quality Patient Safety Indicators and the Centers for Medicare and Medicaid Hospital-acquired Conditions: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Winters, Bradford D; Bharmal, Aamir; Wilson, Renee F; Zhang, Allen; Engineer, Lilly; Defoe, Deidre; Bass, Eric B; Dy, Sydney; Pronovost, Peter J

    2016-12-01

    The Agency for Health Care Research and Quality Patient Safety Indicators (PSIs) and Centers for Medicare and Medicaid Services Hospital-acquired Conditions (HACs) are increasingly being used for pay-for-performance and public reporting despite concerns over their validity. Given the potential for these measures to misinform patients, misclassify hospitals, and misapply financial and reputational harm to hospitals, these need to be rigorously evaluated. We performed a systematic review and meta-analysis to assess PSI and HAC measure validity. We searched MEDLINE and the gray literature from January 1, 1990 through January 14, 2015 for studies that addressed the validity of the HAC measures and PSIs. Secondary outcomes included the effects of present on admission (POA) modifiers, and the most common reasons for discrepancies. We developed pooled results for measures evaluated by ≥3 studies. We propose a threshold of 80% for positive predictive value or sensitivity for pay-for-performance and public reporting suitability. Only 5 measures, Iatrogenic Pneumothorax (PSI 6/HAC 17), Central Line-associated Bloodstream Infections (PSI 7), Postoperative hemorrhage/hematoma (PSI 9), Postoperative deep vein thrombosis/pulmonary embolus (PSI 12), and Accidental Puncture/Laceration (PSI 15), had sufficient data for pooled meta-analysis. Only PSI 15 (Accidental Puncture and Laceration) met our proposed threshold for validity (positive predictive value only) but this result was weakened by considerable heterogeneity. Coding errors were the most common reasons for discrepancies between medical record review and administrative databases. POA modifiers may improve the validity of some measures. This systematic review finds that there is limited validity for the PSI and HAC measures when measured against the reference standard of a medical chart review. Their use, as they currently exist, for public reporting and pay-for-performance, should be publicly reevaluated in light of these

  7. Determinants of Patient-Centered Financial Stress in Patients With Locally Advanced Head and Neck Cancer.

    Science.gov (United States)

    de Souza, Jonas A; Kung, Sunny; O'Connor, Jeremy; Yap, Bonnie J

    2017-04-01

    To prospectively estimate patient-centered financial stress and its relationship with health care utilization in patients with head and neck cancer. This was a survey-based, longitudinal, prospective study of treatment-naïve patients with stage III, IVa, or IVb locally advanced head and neck cancer at a single-institution tertiary care hospital from May 2013 to November 2014. With 121 patients approached, 73 (60%) agreed to participate. Self-reported data were collected on demographics, income, wealth, cost-coping strategies, out-of-pocket costs, supportive medication compliance, and perceived social isolation. Health care utilization was measured by hospital admissions and outpatient appointments on a 6-month timeline. Logistic regression models were constructed to identify factors associated with use of cost-coping strategies. Covariates included all demographics, measures of income, wealth, out-of-pocket costs, indirect costs, and perceived social isolation. Fifty-one patients (69%) relied on at least one coping strategy. On multivariable analysis, Medicaid patients were more likely than privately insured patients to use cost-coping strategies (odds ratio, 42.3; P = .0042). Decreased wealth ( P = .002) and higher total out-of-pocket costs ( P = .003) were independently associated with using cost-coping strategies. Patients with high perceived social isolation were also more likely to use cost-coping strategies (odds ratio, 11.5; P = .01). Patients with high perceived social isolation were more likely to report nonadherence to supportive medications (21.4 v 5.45 days over 6 months; P = .0278) and missed appointments (seven v three; P = .0077). A majority of patients used at least one cost-coping strategy during their treatment, highlighting the financial stress that patients experience. Perceived social isolation is an important social determinant of increased medication nonadherence, missed appointments, and use of cost-coping strategies. Interventions should

  8. Patient satisfaction with quality of primary health care in Benghazi ...

    African Journals Online (AJOL)

    Objectives: To assess patient satisfaction with quality of PHC assessed in terms of (a) customer profile, (b) patient satisfaction, and (c) health care-seeking behavior. Methodology: A sample of nine health centers and seven polyclinics from various locations in Benghazi, Libya were selected for gathering information by ...

  9. Care Management Medical Home Center Model: Preliminary Results of a Patient-Centered Approach to Improving Care Quality for Diabetic Patients.

    Science.gov (United States)

    Page, Timothy F; Amofah, St Anthony; McCann, Shelia; Rivo, Julie; Varghese, Asha; James, Terisa; Rivo, Marc; Williams, Mark L

    2015-07-01

    This article presents preliminary findings of the impact of an innovative care management model for diabetic patients. The model was implemented by seven Federally Qualified Health Centers serving 10,000 diabetic patients in Miami-Dade County. A primary intervention of this model is a centralized care management team that makes previsit phone calls to diabetic patients who have scheduled appointments. These previsit phone calls optimize patient knowledge and self-management goals, and provide patient care coordinators with relevant clinical information to optimize the office visit and help to ensure completion of recommended diabetic preventive and chronic care services. Data suggest that following the implementation of this care management model, more diabetic patients are receiving regular care, and compliance with recommended tests and screenings has improved. © 2015 Society for Public Health Education.

  10. Lessons Learned from Implementing the Patient-Centered Medical Home

    Directory of Open Access Journals (Sweden)

    Ellen P. Green

    2012-01-01

    Full Text Available The Patient-Centered Medical Home (PCMH is a primary care model that provides coordinated and comprehensive care to patients to improve health outcomes. This paper addresses practical issues that arise when transitioning a traditional primary care practice into a PCMH recognized by the National Committee for Quality Assurance (NCQA. Individual organizations' experiences with this transition were gathered at a PCMH workshop in Alexandria, Virginia in June 2010. An analysis of their experiences has been used along with a literature review to reveal common challenges that must be addressed in ways that are responsive to the practice and patients’ needs. These are: NCQA guidance, promoting provider buy-in, leveraging electronic medical records, changing office culture, and realigning workspace in the practice to accommodate services needed to carry out the intent of PCMH. The NCQA provides a set of standards for implementing the PCMH model, but these standards lack many specifics that will be relied on in location situations. While many researchers and providers have made critiques, we see this vagueness as allowing for greater flexibility in how a practice implements PCMH.

  11. The impact of managed care and current governmental policies on an urban academic health care center.

    Science.gov (United States)

    Rodriguez, J L; Peterson, D J; Muehlstedt, S G; Zera, R T; West, M A; Bubrick, M P

    2001-10-01

    Managed care and governmental policies have restructured hospital reimbursement. We examined reimbursement trends in trauma care to assess the impact of this market driven change on an urban academic health center. Patients injured between January 1997 and December 1999 were analyzed for Injury Severity Score (ISS), length of hospital stay, hospital cost, payer, and reimbursement. Between 1997 and 1999, the volume of patients with an ISS less than 9 increased and length of stay decreased. In addition, overall cost, payment, and profit margin increased. Commercially insured patients accounted for this margin increase, because the margins of managed care and government insured patients experienced double-digit decreases. Patients with ISS of 9 or greater also experienced a volume increase and a reduction in length of stay; however, costs within this group increased greater than payments, thereby reducing profit margin. Whereas commercially insured patients maintained their margin, managed care and government insured patients did not (double- and triple-digit decreases). Managed care and current governmental policies have a negative impact on urban academic health center reimbursement. Commercial insurers subsidize not only the uninsured but also the government insured and managed care patients as well. National awareness of this issue and policy action are paramount to urban academic health centers and may also benefit commercial insurers.

  12. The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol.

    Science.gov (United States)

    Newell, Stephanie; Jordan, Zoe

    2015-01-01

    The objective of this systematic review is to synthesize the eligible evidence of patients' experience of engaging and interacting with nurses, in the medical-surgical ward setting.This review will consider the following questions: Communication is a way in which humans make sense of the world around them. Communication takes place as an interactive two-way process or interaction, involving two or more people and can occur by nonverbal, verbal, face-to-face or non-face-to-face methods. Effective communication is described to occur when the sender of a message sends their message in a way that conveys the intent of their message and then is understood by the receiver of the message. As a result of the communication from both the sender and the receiver of the message a shared meaning is created between both parties.Communication can therefore be viewed as a reciprocal process. In the health care literature the terms communication and interaction are used interchangeably.Communication failures between clinicians are the most common primary cause of errors and adverse events in health care. Communication is a significant factor in patient satisfaction and complaints about care. Communication plays an integral role in service quality in all service professions including health care professions.Within healthcare, quality care has been defined by the Institute of Medicine as 'care that is safe, effective, timely, efficient, equitable and patient-centred'. Patient-centered care is defined as 'care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient's values guide all clinical decisions. Patient centered-care encompasses the 'individual experiences of a patient, the clinical service, the organizational and the regulatory levels of health care'. At the individual patient level, patient-centered care is care that is 'provided in a respectful manner, assures open and ongoing sharing of useful information in an

  13. Mental Health Services in School-Based Health Centers: Systematic Review

    Science.gov (United States)

    Bains, Ranbir Mangat; Diallo, Ana F.

    2016-01-01

    Mental health issues affect 20-25% of children and adolescents, of which few receive services. School-based health centers (SBHCs) provide access to mental health services to children and adolescents within their schools. A systematic review of literature was undertaken to review evidence on the effectiveness of delivery of mental health services…

  14. Estimate the Health Literacy in Health Centers in the Border of Yazd City: Cross sectional study

    Directory of Open Access Journals (Sweden)

    Sakineh Gerayllo

    2017-06-01

    Conclusion: Health literacy of women in general was unacceptable, and recommendations were made to establish continuous training for women to improve their views. Also consideration should be given to centers to plan the transformation of health literacy which has been launched, to increase the Health literacy of the population being studied as recipients of health services.

  15. Identifying elements of patient-centered care in underserved populations: a qualitative study of patient perspectives.

    Directory of Open Access Journals (Sweden)

    Sheela Raja

    Full Text Available Patient-centered care is an important goal in the delivery of healthcare. However, many patients do not engage in preventive medical care. In this pilot study, we conducted twenty in depth, semi-structured qualitative interviews at the University of Illinois at Chicago Health Sciences campus in a four month time frame. Many patients were underserved and underinsured, and we wanted to understand their experiences in the healthcare system. Using content analysis, several themes emerged from the interview data. Participants discussed the need for empathy and rapport with their providers. They identified provider behaviors that fostered a positive clinical relationship, including step-by step explanations of procedures, attention to body language and clinic atmosphere, and appropriate time management. Participants identified cost as the most common barrier to engaging in preventive care and discussed children and social support as motivating factors. A long-term relationship with a provider was an important motivator for preventive care, suggesting that the therapeutic alliance was essential to many patients. Conversely, many participants discussed a sense of dehumanization in the healthcare system, reporting that their life circumstances were overlooked, or that they were judged based on insurance status or ethnicity. We discuss implications for provider training and healthcare delivery, including the importance of patient-centered medical homes.

  16. Analgesic Usage in Elderly at Public Health Center: A study in West Java, Indonesias

    Directory of Open Access Journals (Sweden)

    Gembong Soeyono Putro

    2017-03-01

    Full Text Available Background: Various analgesics prescriptions for elderly are not appropriate according to the guideline and can cause the increase of side effects such as gastric problems. Puskesmas as a public health center in Indonesia has an important role in anticipating this problem. The objectives of this study was to identify the analgesic usage in elderly patients at the public health center. Methods: This retrospective descriptive study was conducted for 3 months at Tanjungsari public health center, Sumedang, West Java, Indonesia, using total sampling. The data was taken from 417 medical records from 2013. The data taken from medical records were: sex, analgesic drug, diagnosis, and drug for gastric problem. Results: From the collected data, the most analgesics prescribed for the elderly patients was paracetamol, followed by Piroxicam, Mefenamic acid, and Ibuprofen. Not all of the elderly patients who received NSAIDs, were given gastric drug. Conclusions: The most prescribed analgesic drug given to elderly patients at the public health center is paracetamol. [AMJ.2017;4(1:16–9

  17. Role of public health center for nuclear disaster

    International Nuclear Information System (INIS)

    Okada, Tsuyoshi

    2012-01-01

    The role of public health center such as surveillance screening, mass decontamination, health consultation and management, and dosage of stable iodine tablets are thought by Nuclear Safety Commission in 2008. The pollution screening and decontamination, internal exposure screening and valuation, dosage of iodine tablets, health consultation of residents and risk communication, comparative evaluation of health risks, health management under the low dose exposure are discussed to handle problems by the government and local government, and to protect the right to know information. In order to prepare the serious health hazard, the children's thyroid gland test and internal exposure test and the follow-up system have to be practiced by the local government. (S.Y.)

  18. Perception of risk and benefit in patient-centered communication and care

    OpenAIRE

    Hakim, Amin

    2011-01-01

    Amin HakimHealthcare Consulting, Staten Island, NY, USAAbstract: There has been an increase in the adoption of patient-centered communication and accountable care that has generated greater interest in understanding patient perception of risk and benefit (PPRB). Patients find complex medical information hard to understand, resulting in inaccurate conclusions. Health behavior models describe the processes that individuals use to arrive at decisions concerning their own care. Studies have shown...

  19. Hypertension care at primary health care centers: a report from Abha, Saudi Arabia.

    Science.gov (United States)

    Al-Homrany, Mohammed A; Khan, Mohd Yunus; Al-Khaldi, Yahia Mater; Al-Gelban, Khalid S; Al-Amri, Hasan Saed

    2008-11-01

    It is well known that effective management of hypertension reduces the incidence of myo-cardial infarction, stroke and vascular complications. The Ministry of Health, Kingdom of Saudi Arabia, introduced the Quality Assurance Guidelines with the hope to improve the management of hypertension in its centers. We conducted an audit of two Primary Health Care Centers namely, Al-Manhal (MPHCC) and Al-Numais (NPHCC), to evaluate how well hypertension was managened at these centers. A check list was derived from the Quality Assurance Manual to audit the process and to assess the health outcome. A retrospective study on a chosen sample of 120 files of hypertensive patients, out of 256 from both the Primary Health Care Centers was performed, during the last three months of the year 2000. Results showed that 61% of the patients were between 45-64 years of age, 56% were females, 85% were married, 54% were illiterate and 7.5% were smokers. A total of 92% of the patients had primary hypertension and 25% had a positive family history of hypertension. Beta-blockers were the most commonly used drugs in both the centers. Although the recording of the information was not perfect, there was no statistical difference in the socio-demongraphic data and also the means of the total score in both the centres. On the other hand, carrying out the important procedures for hypertensive patients was found to be better at MPHCC in comparison to NPHCC (p compliance to appointment in both the centers. Our study reveals that the process of hypertension care at the two Primary Health Care Centres in Aseer region was not in accordance with the recommended national standards. The reasons include lack of updating systems, recall system and provision of laboratory services and all these factors need to be addressed to improve care.

  20. A Peer-to-Peer Mentoring Program for In-Center Hemodialysis: A Patient-Centered Quality Improvement Program.

    Science.gov (United States)

    St Clair Russell, Jennifer; Southerland, Shiree; Huff, Edwin D; Thomson, Maria; Meyer, Klemens B; Lynch, Janet R

    2017-01-01

    A patient-centered quality improvement program implemented in one Virginia hemodialysis facility sought to determine if peer-to-peer (P2P) programs can assist patients on in-center hemodialysis with self-management and improve outcomes. Using a single-arm, repeatedmeasurement, quasi-experimental design, 46 patients participated in a four-month P2P intervention. Outcomes include knowledge, self-management behaviors, and psychosocial health indicators: self-efficacy, perceived social support, hemodialysis social support, and healthrelated quality of life (HRQoL). Physiological health indicators included missed and shortened treatments, arteriovenous fistula placement, interdialytic weight gain, serum phosphorus, and hospitalizations. Mentees demonstrated increased knowledge, self-efficacy, perceived social support, hemodialysis social support, and HRQoL. Missed treatments decreased. Mentors experienced increases in knowledge, self-management, and social support. A P2P mentoring program for in-center hemodialysis can benefit both mentees and mentors. Copyright© by the American Nephrology Nurses Association.

  1. The relationship between media literacy and health literacy among pregnant women in health centers of Isfahan.

    Science.gov (United States)

    Akbarinejad, Farideh; Soleymani, Mohammad Reza; Shahrzadi, Leila

    2017-01-01

    The ability to access, analyze, evaluate, and convey information in various forms of media including print and nonprint requires media literacy, but the capacity to obtain, process, and understand basic information and services needed for appropriate decisions regarding health, considered an important element in a woman's ability to participate in health promotion and prevention activities for herself and her children, is needed to a level of health literacy. The purpose of this study was to determine the relationship between media literacy and health literacy among pregnant women in health centers in Isfahan. This study used a descriptive correlation study. Data collection tools include Shahin media literacy and functional health literacy in adults' questionnaires. The population include pregnant women in health centers of Isfahan (4080 people). Ten out of the 351 health centers in Isfahan were selected as cluster. Data were analyzed using both descriptive and inferential statistics. Media literacy of respondents in the five dimensions was significantly lower than average 61.5% of pregnant women have inadequate health literacy, 18.8% had marginal health literacy, and only 19.7% of them have had adequate health literacy. There was a significant positive relationship between media literacy and health literacy among pregnant women. This study showed that the majority of pregnant women covered by health centers had limited health literacy and media literacy. Since one of the basic requirements for the utilization of health information is needed for adequate media literacy, promotion of media literacy is necessary for the respondents.

  2. Patient-centered disease management (PCDM) for heart failure: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Bekelman, David B; Plomondon, Mary E; Sullivan, Mark D; Nelson, Karin; Hattler, Brack; McBryde, Connor; Lehmann, Kenneth G; Potfay, Jonathan; Heidenreich, Paul; Rumsfeld, John S

    2013-07-09

    Chronic heart failure (HF) disease management programs have reported inconsistent results and have not included comorbid depression management or specifically focused on improving patient-reported outcomes. The Patient Centered Disease Management (PCDM) trial was designed to test the effectiveness of collaborative care disease management in improving health status (symptoms, functioning, and quality of life) in patients with HF who reported poor HF-specific health status. Patients with a HF diagnosis at four VA Medical Centers were identified through population-based sampling. Patients with a Kansas City Cardiomyopathy Questionnaire (KCCQ, a measure of HF-specific health status) score of patients were randomized to receive usual care or the PCDM intervention, which included: (1) collaborative care management by VA clinicians including a nurse, cardiologist, internist, and psychiatrist, who worked with patients and their primary care providers to provide guideline-concordant care management, (2) home telemonitoring and guided patient self-management support, and (3) screening and treatment for comorbid depression. The primary study outcome is change in overall KCCQ score. Secondary outcomes include depression, medication adherence, guideline-based care, hospitalizations, and mortality. The PCDM trial builds on previous studies of HF disease management by prioritizing patient health status, implementing a collaborative care model of health care delivery, and addressing depression, a key barrier to optimal disease management. The study has been designed as an 'effectiveness trial' to support broader implementation in the healthcare system if it is successful. Unique identifier: NCT00461513.

  3. Stennis Space Center observes 2009 Safety and Health Day

    Science.gov (United States)

    2009-01-01

    Sue Smith, a medical clinic employee at NASA's John C. Stennis Space Center, takes the temperature of colleague Karen Badon during 2009 Safety and Health Day activities Oct. 22. Safety Day activities included speakers, informational sessions and a number of displays on safety and health issues. Astronaut Dominic Gorie also visited the south Mississippi rocket engine testing facility during the day to address employees and present several Silver Snoopy awards for outstanding contributions to flight safety and mission success. The activities were part of an ongoing safety and health emphasis at Stennis.

  4. Building diversity in a complex academic health center.

    Science.gov (United States)

    South-Paul, Jeannette E; Roth, Loren; Davis, Paula K; Chen, Terence; Roman, Anna; Murrell, Audrey; Pettigrew, Chenits; Castleberry-Singleton, Candi; Schuman, Joel

    2013-09-01

    For 30 years, the many diversity-related health sciences programs targeting the University of Pittsburgh undergraduate campus, school of medicine, schools of the health sciences, clinical practice plan, and medical center were run independently and remained separate within the academic health center (AHC). This lack of coordination hampered their overall effectiveness in promoting diversity and inclusion. In 2007, a group of faculty and administrators from the university and the medical center recognized the need to improve institutional diversity and to better address local health disparities. In this article, the authors describe the process of linking the efforts of these institutions in a way that would be successful locally and applicable to other academic environments. First, they engaged an independent consultant to conduct a study of the AHC's diversity climate, interviewing current and former faculty and trainees to define the problem and identify areas for improvement. Next, they created the Physician Inclusion Council to address the findings of this study and to coordinate future efforts with institutional leaders. Finally, they formed four working committees to address (1) communications and outreach, (2) cultural competency, (3) recruitment, and (4) mentoring and retention. These committees oversaw the strategic development and implementation of all diversity and inclusion efforts. Together these steps led to structural changes within the AHC and the improved allocation of resources that have positioned the University of Pittsburgh to achieve not only diversity but also inclusion and to continue to address the health disparities in the Pittsburgh community.

  5. Managing the risks of on-site health centers.

    Science.gov (United States)

    Gorman, Kathleen M; Miller, Ross M

    2011-11-01

    This review sought to assess compliance concerns, determine risk management strategies, and identify opportunities for future research to contribute to employers' understanding of the laws and regulations that apply to on-site care. A comprehensive review of databases, professional organizations' websites, and journals resulted in 22 publications reporting on the consequences of noncompliance among on-site health centers accepted for inclusion. None of those studies reported a study design or quantifiable outcome data. Two noncompliance themes were repeated among the publications. First, direct penalties included fines, civil actions, loss of licensure, and, potentially, criminal charges. Second, noncompliance also resulted in indirect costs such as employee mistrust and lowered standards of care, which jeopardize on-site health centers' ability to demonstrate a return on investment. Further research with rigorous methodology is needed to inform employer decisions about on-site health services and associated risk management. Copyright 2011, SLACK Incorporated.

  6. Patient-Centered Medical Home Undergraduate Internship, Benefits to a Practice Manager: Case Study.

    Science.gov (United States)

    Sasnett, Bonita; Harris, Susie T; White, Shelly

    Health services management interns become practice facilitators for primary care clinics interested in pursuing patient-centered recognition for their practice. This experience establishes a collaborative relationship between the university and clinic practices where students apply their academic training to a system of documentation to improve the quality of patient care delivery. The case study presents the process undertaken, benefits, challenges, lessons learned, and recommendations for intern, practice mangers, and educators. The practice manager benefits as interns become Patient-Centered Medical Home facilitators and assist practice managers in the recognition process.

  7. Nursing schools and academic health centers: toward improved alignment and a synergistic partnership

    Directory of Open Access Journals (Sweden)

    Emami A

    2017-08-01

    Full Text Available Azita Emami,1 Darcy Jaffe,2 Paula Minton-Foltz,3 Grace Parker,4 Susan Manfredi,5 Theresa Braungardt,6 Kelly W Marley,1 Laura Cooley,1 Staishy Bostick Siem7 1University of Washington School of Nursing, Seattle, WA, USA; 2Harborview Medical Center, University of Washington Medicine, Seattle, WA, USA; 3Patient Care Services, Harborview Medical Center, University of Washington Medicine, Seattle, WA, USA; 4University of Washington Medical Center, Seattle, WA, USA; 5Patient Care Services, Northwest Hospital and Medical Center, Seattle, WA, USA; 6Valley Medical Center, Seattle, WA, USA; 7Marketing and Communications, University of Washington School of Nursing, Seattle, WA, USA Abstract: This paper presents the findings from a national survey which the University of Washington conducted among leaders of 32 US academic nursing institutions that are part of academic health centers (AHCs and complements these findings with results from a separate report by the American Association of Colleges of Nursing. While expressing overall satisfaction with their AHC relationships, these leaders find that nursing is often given greater parity in matters of education and research than in mission setting, financial, and governance matters. AHCs are being asked to meet new health care challenges in new ways, starting with the education of health care professionals. AHCs need to be restructured to give nursing full parity if the nation’s and world’s needs for preventive and clinical care are to be best met.Keywords: nursing parity, academic nursing institutions, nurse leaders, institutional alignment

  8. Structural violence and simplified paternalistic ideas of patient empowerment decreases health care access, quality & outcome for ethnic minority patients

    DEFF Research Database (Denmark)

    Sodemann, Morten

    Increasing complexity of health care organization, rapid hyperspecialization of medical care, lack of ’patient literacy’ and pressure on patients to take over responsibility, challenges political dreams of equal access to patient centered high quality secure care....

  9. The contribution of online peer-to-peer communication among patients with adrenal disease to patient-centered care.

    Science.gov (United States)

    Kauw, Dirkjan; Repping-Wuts, Han; Noordzij, Alida; Stikkelbroeck, Nike; Hermus, Ad; Faber, Marjan

    2015-02-25

    Addison's disease and Cushing's syndrome are rare. The Dutch Adrenal Society offers an online forum for Dutch adrenal patients to meet and communicate. However, little is known about the added value such a forum has for the delivery of patient-centered care. Our aim was to analyze the purposes of online patient-to-patient forum conversations, within the context of patient-centered care. For this study a consecutive sample of 300 questions ("threads") from the past 3.5 years was selected from the forum. The content of these patient-driven questions was analyzed based on the dimensions of patient-centeredness of the Picker Institute. This analysis was performed using ATLAS.ti. From the 390 questions analyzed, 80.8% (N=315) were intended to gain more information about the disease, the treatment, and to verify if other patients had similar complaints. To a much lesser extent (38/390, 9.7%), questions expressed a call for emotional support. Patients answered primarily by giving practical tips to fellow patients and to share their own experiences. On an online patient forum for Cushing's syndrome and Addison's disease, patients appear to primarily gain knowledge and, to a lesser extent, emotional support from their peers. This experience-based knowledge has become a very important information source. As such, patients can make a substantial contribution to the creation of patient-centered care if this knowledge is integrated into the care provided by health care professionals.

  10. Results of the Community Health Applied Research Network (CHARN) National Research Capacity Survey of Community Health Centers.

    Science.gov (United States)

    Song, Hui; Li, Vivian; Gillespie, Suzanne; Laws, Reesa; Massimino, Stefan; Nelson, Christine; Singal, Robbie; Wagaw, Fikirte; Jester, Michelle; Weir, Rosy Chang

    2015-01-01

    The mission of the Community Health Applied Research Network (CHARN) is to build capacity to carry out Patient-Centered Outcomes Research at community health centers (CHCs), with the ultimate goal to improve health care for vulnerable populations. The CHARN Needs Assessment Staff Survey investigates CHCs' involvement in research, as well as their need for research training and resources. Results will be used to guide future training. The survey was developed and implemented in partnership with CHARN CHCs. Data were collected across CHARN CHCs. Data analysis and reports were conducted by the CHARN data coordinating center (DCC). Survey results highlighted gaps in staff research training, and these gaps varied by staff role. There is considerable variation in research involvement, partnerships, and focus both within and across CHCs. Development of training programs to increase research capacity should be tailored to address the specific needs and roles of staff involved in research.

  11. The digital divide at an urban community health center: implications for quality improvement and health care access.

    Science.gov (United States)

    Denizard-Thompson, Nancy M; Feiereisel, Kirsten B; Stevens, Sheila F; Miller, David P; Wofford, James L

    2011-06-01

    Health care policy encourages better electronic connectivity between patient and the office practice. However, whether patients are able to partner with the practice in using communication technologies is not known. We sought to determine (1) the proportion of clinic patients who use internet and cell phone text messaging technologies, (2) the level of patient interest in using these technologies for the purpose of managing clinical appointments and patient education. Consecutive adult patients, clinicians and staff at an urban community health center were surveyed during a one-week period in order to estimate the frequency of technology use by patients. A total of 308 survey cards were collected during the designated week (response rate of 85% (308/362). One-third (34.0%, 105) of surveyed patients used the internet and text messaging daily or weekly, while nearly two-thirds (59.7%, 182) never used these technologies. There were no racial or gender differences in the proportion of patients who used the internet daily or weekly. In contrast, African-Americans used text messaging more often than whites (28.2 vs. 21.4%, P 50) used the internet and text messaging more often than older patients (50.6 vs. 16.6%, 44.3 vs. 7.3%, respectively). Despite the low use of both technologies, patient's interest in managing clinic appointments was high (40.3% for the Internet and 56.8% for text messaging). Clinicians and staff estimated patient's daily/weekly use of internet and cellphone messaging at 40.3% (± 22.0), and 56.8% (± 25.7), respectively. Most patients at this urban community health center reported never using the internet or cell phone text messaging. Clinicians overestimated technology use by patients. Planning for clinic infrastructure, quality improvement, and patient education should include assessment of technology use patterns by patients.

  12. Are health centers in Thailand ready for health information technology? : a national survey.

    Science.gov (United States)

    Kijsanayotin, Boonchai; Speedie, Stuart

    2006-01-01

    The Thailand universal health care coverage scheme was instituted in 2001 and The Thailand Ministry of Public Health (MOPH) is restructuring its information systems to support this reform. The MOPH anticipates developing computerized health information systems which can provide information for administration tasks and can improve both healthcare delivery and public health services. To achieve these target goals, knowledge about users and organizations is vital. The knowledge of how health center workers currently use information technology (IT), their knowledge of IT, and acceptance of IT are not only beneficial to policy makers but also to system designers and implementers. The primary objective of this study is to learn how health centers in Thailand use IT, the level of basic IT knowledge among their workers, and their acceptance of health IT. We surveyed a random cross sectional sample of 1,607 health centers representing the total of 9,806 in Thailand in 2005. With an 82% response rate, the preliminary results indicate that information technology usage is pervasive in health centers. The respondents showed a moderately high degree of health information technology acceptance with a modest level of basic IT knowledge. There were no differences in degrees of acceptance among the four geographic regions. The mean score of "intention to use IT" was 5.6 on a scale of 7 and the average basic IT knowledge score was 13 out of 20. These results suggests the possibility of project success if the national health center information system projects are developed and implemented.

  13. Lessons for the new CMS innovation center from the Medicare health support program.

    Science.gov (United States)

    Barr, Michael S; Foote, Sandra M; Krakauer, Randall; Mattingly, Patrick H

    2010-07-01

    The Patient Protection and Affordable Care Act establishes a new Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services (CMS). The center is intended to enhance the CMS's role in promoting much-needed improvements in payment and service delivery. Lessons from the Medicare Health Support Program, a chronic care pilot program that ran between 2005 and 2008, illustrate the value of drawing on experience in planning for the center and future pilot programs. The lessons include the importance of strong leadership; collaboration and flexibility to foster innovation; receptivity of beneficiaries to care management; and the need for timely data on patients' status. The lessons also highlight pitfalls to be avoided in planning future pilot programs, such as flawed strategies for selecting populations to target when testing payment and service delivery reforms.

  14. The Adolescent "Expanded Medical Home": School-Based Health Centers Partner with a Primary Care Clinic to Improve Population Health and Mitigate Social Determinants of Health.

    Science.gov (United States)

    Riley, Margaret; Laurie, Anna R; Plegue, Melissa A; Richarson, Caroline R

    2016-01-01

    Access to high-quality health care is a crucial social determinant of health. We describe the implementation of an "expanded medical home" partnering a primary care practice (the Ypsilanti Health Center [YHC]) with local school-based health centers (the Regional Alliance for Healthy Schools [RAHS]), and to assess whether this model improves access to and quality of care for shared patients. Using the Consolidated Framework for Implementation Research, we define the steps in, barriers to, and facilitating factors in implementing the expanded medical home model. Visits and quality measures were assessed for patients seen by YHC only versus YHC/RAHS at baseline and during the intervention. At baseline, patients seen at YHC/RAHS had higher compliance with most quality metrics compared with those seen at YHC only. The proportion of shared patients significantly increased because of the intervention (P partnership between primary care physicians and school-based health centers increases the number of shared high-risk adolescent patients. Shared patients have improved compliance with quality measures, which may lead to long-term improved health equity. © Copyright 2016 by the American Board of Family Medicine.

  15. Secure Cloud-Based Solutions for Different eHealth Services in Spanish Rural Health Centers

    Science.gov (United States)

    2015-01-01

    Background The combination of eHealth applications and/or services with cloud technology provides health care staff—with sufficient mobility and accessibility for them—to be able to transparently check any data they may need without having to worry about its physical location. Objective The main aim of this paper is to put forward secure cloud-based solutions for a range of eHealth services such as electronic health records (EHRs), telecardiology, teleconsultation, and telediagnosis. Methods The scenario chosen for introducing the services is a set of four rural health centers located within the same Spanish region. iCanCloud software was used to perform simulations in the proposed scenario. We chose online traffic and the cost per unit in terms of time as the parameters for choosing the secure solution on the most optimum cloud for each service. Results We suggest that load balancers always be fitted for all solutions in communication together with several Internet service providers and that smartcards be used to maintain identity to an appropriate extent. The solutions offered via private cloud for EHRs, teleconsultation, and telediagnosis services require a volume of online traffic calculated at being able to reach 2 Gbps per consultation. This may entail an average cost of €500/month. Conclusions The security solutions put forward for each eHealth service constitute an attempt to centralize all information on the cloud, thus offering greater accessibility to medical information in the case of EHRs alongside more reliable diagnoses and treatment for telecardiology, telediagnosis, and teleconsultation services. Therefore, better health care for the rural patient can be obtained at a reasonable cost. PMID:26215155

  16. Secure Cloud-Based Solutions for Different eHealth Services in Spanish Rural Health Centers.

    Science.gov (United States)

    de la Torre-Díez, Isabel; Lopez-Coronado, Miguel; Garcia-Zapirain Soto, Begonya; Mendez-Zorrilla, Amaia

    2015-07-27

    The combination of eHealth applications and/or services with cloud technology provides health care staff—with sufficient mobility and accessibility for them—to be able to transparently check any data they may need without having to worry about its physical location. The main aim of this paper is to put forward secure cloud-based solutions for a range of eHealth services such as electronic health records (EHRs), telecardiology, teleconsultation, and telediagnosis. The scenario chosen for introducing the services is a set of four rural health centers located within the same Spanish region. iCanCloud software was used to perform simulations in the proposed scenario. We chose online traffic and the cost per unit in terms of time as the parameters for choosing the secure solution on the most optimum cloud for each service. We suggest that load balancers always be fitted for all solutions in communication together with several Internet service providers and that smartcards be used to maintain identity to an appropriate extent. The solutions offered via private cloud for EHRs, teleconsultation, and telediagnosis services require a volume of online traffic calculated at being able to reach 2 Gbps per consultation. This may entail an average cost of €500/month. The security solutions put forward for each eHealth service constitute an attempt to centralize all information on the cloud, thus offering greater accessibility to medical information in the case of EHRs alongside more reliable diagnoses and treatment for telecardiology, telediagnosis, and teleconsultation services. Therefore, better health care for the rural patient can be obtained at a reasonable cost.

  17. Patient health record on a smart card.

    Science.gov (United States)

    Naszlady, A; Naszlady, J

    1998-02-01

    A validated health questionnaire has been used for the documentation of a patient's history (826 items) and of the findings from physical examination (591 items) in our clinical ward for 25 years. This computerized patient record has been completed in EUCLIDES code (CEN TC/251) for laboratory tests and an ATC and EAN code listing for the names of the drugs permanently required by the patient. In addition, emergency data were also included on an EEPROM chipcard with a 24 kb capacity. The program is written in FOX-PRO language. A group of 5000 chronically ill in-patients received these cards which contain their health data. For security reasons the contents of the smart card is only accessible by a doctor's PIN coded key card. The personalization of each card was carried out in our health center and the depersonalized alphanumeric data were collected for further statistical evaluation. This information served as a basis for a real need assessment of health care and for the calculation of its cost. Code-combined with an optical card, a completely paperless electronic patient record system has been developed containing all three information carriers in medicine: Texts, Curves and Pictures.

  18. New York State Health Foundation grant helps health centers win federal expansion funds.

    Science.gov (United States)

    Sandman, David; Cozine, Maureen

    2012-11-01

    With approximately 1.2 million New Yorkers poised to gain health insurance coverage as a result of federal health reform, demand for primary care services is likely to increase greatly. The Affordable Care Act includes $11 billion in funding to enhance primary care access at community health centers. Recognizing a need and an opportunity, in August 2010 the New York State Health Foundation made a grant of nearly $400,000 to the Community Health Care Association of New York State to work with twelve health centers to develop successful proposals for obtaining and using these federal funds. Ultimately, eleven of the twelve sites are expected to receive $25.6 million in federal grants over a five-year period-a sixty-four-fold return on the foundation's investment. This article describes the strategy for investing in community health centers; identifies key project activities, challenges, and lessons; and highlights its next steps for strengthening primary care.

  19. The many "Disguises" of patient-centered communication: Problems of conceptualization and measurement.

    Science.gov (United States)

    Street, Richard L

    2017-11-01

    To critically examine different approaches to the measurement of patient-centered communication. Provides a critique of 7 different measures of patient-centered communication with respect to differences in their assumptions about what constitutes patient-centeredness and in their approaches to measurement. The measures differed significantly with regard to whether the measure captured behavior (what the interactants did) or judgment (how well the behavior was performed), focused on the individual clinician or on the interaction as a whole, and on who makes the assessment (participant or observer). A multidimensional framework for developing patient-centered communication measures is presented that encompasses the patient's perspective and participation, the biopsychosocial context of the patient's health, the clinician-patient relationship, quality of information-exchange, shared understanding, and shared, evidence-based decision-making. The state of measurement of the patient-centered communication construct lacks coherence, in part because current measures were developed either void of a conceptual framework or from very different theoretical perspectives. Assessment of patients' experiences with quality of communication in medical encounters should drill down into specific domains of patient-centeredness. Copyright © 2017. Published by Elsevier B.V.

  20. [Using the subcutaneous approach for symptoms control in a health center].

    Science.gov (United States)

    Pascual López, L; Portaceli Armiñana, A; Ros Sáez, A

    2001-01-01

    To describe the use of the subcutaneous tract for symptoms control in patients those are in phase of palliative treatment of their illness. Observational study. Primary care. Patients seen in a health center, in phase of palliative treatment of their illness, that needed for symptoms control the subcutaneous administration of drugs. Most of the patients were in terminal phase (19), the fundamental cause (17 cases) that justified the use of the subcutaneous tract was the difficulty to take drugs by oral tract in the last days of life, attention on death throes. The infusion continuous through injector type travenol, at an infusion speed of 2 ml/h, it was the most common way of drug administration (19 patients). The drugs and initial average dose most used were: morphine 19 patients dose 100 mg/24 h, hyoscine butylbromide (Buscapina), 13 patients, 60 mg/24 h, haloperidol 12 patients, 4 mg/24 h. The patients death was the main cause that justified the retirement of the continuous infusion (17 people sick), happening in its own home. Symptoms control was good or very good in the most of patients (14). The experience on using the subcutaneous tract for symptoms control in our health center is positive, being the fundamental cause for its use symptoms control in the last days of the patients life. The continuous subcutaneous infusion should be used in primary attention, as an usual technique for the symptoms control in patients that are in phase of palliative treatment of their illness.

  1. Through the patient's eyes: the value of a comprehensive brain tumor center.

    Science.gov (United States)

    Robin, Adam M; Walbert, Tobias; Mikkelsen, Tom; Kalkanis, Steven N; Rock, Jack; Lee, Ian; Rosenblum, Mark L

    2014-09-01

    Since the founding of the Tumor Section of the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) in 1984 much in neurosurgical oncology has changed. More than 40,000 papers have been published on glioma since the arrival of the AANS/CNS Tumor Section. Increasingly, research is focusing on more patient-centered care and quality of life. Preliminary work suggests that a greater emphasis on the patient and caregiver's experience of disease is crucial. Also, the provision of hope and appropriate information and communication with health care providers helps to lessen anxiety and promote improved quality of life. Lastly, our patients need a mechanism for continued symptom control and psychosocial support throughout their experience of this disease. An excellent venue for providing these facets of neurooncological patient care is the multidisciplinary brain tumor board and symptom management team. Herein, we present the philosophy and practice of the Hermelin Brain Tumor Center at the Henry Ford Health System as one type of approach to caring for the patient with a malignant glioma. The authors are aware of several brain tumor centers that share our philosophy and approach to patient care. Our comments are not meant to be exclusive to our experience and should be interpreted as representative of the growing movement in neurosurgery to provide comprehensive, multidisciplinary, patient-centered care.

  2. Relationship between Teach-back and patient-centered communication in primary care pediatric encounters.

    Science.gov (United States)

    Badaczewski, Adam; Bauman, Laurie J; Blank, Arthur E; Dreyer, Benard; Abrams, Mary Ann; Stein, Ruth E K; Roter, Debra L; Hossain, Jobayer; Byck, Hal; Sharif, Iman

    2017-07-01

    We proposed and tested a theoretical framework for how use of Teach-back could influence communication during the pediatric clinical encounter. Audio-taped pediatric primary care encounters with 44 children with asthma were coded using the Roter Interaction Analysis System to measure patient-centered communication and affective engagement of the parent. A newly created Teach-back Loop Score measured the extent to which Teach-back occurred during the clinical encounter; parental health literacy was measured by Newest Vital Sign. Logistic regression was used to test the relationship between Teach-back and features of communication. Focus groups held separately with clinicians and parents elicited perceptions of Teach-back usefulness. Teach-back was used in 39% of encounters. Visits with Teach-back had more patient centered communication (p=0.01). Adjusting for parent health literacy, parent age, and child age, Teach-back increased the odds of both patient centered communication [proportional AOR (95% CI)=4.97 (4.47-5.53)]and negative affect [AOR (95% CI)=5.39 (1.68-17.31)]. Focus group themes common to clinicians and parents included: Teach-back is effective, could cause discomfort, should be used with children, and nurses should use it. Teach-back was associated with more patient-centered communication and increased affective engagement of parents. Standardizing Teach-back use may strengthen patient-centered communication. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Adolescent Health Care in School-Based Health Centers. Position Statement

    Science.gov (United States)

    National Assembly on School-Based Health Care, 2008

    2008-01-01

    School-based health centers (SBHCs) are considered one of the most effective strategies for delivering preventive care, including reproductive and mental health care services, to adolescents--a population long considered difficult to reach. National Assembly on School-Based Health Care (NASBHC) recommends practices and policies to assure…

  4. 75 FR 42448 - Board of Scientific Counselors (BSC), Coordinating Center for Health Promotion (CCHP): Notice of...

    Science.gov (United States)

    2010-07-21

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention (CDC) Board of Scientific Counselors (BSC), Coordinating Center for Health Promotion (CCHP): Notice of Charter Amendment... Disease Prevention and Health Promotion (NCCDPHP). [[Page 42449

  5. [Attendance at a health center by clandestine prostitutes in Djibouti].

    Science.gov (United States)

    Philippon, M; Saada, M; Kamil, M A; Houmed, H M

    1997-01-01

    The extent of clandestine prostitution in Djibouti is difficult to evaluate. Due to the secrecy of the prostitutes and often their low level of education, the follow-up of these patients is also difficult. A sexually transmitted disease clinic specialized in the treatment of prostitutes and their customers has been established in Djibouti since 1963. We tried to evaluate the available data on the clandestine prostitutes attendance at the center. The population was young with a mean age of 23 years. Fifty percent had children and 60% were divorced or separated. Ninety-one percent were Ethiopian and 73% lived in the same district of the city of Djibouti. Almost half of them were HIV positive. The duration of residence in Djibouti before the first visit to the clinic varied widely with a median of 12 months. However, the total duration of prostitution before the first visit was shorter with a median of 3 months. The complaint at the first visit was most often minor. Among the prostitutes who first came to the center in 1993, half of them came only once. The overall duration of follow-up was 8 months, for an average of 3.7 visits per patient. Alternatively, 20 patients had more than 10 consultations and this represented one third of the consultations given to previous patients. This last group is the only one which tended to respect the monthly visits proposed to each patient at the first consultation. The other patients seemed to come only when they felt ill. The routine statistical activities which separately counted the new and previous patients gave an optimistic but faulty impression: these showed an increase in the total number of patients and also an increase in the percentage of previous patients visiting (from 42 to 69% between 1988 and 1994). It is difficult to evaluate the follow-up of such a mobile population. The few patients known for their fidelity contrasted with the fact that half of the patients had visited the center only once. This low frequency of

  6. Biosecurity and Health Monitoring at the Zebrafish International Resource Center.

    Science.gov (United States)

    Murray, Katrina N; Varga, Zoltán M; Kent, Michael L

    2016-07-01

    The Zebrafish International Resource Center (ZIRC) is a repository and distribution center for mutant, transgenic, and wild-type zebrafish. In recent years annual imports of new zebrafish lines to ZIRC have increased tremendously. In addition, after 15 years of research, we have identified some of the most virulent pathogens affecting zebrafish that should be avoided in large production facilities, such as ZIRC. Therefore, while importing a high volume of new lines we prioritize safeguarding the health of our in-house fish colony. Here, we describe the biosecurity and health-monitoring program implemented at ZIRC. This strategy was designed to prevent introduction of new zebrafish pathogens, minimize pathogens already present in the facility, and ensure a healthy zebrafish colony for in-house uses and shipment to customers.

  7. [Patient-centered care. Improvement of communication between university medical centers and general practitioners for patients in neuro-oncology].

    Science.gov (United States)

    Renovanz, M; Keric, N; Richter, C; Gutenberg, A; Giese, A

    2015-12-01

    Communication between university medical centers and general practitioners (GP) is becoming increasingly more important in supportive patient care. A survey among GPs was performed with the primary objective to assess their opinion on current workflow and communication between GPs and the university medical center. The GPs were asked to score (grades 1-6) their opinion on the current interdisciplinary workflow in the care of patients with brain tumors, thereby rating communication between a university medical center in general and the neuro-oncology outpatient center in particular. Questionnaires were sent to1000 GPs and the response rate was 15 %. The mean scored evaluation of the university medical center in general was 2.62 and of the neuro-oncological outpatient clinic 2.28 (range 1-6). The most often mentioned issues to be improved were easier/early telephone information (44 %) and a constantly available contact person (49 %). Interestingly, > 60 % of the GPs indicated they would support web-based tumor boards for interdisciplinary and palliative neuro-oncological care. As interdisciplinary care for neuro-oncology patients is an essential part of therapy, improvement of communication between GPs and university medical centers is indispensable. Integrating currently available electronic platforms under data protection aspects into neuro-oncological palliative care could be an interesting tool in order to establish healthcare networks and could find acceptance with GPs.

  8. Changing structure to improve function: one academic health center's experience.

    Science.gov (United States)

    Alexander, B; Davis, L; Kohler, P O

    1997-04-01

    Academic health centers (AHCs) have been under siege for the past few years, with decreased federal and state funding for educational and research programs and increasing competition in the health care marketplace. In addition, many AHCs are burdened with the bureaucratic red tape of large educational institutions, which makes agility in responding to a demanding health care market difficult. The authors describe the response to these threats by Oregon Health Sciences University (OHSU), an approach that has been different from those of most similar institutions. OHSU chose to change its structure from being part of the state system of higher education to being an independent public corporation. The authors outline the political process of building widespread support for the legislation passed in 1995, the key features of the restructuring, the challenges faced before and after the transition to a public corporation, and lessons learned in this metamorphosis to a new form.

  9. Health science center faculty attitudes towards interprofessional education and teamwork.

    Science.gov (United States)

    Gary, Jodie C; Gosselin, Kevin; Bentley, Regina

    2018-03-01

    The attitudes of faculty towards interprofessional education (IPE) and teamwork impact the education of health professions education (HPE) students. This paper reports on a study evaluating attitudes from health professions educators towards IPE and teamwork at one academic health science center (HSC) where modest IPE initiatives have commenced. Drawing from the results of a previous investigation, this study was conducted to examine current attitudes of the faculty responsible for the training of future healthcare professionals. Survey data were collected to evaluate attitudes from HSC faculty, dentistry, nursing, medicine, pharmacy and public health. In general, positive HSC faculty attitudes towards interprofessional learning, education, and teamwork were significantly predicted by those affiliated with the component of nursing. Faculty development aimed at changing attitudes and increasing understanding of IPE and teamwork are critical. Results of this study serve as an underpinning to leverage strengths and evaluate weakness in initiating IPE.

  10. Oncology nurse communication barriers to patient-centered care.

    Science.gov (United States)

    Wittenberg-Lyles, Elaine; Goldsmith, Joy; Ferrell, Betty

    2013-04-01

    Although quality communication has been identified as a necessary component to cancer care, communication skills training programs have yet to focus on the unique role of nurses. This study explored communication barriers as reported by seven nurse managers to better identify communication skills needed for oncology nurses to practice patient-centered care. Thematic analysis of transcripts was used to identify barriers to patient and family communication and desirable patient-centered nursing communication skills. Overall, the nurse managers reported that nurses experience patient and family communication difficulties as a result of inconsistent messages to patients and family from other healthcare staff. Physician assumptions about nursing left nurses feeling uncomfortable asking for clarification, creating a barrier to team communication processes. Patient-centered communication and care cannot be actualized for nurses unless team roles are clarified and nurses receive training in how to communicate with physicians, patients, and family. Therefore, the authors of this article created the COMFORT communication training protocol, and key concepts and resources for nurse communication training through COMFORT are detailed in this article.

  11. Patient-centered variables in primary and team nursing.

    Science.gov (United States)

    Hamera, E; O'Connell, K A

    1981-03-01

    Patient-centered variables and their relationship to primary and team nursing have rarely been studied. In the present study the investigation focused on the following patient-centered variables: nurturance received, patient involvement, and frequency of nurse-patient contacts. Baseline observational data were collected on 12 adult medical patients experiencing team nursing care. A primary nursing care approach was then implemented on the same nursing unit, and 6 months later 12 patients were observed under this system. Patients were directly observed 24 hours a day for 5 days of hospitalization and audiotaped, using a specimen record method. This method produced transcripts that were coded for nurturance, involvement, and nurse-patient contacts. Results of the study showed that there were no differences between primary and team nursing care groups in the number of contacts, nurturance, or patient involvement with all nursing personnel or with professional nurses. However, when the primary group was adjusted to include only those patients for whom primary nursing care was fully implemented, the primary group received more nurturance (p less than .05) and had a tendency to be more active involved than did the team group (p less than .10). These findings indicate that the institution of primary nursing care is related to increased quality of nursing care.

  12. Barriers to colorectal cancer screening in community health centers: A qualitative study

    Directory of Open Access Journals (Sweden)

    Fletcher Robert H

    2008-02-01

    Full Text Available Abstract Background Colorectal cancer screening rates are low among disadvantaged patients; few studies have explored barriers to screening in community health centers. The purpose of this study was to describe barriers to/facilitators of colorectal cancer screening among diverse patients served by community health centers. Methods We identified twenty-three outpatients who were eligible for colorectal cancer screening and their 10 primary care physicians. Using in-depth semi-structured interviews, we asked patients to describe factors influencing their screening decisions. For each unscreened patient, we asked his or her physician to describe barriers to screening. We conducted patient interviews in English (n = 8, Spanish (n = 2, Portuguese (n = 5, Portuguese Creole (n = 1, and Haitian Creole (n = 7. We audiotaped and transcribed the interviews, and then identified major themes in the interviews. Results Four themes emerged: 1 Unscreened patients cited lack of trust in doctors as a barrier to screening whereas few physicians identified this barrier; 2 Unscreened patients identified lack of symptoms as the reason they had not been screened; 3 A doctor's recommendation, or lack thereof, significantly influenced patients' decisions to be screened; 4 Patients, but not their physicians, cited fatalistic views about cancer as a barrier. Conversely, physicians identified competing priorities, such as psychosocial stressors or comorbid medical illness, as barriers to screening. In this culturally diverse group of patients seen at community health centers, similar barriers to screening were reported by patients of different backgrounds, but physicians perceived other factors as more important. Conclusion Further study of these barriers is warranted.

  13. Advantages and Disadvantages of the Patient-Centered Medical Home: A Critical Analysis and Lessons Learned.

    Science.gov (United States)

    Budgen, Jacqueline; Cantiello, John

    This article provides a detailed examination of the pros and cons associated with patient-centered medical homes (PCMHs). Opinions and findings from those who have studied PCMHs and those who have been directly involved with this type of health care model are outlined. Key lessons from providers are detailed, and critical success factors are highlighted. This synthesized analysis serves to lend evidence to health care managers and providers who are considering implementation of the PCMH model.

  14. Cost-income analysis of oral health units of health care centers in Yazd city

    Directory of Open Access Journals (Sweden)

    Hosein Fallahzadeh

    2012-01-01

    Full Text Available Background and Aims: Increasing demands for health care's services on one hand and limited resources on the other hand brings about pressure over governments to find out a mechanism for fair and appropriate distribution of resources. Economic analysis is one of the appropriate tools for policy making on this priority. The aim of this study was to assess capital and consumption of oral health units of health care centers in Yazd city and comparing it with revenue of these centers and determining of cost effectiveness.Materials and Methods: In this descriptive cross sectional study, all health care centers of Yazd city with active dentistry department were evaluated. The data has been extracted from current documents in health care center of county based issued receipts and daily information registers.Results: Expended cost for providing of oral hygiene services in second half of 2008 in 13 medical health centers of Yazd included active dentistry section was 557.887.500 Rials and revenue to cost ratio was about 34%. The most provided service was related to tooth extraction and the average of tooth restoration in each working day was 0.48.Conclusion: With attention to low tariffs of dentistry services in medical health centers and paying subsidy to target groups, expenses of oral hygiene are always more than its revenue.

  15. UNDER-UTILIZATION OF COMMUNITY HEALTH CENTERS IN PURWOREJO REGENCY, CENTRAL JAVA

    OpenAIRE

    Atik Triratnawati

    2006-01-01

    The basic strategy of the Ministry of Health to achieve Health For All In Indonesia 2010 is through health paradigm, decentralization, professionalism and health service management. Community health centers play an important role to achieve the goal. Unfortunately, underutilization of community health centers is still a problem in Purworejo. The purpose of this study was to know the utilization of community health centers using a sociological health approach. Qualitative research by observati...

  16. Community Health Center Provider and Staff’s Spanish Language Ability and Cultural Awareness

    Science.gov (United States)

    Baig, Arshiya A.; Benitez, Amanda; Locklin, Cara A.; Campbell, Amanda; Schaefer, Cynthia T.; Heuer, Loretta J.; Mee Lee, Sang; Solomon, Marla C.; Quinn, Michael T.; Burnet, Deborah L.; Chin, Marshall H.

    2014-01-01

    Many community health center providers and staff care for Latinos with diabetes, but their Spanish language ability and awareness of Latino culture are unknown. We surveyed 512 Midwestern health center providers and staff who managed Latino patients with diabetes. Few respondents had high Spanish language (13%) or cultural awareness scores (22%). Of respondents who self-reported 76–100% of their patients were Latino, 48% had moderate/low Spanish language and 49% had moderate/low cultural competency scores. Among these respondents, 3% lacked access to interpreters and 27% had neither received cultural competency training nor had access to training. Among all respondents, Spanish skills and Latino cultural awareness were low. Respondents who saw a significant number of Latinos had good access to interpretation services but not cultural competency training. Improved Spanish-language skills and increased access to cultural competency training and Latino cultural knowledge are needed to provide linguistically and culturally tailored care to Latino patients. PMID:24858866

  17. Community health center provider and staff's Spanish language ability and cultural awareness.

    Science.gov (United States)

    Baig, Arshiya A; Benitez, Amanda; Locklin, Cara A; Campbell, Amanda; Schaefer, Cynthia T; Heuer, Loretta J; Lee, Sang Mee; Solomon, Marla C; Quinn, Michael T; Burnet, Deborah L; Chin, Marshall H

    2014-05-01

    Many community health center providers and staff care for Latinos with diabetes, but their Spanish language ability and awareness of Latino culture are unknown. We surveyed 512 Midwestern health center providers and staff who managed Latino patients with diabetes. Few respondents had high Spanish language (13%) or cultural awareness scores (22%). Of respondents who self-reported 76-100% of their patients were Latino, 48% had moderate/low Spanish language and 49% had moderate/low cultural competency scores. Among these respondents, 3% lacked access to interpreters and 27% had neither received cultural competency training nor had access to training. Among all respondents, Spanish skills and Latino cultural awareness were low. Respondents who saw a significant number of Latinos had good access to interpretation services but not cultural competency training. Improved Spanish-language skills and increased access to cultural competency training and Latino cultural knowledge are needed to provide linguistically and culturally tailored care to Latino patients.

  18. Patient-Centered Drug Approval: The Role of Patient Advocacy in the Drug Approval Process.

    Science.gov (United States)

    Mattingly, T Joseph; Simoni-Wastila, Linda

    2017-10-01

    Recent approval of eteplirsen for Duchenne muscular dystrophy (DMD), a rare disease with few treatment alternatives, has reignited the debate over the U.S. drug approval process. The evolution of legal and regulatory restrictions to the marketing and sale of pharmaceuticals has spanned more than a century, and throughout this history, patient advocacy has played a significant role. Scientific evidence from clinical trials serves as the foundation for drug approval, but the patient voice has become increasingly influential. Although the gold standard for establishing safety and efficacy through randomized controlled trials has been in place for more than 50 years, it poses several limitations for rare disorders where patient recruitment for traditional clinical trials is a major barrier. Organized efforts by patient advocacy groups to help patients with rare diseases access investigational therapy have had a legislative and regulatory effect. After approval by the FDA, patient access to therapy may still be limited by cost. A managed care organization (MCO) with the fiduciary responsibility of managing the health of a population must weigh coverage decisions for costly therapies with questionable effectiveness against alternatives within the constraint of a finite budget. Even when the FDA deems a drug safe and effective, an MCO may determine that the drug should only be made available at a tier level where out-of-pocket costs are still too high for many patients. This limitation of availability may be due to cost, other treatment alternatives, or outcomes from existing clinical evidence. However, if the MCO makes a costly new treatment for a rare disease readily available, it may temporarily satisfy a small contingency at the cost of all of its members. This article examines the risks and benefits of patient-centered drug approval and the potential economic effect of patient-centered drug approval on population health. There is no funding to disclose. Mattingly

  19. The patient-centered medical home neighbor: A primary care physician's view.

    Science.gov (United States)

    Sinsky, Christine A

    2011-01-04

    The American College of Physicians' position paper on the patient-centered medical home neighbor (PCMH-N) extends the work of the patient-centered medical home (PCMH) as a means of improving the delivery of health care. Recognizing that the PCMH does not exist in isolation, the PCMH-N concept outlines expectations for comanagement, communication, and care coordination and broadens responsibility for safe, effective, and efficient care beyond primary care to include physicians of all specialties. As such, it is a fitting follow-up to the PCMH and moves further down the road toward improved care for complex patients. Yet, there is more work to be done. Truly transforming the U.S. health care system around personalized medical homes embedded in highly functional medical neighborhoods will require better staffing models; more robust electronic information tools; aligned incentives for quality and efficiency within payment and regulatory policies; and a culture of greater engagement of patients, their families, and communities.

  20. 76 FR 35683 - Medicare Program; Conditions of Participation (CoPs) for Community Mental Health Centers

    Science.gov (United States)

    2011-06-17

    ... Community Mental Health Centers; Proposed Rule #0;#0;Federal Register / Vol. 76 , No. 117 / Friday June 17... (CoPs) for Community Mental Health Centers AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS... participation (CoPs) that community mental health centers (CMHCs) would have to meet in order to participate in...

  1. Human resource management in patient-centered pharmaceutical care.

    Science.gov (United States)

    White, S J

    1994-04-01

    Patient-centered care may have the pharmacists and technicians reporting either directly or in a matrix to other than pharmacy administration. The pharmacy administrative people will need to be both effective leaders and managers utilizing excellent human resource management skills. Significant creativity and innovation will be needed for transition from departmental-based services to patient care team services. Changes in the traditional methods of recruiting, interviewing, hiring, training, developing, inspiring, evaluating, and disciplining are required in this new environment.

  2. Disparities in Diabetes Care Quality by English Language Preference in Community Health Centers.

    Science.gov (United States)

    Leung, Lucinda B; Vargas-Bustamante, Arturo; Martinez, Ana E; Chen, Xiao; Rodriguez, Hector P

    2018-02-01

    To conduct a parallel analysis of disparities in diabetes care quality among Latino and Asian community health center (CHC) patients by English language preference. Clinical outcomes (2011) and patient survey data (2012) for Type 2 diabetes adults from 14 CHCs (n = 1,053). We estimated separate regression models for Latino and Asian patients by English language preference for Clinician & Group-Consumer Assessment of Healthcare Providers and System, Patient Assessment of Chronic Illness Care, hemoglobin A1c, and self-reported hypoglycemic events. We used the Blinder-Oaxaca decomposition method to parse out observed and unobserved differences in outcomes between English versus non-English language groups. After adjusting for socioeconomic and health characteristics, disparities in patient experiences by English language preference were found only among Asian patients. Unobserved factors largely accounted for linguistic disparities for most patient experience measures. There were no significant differences in glycemic control by language for either Latino or Asian patients. Given the importance of patient retention in CHCs, our findings indicate opportunities to improve CHC patients' experiences of care and to reduce disparities in patient experience by English preference for Asian diabetes patients. © Health Research and Educational Trust.

  3. Accessing patient-centered care using the advanced access model.

    Science.gov (United States)

    Tantau, Catherine

    2009-01-01

    Waits and delays for healthcare are legendary. These delays are not only frustrating and potentially hazardous for patients and providers but also represent significant cost to office practices. The traditional medical model that defines urgent care versus routine care is a vain and futile attempt to sort demand. This approach is at constant odds with patients' definition of urgency. Trusting patients to determine when and how they want to access care makes sense from a customer service perspective. If approached systematically using the principles of Advanced Access, patient demand patterns can be tracked to forecast demand. These demand patterns become the template for deploying the resources necessary to meet patients' needs. Although not a simple journey, the transformation to Advanced Access provides an entree to patient-centered care where patients can say, "I get exactly the care I want and need, when I want and need it."

  4. Community health centers and community development financial institutions: joining forces to address determinants of health.

    Science.gov (United States)

    Kotelchuck, Ronda; Lowenstein, Daniel; Tobin, Jonathan N

    2011-11-01

    Community health centers and community development financial institutions share similar origins and missions and are increasingly working together to meet community needs. Addressing the social and economic determinants of health is a common focus. The availability of new federal grants and tax credits has led these financial institutions to invest in the creation and expansion of community health centers. This article reviews the most recent trends in these two sectors and explores opportunities for further collaboration to transform the health and well-being of the nation's low-income communities.

  5. Analysis of suffering at work in Family Health Support Centers.

    Science.gov (United States)

    Nascimento, Débora Dupas Gonçalves do; Oliveira, Maria Amélia de Campos

    2016-01-01

    Analyzing the work process in the Family Health Support Center. An exploratory, descriptive case study using a qualitative approach. Focus groups were conducted with 20 workers of a Family Health Support Center, and the empirical material was subjected to content analysis technique and analyzed in light of Work Psychodynamics. The category of suffering is presented herein as arising from the dialectical contradiction between actual work and prescribed work, from resistance to the Family Health Support Center's proposal and a lack of understanding of their role; due to an immediatist and curative culture of the users and the Family Health Strategy; of the profile, overload and identification with work. The dialectical contradiction between expectations from Family Health Strategy teams and the work in the Family Health Support Center compromises its execution and creates suffering for workers. Analisar o processo de trabalho no Núcleo de Apoio à Saúde da Família. Estudo de caso exploratório, descritivo e de abordagem qualitativa. Grupos focais foram realizados com 20 trabalhadores do Núcleo de Apoio à Saúde da Família, o material empírico foi submetido à técnica de análise de conteúdo e analisado à luz da Psicodinâmica do Trabalho. Apresenta-se aqui a categoria sofrimento que neste estudo decorre da contradição dialética entre o trabalho real e o trabalho prescrito, da resistência à proposta do Núcleo de Apoio à Saúde da Família e da falta de compreensão de seu papel; da cultura imediatista e curativa do usuário e da Estratégia Saúde da Família; do perfil, sobrecarga e identificação com o trabalho. A contradição dialética entre expectativas das equipes da Estratégia Saúde da Família e o trabalho no Núcleo de Apoio à Saúde da Família compromete sua efetivação e gera sofrimento aos trabalhadores.

  6. Relationship-centered health care as a Lean intervention.

    Science.gov (United States)

    Dunsford, Jennifer; Reimer, Laura E

    2017-12-01

    Continuous improvement efforts, recognized in much literature as Lean management techniques have been used in efforts to improve efficiency in democratic health care contexts for some time to varying degrees of success. The complexity of the health care system is magnified by the sheer number of processes and sub processes required to deliver value within a bureaucratic environment, while maintaining some level of compassionate and personalized care. There is inherent tension between what is required to be efficient and what is required to be caring and this conflict presses against Lean practice at the level of delivery.Administration and care intersect at the point of the patient's experience. In order to achieve the dual goals of improved value and lower costs, the application of Lean thinking for meaningful health care reform must acknowledge the fundamental dichotomy between the impersonal tasks required to provide health services, and human interactions. Meaningful health care reform requires an acknowledgement of this distinction, currently not recognized in literature. While administrative process improvements are necessary, they are insufficient to achieve a sustainable and caring health care system. Lean thinking must be applied differently for administrative processes and patient care encounters, because these are fundamentally different processes. In this way, Lean principles will effectively contribute to sustainable health system improvements. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Costs and clinical quality among Medicare beneficiaries: associations with health center penetration of low-income residents.

    Science.gov (United States)

    Sharma, Ravi; Lebrun-Harris, Lydie A; Ngo-Metzger, Quyen

    2014-01-01

    Determine the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs). Data on elderly fee-for-service beneficiaries across 306 HRRs came from CMS' Geographic Variation in Medicare Spending and Utilization database (2010). We merged data on number of health center patients (HRSA's Uniform Data System) and number of low-income residents (American Community Survey). We estimated access to primary care in each HRR by "health center penetration" (health center patients as a proportion of low-income residents). We calculated total Medicare spending (adjusted for population size, local input prices, and health risk). We assessed clinical quality by preventable hospital admissions, hospital readmissions, and emergency department visits. We sorted HRRs by health center penetration rate and compared spending and quality measures between the high- and low-penetration deciles. We also employed linear regressions to estimate spending and quality measures as a function of health center penetration. The high-penetration decile had 9.7% lower Medicare spending ($926 per capita, p=0.01) than the low-penetration decile, and no different clinical quality outcomes. Compared with elderly fee-for-service beneficiaries residing in areas with low-penetration of health center patients among low-income residents, those residing in high-penetration areas may accrue Medicare cost savings. Limited evidence suggests that these savings do not compromise clinical quality.

  8. User-centered design and the development of patient decision aids: protocol for a systematic review.

    Science.gov (United States)

    Witteman, Holly O; Dansokho, Selma Chipenda; Colquhoun, Heather; Coulter, Angela; Dugas, Michèle; Fagerlin, Angela; Giguere, Anik Mc; Glouberman, Sholom; Haslett, Lynne; Hoffman, Aubri; Ivers, Noah; Légaré, France; Légaré, Jean; Levin, Carrie; Lopez, Karli; Montori, Victor M; Provencher, Thierry; Renaud, Jean-Sébastien; Sparling, Kerri; Stacey, Dawn; Vaisson, Gratianne; Volk, Robert J; Witteman, William

    2015-01-26

    Providing patient-centered care requires that patients partner in their personal health-care decisions to the full extent desired. Patient decision aids facilitate processes of shared decision-making between patients and their clinicians by presenting relevant scientific information in balanced, understandable ways, helping clarify patients' goals, and guiding decision-making processes. Although international standards stipulate that patients and clinicians should be involved in decision aid development, little is known about how such involvement currently occurs, let alone best practices. This systematic review consisting of three interlinked subreviews seeks to describe current practices of user involvement in the development of patient decision aids, compare these to practices of user-centered design, and identify promising strategies. A research team that includes patient and clinician representatives, decision aid developers, and systematic review method experts will guide this review according to the Cochrane Handbook and PRISMA reporting guidelines. A medical librarian will hand search key references and use a peer-reviewed search strategy to search MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, the ACM library, IEEE Xplore, and Google Scholar. We will identify articles across all languages and years describing the development or evaluation of a patient decision aid, or the application of user-centered design or human-centered design to tools intended for patient use. Two independent reviewers will assess article eligibility and extract data into a matrix using a structured pilot-tested form based on a conceptual framework of user-centered design. We will synthesize evidence to describe how research teams have included users in their development process and compare these practices to user-centered design methods. If data permit, we will develop a measure of the user-centeredness of development processes and identify practices that are likely

  9. Health at the center of health systems reform: how philosophy can inform policy.

    Science.gov (United States)

    Sturmberg, Joachim P; Martin, Carmel M; Moes, Mark M

    2010-01-01

    Contemporary views hold that health and disease can be defined as objective states and thus should determine the design and delivery of health services. Yet health concepts are elusive and contestable. Health is neither an individual construction, a reflection of societal expectations, nor only the absence of pathologies. Based on philosophical and sociological theory, empirical evidence, and clinical experience, we argue that health has simultaneously objective and subjective features that converge into a dynamic complex-adaptive health model. Health (or its dysfunction, illness) is a dynamic state representing complex patterns of adaptation to body, mind, social, and environmental challenges, resulting in bodily homeostasis and personal internal coherence. The "balance of health" model-emergent, self-organizing, dynamic, and adaptive-underpins the very essence of medicine. This model should be the foundation for health systems design and also should inform therapeutic approaches, policy decision-making, and the development of emerging health service models. A complex adaptive health system focused on achieving the best possible "personal" health outcomes must provide the broad policy frameworks and resources required to implement people-centered health care. People-centered health systems are emergent in nature, resulting in locally different but mutually compatible solutions across the whole health system.

  10. Academic-Community Partnership to Develop a Patient-Centered Breast Cancer Risk Reduction Program for Latina Primary Care Patients.

    Science.gov (United States)

    Castañeda, Sheila F; Giacinto, Rebeca E; Medeiros, Elizabeth A; Brongiel, Ilana; Cardona, Olga; Perez, Patricia; Talavera, Gregory A

    2016-06-01

    This collaborative study sought to address Latina breast cancer (BC) disparities by increasing health literacy (HL) in a community health center situated on the US-Mexico border region of San Diego County. An academic-community partnership conducted formative research to develop a culturally tailored promotora-based intervention with 109 individuals. The Spanish language program, entitled Nuestra Cocina: Mesa Buena, Vida Sana (Our Kitchen: Good Table, Healthy Life), included six sessions targeting HL, women's health, BC risk reduction, and patient-provider communication; sessions include cooking demonstrations of recipes with cancer-risk-reducing ingredients. A pilot study with 47 community health center Latina patients was conducted to examine the program's acceptability, feasibility, and ability to impact knowledge and skills. Pre- and post-analyses demonstrated that participants improved their self-reported cancer screening, BC knowledge, daily fruit and vegetable intake, and ability to read a nutrition label (p < 0.05). Results of the pilot study demonstrate the importance of utilizing patient-centered culturally appropriate noninvasive means to educate and empower Latina patients.

  11. Patient-centered pharmacovigilance: A review | Saleh | Tropical ...

    African Journals Online (AJOL)

    The studies were extracted from seven databases, viz, Google Scholars, Medline, Academic Search Complete “EBSCO”, Health and Medical Complete ProQuest, Science Direct- Elsevier, SCOPUS and Wiley Online Library. Results: The review revealed that although the reports by patients were of good quality, the patients' ...

  12. Development of a Patient-Centered Antipsychotic Medication Adherence Intervention

    Science.gov (United States)

    Pyne, Jeffrey M.; Fischer, Ellen P.; Gilmore, LaNissa; McSweeney, Jean C.; Stewart, Katharine E.; Mittal, Dinesh; Bost, James E.; Valenstein, Marcia

    2014-01-01

    Objective: A substantial gap exists between patients and their mental health providers about patient's perceived barriers, facilitators, and motivators (BFMs) for taking antipsychotic medications. This article describes how we used an intervention mapping (IM) framework coupled with qualitative and quantitative item-selection methods to…

  13. The importance of patient-centered care for various patient groups.

    NARCIS (Netherlands)

    Boer, D. de; Delnoij, D.; Rademakers, J.

    2013-01-01

    Objectives: To assess differences in the importance ascribed to patient-centered care between various patient groups and demographic groups. Methods: Survey data collected using questionnaires were analyzed for patients that underwent hip or knee surgery (n=214), patients suffering from rheumatoid

  14. Customer Quality during Prenatal Care in Health Care Centers in Tabriz City

    Directory of Open Access Journals (Sweden)

    Jafar Sadegh Tabrizi

    2015-07-01

    Full Text Available Background and Objectives :  Customer Quality (CQ refers to customer’s characteristics and is concerned with the knowledge, skills and confidence of health services customers who actively participate with health team in proper decision-making, appropriate activities and changing environment and health related behaviors. The purpose of this study was measuring customer quality of pregnant women during prenatal care. Materials and Methods :  This is a cross- sectional study which was conducted with the participation of 185 pregnant women who received prenatal care from urban health centers in Tabriz city. All participants were selected randomly from 40 health centers. Customer quality was measured based on CQMH-CQ questionnaire.  Questionnaire content validity was reviewed and confirmed by 10 experts and its reliability was confirmed based on Cronbach's alpha index (α = 0.714. Spss v.17 was used for data analysis. Results : According to the results, the mean score of customer quality among pregnant women was (11.29± 67.79   and only %14 of the participants reported the highest customer quality score and ability of continuity of care under stressful situations. There was a positive relationship between customer quality score and visiting midwife and a better evaluation of overall quality of care, but there was inverse relationship with early registration at health centers. Conclusion :  The participation of pregnant women in service delivery process and decision-making can promote costumer quality. Furthermore, training health care providers in empowering patients and using their abilities to improve quality of care and paying attention to patient-centered care will be helpful. ​

  15. Patient-centered outcomes research in radiology: trends in funding and methodology.

    Science.gov (United States)

    Lee, Christoph I; Jarvik, Jeffrey G

    2014-09-01

    The creation of the Patient-Centered Outcomes Research Trust Fund and the Patient-Centered Outcomes Research Institute (PCORI) through the Patient Protection and Affordable Care Act of 2010 presents new opportunities for funding patient-centered comparative effectiveness research (CER) in radiology. We provide an overview of the evolution of federal funding and priorities for CER with a focus on radiology-related priority topics over the last two decades, and discuss the funding processes and methodological standards outlined by PCORI. We introduce key paradigm shifts in research methodology that will be required on the part of radiology health services researchers to obtain competitive federal grant funding in patient-centered outcomes research. These paradigm shifts include direct engagement of patients and other stakeholders at every stage of the research process, from initial conception to dissemination of results. We will also discuss the increasing use of mixed methods and novel trial designs. One of these trial designs, the pragmatic trial, has the potential to be readily applied to evaluating the effectiveness of diagnostic imaging procedures and imaging-based interventions among diverse patient populations in real-world settings. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

  16. Utilization of Mental Health Services in School-Based Health Centers.

    Science.gov (United States)

    Bains, Ranbir M; Cusson, Regina; White-Frese, Jesse; Walsh, Stephen

    2017-08-01

    We summarize utilization patterns for mental health services in school-based health centers. Administrative data on school-based health center visits in New Haven, Connecticut were examined for the 2007-2009 school years. Relative frequencies of mental health visits by age were calculated as a percentage of all visits and were stratified by sex, ethnicity/race, and insurance status. Mental health visits accounted for the highest proportion of visits (31.8%). The proportion of mental health visits was highest at 8 years (42.8%) and at 13 years (39.0%). The proportion of mental health visits among boys (38.4%) was higher than among girls (26.7%). Hispanic students had a lower proportion of mental health visits than black students (23.5% vs 35.8%) in all but 2 age groups. Students in the white/other ethnicity category had higher proportions of mental health visits than Hispanic and black students between ages 12 and 15. Students with no health insurance (22.5%) had lower proportions of mental health visits than students covered by Medicaid (34.3%) or private insurance (33.9%). The percentage of mental health visits by students with private insurance was highest (37.2%-49%) in the 13-15 age range. Usage patterns for mental health issues show pronounced, nonrandom variation relative to age and other demographic characteristics especially with 8-year-old boys. © 2017, American School Health Association.

  17. Role of Nurses in Community Mental Health Centers: Example of England

    Directory of Open Access Journals (Sweden)

    Beyhan Bag

    2012-12-01

    Full Text Available The goal of the community mental health centers, which constitute the core of community based mental health service model, is to register the patients who live in a certain geographical region and have serious mental disorder in the center, to observe them regularly and to bring them back to community by providing their rehabilitation and treatment. The practice of community based mental health, which English health service carries out in one hand for the psychiatry patients’ treatment and care, has many benefits, such as minimizing the sequence of going to hospital. The community mental health nurse, who works as an incidence manager, takes on the responsibility of treatment and care of the patient in the place where he/she lives, and the directly protective effect of this responsibility is an unquestionable fact. With this practice, the process of taking cure in hospital and the cost of treatment and care decrease. In our country, this sub-field of psychiatry is still in its incipient stage. Being familiar with the successful model practices in different countries may constitute a good model for the community mental health nursing practices which are on the first level in our country. For this purpose, the role of the nurses who work for the community mental health service in England is presented in this study.

  18. Reporting From the Front Lines: Implementing Oregon's Alternative Payment Methodology in Federally Qualified Health Centers.

    Science.gov (United States)

    Cottrell, Erika K; Hall, Jennifer D; Kautz, Glenn; Angier, Heather; Likumahuwa-Ackman, Sonja; Sisulak, Laura; Keller, Sara; Cameron, David C; DeVoe, Jennifer E; Cohen, Deborah J

    Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. We conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations that were part of Oregon's Alternative Payment Methodology demonstration project. Data were analyzed using an immersion-crystallization approach. We identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment. Future research is needed to further understand the implications of these changes.

  19. Oral health knowledge of health care workers in special children's center.

    Science.gov (United States)

    Wyne, Amjad; Hammad, Nouf; Splieth, Christian

    2015-01-01

    To determine the oral health knowledge of health care workers in special children's center. A self-administered questionnaire was used to collect following information: demographics, oral hygiene practices, importance of fluoride, dental visits, cause of tooth decay, gingival health, and sources of oral health information. The study was conducted at Riyadh Center for Special Children in Riyadh City from December 2013 to May 2014. All 60 health care workers in the center completed the questionnaire. A great majority (95%) of the workers brushed their teeth twice or more daily. More than two-third (71.7%) of the workers knew that fluoride helps in caries prevention. One in five (21.7%) workers thought that a dental visit only becomes necessary in case of a dental problem. Similarly, 13.3% of the workers thought to "wait till there is some pain in case of a dental cavity" before seeking dental treatment. The workers ranked soft drinks/soda (98.3%), flavored fizzy drinks (60%) and sweetened/flavored milks (43.3%) as top three cariogenic drinks. A great majority (95%) of the workers correctly responded that blood on toothbrush most probably is a sign of "gum disease". Dentists (50%) and media (45%) were the main source of their oral health information. There was no significant difference (p > 0.05) in workers' response in relation to their specific job. The special health care workers in the disabled children's center generally had satisfactory oral health knowledge and practices.

  20. Setting the vision: applied patient-reported outcomes and smart, connected digital healthcare systems to improve patient-centered outcomes prediction in critical illness.

    Science.gov (United States)

    Wysham, Nicholas G; Abernethy, Amy P; Cox, Christopher E

    2014-10-01

    Prediction models in critical illness are generally limited to short-term mortality and uncommonly include patient-centered outcomes. Current outcome prediction tools are also insensitive to individual context or evolution in healthcare practice, potentially limiting their value over time. Improved prognostication of patient-centered outcomes in critical illness could enhance decision-making quality in the ICU. Patient-reported outcomes have emerged as precise methodological measures of patient-centered variables and have been successfully employed using diverse platforms and technologies, enhancing the value of research in critical illness survivorship and in direct patient care. The learning health system is an emerging ideal characterized by integration of multiple data sources into a smart and interconnected health information technology infrastructure with the goal of rapidly optimizing patient care. We propose a vision of a smart, interconnected learning health system with integrated electronic patient-reported outcomes to optimize patient-centered care, including critical care outcome prediction. A learning health system infrastructure integrating electronic patient-reported outcomes may aid in the management of critical illness-associated conditions and yield tools to improve prognostication of patient-centered outcomes in critical illness.

  1. Psychometrics of shared decision making and communication as patient centered measures for two language groups.

    Science.gov (United States)

    Alvarez, Kiara; Wang, Ye; Alegria, Margarita; Ault-Brutus, Andrea; Ramanayake, Natasha; Yeh, Yi-Hui; Jeffries, Julia R; Shrout, Patrick E

    2016-09-01

    Shared decision making (SDM) and effective patient-provider communication are key and interrelated elements of patient-centered care that impact health and behavioral health outcomes. Measurement of SDM and communication from the patient's perspective is necessary in order to ensure that health care systems and individual providers are responsive to patient views. However, there is a void of research addressing the psychometric properties of these measures with diverse patients, including non-English speakers, and in the context of behavioral health encounters. This study evaluated the psychometric properties of 2 patient-centered outcome measures, the Shared Decision-Making Questionnaire-9 (SDM-Q) and the Kim Alliance Scale-Communication subscale (KAS-CM), in a sample of 239 English and Spanish-speaking behavioral health patients. One dominant factor was found for each scale and this structure was used to examine whether there was measurement invariance across the 2 language groups. One SDM-Q item was inconsistent with the configural invariance comparison and was removed. The remaining SDM-Q items exhibited strong invariance, meaning that item loadings and item means were similar across the 2 groups. The KAS-CM items had limited variability, with most respondents indicating high communication levels, and the invariance analysis was done on binary versions of the items. These had metric invariance (loadings the same over groups) but several items violated the strong invariance test. In both groups, the SDM-Q had high internal consistency, whereas the KAS-CM was only adequate. These findings help interpret results for individual patients, taking into account cultural and linguistic differences in how patients perceive SDM and patient-provider communication. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  2. A linguistic study of patient-centered interviewing: emergent interactional effects.

    Science.gov (United States)

    Hesson, Ashley M; Sarinopoulos, Issidoros; Frankel, Richard M; Smith, Robert C

    2012-09-01

    To evaluate interactional effects of patient-centered interviewing (PCI) compared to isolated clinician-centered interviewing (CCI). We conducted a pilot study comparing PCI (N=4) to CCI (N=4) for simulated new-patient visits. We rated interviews independently and measured patient satisfaction with the interaction via a validated questionnaire. We conducted interactional sociolinguistic analysis on the interviews and compared across three levels of analysis: turn, topic, and interaction. We found significant differences between PCI and CCI in physician responses to patients' psychosocial cues and concerns. The number and type of physician questions also differed significantly across PCI and CCI sets. Qualitatively, we noted several indicators of physician-patient attunement in the PCI interviews that were not present in the CCI interviews. They spanned diverse aspects of physician and patient speech, suggesting interactional accommodation on the part of both participants. This small pilot study highlights a variety of interactional variables that may underlie the effects associated with patient-centered interviewing (e.g., positive relationships, health outcomes). Question form, phonological accommodation processes, and use of stylistic markers are relatively unexplored in controlled studies of physician-patient interaction. This study characterizes several interactional variables for larger scale studies and contributes to models of patient-centeredness in practice. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  3. Employee health benefit redesign at the academic health center: a case study.

    Science.gov (United States)

    Marshall, Julie; Weaver, Deirdre C; Splaine, Kevin; Hefner, David S; Kirch, Darrell G; Paz, Harold L

    2013-03-01

    The rapidly escalating cost of health care, including the cost of providing health care benefits, is a significant concern for many employers. In this article, the authors examine a case study of an academic health center that undertook a complete redesign of its health benefit structure to control rising costs, encourage use of its own provider network, and support employee wellness. With the implementation in 2006 of a high-deductible health plan combined with health reimbursement arrangements and wellness incentives, the Penn State Hershey Medical Center (PSHMC) was able to realize significant cost savings and increase use of its own network while maintaining a high level of employee satisfaction. By contracting with a single third-party administrator for its self-insured plan, PSHMC reduced its administrative costs and simplified benefit choices for employees. In addition, indexing employee costs to salary ensured that this change was equitable for all employees, and the shift to a consumer-driven health plan led to greater employee awareness of health care costs. The new health benefit plan's strong focus on employee wellness and preventive health has led to significant increases in the use of preventive health services, including health risk assessments, cancer screenings, and flu shots. PSHMC's experience demonstrates the importance of clear and ongoing communication with employees throughout--before, during, and even after--the process of health benefit redesign.

  4. A long and winding road: federally qualified health centers, community variation and prospects under reform.

    Science.gov (United States)

    Katz, Aaron B; Felland, Laurie E; Hill, Ian; Stark, Lucy B

    2011-11-01

    Community health centers have evolved from fringe providers to mainstays of many local health care systems. Those designated as federally qualified health centers (FQHCs), in particular, have largely established themselves as key providers of comprehensive, efficient, high-quality primary care services to low-income people, especially Medicaid and uninsured patients. The Center for Studying Health System Change's (HSC's) site visits to 12 nationally representative metropolitan communities since 1996 document substantial growth in FQHC capacity, based on growing numbers of Medicaid enrollees and uninsured people, increased federal support, and improved managerial acumen. At the same time, FQHC development has varied considerably across communities because of several important factors, including local health system characteristics and financial and political support at federal, state and local levels. Some communities--Boston; Syracuse, N.Y.; Miami; and Seattle--have relatively extensive FQHC capacity for their Medicaid and uninsured populations, while other communities--Lansing, Mich.; northern New Jersey; Indianapolis; and Greenville, S.C.--fall in the middle. FQHC growth in Phoenix; Little Rock, Ark.; Cleveland; and Orange County, Calif.; has lagged in comparison. Today, FQHCs seem poised to play a key role in federal health care reform, including coverage expansions and the emphasis on primary care and medical homes.

  5. The ethical leadership challenge: creating a culture of patient- and family-centered care in the hospital setting.

    Science.gov (United States)

    Piper, Llewellyn E

    2011-01-01

    The growing number of medical errors and resulting preventable deaths in hospitals presents an ethical dilemma that must be addressed by health care leaders and managers. These medical errors and deaths raise questions about safety and quality issues resulting in rising public mistrust and patient dissatisfaction. Many of these medical errors and deaths could have been avoided by including the patient and family in the care. The ethical challenge for leadership is creating a culture of patient- and family-centered care as a means to improve quality, safety, patient satisfaction, and public trust. This article addresses ways to improve safety, quality, patient satisfaction, and cost and thereby reduce medical errors and deaths by implementing a patient- and family-centered care culture. The first critical step for improvement is for hospital leaders and managers to answer the ethical call to create a culture centered on patient- and family-centered care in the hospital setting.

  6. Hypertension care at primary health care centers: A report from Abha, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Al-Homrany Mohammed

    2008-01-01

    Full Text Available It is well known that effective management of hypertension reduces the incidence of myo-cardial infarction, stroke and vascular complications. The Ministry of Health, Kingdom of Saudi Arabia, introduced the Quality Assurance Guidelines with the hope to improve the management of hypertension in its centers. We conducted an audit of two Primary Health Care Centers namely, Al-Manhal (MPHCC and Al-Numais (NPHCC, to evaluate how well hypertension was managened at these centers. A check list was derived from the Quality Assurance Manual to audit the process and to assess the health outcome. A retrospective study on a chosen sample of 120 files of hypertensive patients, out of 256 from both the Primary Health Care Centers was performed, during the last three months of the year 2000. Results showed that 61% of the patients were between 45-64 years of age, 56% were females, 85% were married, 54% were illiterate and 7.5% were smokers. A total of 92% of the patients had primary hypertension and 25% had a positive family history of hypertension. Beta-blockers were the most commonly used drugs in both the centers. Although the recording of the information was not perfect, there was no statistical difference in the socio-demongraphic data and also the means of the total score in both the centres. On the other hand, carrying out the important procedures for hypertensive patients was found to be better at MPHCC in com-parison to NPHCC (p < 0.05. The commonly missed procedures were chest x-rays, electrolytes and ECG. Hypertension was well controlled in 63% of the patients, 58% were found to have obesity, 9% suffered from hypertension-related complications while almost 50% had good compliance to appointment in both the centers. Our study reveals that the process of hypertension care at the two Primary Health Care Centres in Aseer region was not in accordance with the recommended national standards. The reasons include lack of updating systems, recall system and

  7. Patient-Centered Prescription Model to improve therapeutic adherence in patients with multimorbidity

    Directory of Open Access Journals (Sweden)

    Javier González-Bueno

    2018-05-01

    Full Text Available To date, interventions to improve medication adherence in patients with multimorbidity have shown modest and inconsistent efficacy among available studies. Thereby, we should define new approaches aimed at improving medication adherence tailored to effective prescribing, with a multidisciplinary approach and patient-centered. In this regard, the Patient-Centered Prescription Model has shown its usefulness on improving appropriateness of drug treatments in patients with clinical complexity. For that, this strategy addresses the following four steps: 1 Patient-Centered assessment; 2 Diagnosis-Centered assessment; 3 Medication-Centered assessment; and 4 Therapeutic Plan. We propose through a clinical case an adaptation of the Patient-Centered Prescription Model to enhance both appropriateness and medication adherence in patients with multimorbidity. To this end, we have included on its first step the Spanish version of a cross-culturally adapted scale for the multidimensional assessment of medication adherence. Furthermore, we suggest a set of interventions to be applied in the three remaining steps of the model. These interventions were firstly identified by an overview of systematic reviews and then selected by a panel of experts based on Delphi methodology. All of these elements have been considered appropriate in patients with multimorbidity according to three criteria: strength of their supporting evidence, usefulness in the target population and feasibility of implementation in clinical practice. The proposed approach intends to lay the foundations for an innovative way in tackling medication adherence in patients with multimorbidity.

  8. Politics and the success of school-based health centers.

    Science.gov (United States)

    Rienzo, B A; Button, J W; Wald, K D

    2000-10-01

    School-based health centers (SBHCs) provide access to health services by bringing providers to children (and sometimes parents) and furnishing low cost services in an atmosphere of trust. While the number of SBHCs has continued to grow and some clinics have continued to expand their services, others have barely survived and some have even closed. This study investigated factors, particularly political forces, that affected the success of SBHCs. Using a national survey of clinic directors, this study assessed clinic success in terms both of longevity and service delivery. Findings indicate the factors most consistently and significantly associated with success include not only measures of "need" (school size and percent African-American enrollment or population) but of "politics" (citizen political ideology and Southern conservatism). Thus, politics matters more than previous studies suggested.

  9. Cost-effectiveness analysis of a patient-centered care model for management of psoriasis.

    Science.gov (United States)

    Parsi, Kory; Chambers, Cindy J; Armstrong, April W

    2012-04-01

    Cost-effectiveness analyses help policymakers make informed decisions regarding funding allocation of health care resources. Cost-effectiveness analysis of technology-enabled models of health care delivery is necessary to assess sustainability of novel online, patient-centered health care models. We sought to compare cost-effectiveness of conventional in-office care with a patient-centered, online model for follow-up treatment of patients with psoriasis. Cost-effectiveness analysis was performed from a societal perspective on a randomized controlled trial comparing a patient-centered online model with in-office visits for treatment of patients with psoriasis during a 24-week period. Quality-adjusted life expectancy was calculated using the life table method. Costs were generated from the original study parameters and national averages for salaries and services. No significant difference existed in the mean change in Dermatology Life Quality Index scores between the two groups (online: 3.51 ± 4.48 and in-office: 3.88 ± 6.65, P value = .79). Mean improvement in quality-adjusted life expectancy was not significantly different between the groups (P value = .93), with a gain of 0.447 ± 0.48 quality-adjusted life years for the online group and a gain of 0.463 ± 0.815 quality-adjusted life years for the in-office group. The cost of follow-up psoriasis care with online visits was 1.7 times less than the cost of in-person visits ($315 vs $576). Variations in travel time existed among patients depending on their distance from the dermatologist's office. From a societal perspective, the patient-centered online care model appears to be cost saving, while maintaining similar effectiveness to standard in-office care. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  10. Patient-Centered Tablet Application for Improving Medication Adherence after a Drug-Eluting Stent.

    Science.gov (United States)

    Shah, Vicki; Dileep, Anandu; Dickens, Carolyn; Groo, Vicki; Welland, Betty; Field, Jerry; Baumann, Matthew; Flores, Jose D; Shroff, Adhir; Zhao, Zhongsheng; Yao, Yingwei; Wilkie, Diana J; Boyd, Andrew D

    2016-01-01

    This study's objective was to evaluate a patient-centered educational electronic tablet application, "My Interventional Drug-Eluting Stent Educational App" (MyIDEA) to see if there was an increase in patient knowledge about dual antiplatelet therapy (DAPT) and medication possession ratio (MPR) compared to treatment as usual. In a pilot project, 24 elderly (≥50 years old) research participants were recruited after a drug-eluting stent. Eleven were randomized to the control arm and 13 to the interventional arm. All the participants completed psychological and knowledge questionnaires. Adherence was assessed through MPR, which was calculated at 3 months for all participants who were scheduled for second and third follow-up visits. Relative to control, the interventional group had a 10% average increase in MPR. As compared to the interventional group, more patients in the control group had poor adherence (<80% MPR). The psychological data revealed a single imbalance in anxiety between the control and interventional groups. On average, interventional participants spent 21 min using MyIDEA. Consumer health informatics has enabled us to engage patients with their health data using novel methods. Consumer health technology needs to focus more on patient knowledge and engagement to improve long-term health. MyIDEA takes a unique approach in targeting DAPT from the onset. MyIDEA leverages patient-centered information with clinical care and the electronic health record highlighting the patients' role as a team member in their own health care. The patients think critically about adverse events and how to solve issues before leaving the hospital.

  11. Injustice in Access to Health Information: The Difference between Health Professionals and Patients

    Directory of Open Access Journals (Sweden)

    Hasan Ashrafi-rizi

    2016-10-01

    Full Text Available The role of information is undeniable in promoting public health (1-3. “Access to health information for all” was the slogan of the World Health Organization in 2004 (4. The proving of this slogan requires access to health information by beneficiaries (health professionals and patients. Access to health information by specialists as partly been achieved, but access to health information for patients and their families is considered low (5-7, which could have adverse effects. Health professionals have quick and easy access to information through libraries and medical information centers, participation in seminars, exchange of scientific information with other professionals, as well as identifying ways to effectively access to health information, but patients and their families do not have access to such facilities and capabilities. Therefore, patients and their families are faced with a phenomenon known as “inequity in access to health information” and the continuation of the injustice leads to health information poverty. Thus, the main question now is what we should do? It seems that the government needs to develop a national policy in the field of health information and it is the most important step. In the next step, the government should expand the concept production via using potentials of different organizations like public media (TV and Radio, health ministry and press and increase the access of patients to health information in the easy language (level of health information between health professionals and patients is different.

  12. Patients first! Engaging the hearts and minds of nurses with a patient-centered practice model.

    Science.gov (United States)

    Small, Deborah C; Small, Robert M

    2011-05-31

    Like every healthcare system today, the Cleveland Clinic health system is a combination of medical hospitals, institutes, and services in which the implementation of uniform care methodologies faces significant barriers. The guiding principle of the Cleveland Clinic, 'Patients First,' focuses on the principle of patient- and family-centered care (PFCC) but deliberately lacks details due to the wide scope of care delivered by the organization. The Stanley Shalom Zielony Institute of Nursing Excellence (the Nursing Institute) at the Cleveland Clinic was charged with standardizing nursing practice across a system with 11,000 registered nurses and 800 advanced practice nurses. The challenge involved providing firm direction on delivering PFCC that was appropriate for all clinical disciplines and could be implemented quickly across existing practices and technologies. Successful implementation required full engagement in the concept of PFCC by what the Institute for Healthcare Improvement has termed the 'hearts and minds' of nurses. To achieve these ends, development of a systemwide nursing practice model was initiated. In this article the authors identify the essence of PFCC, consider barriers to PFCC, review their process of developing PFCC, and describe how the Cleveland Clinic health system has implemented a PFCC nursing practice model. In doing so the authors explore how the concept of 'Passion for Nursing' was used to stimulate nurse engagement in PFCC.

  13. Bone health in cancer patients

    DEFF Research Database (Denmark)

    Coleman, R; Body, J J; Aapro, M

    2014-01-01

    There are three distinct areas of cancer management that make bone health in cancer patients of increasing clinical importance. First, bone metastases are common in many solid tumours, notably those arising from the breast, prostate and lung, as well as multiple myeloma, and may cause major...... morbidity including fractures, severe pain, nerve compression and hypercalcaemia. Through optimum multidisciplinary management of patients with bone metastases, including the use of bone-targeted treatments such as potent bisphosphonates or denosumab, it has been possible to transform the course of advanced...... cancer for many patients resulting in a major reduction in skeletal complications, reduced bone pain and improved quality of life. Secondly, many of the treatments we use to treat cancer patients have effects on reproductive hormones, which are critical for the maintenance of normal bone remodelling...

  14. Compliance with recommended care at trauma centers: association with patient outcomes.

    Science.gov (United States)

    Shafi, Shahid; Barnes, Sunni A; Rayan, Nadine; Kudyakov, Rustam; Foreman, Michael; Cryer, H Gil; Alam, Hasan B; Hoff, William; Holcomb, John

    2014-08-01

    State health departments and the American College of Surgeons focus on the availability of optimal resources to designate hospitals as trauma centers, with little emphasis on actual delivery of care. There is no systematic information on clinical practices at designated trauma centers. The objective of this study was to measure compliance with 22 commonly recommended clinical practices at trauma centers and its association with in-hospital mortality. This retrospective observational study was conducted at 5 Level I trauma centers across the country. Participants were adult patients with moderate to severe injuries (n = 3,867). The association between compliance with 22 commonly recommended clinical practices and in-hospital mortality was measured after adjusting for patient demographics and injuries and their severity. Compliance with individual clinical practices ranged from as low as 12% to as high as 94%. After adjusting for patient demographics and injury severity, each 10% increase in compliance with recommended care was associated with a 14% reduction in the risk of death. Patients who received all recommended care were 58% less likely to die (odds ratio = 0.42; 95% CI, 0.28-0.62) compared with those who did not. Compliance with commonly recommended clinical practices remains suboptimal at designated trauma centers. Improved adoption of these practices can reduce mortality. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  15. The Schwartz Center Rounds: evaluation of an interdisciplinary approach to enhancing patient-centered communication, teamwork, and provider support.

    Science.gov (United States)

    Lown, Beth A; Manning, Colleen F

    2010-06-01

    To assess the impact of Schwartz Center Rounds, an interdisciplinary forum where attendees discuss psychosocial and emotional aspects of patient care. The authors investigated changes in attendees' self-reported behaviors and beliefs about patient care, sense of teamwork, stress, and personal support. In 2006-2007, researchers conducted retrospective surveys of attendees at six sites offering Schwartz Center Rounds ("the Rounds") for > or =3 years and prospective surveys of attendees at 10 new Rounds sites that have held > or =7 Rounds. Most of the retrospective survey respondents indicated that attending Rounds enhanced their likelihood of attending to psychosocial and emotional aspects of care and enhanced their beliefs about the importance of empathy. Respondents reported better teamwork, including heightened appreciation of the roles and contributions of colleagues. There were significant decreases in perceived stress (P teamwork (both: P communication, teamwork, and provider support. The impact on measured outcomes increased with the number of Rounds attended. The Rounds represent an effective strategy for providing support to health care professionals and for enhancing relationships among them and with their patients.

  16. 75 FR 55587 - Family-to-Family Health Information Center Program

    Science.gov (United States)

    2010-09-13

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Family-to-Family Health Information Center Program AGENCY: Health Resources and Services Administration, HHS... Vermont Family-to-Family Health Information Center (F2F HIC) grant (H84MC00002) from the Parent to Parent...

  17. 77 FR 50519 - Center for Mental Health Services (CMHS); Amendment of Meeting

    Science.gov (United States)

    2012-08-21

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Mental Health Services (CMHS); Amendment of Meeting Pursuant to Public Law 92-463, notice is... Substance Abuse and Mental Health Services Administration's (SAMHSA), Center for Mental Health Services...

  18. Facilitating primary care provider use in a patient-centered medical home intervention study for chronic hemodialysis patients.

    Science.gov (United States)

    Chukwudozie, Ifeanyi Beverly; Fitzgibbon, Marian L; Schiffer, Linda; Berbaum, Michael; Gilmartin, Cheryl; David, Pyone; Ekpo, Eson; Fischer, Michael J; Porter, Anna C; Aziz-Bradley, Alana; Hynes, Denise M

    2018-05-23

    Patients with chronic kidney disease have a high disease burand may benefit from primary care services and care coord A medical home model with direct access to primary care services is one approach that may address this need, yet has not been examined. As a substudy of the Patient-Centered Outcomes Research Institute (PCORI) patient-centered medical home for kidney disease (PCMH-KD) health system intervention study, we examined the uptake of free primary care physician (PCP) services. The PCORI PCMH-KD study was an initial step toward integrating PCPs, a nurse coordinator, a pharmacist, and community health workers (CHWs) within the health care delivery team. Adult chronic hemodialysis (CHD) at two urban dialysis centers were enrolled in the intervention. We examined trends and factors associated with the use of the PCMH-KD PCP among two groups of patients based on their report of having a regular physician for at least six months (established-PCP) or not (no-PCP). Of the 173 enrolled patients, 91 (53%) patients had at least one visit with the PCMH-KD PCP. The rate of visits was higher in those in the no-PCP group compared with those in the established-PCP group (62% vs. 41%, respectively). Having more visits with the CHW was positively associated with having a visit with the PCMH-KD PCPs for both groups. Embedded CHWs within the care team played a role in facilithe uptake of PCMH-KD PCP. Lessons from this health system intervention can inform future approaches on the integration of PCPs and care coordination for CHD patients.

  19. The Phoenix Physician: defining a pathway toward leadership in patient-centered care.

    Science.gov (United States)

    Good, Robert G; Bulger, John B; Hasty, Robert T; Hubbard, Kevin P; Schwartz, Elliott R; Sutton, John R; Troutman, Monte E; Nelinson, Donald S

    2012-08-01

    Health care delivery has evolved in reaction to scientific and technological discoveries, emergent patient needs, and market forces. A current focus on patient-centered care has pointed to the need for the reallocation of resources to improve access to and delivery of efficient, cost-effective, quality care. In response to this need, primary care physicians will find themselves in a new role as team leader. The American College of Osteopathic Internists has developed the Phoenix Physician, a training program that will prepare primary care residents and practicing physicians for the changes in health care delivery and provide them with skills such as understanding the contributions of all team members (including an empowered and educated patient), evaluating and treating patients, and applying performance metrics and information technology to measure and improve patient care and satisfaction. Through the program, physicians will also develop personal leadership and communication skills.

  20. Lessons Learned Recruiting Minority Participants for Research in Urban Community Health Centers.

    Science.gov (United States)

    Fam, Elizabeth; Ferrante, Jeanne M

    2018-02-01

    To help understand and mitigate health disparities, it is important to conduct research with underserved and underrepresented minority populations under real world settings. There is a gap in the literature detailing real-time research staff experience, particularly in their own words, while conducting in-person patient recruitment in urban community health centers. This paper describes challenges faced at the clinic, staff, and patient levels, our lessons learned, and strategies implemented by research staff while recruiting predominantly low-income African-American women for an interviewer-administered survey study in four urban Federally Qualified Health Centers in New Jersey. Using a series of immersion-crystallization cycles, fieldnotes and research reflections written by recruiters, along with notes from team meetings during the study, were qualitatively analyzed. Clinic level barriers included: physical layout of clinic, very low or high patient census, limited private space, and long wait times for patients. Staff level barriers included: unengaged staff, overburdened staff, and provider and staff turnover. Patient level barriers included: disinterested patients, patient mistrust and concerns over confidentiality, no-shows or lack of patient time, and language barrier. We describe strategies used to overcome these barriers and provide recommendations for in-person recruitment of underserved populations into research studies. To help mitigate health disparities, disseminating recruiters' experiences, challenges, and effective strategies used will allow other researchers to build upon these experience in order to increase recruitment success of underserved and underrepresented minority populations into research studies. Copyright © 2018 National Medical Association. Published by Elsevier Inc. All rights reserved.