The Impact of Certified Diabetes Educators on Diabetes Performance and Variation Among Primary Care Sites Within an Integrated Health System

2014 ◽  
Vol 5 (2) ◽  
pp. 80-84 ◽  
Author(s):  
James Grigg ◽  
Yuming Ning ◽  
Calie Santana
Keyword(s):  
Primary Care ◽  
Health System ◽  
Integrated Health ◽  
The Impact ◽  
Diabetes Educators

scholarly journals Implementing Primary Care Mediated Population Genetic Screening within an Integrated Health System

2020 ◽  
Author(s):  
Sean P David ◽  
Henry M Dunnenberger ◽  
Raabiah Ali ◽  
Adam Matsil ◽  
Amy A Lemke ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Genetic Screening ◽  
Screening Program ◽  
Median Number ◽  
Large Impact ◽  
Preventative Care ◽  
Number Of Patients ◽  
Integrated Health ◽  
The Impact

AbstractIntroductionGenetic screenings can have a large impact on enabling personalized preventative care. However, this can be limited by the primary use of medical history-based screenings in determining care. The purpose of this study was to understand the impact of DNA10K, a population-based genetic screening program mediated by primary care physicians (PCPs) within an integrated health system to emphasize its contribution to preventative healthcare.MethodsConstruction of the patient experience as part of DNA10K shaped the context for PCP engagement within the program. A cross-sectional analysis of patient consents, orders, tests, and results of nearly 10,000 patients within the primary care specialties of family medicine, internal medicine or obstetrics/gynecology between April 1, 2019 and January 22, 2020 was conducted.ResultsAcross all specialties, a median number of 7.5 cancer and cardiovascular disease variants per PCP was found. The average age of the study population was 49.6 years. Over 8% of these patients had at least one actionable genetic risk variant and almost 2% of patients had at least one CDC Tier 1 variant. The median number of patients per PCP with either hereditary breast and ovarian cancer, Lynch Syndrome, or Familial Hypercholesterolemia was 1 (Interquartile Range 0-2).DiscussionThe analysis of test results and the engagement of an integrated healthcare system in the implementation of a genetic screening program suggests that it can have a large impact on population health outcomes and minimal referral burden to PCPs if identified risks can lead to preventative care.

scholarly journals 1536. Impact of Type of Provider on Appropriateness of Treatment for Gonorrhea and Chlamydia in Outpatient Clinics

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S768-S768
Author(s):  
Katherine Sittig ◽  
Rossana Rosa Espinoza
Keyword(s):  
Health System ◽  
Adult Patients ◽  
Outpatient Clinics ◽  
P Value ◽  
Lower Odds ◽  
Des Moines ◽  
Appropriate Treatment ◽  
Integrated Health ◽  
Pregnancy Status ◽  
The Impact

Abstract Background Patients with sexually transmitted infections (STIs) receive care in a variety of outpatient settings with medical providers of different levels of training and expertise, especially regarding STIs. We aimed to determine the impact of type of provider on the appropriateness of treatment for chlamydia and gonorrhea in a large integrated health system. Methods We conducted a retrospective cohort study of adult patients diagnosed with chlamydia and/or gonorrhea at any outpatient clinic within an integrated health system in Des Moines, Iowa. Nucleic-acid amplification tests were used for diagnosis, and all samples were processed at the same laboratory. Adequate treatment was defined as prescription for appropriate antibiotic, dose and duration within 7 days of the positive test. Logistic regression models with robust standard errors and adjusting for clustering by clinic were built. Results We identified 481 unique patients and a total of 515 unique encounters. Considering unique patients only, the median patient age was 23 years (IQR 20-26), 466/481 (96.9%) were female (96.9%), 15/481 (3.1%) were male, and 79/481 (16.4%) were pregnant. Table 1 shows the patient demographic and provider characteristics by appropriateness of treatment for individual visits. A total of 53 patients had inappropriate treatment, some with multiple errors which are described in Table 2. Provider type, age, type of infection, and pregnancy status were significantly associated with appropriateness of treatment. After adjusting for type of infection, pregnancy status and clustering by clinic, compared to physicians, certified nurse midwives (CNMs) had 33% lower odds of prescribing appropriate treatment (95% CI 0.49-0.91; p-value = 0.010), with no difference in appropriateness of prescribing by mid-level providers (OR 1.61, 95% CI 0.82-3.17; p-value = 0.167). Pregnancy was independently associated with lower odds of appropriate treatment (OR 0.35, 95% CI 0.24-0.52; p-value < 0.001), as was infection with gonorrhea (OR 0.29, 95% CI 0.12-0.68; p-value = 0.004). Table 1. Demographic characteristics of adult patients diagnosed with chlamydia and/or gonorrhea in outpatient clinics by appropriateness of treatment. Des Moines, Iowa, January 1, 2019 to December 31, 2019 Table 2. Type of therapeutic errors encountered among patients diagnosed with chlamydia or gonorrhea Conclusion CNMs had lower odds of prescribing appropriate treatment for STIs. Efforts aimed at improving prescribing by healthcare providers should actively engage with this group. Disclosures All Authors: No reported disclosures

Oncologist and primary care physician attitudes and practices toward cancer survivor follow-up care in an integrated health system.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 105-105 ◽  
Author(s):  
Bijal A. Balasubramanian ◽  
Katelyn K Jetelina ◽  
Simon Craddock Lee
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Health System ◽  
Care Physician ◽  
Cancer Surveillance ◽  
Attitudes And Practices ◽  
Follow Up Care ◽  
Integrated Health ◽  
Communication And Coordination

105 Background: Previous research using nationally representative data showed significant differences between primary care physician (PCP) and oncologists’ attitudes and practices with respect to care of cancer survivors and called for more effective communication and coordination to improve care. This study compared PCP and oncologists’ attitudes and practices for follow-up cancer care within an integrated health system sharing a common electronic health record and clinical infrastructure to examine whether the integrated setting facilitated communication and coordination between PCPs and oncologists. Methods: 41 PCPs and 24 oncologists (response rate = 52%) affiliated with an integrated safety-net health system completed a validated survey. The survey assessed PCP and oncologists’ preferred models for delivering care, attitudes towards follow-up care, and cancer surveillance practices in this setting. Results: 41% of PCPs preferred an oncologist-led care delivery model as compared to 21% of oncologists. More PCPs than oncologists (73% vs 58%) agreed that PCPs have the skills necessary to initiate cancer surveillance. Yet, PCPs more often disagreed (56% vs 42% of oncologists) that they should have primary responsibility for providing cancer follow-up care. PCPs and oncologists differed significantly over cancer surveillance practices. Oncologists more consistently reported that PCPs ordered tests for cancer surveillance, evaluated patients for cancer recurrence and for adverse physical and psychological effects of cancer or its treatment, as well as managed pain and adverse outcomes of cancer treatment. PCPs, however, did not report equivalent ordering for these services. Conclusions: Even within an integrated health system, we found significant uncertainty as to who is responsible for care of cancer survivors. Oncologists more commonly assigned responsibility for cancer survivorship care to PCPs than PCPs recognized. This imbalance indicates many cancer survivors may not be receiving recommended care. Consensus guidelines are needed to delineate shared responsibilities for cancer survivors between primary care and oncology specialty care physicians.

Predicting Primary Care Use Among Patients in a Large Integrated Health System

Medical Care ◽  
2019 ◽  
Vol 57 (8) ◽  
pp. 608-614 ◽  
Author(s):  
Edwin S. Wong ◽  
Matthew L. Maciejewski ◽  
Paul L. Hebert ◽  
Ashok Reddy ◽  
Chuan-Fen Liu
Keyword(s):  
Primary Care ◽  
Health System ◽  
Integrated Health

scholarly journals Auto-assignment of providers in Medicaid Managed Care and factors influencing seasonal flu vaccine uptake: a retrospective analysis

2021 ◽  
Author(s):  
Colleen J Klein ◽  
Matthew D Dalstrom ◽  
Roopa Foulger ◽  
Laurence G Weinzimmer
Keyword(s):  
Primary Care ◽  
Managed Care ◽  
Health System ◽  
Care Provider ◽  
Primary Care Provider ◽  
Vaccine Uptake ◽  
Medicaid Managed Care ◽  
Factors Influencing ◽  
Flu Vaccine ◽  
The Impact

Abstract Objectives Over 50 million people in the USA are enrolled in a Medicaid Managed Care plan. If they do not select a primary care provider, they are auto-assigned to one. The impact of auto-assignment has largely been understudied outside the context of patient satisfaction with the insurance plan. The purpose of the study was to explore the association between auto-assignment and flu vaccination use, which will contribute to our understanding of factors influencing the COVID-19 vaccine uptake. Methods Retrospective data from the Enterprise Data Warehouse of a health system were obtained for adult Medicaid enrolees assigned to a Midwestern health system in 2019. Descriptive statistics, independent t-tests and tetrachoric correlations were used to explore the relationship between auto-assignment and flu vaccine receipt among a large sample of Illinois residents (N = 7224). The sample was then divided into those who chose their provider (n = 6027) and those who were auto-assigned (n = 1197). Key findings Individuals who selected their provider were deemed to have flu vaccine coverage over those who were auto-assigned (33.2% vs. 6.6%). Furthermore, among those who were auto-assigned, age, number of office visits and having chronic morbidities, including chronic obstructive pulmonary disease (P < 0.01), diabetes (P < 0.01) and heart failure (P < 0.01), were positively associated with flu vaccine receipt. Conclusions Individuals who are auto-assigned to a primary care provider are less likely to be flu vaccine recipients than those who choose their provider. This suggests that auto-assignment is a risk factor that influences vaccine receipt. This research provides perspectives for outreach efforts that target individuals who are auto-assigned to a provider.

scholarly journals Evolution of Public Health Expenditure Financed by the Romanian Social Health Insurance Scheme From 1999 to 2019

2021 ◽  
Vol 9 ◽  
Author(s):  
Ciprian-Paul Radu ◽  
Bogdan Cristian Pana ◽  
Daniel Traian Pele ◽  
Radu Virgil Costea
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Health System ◽  
Structural Changes ◽  
Emergency Services ◽  
Health Sector ◽  
Social Health Insurance ◽  
Social Health ◽  
State And Local ◽  
The Impact

The Romanian health system is mainly public financed (80.45%) through the following sources: Social Health Insurance (65%), State and Local Authorities Budget (15.45%), while the private sources (voluntary health insurance and out of pocket) adds an additional 19.55% to the public funds. The shares of the types of expenditure reflect the importance of each sector in the overall health system, and trends in expenditure show the impact of financing on the health sector's structural changes. We analyzed the 20-year trend of the Social Health Insurance budget, from 1999 to 2019. The influences of the different allocations, subcategories, and new budget categories appearing over time were adjusted to reveal relevant trends. Of the 14 medical service categories and the stand-alone Administrative expenditure category, six expenditure categories including Hospital services, Total drugs, and Primary care showed stationary 20-year trends; five including Medical devices, Dialysis, and Homecare services showed ascendant trends; and four including Dentistry and Emergency services showed descendant trends. Stationary trends imply no structural changes in the health sector of relevant magnitude to impact the financing shares of major categories: hospitals, drugs, or primary care. Emerging trends related to the impact of different reforms were revealed only in the low share of expenditures categories. The allocation methodology and statistical analysis of the trends reveal a new perspective on the evolution of health sector in Romania.

scholarly journals Implementation of Patient and Family Advisory Councils in Primary Care Practices in a Large, Integrated Health System

2018 ◽  
Vol 34 (2) ◽  
pp. 190-191 ◽  
Author(s):  
Anita D. Misra-Hebert ◽  
Susannah Rose ◽  
Colleen Clayton ◽  
Kevin Phipps ◽  
Scott Dynda ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Advisory Councils ◽  
Integrated Health ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Courtney Devane ◽  
Regina M. Renner ◽  
Sarah Munro ◽  
Édith Guilbert ◽  
Sheila Dunn ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Diffusion Of Innovations ◽  
Scale Up ◽  
Medical Abortion ◽  
First Trimester ◽  
Validated Questionnaire ◽  
Barriers To Implementation ◽  
Facilitators And Barriers ◽  
The Impact

Abstract Background Direct primary care provision of first-trimester medical abortion could potentially address inequitable abortion access in Canada. However, when Health Canada approved the combination medication Mifegymiso® (mifepristone 200 mg/misoprostol 800 mcg) for medical abortion in July 2015, we hypothesized that the restrictions to distribution, prescribing, and dispensing would impede the uptake of this evidence-based innovation in primary care. We developed and pilot-tested a survey related to policy and practice facilitators and barriers to assess successful initiation and ongoing clinical provision of medical abortion service by physicians undertaking mifepristone training. Additionally, we explored expert, stakeholder, and physician perceptions of the impact of facilitators and barriers on abortion services throughout Canada. Methods In phase 1, we developed a survey using 2 theoretical frameworks: Greenhalgh’s conceptual model for the Diffusion of Innovations in health service organizations (which we operationalized) and Godin’s framework to assess the impact of professional development on the uptake of new practices operationalized in Légaré’s validated questionnaire. We finalized questions in phase 2 using the modified Delphi methodology. The survey was then tested by an expert panel of 25 nationally representative physician participants and 4 clinical content experts. Qualitative analysis of transcripts enriched and validated the content by identifying these potential barriers: physicians dispensing the medication, mandatory training to become a prescriber, burdens for patients, lack of remuneration for mifepristone provision, and services available in my community. To assess the usability and reliability of the online survey, in phase 3, we pilot-tested the survey for feasibility. Results We developed and tested a 61-item Mifepristone Implementation Survey suitable to study the facilitators and barriers to implementation of mifepristone first-trimester medical abortion practice by physicians in Canada. Conclusions Our team operationalized Greenhalgh’s theoretical framework for Diffusion of Innovations in health systems to explore factors influencing the implementation of first-trimester medical abortion provision. This process may be useful for those evaluating other health system innovations. Identification of facilitators and barriers to implementation of mifepristone practice in Canada and knowledge translation has the potential to inform regulatory and health system changes to support and scale up facilitators and mitigate barriers to equitable medical abortion provision.

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