Not Perfect, but Better: Primary Care Providers’ Experiences with Electronic Referrals in a Safety Net Health System

BackgroundElectronic referrals can improve access to subspecialty care in safety net settings. In January 2007, San Francisco General Hospital (SFGH) launched an electronic referral portal that incorporated subspecialist triage, iterative communication with referring providers, and existing electronic health record data to improve access to subspecialty care.ObjectiveWe surveyed primary care providers (PCPs) to assess the impact of electronic referrals on workflow and clinical care.DesignWe administered an 18-item, web-based questionnaire to all 368 PCPs who had the option of referring to SFGH.MeasurementsWe asked participants to rate time spent submitting a referral, guidance of workup, wait times, and change in overall clinical care compared to prior referral methods using 5-point Likert scales. We used multivariate logistic regression to identify variables associated with perceived improvement in overall clinical care.ResultsTwo hundred ninety-eight PCPs (81.0%) from 24 clinics participated. Over half (55.4%) worked at hospital-based clinics, 27.9% at county-funded community clinics, and 17.1% at non-county-funded community clinics. Most (71.9%) reported that electronic referrals had improved overall clinical care. Providers from non-county-funded clinics (AOR 0.40, 95% CI 0.14-0.79) and those who spent > or =6 min submitting an electronic referral (AOR 0.33, 95%CI 0.18-0.61) were significantly less likely than other participants to report that electronic referrals had improved clinical care.ConclusionsPCPs felt electronic referrals improved health-care access and quality; those who reported a negative impact on workflow were less likely to agree. While electronic referrals hold promise as a tool to improve clinical care, their impact on workflow should be considered

Nephronophthisis

Nephronophthisis (NPH) is an autosomal recessive disease characterized by a chronic tubulointerstitial nephritis that progress to terminal renal failure during the second decade (juvenile form) or before the age of 5 years (infantile form). In the juvenile form, a urine concentration defect starts during the first decade, and a progressive deterioration of renal function is observed in the following years. Kidney size may be normal, but loss of corticomedullary differentiation is often observed, and cysts occur usually after patients have progressed to end-stage renal failure. Histologic lesions are characterized by tubular basement membrane anomalies, tubular atrophy, and interstitial fibrosis. The infantile form is characterized by cortical microcysts and progression to end-stage renal failure before 5 years of age. Some children present with extrarenal symptoms: retinitis pigmentosa (Senior-Løken syndrome), mental retardation, cerebellar ataxia, bone anomalies, or liver fibrosis. Positional cloning and candidate gene approaches led to the identification of eight causative genes (NPHP1, 3, 4, 5, 6, 7, 8, and 9) responsible for the juvenile NPH and one gene NPHP2 for the infantile form. NPH and associated disorders are considered as ciliopathies, as all NPHP gene products are expressed in the primary cilia, similarly to the polycystic kidney disease (PKD) proteins

Let's go to discover soil biodiversity

The edition of this booklet was possible thanks to the collaboration of the Agrobiological Research lnstitute of Galicia of the Spanish National Research Council (IIAG-CSIC, Spain), Spanish Society of Soil Science (SECS), Nebrodi Natural Park, ltalian 5ociety of Pedology, ltalian Society of Soil Science and European Society for Soil Conservation.Peer reviewe

Andiamo alla scoperta della biodiversità del suolo

L'edizione di questo opuscolo e stata possibile grazie alla collaborazione dell'lstituto di Ricerca Agrobiologica della Galizia del Consiglio Nazionale delle Ricerche Spagnolo (IIAG-CSIC, Spagna), della Societa Spagnola di Scienza del Suolo (SECS), del Parco Naturale dei Nebrodi, della Societa Italiana di Pedologia (SIPe), della Societa Italiana della Scienza del Suolo (5155) e della Societa Europea perla Conservazione del Suolo (ESSC).Peer reviewe

Listos para descubrir la biodiversidad del suelo

La edición de este libro ha sido posible gracias a la colaboración del Instituto de Investigaciones Agrobiológicas de Galicia del Consejo Superior de Investigaciones Científicas (IIAG-CSIC, España), la Sociedad Española de la Ciencia del Suelo (SECS), el Parque Natural de Nebrodi, la Sociedad de Pedología de Italia (SI Pe), la Sociedad Italiana de la Ciencia del Suelo (SISS) y la Sociedad Europea para la Conservación del Suelo (ESSC).Peer reviewe

Thick-film magnetoresistors and related sensors

This paper deals with ferromagnetic thick-film materials and with sensors relying on the resistance change due to an external magnetic field, usually in the range from 10(4) A m(-1) to 10(5) A m(-1). The research for the development of thick-film magnetoresistors (TF-MRs) is briefly summarized from Ni-based air-fireable pastes to NixCoy-based films fireable in N-2 atmosphere. The different materials are compared, regarding their magnetoresistive performances (mainly in terms of magnetoresistive anisotropy and temperature sensitivity). Some applications are described, covering the area of position sensing (displacement, proximity switch, angle) and the measurement of dynamic quantities (angular rotation) either for digital or analogue control systems

Microstructure and surface composition of ferromagnetic thick films prepared with NiCo polyol-derived powders

Interest in ferromagnetic thick films stems from their magnetoresistive properties which open new opportunities for achieving reliable and cheap contactless physical sensors. In previous work we have studied the properties of different classes of ferromagnetic metal-based thick films, either prepared from commercial Ni-based pastes, or from prototype NiCo-based pastes, including those prepared with NiCo powders obtained with a polyol process. The latter has been found to give comparatively better magnetoresistive and magnetic responses; nevertheless the information on the real microstructure of the films was incomplete, especially with regard to the surface composition and contamination. In this paper results of an investigation aimed at clarifying these features and their evolution with the firing conditions are reported. The study included analyses of powders and films with scanning electron microscopy (SEM) and X-ray photoemission spectroscopy (XPS). Results show the evolution of sintering and grain growth with the peak firing temperature and give evidence of residual contamination of carbonaceous residues on the films together with an extensive surface oxidation, although the firing process was carried out in nitrogen flow. Moreover the film surfaces are Co rich. These results can guide in the choice of composition and processing conditions for further improvement of the magnetic and magnetoresistive properties of the films