scholarly journals The COVID-19 Pandemic as an Opportunity for Operational Innovation at 2 Student-Run Free Clinics

2021 ◽  
Vol 12 ◽  
pp. 215013272199363
Author(s):  
Gabriela D.M. Ruiz Colón ◽  
Bianca Mulaney ◽  
Ruby E. Reed ◽  
Sierra K. Ha ◽  
Victoria Yuan ◽  
...  
Keyword(s):  
Social Needs ◽  
Evidence Based ◽  
Free Clinics ◽  
Training Module ◽  
Care Needs ◽  
Medical Needs ◽  
Student Management ◽  
Student Volunteers ◽  
Operational Innovation ◽  
Key Innovations

The onset of the COVID-19 pandemic and subsequent county shelter-in-place order forced the Cardinal Free Clinics (CFCs), Stanford University’s 2 student-run free clinics, to close in March 2020. As student-run free clinics adhering to university-guided COVID policies, we have not been able to see patients in person since March of 2020. However, the closure of our in-person operations provided our student management team with an opportunity to innovate. In consultation with Stanford’s Telehealth team and educators, we rapidly developed a telehealth clinic model for our patients. We adapted available telehealth guidelines to meet our patient care needs and educational objectives, which manifested in 3 key innovations: reconfigured clinic operations, an evidence-based social needs screen to more effectively assess and address social needs alongside medical needs, and a new telehealth training module for student volunteers. After 6 months of piloting our telehealth services, we believe that these changes have made our services and operations more robust and provided benefit to both our patients and volunteers. Despite an uncertain and evolving public health landscape, we are confident that these developments will strengthen the future operations of the CFCs.

scholarly journals Addressing Social Determinants While Social Distancing: The Development of an Evidence-Based Social Needs Screening for a Telehealth Setting

2021 ◽  
Author(s):  
Ruby Reed ◽  
María Suárez-Nieto ◽  
Jiwoo Lee ◽  
Neil Wary ◽  
Songnan Wang ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Patient Population ◽  
Clinical Care ◽  
Community Organizations ◽  
Social Needs ◽  
Determinants Of Health ◽  
Evidence Based ◽  
Free Clinics ◽  
The Social

Effectively addressing social determinants of health in clinical care can be challenging, and screening for such social needs is often overlooked. The COVID-19 pandemic has exacerbated health disparities and the impacts of social determinants of health, increasing the importance of both effective screening and intervention to address social needs. In response, the student-run free clinics at Stanford University sought to meet this need amongst our patient population by developing an evidence-based social needs screening (SNS) and referral protocol and integrating it into our novel telehealth model. The new protocol was implemented significantly more consistently compared to our previous checklist-based SNS, and more need was identified amongst our patient population than with the checklist-based, pre-pandemic screen. The new screening and referral protocol facilitated comprehensive patient care that addresses the social determinants of health in the clinical setting by improving our ability to identify patient social needs and refer such patients to community organizations. In describing the development, design, and implementation of this SNS, we hope to provide an example strategy for addressing social determinants of health within a student-run free clinic setting, and to encourage other student-run clinics and/or free clinics to similarly expand locally relevant social needs services.

scholarly journals The Evolution of IBD Perceived Engagement and Care Needs Across the Life-Cycle: A Scoping Review

2020 ◽  
Author(s):  
Eleonora Volpato ◽  
Caterina Bosio ◽  
Enrica Previtali ◽  
Salvatore Leone ◽  
Alessandro Armuzzi ◽  
...  
Keyword(s):  
Life Cycle ◽  
Scoping Review ◽  
Psychological Needs ◽  
Social Needs ◽  
Care Process ◽  
Care Needs ◽  
Work Related ◽  
Medical Needs ◽  
Scoping Reviews ◽  
Social Discomfort

Abstract Background: The chronic and progressive evolution of Inflammatory Bowel Diseases (IBD), with its prototypical fluctuating trend, creates a condition of psycho-social discomfort, impacting the quality of life in terms of personal, working and interpersonal.Aims: In this article, we want to identify the nature and extent of the research evidence on the life experiences, the perceived engagement and the psychosocial and medical needs of people affected by IBD across the lifecycle. Methods: Following the approach set out by Arksey and O’Malley and the PRISMA extension for scoping reviews, we conducted a scoping review in March 2019 and closed the review with an update in October 2019. It was performed using electronic databases covering Health and Life Sciences, Social Sciences and Medical Sciences, such as PubMed, Medline, Embase, Scopus, Cochrane, Web of Science, PsycInfo.Results: We identified 95 peer-reviewed articles published from 2009 to 2019, that allowed to detect the main needs in children (psychological, need to be accepted, physical activity, feeding, parent style and support, social needs), adolescents (to understand, physical and psychological needs, protection, relational, gratitude, respect and engagement) and adults (information, medical, psychological, social, work-related, practical, future-related, engagement). Although the literature confirms that the majority of the IBD units have planned provision for the different types of transitions, the quality and appropriateness of these services have not been assessed or audited for all the kind of challenges across the life cycle. Conclusions: The literature shows the relevance of organising a flexible, personalised health care process across all the critical phases of the life cycle, providing adequate benchmarks for comparison in a multidisciplinary perspective and ensuring continuity between hospital and territory.

scholarly journals Addressing Health Disparities in Adults with Developmental Disabilities

2019 ◽  
Vol 29 (Supp2) ◽  
pp. 355-358 ◽  
Author(s):  
Andrea S. Videlefsky ◽  
Jeffrey M. Reznik ◽  
Janice T. Nodvin ◽  
Harry J. Heiman
Keyword(s):  
Health Care ◽  
Health Disparities ◽  
Developmental Disabilities ◽  
Best Practices ◽  
Social Needs ◽  
Future Research ◽  
Evidence Based ◽  
Care Needs ◽  
The Impact ◽  
Adults With Developmental Disabilities

 Adults with developmental disabilities are a growing population that experiences significant health disparities due to unmet health care and social needs. Few standard­ized health care guidelines are available or broadly accepted as best practices for this population. The Adult Disability Medical Healthcare (ADMH) is a community-based clinic that provides a unique multidisci­plinary team-based approach to addressing the social and health care needs of adults with developmental disabilities within the framework of a Patient Centered Medical Home model. ADMH is developing the nec­essary research infrastructure and obtaining input from individuals with developmental disabilities, their families, and community stakeholders and is performing foundational analysis to inform the development of guidelines for evidence-based best practices for the care of adults with developmental disabilities. This will set the stage for future research evaluating the impact of these guidelines on health outcomes and the reduction of health disparities in this popu­lation. This commentary highlights a process for development of evidence-based guide­lines and best practices for care of adults with developmental disabilities.Ethn Dis. 2019;29(Suppl 2):355-358. doi:10.18865/ed.29.S2.355

scholarly journals Ageing at home? Meeting housing, health and social needs

2014 ◽  
Vol 22 (5/6) ◽  
pp. 242-252 ◽  
Author(s):  
Jill Stewart ◽  
Rachel Crockett ◽  
Jim Gritton ◽  
Brendon Stubbs ◽  
Ann Pascoe
Keyword(s):  
Social Care ◽  
Good Practice ◽  
Social Needs ◽  
Evidence Based ◽  
Ageing Population ◽  
Care Needs ◽  
Content Type ◽  
Age In Place ◽  
Starting Point ◽  
Health And Social Care

Purpose – The purpose of this paper is to consolidate the range of issues relevant to owner occupiers who age in place and to offer an initial overview of how effective partnerships can respond to and meet the changing needs of housing, health and social care of our ageing population. Design/methodology/approach – Issues affecting older people's changing needs are considered holistically and considered in terms of how partnerships can be enhanced to develop improved services in the future. Findings – Most owners wish to stay in their own homes for as long as possible and it can be cost-effective to do so; however, we need to look at new and innovative ways of developing and providing front-line services to enhance health and safety in the home, but also quality of life and wellbeing such as combating loneliness and isolation. However, although there are examples of evidence-based good practice, service provision is variable and there is a risk that many older home owners may miss out on services for which they may are eligible. With this in mind, it may be helpful to develop a new framework where one key practitioner holds responsibility to consolidate and coordinate the range of local services available as a package that offers a range of housing, health and social care services. Originality/value – There are currently many policy and practice gaps in older owner occupier's housing conditions and suitability to meet their changing needs. This paper has a particular starting point in housing, and how other personal or technological services can help support independence for as long as possible and adapt to the owner-occupier's changing health and social care needs as they age in place. The authors emphasise the importance of sharing evidence-based good practice partnerships.

Clinical practice guidelines for comprehensive patient assessment in emergency care: A quality evaluation study

2021 ◽  
pp. 205715852110069
Author(s):  
Åsa Falchenberg ◽  
Ulf Andersson ◽  
Birgitta Wireklint Sundström ◽  
Anders Bremer ◽  
Henrik Andersson
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Emergency Care ◽  
Quality Evaluation ◽  
Evaluation Study ◽  
Evidence Based ◽  
Patient Assessment ◽  
Care Needs ◽  
Home Based

Emergency care nurses (ECNs) face several challenges when they assess patients with different symptoms, signs, and conditions to determine patients’ care needs. Patients’ care needs do not always originate from physical or biomedical dysfunctions. To provide effective patient-centred care, ECNs must be sensitive to patients’ unique medical, physical, psychological, social, and existential needs. Clinical practice guidelines (CPGs) provide guidance for ECNs in such assessments. The aim of this study was to evaluate the quality of CPGs for comprehensive patient assessments in emergency care. A quality evaluation study was conducted in Sweden in 2017. Managers from 97 organizations (25 emergency medical services and 72 emergency departments) were contacted, covering all 20 Swedish county councils. Fifteen guidelines were appraised using the validated Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. The results revealed that various CPGs are used in emergency care, but none of the CPGs support ECNs in performing a comprehensive patient assessment; rather, the CPGs address parts of the assessment primarily related to biomedical needs. The results also demonstrate that the foundation for evidence-based CPGs is weak and cannot confirm that an ECN has the prerequisites to assess patients and refer them to treatment, such as home-based self-care. This may indicate that Swedish emergency care services utilize non-evidence-based guidelines. This implies that ECN managers and educators should actively seek more effective ways of highlighting and safeguarding patients’ various care needs using more comprehensive guidelines.

scholarly journals Effective Elements for Workplace Responses to Critical Incidents and Suicide: A Rapid Review

2021 ◽  
Vol 18 (9) ◽  
pp. 4821
Author(s):  
Tania Pearce ◽  
Lyndal Bugeja ◽  
Sarah Wayland ◽  
Myfanwy Maple
Keyword(s):  
Critical Incidents ◽  
Grey Literature ◽  
Rapid Review ◽  
Evidence Based ◽  
Study Quality ◽  
Training Module ◽  
Critical Response ◽  
Response Training ◽  
Academic Search ◽  
And Training

Despite high rates of critical incidents (CIs) in working class occupations, there is a significant gap in our understanding of responses to these events. In this study, we aimed to inform a response training module by synthesising the key elements of pre-, during- and post-incident responses to CIs and suicide in the workplace. A rapid review identified studies on responses to CIs or suicide deaths in the workplace published between January 2015 and June 2020. A systematic search of six databases (Medline, CINAHL, PsycINFO, Sociology Collection, Academic Search and Business Search Complete) and grey literature was performed. Studies were excluded if the focus was on non-colleagues. Two reviewers independently conducted record screening, a review of the full text and assessed study quality. The existing evidence was synthesised and interventions were categorised using Haddon’s Matrix. Five studies were included, reporting on CIs across a range of workplace settings, including railways, factories, police and military, along with external critical response units. Overall, study quality was assessed as being poor. Most of the evidence focused on the pre-incident and post-incident stage. There is little evidence on responses to CIs in the workplace. Evidence-based education and training is necessary to establish organisational responses to assist with supporting workers exposed to workplace CIs.

Overview of a Pilot Health-focused Reentry Program for Racial/Ethnic Minority Probationers ages 18 to 26 in Southern California

2021 ◽  
pp. 0306624X2110137
Author(s):  
Victoria D. Ojeda ◽  
Emily Berliant ◽  
Tamara Parker ◽  
Maurice Lyles ◽  
Todd M. Edwards ◽  
...  
Keyword(s):  
Ethnic Minority ◽  
Southern California ◽  
Life Stage ◽  
Social Needs ◽  
Service Needs ◽  
Physical And Mental Health ◽  
Care Needs ◽  
Transitions To Adulthood ◽  
Nutrition Assistance ◽  
Racial Ethnic

There is a significant gap in reentry programming that is tailored to the needs of young adults ages 18 to 26 who are in a unique developmental life stage that involves ongoing maturity in their neurobiology, cognitive development, and social and financial transitions to adulthood and independence. This article describes the structure and approach of a 6-month health-focused reentry program designed for racial/ethnic minority young adult (YA) probationers in Southern California. The UCSD RELINK program includes service navigation and an optional psychoeducation health coaching program to build health literacy, problem-solving, and executive functioning skills relevant across multiple life domains. We describe participant characteristics and service needs at intake. Between 2017 and 2019, 122 YA probationers ages 18 to 26 responded to interviewer-administered baseline surveys. Participants needed basic services including housing, nutrition assistance, employment, and educational/vocational training. Depression and anxiety symptoms, Adverse Childhood Events, trauma, and unmet physical and mental health care needs were pervasive. Given the dearth of research on reentry programming for YA, this article documents the approaches taken in this multi-pronged health-focused reentry program to ensure that the program was tailored to YA reentrants’ comprehensive needs. These data serve to concretely illustrate the range of needs and how YA reentrants view their own health and social needs in the context of multiple competing demands; such data may be useful for program planners and policymakers seeking to advance service delivery for YA minority reentrants.

scholarly journals Value-Based Interventional Pain Management: A Review of Medicare National and Local Coverage Determination Policies

2013 ◽  
Vol 3;16 (3;5) ◽  
pp. E145-E180 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Pain Management ◽  
Randomized Clinical Trials ◽  
Medical Community ◽  
Final Decision ◽  
Evidence Based ◽  
Level Of Evidence ◽  
General Acceptance ◽  
Medical Needs ◽  
Medicare Coverage ◽  
Interventional Pain Management

Major policies, regulations, and practice patterns related to interventional pain management are dependent on Medicare policies which include national coverage policies – national coverage determinations (NCDs), and local coverage policies – local coverage determinations (LCDs). The NCDs are Medicare coverage policies issued by the Centers for Medicare and Medicaid Services (CMS). The process used by the CMS in deciding what is and what is not medically necessary is lengthy, involving a review of evidence-based literature on the subject, expert opinion, and public comments. In contrast, LCDs are rules and Medicare coverage that are issued by regional contractors and fiscal intermediaries when an NCD has not addressed the policy at issue. The evidence utilized in preparing LCDs includes the highest level of evidence which is based on published authoritative evidence derived from definitive randomized clinical trials or other definitive studies, and general acceptance by the medical community (standard of practice), as supported by sound medical evidence. In addition, the intervention must be safe and effective and appropriate including duration and frequency that is considered appropriate for the item or service in terms of whether it is furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function. In addition, the safe and effective provision includes that service must be furnished in a setting appropriate to the patient’s medical needs and condition, ordered and furnished by qualified personnel, the service must meet, but does not exceed, the patient’s medical need, and be at least as beneficial as an existing and available medically appropriate alternative. The LCDs are prepared with literature review, state medical societies, and carrier advisory committees (CACs) of which interventional pain management is a member. The LCDs may be appealed by beneficiaries. The NCDs are prepared by the CMS following a request for a national coverage decision after an appropriate national coverage request along with a draft decision memorandum, and public comments. After the request, the staff review, external technology assessment, Medicare Evidence Development and Coverage Advisory Committee (MedCAC) assessment, public comments, a draft decision memorandum may be posted which will be followed by a final decision and implementation instructions. This decision may be appealed to the department appeals board, but may be difficult to reverse. This manuscript describes NCDs and LCDs and the process of development, their development, issues related to the development, and finally their relation to interventional pain management. Key words: Interventional pain management, interventional techniques, national coverage determinations (NCDs), local coverage determinations (LCDs), contractor medical director (CMD), Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services (HHS), guidelines, evidence-based medicine, evidence development with coverage

scholarly journals Enthusiasm-Based or Evidence-Based Charities: Personal Reflections Based on the Project P.A.T.H.S. in Hong Kong

2008 ◽  
Vol 8 ◽  
pp. 802-810 ◽  
Author(s):  
Daniel T. L. Shek
Keyword(s):  
Hong Kong ◽  
Scientific Evidence ◽  
Social Needs ◽  
Intervention Programs ◽  
Evidence Based ◽  
Charitable Foundations ◽  
The World ◽  
Research Findings ◽  
Personal Reflections ◽  
The Needy

In charitable foundations throughout the world, different approaches are used to allocate funding. As many projects with good will (i.e., enthusiasm-based charity) actually fail to help those who really need it, it is argued that the evidence-based approach (i.e., charity guided by scientific evidence) represents the best strategy to support projects that can really help the needy. Using this approach, scientific research findings are systematically used to (1) understand the nature of the problem and/or social needs, (2) design appropriate intervention programs based on the best available evidence, and (3) systematically evaluate the outcomes of the developed program. Using the Project P.A.T.H.S. funded by the Hong Kong Jockey Club Charities Trust as an example, the characteristics underlying this approach are outlined. The systematic use of scientific evidence in the Project P.A.T.H.S. is exemplary in different Chinese societies. This project provides much insight for charitable foundations and funding bodies locally and globally.

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