Health Care Opinion Leaders' Views on Delivery System Innovation and Improvement

Presents survey results on healthcare experts' views on strategies and models for fostering coordination and integration, such as accountable care systems, medical homes, and bundled payments; priorities among reform provisions; and market concerns

Sharing Resources: Opportunities for Smaller Primary Care Practices to Increase Their Capacity for Patient Care

Outlines findings linking shared resources with use of health information technology, care coordination, self-management, and quality monitoring, and strategies to increase resources among small and midsize practices by expanding shared resource models

Mindfulness and psychoeducation to manage stress in amnestic mild cognitive impairment : a pilot study

Objectives: Amnestic mild cognitive impairment (aMCI) often corresponds to the prodromal stage of Alzheimer disease (AD). The aMCI stage represents a crucial time window to apply preventive interventions in an attempt to delay cognitive decline. Stress, one of AD’s modifiable risk factors frequently co-occurring with aMCI, stands out as a key intervention target. The goal of this study was to assess the impacts of two nonpharmacological interventions, mindfulness and psychoeducation, on stress at the psychological and physiological levels among aMCI older adults. Methods: Forty-eight aMCI participants were randomized between a mindfulness-based intervention (MBI) and a psychoeducation-based intervention (PBI) for eight weekly sessions. Anxiety symptoms, perceived stress levels, cortisol awakening response (CAR), and coping strategies were assessed pre- and post-intervention. Mindfulness attitudes and time dedicated to at-home meditative practices were evaluated in the MBI group. Results: The main results revealed a slight reduction of the CAR among MBI participants who practiced meditation at home the most and a decrease in perceived stress levels in the PBI group. Both interventions enhanced problem-focused coping strategies. Conclusion: In sum, this pilot study supports the potential of MBI and PBI to reduce stress at the physiological and psychological level, respectively, and increase coping strategies in older adults at risk for AD

Delivery System Reform Tracking: A Framework for Understanding Change

Proposes a framework for tracking progress on delivery system reforms such as patient-centered medical homes and accountable care organizations by assessing structures, capabilities, incentives, and outcomes. Outlines challenges for data collection

Experiences and Attitudes of Primary Care Providers Under the First Year of ACA Coverage Expansion: Findings from the Kaiser Family Foundation/Commonwealth Fund 2015 National Survey of Primary Care Providers

A new survey from The Kaiser Family Foundation and The Commonwealth Fund asked primary care providers—physicians, nurse practitioners, and physician assistants—about their views of and experiences with the Affordable Care Act (ACA) and other changes in health care delivery and payment, as well as their thoughts on the future of primary care. In this first brief based on the survey, many providers reported seeing an increased number of patients since the coverage expansions went into effect, but not an accompanying compromise in quality of care. A large majority of primary care providers are satisfied with their medical practice, but a substantial percentage of physicians expressed pessimism about the future of primary care. Similar to the population overall, providers' views of the ACA are divided along party lines. A second brief will report on providers' reactions to other changes occurring in primary care delivery and payment

Effects of a mindfulness-based intervention on circulating cytokine levels in individuals with amnestic mild cognitive impairment : a pilot study

Peripheral inflammation plays an important role in the pathophysiology of Alzheimer’s disease (AD) and dysregulations in circulating levels of different inflammatory mediators are detectable as early as the mild cognitive impairment (MCI) stage towards AD. Depressive symptoms, another risk factor of AD, are often found in individuals with MCI and associated with heightened levels of peripheral inflammatory mediators. Diminution in depressive symptoms and alterations of peripheral inflammation profiles have been observed following Mindfulness-based interventions (MBIs). In this pilot randomized-control trial, the impact of a mindfulness-based intervention (MBI) was compared to that of a psychoeducation-based intervention (PBI) on the peripheral inflammation profile and depressive symptomatology of participants with MCI. Plasma samples and scores on the Geriatric Depression scale (GDS) were obtained from 12 participants per group before and after the 8-week interventions. Flow cytometry allowed for inter-group comparisons of the pro-inflammatory cytokines Interleukin (IL)-6 and Tumor Necrosis Factor (TNF)-α levels. Post-MBI, two tendencies stand out regarding inflammation profiles: 1) a decrease of TNF-α for participants having higher initial levels of this cytokine, and 2) an increase of IL-6 levels for all participants. In the PBI group, the cytokine levels remained unchanged post-intervention. Regarding depressive symptomatology, no significant variations were noted for both groups. Moreover, variations on depressive symptoms and peripheral levels of cytokines were not correlated. MBI could exert a physiological effect on an important feature of AD, namely inflammation. Furthermore, action mechanisms behind physiological and psychological effects of MBIs could stem from independent sources. This remains to be demonstrated with more robust data

High Performance Accountable Care: Building on Success and Learning From Experience

Presents the rationale for creating accountable care organizations, promising models, and the Commonwealth Fund Commission on a High Performance Health System's recommendations for implementing ACOs widely to achieve improved quality and efficiency

Démarche de pratique réflexive au collégial dans l'enseignement de la philosophie et du français, langue d'enseignement et littérature

"La présente recherche a été subventionnée par le ministère de l'Éducation, du Loisir et du Sport dans le cadre du Programme d'aide à la recherche sur l'enseignement et l'apprentissage (PAREA)"Titre de l'écran-titre (visionné le 12 nov. 2008).Également disponible en format papier.Médiagraphi

An administrator competency in equity and diversity : new frames of reference and training : an executive summary

Ce document est une traduction de : Synthèse du rapport "Les compétences des directions en matière d’équité et de diversité : pistes pour les cadres de référence et la formation" du Groupe de travail sur les compétences et la formation des directions en matière d’équité et de diversité