Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
14,584
result(s) for
"Health Care Reform organization "
Sort by:
The Care Transitions Innovation (C-TraIn) for Socioeconomically Disadvantaged Adults: Results of a Cluster Randomized Controlled Trial
Background
Despite growing emphasis on transitional care to reduce costs and improve quality, few studies have examined transitional care improvements in socioeconomically disadvantaged adults. It is important to consider these patients separately as many are high-utilizers, have different needs, and may have different responses to interventions.
Objective
To evaluate the impact of a multicomponent transitional care improvement program on 30-day readmissions, emergency department (ED) use, transitional care quality, and mortality.
Design
Clustered randomized controlled trial conducted at a single urban academic medical center in Portland, Oregon.
Participants
Three hundred eighty-two hospitalized low-income adults admitted to general medicine or cardiology who were uninsured or had public insurance.
Intervention
Multicomponent intervention including (1) transitional nurse coaching and education, including home visits for highest risk patients; (2) pharmacy care, including provision of 30 days of medications after discharge for those without prescription drug coverage; (3) post-hospital primary care linkages; (4) systems integration and continuous quality improvement.
Measurements
Primary outcomes included 30-day inpatient readmission and ED use. Readmission data were obtained using state-wide administrative data for all participants (insured and uninsured). Secondary outcomes included quality (3-item Care Transitions Measure) and mortality. Research staff administering questionnaires and assessing outcomes were blinded.
Results
There was no significant difference in 30-day readmission between C-TraIn (30/209, 14.4 %) and control patients (27/173, 16.1 %),
p
= 0.644, or in ED visits between C-TraIn (51/209, 24.4 %) and control (33/173, 19.6 %),
p
= 0.271. C-TraIn was associated with improved transitional care quality; 47.3 % (71/150) of C-TraIn patients reported a high quality transition compared to 30.3 % (36/119) control patients, odds ratio 2.17 (95 % CI 1.30–3.64). Zero C-TraIn patients died in the 30-day post-discharge period compared with five in the control group (unadjusted
p
= 0.02).
Conclusions
C-TraIn did not reduce 30-day inpatient readmissions or ED use; however, it improved transitional care quality.
Journal Article
A Randomized, Controlled Trial of Implementing the Patient-Centered Medical Home Model in Solo and Small Practices
ABSTRACT
BACKGROUND
Transition to a Patient-Centered Medical Home (PCMH) is challenging in primary care, especially for smaller practices.
OBJECTIVE
To test the effectiveness of providing external supports, including practice redesign, care management and revised payment, compared to no support in transition to PCMH among solo and small (<2–10 providers) primary care practices over 2 years.
DESIGN
Randomized Controlled Trial.
PARTICIPANTS
Eighteen supported practices (intervention) and 14 control practices (controls).
INTERVENTIONS
Intervention practices received 6 months of intensive, and 12 months of less intensive, practice redesign support; 2 years of revised payment, including cost of National Council for Quality Assurance’s (NCQA) Physician Practice Connections
®
─
Patient-Centered Medical Home™ (PPC
®
-PCMH™) submissions; and 18 months of care management support. Controls received yearly participation payments plus cost of PPC
®
-PCMH™.
MAIN MEASURES
PPC
®
-PCMH™ at baseline and 18 months, plus intervention at 7 months.
KEY RESULTS
At 18 months, 5 % of intervention practices and 79 % of control practices were not recognized by NCQA; 10 % of intervention practices and 7 % of controls achieved PPC
®
-PCMH™ Level 1; 5 % of intervention practices and 0 % of controls achieved PPC
®
-PCMH™ Level 2; and 80 % of intervention practices and 14 % of controls achieved PPC
®
-PCMH™ Level 3. Intervention practices were 27 times more likely to improve PPC
®
-PCMH™ by one level, irrespective of practice size (
p
< 0.001) 95 % CI (5–157). Among intervention practices, a multilevel ordinal piecewise model of change showed a significant and rapid 7-month effect (p
time7
= 0.01), which was twice as large as the sustained effect over subsequent 12 months (p
time18
= 0.02). Doubly multivariate analysis of variance showed significant differential change by condition across PPC
®
-PCMH™ standards over time (p
time x group
= 0.03). Intervention practices improved eight of nine standards, controls improved three of nine (p
PPC1
= 0.009; p
PPC2
= 0.005; p
PPC3
= 0.007).
CONCLUSIONS
Irrespective of size, practices can make rapid and sustained transition to a PCMH when provided external supports, including practice redesign, care management and payment reform. Without such supports, change is slow and limited in scope.
Journal Article
What can we learn from China’s health system reform?
Qingyue Meng and colleagues assess what China’s health system reform has achieved and what needs to be done over the next decade
Journal Article
The doctor crisis : how physicians can, and must, lead the way to better health care
\"When Dr. Jack Cochran took over leadership of the Colorado Permanente Medical Group in the mid-1990s, he oversaw high-quality medical teams providing excellent care, but dealt with organizational troubles so deep rooted that patients and physicians fled in droves. In The Doctor Crisis, Cochran, now executive director of The Permanente Federation, and author Charles Kenney show how we can improve health care on a grass roots level, regardless of political policy disputes, by improving conditions for physicians and asking them to take on broader accountability. Doctors, they argue, are the key to making health care in the United States truly great, and we must do all we can to preserve and enhance the careers of physicians. They clarify the steps needed to take to support doctors so that they can focus on patient care, and offer concrete ideas for creating an environment and establishing systems that encourage doctors to put patients' needs above all else\"--Provided by publisher.
Book
SA HealthPlus: A Controlled Trial of a Statewide Application of a Generic Model of Chronic Illness Care
SA HealthPlus, one of nine national Australian coordinated care trials, addressed chronic illness care by testing whether coordinated care would improve health outcomes at the cost of usual care. SA HealthPlus compared a generic model of coordinated care for 3,115 intervention patients with the usual care for 1,488 controls. Service coordinators and the behavioral and care-planning approach were new. The health status (SF-36) in six of eight projects improved, and those patients who had been hospitalized in the year immediately preceding the trial were the most likely to save on costs. A mid-trial review found that health benefits from coordinated care depended more on patients' self-management than the severity of their illness, a factor leading to the Flinders Model of Self-Management Support.
Journal Article
European nurses' life and work under restructuring
An examination of nurses' professional work and life in the context of the ongoing institutional restructuring of health care systems in seven European countries, England, Finland, Greece, Ireland, Portugal, Spain and Sweden. Professional experience and expertise is discussed from the nurses' perspective and focuses on how they deal with restructuring measures caused by changes in policy and administration.
Book
Pharmaceutical reform : a guide to improving performance and equity
This publication, which is based on the unique methodology and tools developed for the World Bank Institute/Harvard School of Public Health Flagship Course on Health System Reform and Sustainable Financing, provides a powerful set of resources to help policy makers better navigate the complicated process of reforming pharmaceutical systems. Its problem solving approach complements technical resources and training curricula available on the discrete elements of a pharmaceutical sector. The application of the flagship approach to the pharmaceutical sector is both useful and timely. Ensuring the availability of medicines and the effective management of their procurement and distribution is central to the drive to achieve coverage and access to basic health care that is both universal and financially sustainable. Together, the methodology and case materials contained in this publication provide a rich resource from which policy makers in developing countries may draw to guide their efforts to meet these challenges. This book is designed to help participants gain a better understanding of all that goes on in the pharmaceutical sector. As noted above, it uses the flagship framework that we helped develop over the past decade. The essence of that approach is not to try to tell policy makers in detail what they should do. Rather it comprises a set of analytical tools that are combined into an overall, structured methodology for developing, adopting, and implementing reform proposals. The flagship framework also includes a comprehensive review of reform alternatives and a systematic review of their strengths and weaknesses in various situations. Throughout this book the authors have used the flagship framework to structure our analysis of pharmaceutical reform, continuously and explicitly applying its methods and concepts to the pharmaceutical sector. With a few minor exceptions, all the examples and all of the reform options come directly from pharmaceutical reform efforts around the world. The authors have also given specific attention to issues in pharmaceutical policy related to reproductive health.
eBook