82,561 research outputs found

    Montefiore Medical Center: Integrated Care Delivery for Vulnerable Populations

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    Describes a system of hospitals and community- and school-based clinics tailored to low-income patients through systemwide strategies, high-quality specialty and hospital care, and integrated care delivery via care management and information technology

    Emerging needs in behavioral health and the integrated care model

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    Medically vulnerable populations are constantly at risk of having poor health related outcomes, low satisfaction in the healthcare system and increased mortality. Studies have shown the increased prevalence rates of various medical comorbidities in patients with severe mental illness. These patients are obviously vulnerable because of their mental illness but they are also more likely to have severe cases of medical conditions commonly seen in the general population. Expenditures and utilization of resources is often inappropriate due to frequent visits for acute needs and low rates of preventative care and primary care appointments. My proposed model focuses on the implementation of the integrated care model which encourages collaboration between mental health professionals and primary care physicians through referral programs or integrated clinic settings. This model is initiated with education to both current clinicians as well as future clinicians through medical schools and residency programs. Once the education component has begun, the next steps are formal exploration, preparation, implementation and evaluation of the model in clinics. The aim is to improve health outcomes by increasing preventative care and using behavioral techniques to assist with adherence, increase satisfaction in the healthcare system and contain expenditures by utilizing primary care services instead of emergency services when appropriate

    Sentara Healthcare: A Case Study Series on Disruptive Innovation Within Integrated Health Systems

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    Examines how integration and ties with health plans, physicians, and hospitals helped protect against revenue volatility and enabled experimentation; factors that facilitate integration; innovative practices; lessons learned; and policy implications

    Women’s use of Preventive Primary Care in the Late Postpartum Period

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    The literature has limited data on how women access health care after the traditional postpartum period (postpartum). Modeled after a paper by Bryant (2016), this project assesses the prevalence of primary care visits in the late postpartum period (LPP)(60- 730 days postpartum). Study objectives included (1) Identify demographics of general delivering population at UVMMC compared to patients with UVM-affiliated primary care provider (UVMPCP). (2) Understand how the general delivering population uses the UVMHN LPP (3) Among women with a UVM-affiliated PCP, identify the prevalence of preventive care visits in the LPP. (4) Identify characteristics associated with LPP visit attendance. Hypothesis: Women with an established PCP prior to pregnancy are more likely to attend preventive PCP LPP visits. This was a retrospective cohort study for all women who delivered at UVMMC between 7/1/2015-6/30/2017. Data was extracted from Epic EMR. During the study period, 4169 women had one singleton pregnancy, 3413 (82%) had a known PCP, and 1279 (31%) had UVMPCP. 2535 (61%) of all delivering singleton women and 1112 (87%) of UVMPCP women had at least one clinical visit within UVMHN in the LPP. 959 (75%) of UVMPCP women had a LPP PCP visit, and 382 patients (30%) had preventative PCP LPP visits. Our hypothesis was rejected (OR 0.930), but attending any LPP PCP visit was associated with having a PCP established prior to pregnancy (OR 1.684). Attending preventive PCP visit was associated with having the same delivering provider as PCP (OR 1.742), a pre-pregnancy PCP visit (OR 1.460), a PCP visit during prenatal time (OR 1.459), ED visit early postpartum period (OR 0.402), a fetal or neonatal demise (OR 0.445), being single (0.601), and with public insurance (OR 0.489). Further work in understanding these associations will be important in developing improved transition of care models and increasing overall engagement in women’s preventive medicine

    Expanding Paramedicine in the Community (EPIC): study protocol for a randomized controlled trial.

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    BackgroundThe incidence of chronic diseases, including diabetes mellitus (DM), heart failure (HF) and chronic obstructive pulmonary disease (COPD) is on the rise. The existing health care system must evolve to meet the growing needs of patients with these chronic diseases and reduce the strain on both acute care and hospital-based health care resources. Paramedics are an allied health care resource consisting of highly-trained practitioners who are comfortable working independently and in collaboration with other resources in the out-of-hospital setting. Expanding the paramedic's scope of practice to include community-based care may decrease the utilization of acute care and hospital-based health care resources by patients with chronic disease.Methods/designThis will be a pragmatic, randomized controlled trial comparing a community paramedic intervention to standard of care for patients with one of three chronic diseases. The objective of the trial is to determine whether community paramedics conducting regular home visits, including health assessments and evidence-based treatments, in partnership with primary care physicians and other community based resources, will decrease the rate of hospitalization and emergency department use for patients with DM, HF and COPD. The primary outcome measure will be the rate of hospitalization at one year. Secondary outcomes will include measures of health system utilization, overall health status, and cost-effectiveness of the intervention over the same time period. Outcome measures will be assessed using both Poisson regression and negative binomial regression analyses to assess the primary outcome.DiscussionThe results of this study will be used to inform decisions around the implementation of community paramedic programs. If successful in preventing hospitalizations, it has the ability to be scaled up to other regions, both nationally and internationally. The methods described in this paper will serve as a basis for future work related to this study.Trial registrationClinicalTrials.gov: NCT02034045. Date: 9 January 2014

    Emergency Department: Effectiveness of a Referral Intervention for High Utilizers

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    This research examined the impact of a referral intervention for patients with high utilization of the Emergency Department (ED) for non-­‐emergent care. The referral intervention was offered by the ED provider who provided the patient with feedback regarding their utilization along with a referral to outpatient services including: primary care physicians, mental health services, and brochure of available resources in the local area. This study used archival retrospective data, and compared frequency of ED visits pre-­‐ intervention and referral to post-­‐intervention frequency of visits and length of time between intervention and next visit. Following the intervention, the participants were classified as either responders or non-­‐responders based on their recidivism. An independent sample t-­‐test showed that the responder group had a significant decrease in number of visits to the ED during the post-­‐intervention period. Additionally, the responders had a significantly longer lag time before they returned to the ED as compared to the non-­‐responders. The referral did not significantly increase patients’ visits to their primary care physician/behavioral health consultant. Therefore brief-­‐ED based intervention may be useful in reducing recidivism in the ED

    Organizing the U.S. Health Care Delivery System for High Performance

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    Analyzes the fragmentation of the healthcare delivery system and makes policy recommendations -- including payment reform, regulatory changes, and infrastructure -- for creating mechanisms to coordinate care across providers and settings

    CareOregon: Transforming the Role of a Medicaid Health Plan From Payer to Partner

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    Details Triple Aim pilot programs designed to offer patient-centered medical homes and multidisciplinary case management in an effort to improve population health, enhance patients' experience, and slow cost growth
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