Effects of Fragmentation and the Case for Greater Cohesion in Neurologic Care Delivery

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013079
Author(s):  
Mary A O'Neal ◽  
Nassim Zecavati ◽  
Melissa Yu ◽  
Rebecca Spain ◽  
Scott M Friedenberg ◽  
...  
Keyword(s):  
Work Group ◽  
Care Delivery ◽  
Work Force ◽  
Evidence Based ◽  
Care Models ◽  
Fragmentation Potential ◽  
Evidence Based Guidelines ◽  
Evidence Based Care ◽  
American Academy Of Neurology ◽  
Care Fragmentation

Goals:To define fragmentation in neurological care delivery; explain the positive and negative drivers in neurologic practice that contribute to fragmentation; illustrate situations that increase fragmentation risk; emphasize the costs and impact on both patients and providers; propose solutions that allow for more cohesive care.Work group:The Transforming Leaders Program (TLP) class of 2020 was tasked by American Academy of Neurology (AAN) leadership to identify the leading trends in inpatient and outpatient neurology and to predict their effects on future neurologic practice.Methods:Research material included AAN data bases, PubMed searches, discussion with topic experts and AAN leadership.Results:Trends in care delivery are driven by changes in the work force, shifts in health care delivery, care costs, changes in evidence-based care and patient factors. These trends can contribute to care fragmentation. Potential solutions to these problems are proposed based on care models developed in oncology and medicine.Limitations:This paper shares our opinions as there is a lack of evidence-based guidelines as to optimal neurological care delivery.

Preparing for an Epidemic: Cancer Care in an Aging Population

2014 ◽  
pp. 133-137 ◽  
Author(s):  
Ya-Chen Tina Shih ◽  
Arti Hurria
Keyword(s):  
Older Adults ◽  
Cancer Care ◽  
Care Delivery ◽  
Quality Care ◽  
Aging Population ◽  
Population Based ◽  
Cancer Drug ◽  
Evidence Based ◽  
Evidence Based Care

The Institute of Medicine's (IOM) Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population was charged with evaluating and proposing recommendations on how to improve the quality of cancer care, with a specific focus on the aging population. Based on their findings, the IOM committee recently released a report highlighting their 10 recommendations for improving the quality of cancer care. Based on those recommendations, this article highlights ways to improve evidence-based care and addresses rising costs in health care for older adults with cancer. The IOM highlighted three recommendations to address the current research gaps in providing evidence-based care in older adults with cancer, which included (1) studying populations which match the age and health-risk profile of the population with the disease, (2) legislative incentives for companies to include patients that are older or with multiple morbidities in new cancer drug trials, and (3) expansion of research that contributes to the depth and breadth of data available for assessing interventions. The recommendations also highlighted the need to maintain affordable and accessible care for older adults with cancer, with an emphasis on finding creative solutions within both the care delivery system and payment models in order to balance costs while preserving quality of care. The implementation of the IOM's recommendations will be a key step in moving closer to the goal of providing accessible, affordable, evidence-based, high-quality care to all patients with cancer.

Challenges in management of Major Depression in patients with co-morbid medical conditions

2018 ◽  
Vol 1 (01) ◽  
pp. 18-24
Author(s):  
Vikas Menon ◽  
Pooja Patnaik Kuppili
Keyword(s):  
Physical Illness ◽  
Social Impairment ◽  
Medical Illness ◽  
Evidence Based ◽  
Medical Conditions ◽  
Clinical Scenarios ◽  
Co Morbidity ◽  
Management Plans ◽  
Care Models ◽  
Evidence Based Care

Depression is a heterogeneous illness and depression with co-morbid physical illness may represent a phenotype of depression. Concurrent medical illness in depression is associated with greater functional and social impairment and significantly higher health care costs. A variety of mechanisms including lifestyle factors, immune-inflammatory pathways, medications and psychological factors have been proposed to explain the association between depression and physical illness. However, each of these pathways engenders unique challenges in managing such patients. Of utmost importance is to establish the nature of the underlying medical or psychological cause(s) which will inform customized management plans. This article initially reviews the prevalence of depression in medical conditions and vice versa. Subsequently, we move on to discuss specific approaches to diagnosis of depression in the context of medical co-morbidity. Finally, we describe evidence based pharmacological and psychosocial intervention strategies with some recommendations for common clinical scenarios. Evidence based care models to manage depression with physical illness are described which may be adapted for use in low resource settings.

scholarly journals Challenges in management of Major Depression in patients with co-morbid medical conditions

2018 ◽  
Vol 1 (01) ◽  
pp. 18-24
Author(s):  
Vikas Menon ◽  
Pooja Patnaik Kuppili
Keyword(s):  
Physical Illness ◽  
Social Impairment ◽  
Medical Illness ◽  
Evidence Based ◽  
Medical Conditions ◽  
Clinical Scenarios ◽  
Co Morbidity ◽  
Management Plans ◽  
Care Models ◽  
Evidence Based Care

Depression is a heterogeneous illness and depression with co-morbid physical illness may represent a phenotype of depression. Concurrent medical illness in depression is associated with greater functional and social impairment and significantly higher health care costs. A variety of mechanisms including lifestyle factors, immune-inflammatory pathways, medications and psychological factors have been proposed to explain the association between depression and physical illness. However, each of these pathways engenders unique challenges in managing such patients. Of utmost importance is to establish the nature of the underlying medical or psychological cause(s) which will inform customized management plans. This article initially reviews the prevalence of depression in medical conditions and vice versa. Subsequently, we move on to discuss specific approaches to diagnosis of depression in the context of medical co-morbidity. Finally, we describe evidence based pharmacological and psychosocial intervention strategies with some recommendations for common clinical scenarios. Evidence based care models to manage depression with physical illness are described which may be adapted for use in low resource settings.

Factors Associated With Evidence-Based Care in Community-Based Child Psychotherapy

2010 ◽  
Author(s):  
Lauren Brookman-Frazee ◽  
Rachel A. Haine ◽  
Mary J. Baker-Ericzen ◽  
Ann F. Garland
Keyword(s):  
Child Psychotherapy ◽  
Evidence Based ◽  
Community Based ◽  
Factors Associated ◽  
Evidence Based Care
Sign in / Sign up

Export Citation Format

Share Document