Southern New England Practice Transformation Network: Thinking Outside the Box Solved Our Enrollment Challenges

The strategies used by the Southern New England Practice Transformation Network (SNE-PTN), a collaborative led by UMass Medical School and UConn Health, to enroll more than 5,000 clinicians from a variety of specialties by the end of October 2016. The strategies led SNE-PTN to achieve 186 percent of the year one enrollment target. SNE-PTN is one of 29 practice transformation networks across the country chosen by the Centers for Medicare and Medicaid Services to be part of its Transforming Clinical Practices Initiative. This practice transformation program aims to bring together specialty and primary care clinicians to work individually and collaboratively to transform care delivery under rapidly evolving payment models

Social Work – A Career for the Deaf Person

Non

The Dynamics of State University Participation in State Medicaid Administration

It is not uncommon for state university faculty to participate as part-time consultants in the administration of state Medicaid programs. However, rarely do state universities participate institutionally as public agencies in the administration of state Medicaid programs since the propriety, value and parameters of these engagements are usually not recognized. Even in states where they flourish, collaborations between state universities and state Medicaid agencies are not well understood and suggest to some people an unlikely confluence of two worlds. The missions of state universities and state Medicaid programs differ, their institutional cultures differ, and their protocols differ. In all states, state universities are considered apart from other state agencies, sometimes to the point of not being thought of as state agencies at all. Yet, the appropriateness and benefits of state universities engaging in Medicaid administration have been well established by state universities and the state Medicaid programs that have worked together. In light of the challenges facing state Medicaid programs and what state universities can do for these programs, state universities contributing to Medicaid administration should be more recognized and more common. Explanation and examples follow. Rounding out this discussion will be depictions of collaborations in three states: Maryland, Massachusetts and Ohio. Maryland’s initiative spotlights analytic, program development and program evaluation services; Massachusetts’ features clinical expertise; and, Ohio’s dwells on workforce development. In all three states, the state university partner does far more for Medicaid than is covered here, but these examples suggest the breadth of what state universities can do

Paving the Way for Practice Success Under Value-Based Payments

A comprehensive look at The Southern New England Practice Transformation Network (SNE-PTN), which supports implementation of person-centered, high quality, efficient, and coordinated care. SNE-PTN is funded under the Centers for Medicare & Medicaid Services’ Transforming Clinical Practices Initiative. SNE-PTN is a complex, large-scale care transformation effort that requires a multi-faceted approach and alignment with state and national health care reform efforts. It is important to articulate the value proposition for clinicians

Análisis de protocolos de investigación

Fil: Vanoni, Susana. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.Fil: Carri, Julio Horacio. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.Fil: Montrull, Hilda. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.Análisis de protocolos de investigación. Experiencias de los Comités de Ética de Investigación en Latinoamérica.Ed. Programa de Ciencias Biomédicas y Bioética de la Facultad de Medicina de la Universidad Central de Chile, y Federación Latinoamericana de Instituciones de Bioética, Santiago de Chile 2014.Fil: Vanoni, Susana. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.Fil: Carri, Julio Horacio. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.Fil: Montrull, Hilda. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.Otras Ciencias de la Salu

A qualitative study of the knowledge-brokering role of middle-level managers in service innovation: managing the translation gap in patient safety for older persons’ care

Background: Brokering of evidence into service delivery is crucial for patient safety. We study knowledge brokering by ‘hybrid’ middle-level managers (H-MLMs), who hold responsibility for clinical service delivery as well as a managerial role, in the context of falls, medication management and transition, in care of older people. Objectives: Generate insight into processes and structures for brokering of patient safety knowledge (PSK) by H-MLMs. Design: We utilise mixed methods: semistructured interviews, social network analysis, observation, documentary analysis, tracer studies and focus groups. Setting: NHS East and NHS West Midlands. Participants: One hundred and twenty-seven H-MLMs, senior managers and professionals, in three hospitals, and external producers of PSK. Main outcome measures: Which H-MLMs broker what PSK, and why? (1) How do H-MLMs broker PSK? (2) What are contextual features for H-MLM knowledge brokering? (3) How can H-MLMs be enabled to broker PSK more effectively in older persons’ care? Results: Health-care organisations fail to leverage PSK for service improvement. Attempts by H-MLMs to broker PSK downwards or upwards are framed by policy directives and professional/managerial hierarchy. External performance targets and incentives compel H-MLMs in clinical governance to focus upon compliance. This diverts attention from pulling knowledge downwards, or upwards, for service improvement. Lower-status H-MLMs, closer to service delivery, struggle to push endogenous knowledge upwards, because they lack professional and managerial legitimacy. There is a difference between how PSK is brokered within ranks of nurses and doctors, due to differences in hierarchal characteristics. Rather than a ‘broker chain’ upwards and downwards, a ‘broken chain’ ensues, which constrains learning and service improvement. Conclusions: Clinical governance is decoupled from service delivery. Brokering knowledge for service improvement is a ‘peopled’ activity in which H-MLMs are central. Intervention needs to mediate interprofessional and intraprofessional hierarchy, which, combined with compliance pressures, engender a ‘broken’ chain for applying PSK for service improvement, rather than a ‘brokering’ chain. Lower-status H-MLMs need to have their legitimacy and disposition enhanced to broker knowledge for service improvement. More informal ‘social mechanisms’ are required to complement clinical governance for development of a brokering chain. More research is needed to (1) examine why some H-MLMs are more disposed and able than others to broker PSK for service improvement, and (2) understand how knowledge brokering might be enhanced so that exogenous and endogenous knowledge is better fused for service improvement

Intestinal carriage of Staphylococcus aureus: How does its frequency compare with that of nasal carriage and what is its clinical impact?

The bacterial species Staphylococcus aureus, including its methicillin-resistant variant (MRSA), finds its primary ecological niche in the human nose, but is also able to colonize the intestines and the perineal region. Intestinal carriage has not been widely investigated despite its potential clinical impact. This review summarizes literature on the topic and sketches the current state of affairs from a microbiological and infectious diseases' perspective. Major findings are that the average reported detection rate of intestinal carriage in healthy individuals and patients is 20% for S. aureus and 9% for MRSA, which is approximately half of that for nasal carriage. Nasal carriage seems to predispose to intestinal carriage, but sole intestinal carriage occurs relatively frequently and is observed in 1 out of 3 intestinal carriers, which provides a rationale to include intestinal screening for surveillance or in outbreak settings. Colonization of the intestinal tract with S. aureus at a young age occurs at a high frequency and may affect the host's immune system. The frequency of intestinal carriage is generally underestimated and may significantly contribute to bacterial dissemination and subsequent risk of infections. Whether intestinal rather than nasal S. aureus carriage is a primary predictor for infections is still ill-defined

Applications and Advances in Electronic-Nose Technologies

Electronic-nose devices have received considerable attention in the field of sensor technology during the past twenty years, largely due to the discovery of numerous applications derived from research in diverse fields of applied sciences. Recent applications of electronic nose technologies have come through advances in sensor design, material improvements, software innovations and progress in microcircuitry design and systems integration. The invention of many new e-nose sensor types and arrays, based on different detection principles and mechanisms, is closely correlated with the expansion of new applications. Electronic noses have provided a plethora of benefits to a variety of commercial industries, including the agricultural, biomedical, cosmetics, environmental, food, manufacturing, military, pharmaceutical, regulatory, and various scientific research fields. Advances have improved product attributes, uniformity, and consistency as a result of increases in quality control capabilities afforded by electronic-nose monitoring of all phases of industrial manufacturing processes. This paper is a review of the major electronic-nose technologies, developed since this specialized field was born and became prominent in the mid 1980s, and a summarization of some of the more important and useful applications that have been of greatest benefit to man

Advances in Electronic-Nose Technologies Developed for Biomedical Applications

The research and development of new electronic-nose applications in the biomedical field has accelerated at a phenomenal rate over the past 25 years. Many innovative e-nose technologies have provided solutions and applications to a wide variety of complex biomedical and healthcare problems. The purposes of this review are to present a comprehensive analysis of past and recent biomedical research findings and developments of electronic-nose sensor technologies, and to identify current and future potential e-nose applications that will continue to advance the effectiveness and efficiency of biomedical treatments and healthcare services for many years. An abundance of electronic-nose applications has been developed for a variety of healthcare sectors including diagnostics, immunology, pathology, patient recovery, pharmacology, physical therapy, physiology, preventative medicine, remote healthcare, and wound and graft healing. Specific biomedical e-nose applications range from uses in biochemical testing, blood-compatibility evaluations, disease diagnoses, and drug delivery to monitoring of metabolic levels, organ dysfunctions, and patient conditions through telemedicine. This paper summarizes the major electronic-nose technologies developed for healthcare and biomedical applications since the late 1980s when electronic aroma detection technologies were first recognized to be potentially useful in providing effective solutions to problems in the healthcare industry