Health Care System Changes to Improve Adherence and Long-Term Outcomes for Depressed Patients

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S13) ◽  
pp. 17-25
Author(s):  
Wayne J. Katon
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Treatment Adherence ◽  
Health Care System ◽  
Structural Changes ◽  
Care Delivery ◽  
The United States ◽  
Chronic Illnesses ◽  
Depressed Patients ◽  
Care System

Depression, which is increasingly regarded as a chronic condition, is associated with significant suffering, social and functional impairment, and an estimated $44 billion in direct and indirect costs annually in the United States. Despite this severe burden on the health care system, the management of depression remains suboptimal in primary care, where many depressed patients fail to receive adequate dosage and duration of treatment. Adherence to evidence-based guidelines, essential to improving outcomes, requires key structural changes to the US health care delivery system. Several health care models aimed at improving treatment adherence in patients with chronic illnesses have been evaluated in primary care settings with promising results. Those approaches that have been found to be effective advocate multifaceted collaborative interventions that target patients, families, physicians, and the organization of the health care system to improve adherence and depression outcomes. Enhancing education and the active participation of patients and their families are now considered important elements of interventions to improve adherence to the treatment of chronic illnesses, including depression.

Role of the clinical learning environment in preparing new clinicians to engage in quality improvement efforts to eliminate health care disparities

2019 ◽  
Author(s):  
Baretta R Casey ◽  
Marie Chisholm-Burns ◽  
Morgan Passiment ◽  
Robin Wagner ◽  
Laura Riordan ◽  
...  
Keyword(s):  
Health Care ◽  
Learning Environment ◽  
Learning Environments ◽  
Health Care System ◽  
Health Care Disparities ◽  
Care Delivery ◽  
The United States ◽  
Clinical Learning ◽  
Clinical Learning Environment ◽  
Care System

Abstract Purpose The National Collaborative for Improving the Clinical Learning Environment offers guidance to health care leaders for engaging new clinicians in efforts to eliminate health care disparities. Summary To address health care disparities that are pervasive across the United States, individuals at all levels of the health care system need to commit to ensuring equity in care. Engaging new clinicians is a key element of any systems-based approach, as new clinicians will shape the future of health care delivery. Clinical learning environments, or the hospitals, medical centers, and ambulatory care clinics where new clinicians train, have an important role in this process. Efforts may include training in cultural humility and cultural competency, education about the organization’s vulnerable populations, and continuous interprofessional experiential learning through comprehensive, systems-based QI efforts focused on eliminating health care disparities. Conclusion By preparing and supporting new clinicians to engage in systems-based QI efforts to eliminate health care disparities, clinical learning environments are instilling skills and supporting behaviors that clinicians can build throughout their careers—and helping pave the road towards equity throughout the US health care system.

scholarly journals Health Care Reform in the United States and the Russia Federation: 1990-2015

2016 ◽  
Vol 5 (2) ◽  
pp. 29
Author(s):  
Olga V. Filatova ◽  
David Andrew Schultz
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Reform ◽  
Health Care System ◽  
Russian Federation ◽  
Technological Development ◽  
Care Delivery ◽  
The United States ◽  
The Russian Federation ◽  
Care System

<p>What constitutes adequate medical care and how to deliver it is a problem states across the world confront as they face similar problems of rising costs, access, changing demographics, quality of service, and technological development. This article compares health care reform in the United States and the Russian Federation between 1990 and 2015. The Russian Federation begin this period with a process of rebuilding a health care system out of the previous centralized state-run Soviet system whereas the United States sought to change a health care system largely privately run and which separated health care delivery from health care insurance. Yet, despite differences these two countries and their health care systems have, they show interesting parallels, convergences, and lessons in terms of how reform occurs. In particular, this article demonstrates how both the American and Russian reforms have tried to use market incentives and the shifting to individuals some responsibility to contain costs, the use of government and non-governmental actors to provide health care and insurance, and various levels of centralization and decentralization of select services in order to address cost, quality, and access issues.</p>

Implementing Quality Colon Cancer Survivorship Care: A Practical Proposal for a Path Forward

2020 ◽  
pp. OP.20.00290
Author(s):  
Ronald M. Kline ◽  
Larissa K. F. Temple ◽  
Larissa Nekhlyudov
Keyword(s):  
Health Care ◽  
Colon Cancer ◽  
Health Care System ◽  
Cancer Survivorship ◽  
Care Delivery ◽  
Quality Measurement ◽  
The United States ◽  
Survivorship Care ◽  
Practical Proposal ◽  
Care System

There are currently close to 17 million survivors of cancer in the United States. This number is expected to grow as both an aging population and improved treatment increase the number of survivors. Consequently, the importance of quality survivorship care has been recognized, but implementing, measuring, and paying for this care in a highly fragmented health care system, across a broad spectrum of diseases, is difficult. Quality measurement tied to payment is one approach that has commonly been used to improve the quality of care in the US health care system, but the complexity of applying quality measurement metrics across the spectrum of cancer survivorship care had led to stalemate. In this article, we draw on prior work to develop a quality cancer survivorship framework and propose a practical path forward with a focus on the provision of colon cancer survivorship care within integrated health care delivery networks. With this narrowly defined approach, we hope that we can promote a practical solution that can be extended to other diseases and payment systems over time.

scholarly journals Patient Experience in Primary Care: A Systematic Review of CG-CAHPS Surveys

2018 ◽  
Vol 6 (2) ◽  
pp. 93-102 ◽  
Author(s):  
Jeana M Holt
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Care ◽  
Health Care System ◽  
Patient Experience ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Empirical Literature ◽  
Patient Reports ◽  
Care System

The National Academy of Medicine’s (NAM) vision for 21st-century health care underscored the need for increased patient engagement and charged health-care researchers to develop tools to evaluate patient experience. The most widely studied patient experience tools are the Consumer Assessments of Healthcare Providers and Systems (CAHPS) surveys. The Clinician and Group (CG)-CAHPS survey is the preferred patient experience survey for primary care, and thus a systematic review of patient reports from the CG-CAHPS empirical literature is ideal to appreciate the voice of health-care consumers. This systematic review revealed patient subjective reports regarding the acceptability of health-care delivery models, the effectiveness of interventions, the timeliness of care in different practice climates, and their responses to quality improvement initiatives. The synthesized results inform clinicians, organizations, and the health-care system where to prioritize and how to adapt services to efficiently provide equitable care, achieving the NAM’s vision for a patient-centered US health-care system.

Direct Primary Care: A Successful Financial Model for the Clinical Practice of Lifestyle Medicine

2021 ◽  
pp. 155982762110066
Author(s):  
Amy R. Mechley
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Well Being ◽  
The United States ◽  
Fee For Service ◽  
Financial Model ◽  
Lifestyle Medicine ◽  
Direct Primary

Primary care has been shown to significantly decrease the overall cost of a population’s health care while improving the quality of each person’s well-being. Lifestyle medicine (LM) is ideally positioned to be delivered via primary care and has been shown to improve short- and long-term health outcomes of patients and populations. Direct primary care (DPC) represents a viable alternative to the fee-for-service reimbursement model. It has been shown to be economically and financially sustainable. Furthermore, it has the potential to fulfill the Quadruple Aim of health care in the United States. LM practiced in a DPC model has the potential to transform health care delivery. This article will discuss the need for health care systems change, provide an overview of the DPC model, demonstrate a basic understanding of the benefits, and review the steps needed to de-risk the investment of time, money, and resources for our future DPC providers.

Primary-Care Visits and Hospitalizations for Ambulatory-Care–Sensitive Conditions in an Inner-City Health Care System

2003 ◽  
Vol 3 (6) ◽  
pp. 324-328 ◽  
Author(s):  
John F. Steiner ◽  
Patricia A. Braun ◽  
Paul Melinkovich ◽  
Judith E. Glazner ◽  
Vijayalaxmi Chandramouli ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Inner City ◽  
Ambulatory Care ◽  
Health Care System ◽  
Ambulatory Care Sensitive Conditions ◽  
Care System ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

Micro-Level Analysis of Distributional Changes in Health Care Financing in Finland

1998 ◽  
Vol 3 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Jan Klavus ◽  
Unto Häkkinen
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Structural Changes ◽  
Health Care Expenditure ◽  
Health Care Financing ◽  
Simulated Data ◽  
Health Care Reforms ◽  
Income Data ◽  
Severe Recession ◽  
Care System

Objectives: In the early 1990s the Finnish economy suffered a severe recession at the same time as health care reforms were taking place. This study examines the effects of these changes on the distribution of contributions to health care financing in relation to household income. Explanations for changes in various indicators of health care expenditure and use during that time are offered. Method: The analysis is based partly on actual income data and partly on simulated data from the base year (1990). It employs methods that allow the estimation of confidence intervals for inequality indices (the Gini coefficient and Kakwani's progressivity index). Results: In spite of the substantial decrease in real incomes during the recession, the distribution of income remained almost unaltered. The share of total health care funding derived from poorer households increased somewhat, due purely to structural changes. The financial plight of the public sector led to the share of total funding from progressive income taxes to decrease, while regressive indirect taxes and direct payments by households contributed more. Conclusions: It seems that, aside from an increased financing burden on poorer households, Finland's health care system has withstood the tremendous changes of the early 1990s fairly well. This is largely attributable to the features of the tax-financed health care system, which apportions the effects of financial and functional disturbances equitably.

Should Screening Programs Be Perfect?

PEDIATRICS ◽  
1983 ◽  
Vol 71 (2) ◽  
pp. 301-301
Author(s):  
PHILIP R. WYATT
Keyword(s):  
United States ◽  
Health Care ◽  
Early Detection ◽  
New England ◽  
Health Care System ◽  
The United States ◽  
Neonatal Hypothyroidism ◽  
Screening Programs ◽  
Care System

To the Editor.— The report of the New England Regional Screening Program1 on neonatal hypothyroidism is a stunning illustration of the vulnerability of screening programs. It is unfortunate that this experience will probably be used as an argument to minimize the input of screening programs in the health care system in the United States. The report illustrates that, in addition to the 2% of the screened population that eluded the program, 14 infants with hypothyroidism escaped the full benefits of early detection and treatment.

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