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Prescription for excellence : leadership lessons for creating a world-class customer experience from UCLA Health System
Provides a business model based on the UCLA Health System and explains how other businesses can use the same system to provide excellent customer experiences and dominate their industry.
Book
Using COVID-19 Surveillance Systems to Identify and Monitor Disparities: Best Practices and Recommendations
Inadequate attention to racial health equity is a common challenge to effective, reliable monitoring and mitigation of COVID-19 disparities. Efforts to monitor and mitigate COVID-19 disparities continue to be hampered by inadequacies in how surveillance systems collect, tabulate, and report COVID-19-related outcomes. We conducted environmental scans of existing public health surveillance systems and reporting standards, literature reviews, focus groups with surveillance experts, and consultations with the Centers for Disease Control and Prevention (CDC) and an expert panel on surveillance to identify and explore strengths, weaknesses, and gaps in how existing systems monitor COVID-19 and their implications for addressing disparities in related outcomes. We present recommendations based on these reviews and propose a core minimum set of health indicators and best-practice standards for reporting these indicators by COVID-19 surveillance systems to monitor racial/ethnic and other disparities in the pandemic. These recommendations are relevant to monitoring disparities in the ongoing COVID-19 pandemic and may inform monitoring of future epidemics. This discussion is part of an effort by Project REFOCUS to develop syndemic surveillance systems for monitoring the intersecting pandemics of COVID-19 and racism. Ethn Dis. 2022;32(2):151-164; doi:10.18865/ed.32.2.151
Journal Article
Management of the COPD Patient with Comorbidities: An Experts Recommendation Document
Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines.
To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities.
A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed.
A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography.
This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.
Journal Article
Mid-term outcomes of the R3™ delta ceramic acetabular system in total hip arthroplasty
Background
Whilst bony fixation of hip replacement has stable solutions, there remains controversy over which bearing best optimizes longevity and function. Ceramic-on-ceramic (CoC) bearing combinations are associated with lower risk of revision due to aseptic loosening and dislocation. Evidence for long-term functional outcomes of modern, 4th generation CoC bearings is limited. The aim of this study was to analyze outcomes and complications of the R3™ Acetabular System (Smith & Nephew, Inc., Cordova, TN, USA) in combination with BIOLOX® Delta ceramic femoral head in patients undergoing primary total hip arthroplasty (THA).
Methods
Between June 2009 and May 2011, 175 patients (178 hips) were enrolled into a prospective, study at 6 sites in Europe and prospectively followed-up at 3 months and 1, 3, 5, and 7 years postoperative.
Results
Total WOMAC score improved from 63 (range, 22–91) preoperative to 8 (range, 0–8) at 1-year follow-up and remained unchanged at 7-year follow-up. Modified Harris hip score improved from 45 (range, 10–87) preoperative to 83 (range, 25–100) at 3 months, 91 (range, 42–100) at 1 year, and 92 (range, 46, 100) at 7 years. UCLA Activity Rating Scale score improved from 3.3 (range, 1–8) preoperative to 6.2 (range, 2–8) at 1 year; it marginally declined to 5.8 (range, 3–8) at 7-year follow-up. There were 4 trochanteric fractures and 5 patients died of unrelated reasons. Three hips were revised (2 periprosthetic fractures and 1 subluxation). The 7-year cumulative survival rate was 98.3%.
Conclusion
Clinical and functional improvements of THA with CoC bearing are maintained at 7 years postoperative.
Trial registration
ClinicalTrials.Gov,
NCT03566082
, Registered 10 January 2018—retrospectively registered,
Journal Article
Pediatric Headache in Primary Care and Emergency Departments: Consensus with RAND/UCLA Method
Headache is the most frequent neurological symptom in childhood and the main reason for admission to pediatric emergency departments. The aim of this consensus document is to define a shared clinical pathway between primary care pediatricians (PCP) and hospitals for the management of children presenting with headache. For the purposes of the study, a group of hospital pediatricians and a group of PCP from the Emilia Romagna’s health districts were selected to achieve consensus using the RAND/UCLA appropriateness method. Thirty-nine clinical scenarios were developed: for each scenario, participants were asked to rank the appropriateness of each option from 1 to 9. Agreement was reached if ≥75% of participants ranked within the same range of appropriateness. The answers, results, and discussion helped to define the appropriateness of procedures with a low level of evidence regarding different steps of the diagnostic-therapeutic process: primary care evaluation, emergency department evaluation, hospital admission, acute therapy, prophylaxis, and follow-up. The RAND proved to be a valid method to value appropriateness of procedures and define a diagnostic-therapeutic pathway suitable to the local reality in the management of pediatric headache. From our results, some useful recommendations were developed for optimizing the healthcare professionals’ network among primary care services and hospitals.
Journal Article
Prescribing-Assessment Tools for Long-Term Care Pharmacy Practice: Reaching Consensus through a Modified RAND/UCLA Appropriateness Method
Medicines are the most used health technology in Long-Term Care. The prevalence of potentially inappropriate medicines amongst Long-Term Care patients is high. Pharmacists, assisted by prescribing-assessment tools, can play an important role in optimizing medication use at this level of care. Through a modified RAND/UCLA Appropriateness Method, 13 long-term care and hospital pharmacists assessed as ‘appropriate’, ‘uncertain’, or ‘inappropriate’ a collection of commonly used prescribing-assessment tools as to its suitability in assisting pharmacy practice in institutional long-term care settings. A qualitative analysis of written or transcribed comments of participants was pursued to identify relevant characteristics of prescribing-assessment tools and potential hinders in their use. From 24 different tools, pharmacists classified 9 as ‘appropriate’ for pharmacy practice targeted to long-term care patients, while 3 were classified as ‘inappropriate’. The tools feature most appreciated by study participants was the indication of alternatives to potentially inappropriate medication. Lack of time and/or pharmacists and limited access to clinical information seems to be the most relevant hinders for prescribing-assessment tools used in daily practice.
Journal Article
Developing the University of the Philippines Loneliness Assessment Scale: A Cross-Cultural Measurement
As the existing scales to measure loneliness are almost all Western and there is no single scale developed cross-culturally for this purpose, this study is designed to develop a reliable and valid scale to measure the experience of loneliness of individuals from individualistic or collectivistic cultures. There are three samples for this study with a total of 495 male and female international (n = 202) and local (n = 293) participants (Age range 19–60 years). An initial pool of 70 item scale was administered to a sample of 202 participants (20–60 years old) from 41 countries of the world with collectivistic and individualistic cultures and the data was subjected to factor analysis using principal component extraction. Evidence shows a unidimensional factor loading. The extracted items were subjected to reliability test and 25 items were obtained for the final scale of the UP Loneliness Assessment Scale (UPLAS) with a Cronbach alpha of .93. Further analyses show the following findings: UPLAS has a significant correlation with R-UCLA Loneliness Scale providing evidence for its moderate concurrent validity; there is a significant and inverse relationship between the measures of UPLAS and Subjective Happiness Scale establishing its higher discriminant validity; UPLAS scores are significantly correlated with the measures of negative self-perceptions, depression, and several emotional states associated to loneliness and thus establishing a higher convergent validity. The designing of the UP Loneliness Assessment Scale as a cross-cultural measurement tool may contribute to more research interests in the domain of \"negative perceptions\" as the most contributing factor to loneliness across cultures.
Journal Article