On the Horizon: Older Adults With Autism in a Changing Health Care Environment

2018 ◽  
Vol 3 (15) ◽  
pp. 4-14
Author(s):  
Pamela A. Smith
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Practical Experience ◽  
Health Care Environment ◽  
Adults With Autism ◽  
Number Of Patients ◽  
Driven System ◽  
The Impact ◽  
Growing Population ◽  
Care System

For many years, our health care system has been in a state of change, with most changes occurring as a result of economic issues and not clinical issues. Clinicians working in skilled nursing facilities (SNFs) have navigated a complex web of regulations and processes that are expected to change from a volume-driven system to a value-driven system. Such issues are challenging enough when clinicians are working with disorders with which they have received training and gained practical experience, but the growing population of residents in our facilities who are aging with autism will further complicate the SNF landscape. Because of the increases in prevalence of autism in the general population, the number of patients who will be entering our SNFs will only grow. New regulations and processes will require practice-based evidence and functional outcomes, data which do not exist with adults with autism. This article will discuss the impact of changes in our health care system, specifically in the SNF, and how these changes may impact the provision of care to a growing population of elders with autism.

scholarly journals The impact of the COVID-19 pandemic on Polish orthopedics, in particular on the level of stress among orthopedic surgeons and the education process

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257289
Author(s):  
Łukasz Kołodziej ◽  
Dawid Ciechanowicz ◽  
Hubert Rola ◽  
Szymon Wołyński ◽  
Hanna Wawrzyniak ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Personal Protective Equipment ◽  
Negative Impact ◽  
Protective Equipment ◽  
Orthopedic Surgeons ◽  
Number Of Patients ◽  
The Impact ◽  
Care System

The Coronovirus Disease 2019 –(COVID-19) pandemic had a significant impact on the health care system and medical staff around the world. The orthopedic units were also subject to new restrictions and regulations. Therefore, the aim of our research was to assess how the COVID-19 pandemic affected orthopedic wards in the last year in Poland. We created an online survey, which was sent to 273 members of the Polish Society of Orthopedics and Traumatology. The survey contained 51 questions and was divided into main sections: Preparedness, Training, Stress, Reduction, Awareness. A total of 80 responses to the survey were obtained. In Preparedness section the vast majority of respondents (90%) replied, that they used personal protective equipment during the pandemic, however only 50% of the respondents indicated that their facility received a sufficient amount of personal protective equipment. Most of the respondents indicated that the pandemic negatively affected the quality of training of future orthopedists (69.4%) and that pandemic has had a negative impact on their operating skills (66,7%). In Reduction section most of the doctors indicated that the number of patients hospitalized in their departments decreased by 20–60% (61,2% respondents), while the number of operations performed decreased by 60–100% (60% respondents). The negative impact of pandemic on education was noticeable especially in the group of young orthopedic surgeons: 0–5 years of work experience (p = 0,029). Among the respondents, the level of stress increased over the last year from 4.8 to 6.9 (p <0.001). The greatest increase in the level of stress was observed among orthopedists working in country hospitals (p = 0,03). In section Awareness 36,3% of respondents feel well or very well informed about the latest Covid-19 regulations. In addition, most doctors (82.6%) believe that the Polish health care system was not well prepared to fight the pandemic and that the regulations applied so far are not sufficient to effectively fight the pandemic (66.2%). The COVID-19 pandemic has impact on orthopedics departments in Poland and negatively affected the quality of training of orthopedic surgeons and the level of stress.

scholarly journals The Impact of Increased Hydrocodone Regulation on Opioid Prescribing in an Urban Safety-Net Health Care System

2019 ◽  
Vol 32 (3) ◽  
pp. 362-374 ◽  
Author(s):  
Thomas F. Northrup ◽  
Kelley Carroll ◽  
Robert Suchting ◽  
Yolanda R. Villarreal ◽  
Mohammad Zare ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Safety Net ◽  
Opioid Prescribing ◽  
Urban Safety ◽  
The Impact ◽  
Care System

scholarly journals The impact of the 2006 Massachusetts health care reform law on spine surgery patient payer-mix status and age

2017 ◽  
Vol 27 (6) ◽  
pp. 694-699 ◽  
Author(s):  
Nicolas W. Villelli ◽  
Hong Yan ◽  
Jian Zou ◽  
Nicholas M. Barbaro
Keyword(s):  
Health Care ◽  
New York ◽  
Health Care Reform ◽  
Health Care System ◽  
Spine Surgery ◽  
Private Insurance ◽  
New York State ◽  
Before And After ◽  
The Impact ◽  
Care System

OBJECTIVESeveral similarities exist between the Massachusetts health care reform law of 2006 and the Affordable Care Act (ACA). The authors’ prior neurosurgical research showed a decrease in uninsured surgeries without a significant change in surgical volume after the Massachusetts reform. An analysis of the payer-mix status and the age of spine surgery patients, before and after the policy, should provide insight into the future impact of the ACA on spine surgery in the US.METHODSUsing the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes, the authors obtained demographic information on patients undergoing spine surgery between 2001 and 2012. Payer-mix status was assigned as Medicare, Medicaid, private insurance, uninsured, or other, which included government-funded programs and workers’ compensation. A comparison of the payer-mix status and patient age, both before and after the policy, was performed. The New York State data were used as a control.RESULTSThe authors analyzed 81,821 spine surgeries performed in Massachusetts and 248,757 in New York. After 2008, there was a decrease in uninsured and private insurance spine surgeries, with a subsequent increase in the Medicare and “other” categories for Massachusetts. Medicaid case numbers did not change. This correlated to an increase in surgeries performed in the age group of patients 65–84 years old, with a decrease in surgeries for those 18–44 years old. New York showed an increase in all insurance categories and all adult age groups.CONCLUSIONSAfter the Massachusetts reform, spine surgery decreased in private insurance and uninsured categories, with the majority of these surgeries transitioning to Medicare. Moreover, individuals who were younger than 65 years did not show an increase in spine surgeries, despite having greater access to health insurance. In a health care system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly population. The Massachusetts model continues to show that this type of policy is not causing extreme shifts in the payer mix, and suggests that spine surgery will continue to thrive in the current US health care system.

scholarly journals Engaging African American Veterans with Health Care Access Challenges in a Community Partnered Care Coordination Initiative: A Qualitative Needs Assessment

2018 ◽  
Vol 28 (Supp) ◽  
pp. 475-484
Author(s):  
Adriana Izquierdo ◽  
Michael Ong ◽  
Felica Jones ◽  
Loretta Jones ◽  
David Ganz ◽  
...  
Keyword(s):  
Health Care ◽  
African American ◽  
Los Angeles ◽  
Health Care System ◽  
Health Care Access ◽  
Veterans Health ◽  
Health Administration ◽  
Health Care Environment ◽  
Care Access ◽  
Care System

Background: Little has been written about engaging potentially eligible members of a health care system who are not accessing the care to which they are entitled. Know­ing more about the experiences of African American Veterans who regularly experi­ence health care access challenges may be an important step toward equitable, coordi­nated Veterans Health Administration (VHA) care. This article explores the experiences of African American Veterans who are at risk of experiencing poor care coordination.Design: We partnered with a community organization to recruit and engage Veterans in three exploratory engagement workshops between October 2015 and February 2016.Participants and Setting: Veterans living in South Los Angeles, CaliforniaMain Outcome Measures: Veterans were asked to describe their experiences with community care and the VHA, a division of the US Department of Veterans Affairs (VA). Field notes taken during the workshops were analyzed by community and academic partners using grounded theory methodol­ogy to identify emergent themes.Results: 12 Veterans and 3 family members of Veterans participated in one or more en­gagement workshops. Their trust in the VA was generally low. Positive themes included: Veterans have knowledge to share and want to help other Veterans; and connecting to VA services can result in positive experi­ences. Negative themes included: functional barriers to accessing VA health care services; insensitive VA health care environment; lack of trust in the VA health care system; and Veteran status as disadvantageous for accessing non-VA community services.Conclusions: Veterans living in underserved areas who have had difficulty accessing VA care have unique perspectives on VA services. Partnering with trusted local com­munity organizations to engage Veterans in their home communities is a promising strategy to inform efforts to improve care access and coordination for vulnerable Vet­erans.Ethn Dis. 2018;28(Suppl 2):475-484; doi:10.18865/ed.28.S2.475.

The Impact of Age on Colorectal Cancer Incidence, Treatment, and Outcomes in an Equal-Access Health Care System

2014 ◽  
Vol 57 (3) ◽  
pp. 303-310 ◽  
Author(s):  
Scott R. Steele ◽  
Grace E. Park ◽  
Eric K. Johnson ◽  
Matthew J. Martin ◽  
Alexander Stojadinovic ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Health Care System ◽  
Cancer Incidence ◽  
Equal Access ◽  
Colorectal Cancer Incidence ◽  
The Impact ◽  
Care System

Novel Use of a Nurse-Led Telemedicine Team in Acute Stroke: A Retrospective Review of the Impact on a Regional Health Care System

2019 ◽  
Vol 45 (3) ◽  
pp. 242-248 ◽  
Author(s):  
Susan B. Fowler ◽  
Christian A. Rosado ◽  
Jennifer Jones ◽  
Suzanne Ashworth ◽  
Darlene Adams
Keyword(s):  
Health Care ◽  
Acute Stroke ◽  
Health Care System ◽  
Retrospective Review ◽  
Regional Health ◽  
Regional Health Care ◽  
The Impact ◽  
Care System

Patient Experiences, Trust, and Preferences for Health Data Sharing

2021 ◽  
Author(s):  
Rochelle D. Jones ◽  
Chris Krenz ◽  
Kent A. Griffith ◽  
Rebecca Spence ◽  
Angela R. Bradbury ◽  
...  
Keyword(s):  
Health Care ◽  
Data Sharing ◽  
Health Care System ◽  
Lived Experiences ◽  
Care Delivery ◽  
Group Discussion ◽  
Final Analysis ◽  
Secondary Use ◽  
The Impact ◽  
Care System

PURPOSE: Scholars have examined patients' attitudes toward secondary use of routinely collected clinical data for research and quality improvement. Evidence suggests that trust in health care organizations and physicians is critical. Less is known about experiences that shape trust and how they influence data sharing preferences. MATERIALS AND METHODS: To explore learning health care system (LHS) ethics, democratic deliberations were hosted from June 2017 to May 2018. A total of 217 patients with cancer participated in facilitated group discussion. Transcripts were coded independently. Finalized codes were organized into themes using interpretive description and thematic analysis. Two previous analyses reported on patient preferences for consent and data use; this final analysis focuses on the influence of personal lived experiences of the health care system, including interactions with providers and insurers, on trust and preferences for data sharing. RESULTS: Qualitative analysis identified four domains of patients' lived experiences raised in the context of the policy discussions: (1) the quality of care received, (2) the impact of health care costs, (3) the transparency and communication displayed by a provider or an insurer to the patient, and (4) the extent to which care coordination was hindered or facilitated by the interchange between a provider and an insurer. Patients discussed their trust in health care decision makers and their opinions about LHS data sharing. CONCLUSION: Additional resources, infrastructure, regulations, and practice innovations are needed to improve patients' experiences with and trust in the health care system. Those who seek to build LHSs may also need to consider improvement in other aspects of care delivery.

scholarly journals Reduction in Diabetes-Related Major Amputation Rates After Implementation of a Multidisciplinary Model: An Evaluation in Alberta, Canada

2019 ◽  
pp. 0000-0000 ◽  
Author(s):  
Reza Basiri ◽  
Brent D. Haverstock ◽  
Paul F. Petrasek ◽  
Karim Manji
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Pearson Correlation ◽  
Significant Negative Correlation ◽  
Major Amputation ◽  
Incidence Rates ◽  
Positive Sign ◽  
Supporting Evidence ◽  
The Impact ◽  
Care System

BACKGROUND: Lower limb amputations (LLAs) are a major debilitating complication of diabetes. The toe and flow model (TFM) describes the framework for multidisciplinary centers aiming to reduce this complication. In this study, we investigate the efficacy of the TFM to reduce diabetes-related major LLAs in comparison with the standard of care (SOC) in the Canadian health care system. METHODS: We retrospectively reviewed the anonymized diabetes-related LLA reports in two similar metropolitan health zones in Alberta, Canada from 2007 to 2017. Although both zones have the same provincial health care system and similar demographics, Calgary, our first zone operates on the basis of the TFM while the Edmonton zone operates in accordance with the provincial SOC. LLAs were divided into minor and major amputation cohorts. We used the chi-square test, linear regression, and Pearson correlation for analysis. The lower proportion of major LLAs was denoted as a positive sign for the efficacy of the TFM. RESULTS: Although the number of LLAs remained relatively comparable (Calgary zone: 2238 and Edmonton zone: 2410), the Calgary zone had both significantly lower major (45%) and higher minor (42%) amputation incidence rates compared to the Edmonton zone. The increasing trend in minor LLAs and decreasing trend in major LLAs in the Calgary zone were negatively and significantly correlated (r = -0.730, p = 0.011). No significant correlation was found in the Edmonton zone. CONCLUSIONS: A significant reduction in the incidence rate, decreasing trend of diabetes-related major LLAs and the significant negative correlation of minor and major LLAs rates in the Calgary zone (TFM) compared to its sister zone Edmonton (SOC), provides supporting evidence for the impact of the TFM. This investigation provides support for a modernization of the diabetes-related limb preservation practice in Canada through the implementation of TFMs across the country to combat major LLAs.

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