scholarly journals Medical Oncologists’ Experiences in Using Genomic Testing for Lung and Colorectal Cancer Care

2017 ◽  
Vol 13 (3) ◽  
pp. e185-e196 ◽  
Author(s):  
Stacy W. Gray ◽  
Benjamin Kim ◽  
Lynette Sholl ◽  
Angel Cronin ◽  
Aparna R. Parikh ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Care Delivery ◽  
Participation Rate ◽  
The United States ◽  
Genomic Testing ◽  
Genomic Test ◽  
Medical Oncologists ◽  
Health Care Delivery Systems ◽  
Test Use

Purpose: Genomic testing improves outcomes for many at-risk individuals and patients with cancer; however, little is known about how genomic testing for non–small-cell lung cancer (NSCLC) and colorectal cancer (CRC) is used in clinical practice. Patients and Methods: In 2012 to 2013, we surveyed medical oncologists who care for patients in diverse practice and health care settings across the United States about their use of guideline- and non–guideline-endorsed genetic tests. Multivariable regression models identified factors that are associated with greater test use. Results: Of oncologists, 337 completed the survey (participation rate, 53%). Oncologists reported higher use of guideline-endorsed tests (eg, KRAS for CRC; EGFR for NSCLC) than non–guideline-endorsed tests (eg, Onco typeDX Colon; ERCC1 for NSCLC). Many oncologists reported having no patients with CRC who had mismatch repair and/or microsatellite instability (24%) or germline Lynch syndrome (32%) testing, and no patients with NSCLC who had ALK testing (11%). Of oncologists, 32% reported that five or fewer patients had KRAS and EGFR testing for CRC and NSCLC, respectively. Oncologists, rather than pathologists or surgeons, ordered the vast majority of tests. In multivariable analyses, fewer patients in nonprofit integrated health care delivery systems underwent testing than did patients in hospital or office-based single-specialty group settings (all P < .05). High patient volume and patient requests (CRC only) were also associated with higher test use (all P < .05). Conclusion: Genomic test use for CRC and NSCLC varies by test and practice characteristics. Research in specific clinical contexts is needed to determine whether the observed variation reflects appropriate or inappropriate care. One potential way to reduce unwanted variation would be to offer widespread reflexive testing by pathology for guideline-endorsed predictive somatic tests.

Integrating quality and safety science in nursing education and practice

2011 ◽  
Vol 16 (3) ◽  
pp. 226-240 ◽  
Author(s):  
Gwen Sherwood
Keyword(s):  
Health Care ◽  
Nursing Education ◽  
Health Care Professionals ◽  
Care Delivery ◽  
The United States ◽  
Quality And Safety ◽  
Learning Collaborative ◽  
Train The Trainer ◽  
Safety Science ◽  
Health Care Delivery Systems

Worldwide, health care delivery systems are applying new quality and safety science in response to startling reports of negative patient outcomes. Many health care professionals lack the knowledge, skills and attitudes to change the systems in which they work, calling for radical redesign of nursing education to integrate new safety and quality science. This paper describes the transformation underway in nursing education in the United States to integrate quality and safety competencies through the Quality and Safety Education for Nurses (QSEN) project. A national expert panel defined the competencies and surveyed US schools of nursing to assess current implementation. To model the changes needed, a 15-school Pilot Learning Collaborative completed demonstration projects and surveyed graduating students to self-assess their achievement of the competencies. A Delphi process assessed level and placement of the competencies in the curriculum to offer educators a blueprint for spreading across curricula. Specialty organisations are cross-mapping the competencies for graduate education, educational standards have incorporated the competencies into their essentials documents, and a train the trainer faculty development model is now helping educators transform curriculum. Two key questions emerge from these findings: Are any of these projects replicable in other settings? Will these competencies translate across borders?

scholarly journals The Effect of Medicare Health Care Delivery Systems on Survival for Patients with Breast and Colorectal Cancer

2006 ◽  
Vol 15 (4) ◽  
pp. 769-773 ◽  
Author(s):  
Robert S. Kirsner ◽  
Fangchao Ma ◽  
Lora Fleming ◽  
Daniel G. Federman ◽  
Edward Trapido ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Delivery Systems ◽  
Health Care Delivery Systems

scholarly journals Collaborative Public Health Surveillance Strategies to Address Local Health Needs

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Norma Padron
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Delivery ◽  
Public Health Surveillance ◽  
Care Delivery ◽  
The United States ◽  
Delivery Systems ◽  
Health Surveillance ◽  
Local Health ◽  
Health Care Delivery Systems

IntroductionThis presentation will review the current strategies being used by health care delivery systems across the US to incorporate via linkage, publicly available data assets. The discussion will focus on lessons learned with a specific emphasis of collaborations between health systems to address the opioid crisis. Objectives and ApproachTo review ongoing strategies to incorporate local, publicly available data assets to clinical data assets that health systems have for purposes of collaborations with public health surveillance. The emphasis of the discussion presented will be in the data strategies that local health departments and health care delivery systems have used to address the opioid crisis in the US. This presentation will propose strategies to be explored and bring forth concerns about data fairness, accountability and transparency when collaborations for public health surveillance are in place. ResultsThe presentation will discuss the experiences learned in specific regions in the United States. The main results will center around assessing the effectiveness of current strategies to share and analyze data across health care delivery systems and local agencies and government partners. The lessons learned of what works and what hasn't will be discussed in light of the ongoing epidemic of opioid use and drug overdose deaths in the United States. Finally the presentation will present strategies that could be explored for collaborative public health surveillance that address issues and concers of fairness, accountability and transparency. Conclusion/ImplicationsThe implications of this report and presentation is that ongoing data linkage and sharing strategies have been -for the most part- insufficient to enable delivery systems and local public health departments and government address rising epidemiological concerns. The proposed strategies complement what is being done and advance data-driven public health

Nurse Practitioner Challenges to the Orthodox Structure of Health Care Delivery: Regulation and Restraints on Trade

1985 ◽  
Vol 11 (2) ◽  
pp. 195-225
Author(s):  
Karla Kelly
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Delivery ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Allied Health ◽  
Care Delivery ◽  
The United States ◽  
Care Providers ◽  
Allied Health Care

AbstractUntil recently, physicians have been the primary health care providers in the United States. In response to the rising health care costs and public demand of the past decade, allied health care providers have challenged this orthodox structure of health care delivery. Among these allied health care providers are nurse practitioners, who have attempted to expand traditional roles of the registered nurse.This article focuses on the legal issues raised by several major obstacles to the expansion of nurse practitioner services: licensing restrictions, third party reimbursement policies, and denial of access to medical facilities and physician back-up services. The successful judicial challenges to discriminatory practices against other allied health care providers will be explored as a solution to the nurse practitioners’ dilemma.

scholarly journals Risk and the Republican National Convention: Application of the Novel COVID-19 Operational Risk Assessment

2021 ◽  
pp. 1-6
Author(s):  
David Callaway ◽  
Jeff Runge ◽  
Lucia Mullen ◽  
Lisa Rentz ◽  
Kevin Staley ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Health Care ◽  
Care Delivery ◽  
The United States ◽  
Lessons Learned ◽  
World Health ◽  
Local Health ◽  
Mass Gathering ◽  
Wide Range ◽  
National Convention

Abstract The United States Centers for Disease Control and Prevention and the World Health Organization broadly categorize mass gathering events as high risk for amplification of coronavirus disease 2019 (COVID-19) spread in a community due to the nature of respiratory diseases and the transmission dynamics. However, various measures and modifications can be put in place to limit or reduce the risk of further spread of COVID-19 for the mass gathering. During this pandemic, the Johns Hopkins University Center for Health Security produced a risk assessment and mitigation tool for decision-makers to assess SARS-CoV-2 transmission risks that may arise as organizations and businesses hold mass gatherings or increase business operations: The JHU Operational Toolkit for Businesses Considering Reopening or Expanding Operations in COVID-19 (Toolkit). This article describes the deployment of a data-informed, risk-reduction strategy that protects local communities, preserves local health-care capacity, and supports democratic processes through the safe execution of the Republican National Convention in Charlotte, North Carolina. The successful use of the Toolkit and the lessons learned from this experience are applicable in a wide range of public health settings, including school reopening, expansion of public services, and even resumption of health-care delivery.

Cancer Survivorship Care in Colombia: Review and Implications for Health Policy

2021 ◽  
pp. 154041532110015
Author(s):  
Oscar Yesid Franco-Rocha ◽  
Gloria Mabel Carillo-Gonzalez ◽  
Alexandra Garcia ◽  
Ashley Henneghan
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Policy Development ◽  
Care Delivery ◽  
Developed Countries ◽  
The United States ◽  
Survivorship Care ◽  
Cancer Symptoms

Introduction: The number of cancer survivors is increasing in Colombia, and health policy changes are necessary to meet their unmet needs and improve their health outcomes. Similar trends have been identified in developed countries, and positive changes have been made. Methods: We conducted a narrative review to provide an overview of Colombia’s social structure, health care system, and health care delivery in relation to cancer, with recommendations for improving cancer survivorship in Colombia based on the model of survivorship care in the United States. Results: We proposed general recommendations for improving cancer survivors’ care including (1) recognizing cancer survivorship as a distinct phase of cancer, (2) strengthening methods and metrics for tracking cancer survivorship, (3) assessing and monitoring cancer symptoms and quality of life of cancer survivors, (4) publishing evidence-based guidelines considering the social, economic, and cultural characteristics of Colombian population and cancer survivors’ specific needs. Conclusion: These recommendations could be used to inform and prioritize health policy development in Colombia related to cancer survivorship outcomes.

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