Do Hotspotting Programs Improve Patient Outcomes? A Systematic Review

Background Hotspotting programs train interprofessional teams of health students and professionals to engage with healthcare “super-utilizers” to address individuals’ social needs and coordinate ongoing care and social services. The goal is to improve care for individuals who demonstrate high levels of health care utilization, or “super-utilizers” to reduce future utilization while improving health outcomes, particularly while transitioning from a recent hospital utilization event. Debate exists whether hotspotting programs are effective at both reducing utilization and improving patient wellness. Aims To systematically review the literature on the effect of hotspotting and similar models of transitional care on rates of health care utilization, (hospital admissions, emergency department and primary care visits) health outcomes (e.g., perceived health), and satisfaction with care and behavioral outcomes (e.g., medication adherence). Methods PubMed, EMBASE, SCOPUS, and CINAHL were searched from 2010 through April 2022 for RCTs and controlled observational studies, cohort studies, and before-after studies of hotspotting and similar interprofessional transitional care programs set in the US. Results A total of 10 studies were included, 5 were RCT or non-randomized controlled studies, 3 were cohort studies, and 2 were pre-post intervention studies. All studies reported on rates of hospital admissions, and 8 found lower rates in the hotspotting group than controls over 1-12 months, with 6 of these being statistically significant. In 6 studies reporting on ED visits, 5 were consistent in showing an association between hotspotting and lower rates of ED visits over 1-12 months. However, results were statistically significant in only 2 studies. In four studies that reported on primary care provider (PCP) visits, 1 did not compare results to a control group, and 2 found statistically significant increases in PCP visits 14 days to 1 year following enrollment in the intervention. Only 2 studies reported on outcomes related to patient behaviors and perceptions of health care. One reported on rates of medication adherence >80% after 6 months, finding no effect. The other reported on measures of self-rated physical health, mental health, and patient activation, finding no effect, as well as care quality (comprehensiveness and supportiveness of self-management) and demonstrated a significant benefit. Conclusions The evidence suggests hotspotting demonstrates a relationship with improved healthcare utilization outcomes overall, albeit results of studies are imprecise. A high level of heterogeneity was found among population descriptions, time points, outcomes, and outcome measures across studies. Further evaluation of hotspotting programs’ effects via longitudinal controlled trials will allow for better evaluation of the efficacy of hotspotting in improving rates of health care utilization, overall health, and quality of life for high-needs individuals.Master of Public Healt

Hêgemonía: Hegemony, Classical and Modern

"Hegemony" is a term from the vocabulary of classical Greek history which was deliberately revived in the 19th century to describe a modern phenomenon. In its classical context, the clear denotation of hegemony is a military-political hierarchy, not one of wealth or cultural prestige; although both economic and cultural resources could serve to advance military-political hegemony, they were not at all of the essence. Hegemonic relations were conscious, and based upon complex motives and capacities. Individuals, peoples and states could desire, seek, struggle for, get, keep, lose and regain hegemony. Hegemony was sought or exercised over nations, over territories, over the land or the sea, or over tôn holôn, "the whole"; but "territories" turn out to be the states and nations thereon, "the land" and "the sea" actually meant "the mainland states" and "the island states," and tôn holôn was the world system, the whole system of interacting states. Hegemonic power relationships in the classical style are alive and well today; far from being time-bound, place-bound or culture-bound, hegemony in the classical sense is a transhistorical and transcultural fact that merits comparative-civilizational and comparative-world-systems study. While bilateral, alliance, and regional hegemonies are far more frequent both today and in the past, the most useful hegemony for study in a comparative civilizations/world systems context is systemwide hegemony: a unipolar influence structure that falls short of universal empire

Sistem akuntansi dan informasi, Ed. 2 Jil. 2

Bai

Sistem akuntansi dan informasi, Ed.2 Jil. 1

Bai

Robotic milking and the emergent relational geographies of livestock agriculture

This paper explores the co-constitutive practices associated with robotic milking technologies. Introduced commercially in 1992, they have since become especially prominent in Northern Europe and the USA. Robots are sold with the promise of improved dairy cow welfare and productivity, reduced labour costs and the liberation of farmers and farm workers from the routines of conventional milking: the machines milk cows individually, at any time of a cow's choosing, without direct human involvement or presence. In this paper, we investigate the new modes of relating that emerge through the introduction of these new technologies. Drawing on semi-structured interviews with UK dairy farmers, alongside participant observation around robotic milking practices, we examine the ways in which milking practices are negotiated between cows, farmers and robots. Friction may develop here when cows struggle to adapt, robots find some cows more appropriate for their technologies than others, and farmers are confronted by new forms of information that challenge their understandings of animal welfare. The supposed benefits of robotic technology may as a result be contested, as unanticipated consequences become evident. Through this study, we critique the tendency of geographers to focus on relationships between humans and animals, or humans and technologies, foregrounding instead the complex material-semiotic assemblages that involve not only farmers, cows and robots, but politics and affects of care, productivity and disciplinary tactics. We highlight the different enactments of 'cow' and farmer that emerge and consider the implications of these new relationships for understandings of farm animal welfare