Referral Patterns To Pediatric Pulmonology For Asthma-Like Symptoms

2021 ◽  
Author(s):  
Tory A. Prynn ◽  
Gretchen Garland ◽  
Lucia Mirea ◽  
Rupali Drewek
Keyword(s):  
Health Care Quality ◽  
Asthma Management ◽  
Retrospective Chart Review ◽  
Primary Care Providers ◽  
Care Quality ◽  
Specialty Care ◽  
Care Providers ◽  
Asthma Diagnosis ◽  
Patients Âgés ◽  
Pediatric Pulmonology

Abstract Background: The decision to refer a sick child to a pediatric specialist is important for health care quality, however access to specialty care is worsening. Referrals from primary to specialty care are a critical first step in coordinating specialty care, but there are often shortcomings in the appropriateness, clarity, and completeness of referrals. This study aimed to characterize referrals for asthma-like symptoms to a pediatric pulmonology clinic, evaluate consult interventions, and identify opportunities for improving access. Methods: A retrospective chart review examined patients ages 5-18 years, referred to the pulmonology clinic at Phoenix Children’s Hospital between July 2016 and July 2019. Descriptive statistics summarized demographics, prior asthma diagnosis, ICS use and compliance, reason for referral and intervention during consult. An appropriate referral was defined as prior asthma and ICS Step 3. Results: The total 171 study subjects had mean (standard deviation) age of 9.4 (3.8) years, with 100 (58%) males, and prior asthma diagnosis in 105 (61%). The most common reason for pulmonology referral was asthma in 90 (53%) patients, of which 70 (78% of 90) had prior asthma. Among 105 patients with asthma, 79 (76%) had a history of ICS, with 33 (42% of 79) patients reporting spacer compliance issues. The rate of appropriate referrals was 0.11 (95% confidence interval: 0.06-0.16). During the pulmonology consult, nearly half 10 (53%) of 19 patients appropriately referred received an ICS step up. Among 151 inappropriate referrals, ICS was initiated for 91 (60%) and increased for 45 (30%). Education was provided to all patients during pulmonology consult. Conclusions: Mild-to-moderate asthma can be effectively treated by primary care providers (PCPs) with implementation of ICS, thus prioritizing healthcare resource utilization by enabling the pulmonologist to see higher acuity patients sooner. Further study is warranted to identify strategies and tools for PCPs to optimize asthma management.

Creating Optimal Healing Environments

2014 ◽  
pp. 84-100
Author(s):  
Terri Zborowsky ◽  
Mary Jo Kreitzer
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Built Environment ◽  
Health Care Quality ◽  
Care Quality ◽  
Care Providers ◽  
Design Elements ◽  
Healing Environment ◽  
Care Processes ◽  
Healing Environments

Creating an optimal healing environment requires attentiveness to the built environment as well as care processes, culture, and competencies of care providers and leadership. There are over 1,000 studies that link the physical environment to outcomes such as health care quality, patient safety, reduction of stress and improvements in patient safety. Key design elements highlighted include access to nature, access to daylight, positive distractions, and the ambient environment.

scholarly journals Provision of Social Services and Health Care Quality in US Community Health Centers, 2017

2020 ◽  
Vol 110 (4) ◽  
pp. 567-573 ◽  
Author(s):  
Ashley M. Kranz ◽  
Ammarah Mahmud ◽  
Denis Agniel ◽  
Cheryl Damberg ◽  
Justin W. Timbie
Keyword(s):  
Health Care ◽  
Community Health ◽  
Social Services ◽  
Health Care Quality ◽  
Community Health Centers ◽  
Care Quality ◽  
Social Needs ◽  
Health Centers ◽  
Care Providers ◽  
Provision Of Services

Objectives. To describe the types of social services provided at community health centers (CHCs), characteristics of CHCs providing these services, and the association between on-site provision and health care quality. Methods. We surveyed CHCs in 12 US states and the District of Columbia during summer 2017 (n = 208) to identify referral to and provision of services to address 8 social needs. Regression models estimated factors associated with the provision of social services by CHCs and the association between providing services and health care quality (an 8-item composite). Results. CHCs most often offered on-site assistance for needs related to food or nutrition (43%), interpersonal violence (32%), and housing (30%). Participation in projects with community-based organizations was associated with providing services on-site (odds ratio = 2.48; P = .018). On-site provision was associated with better performance on measures of health care quality (e.g., each additional social service was associated with a 4.3 percentage point increase in colorectal cancer screenings). Conclusions. Some CHCs provide social services on-site, and this was associated with better performance on measures of health care quality. Public Health Implications. Health care providers are increasingly seeking to identify and address patients’ unmet social needs, and on-site provision of services is 1 strategy to consider.

scholarly journals The effect of a mystery shopper scheme on prescribing behavior in primary care: Results from a field experiment

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Roland Cheo ◽  
Ge Ge ◽  
Geir Godager ◽  
Rugang Liu ◽  
Jian Wang ◽  
...  
Keyword(s):  
Primary Care ◽  
Field Experiment ◽  
Fixed Effects ◽  
Choice Model ◽  
Primary Care Providers ◽  
Care Quality ◽  
Care Providers ◽  
Effective Measure ◽  
Prescribing Behavior ◽  
Mystery Shopper

Abstract Background Health care systems in many countries are characterized by limited availability of provider performance data that can be used to design and implement welfare improving reforms in the health sector. We question whether a simple mystery shopper scheme can be an effective measure to improve primary care quality in such settings. Methods Using a randomized treatment-control design, we conducted a field experiment in primary care clinics in a Chinese city. We investigate whether informing physicians of a forthcoming mystery shopper audit influences their prescribing behavior. The intervention effects are estimated using conditional fixed-effects logistic regression. The estimated coefficients are interpreted as marginal utilities in a choice model. Results Our findings suggest that the mystery shopper intervention reduced the probability of prescribing overall. Moreover, the intervention had heterogeneous effects on different types of drugs. Conclusions This study provides new evidence suggesting that announced performance auditing of primary care providers could directly affect physician behavior even when it is not combined with pay-for-performance, or measures such as reminders, feedback or educational interventions.

Asthma Management: Part I: An Overview of the Problem and Current Trends

2002 ◽  
Vol 18 (3) ◽  
pp. 128-137 ◽  
Author(s):  
Valerie O’Toole Baker ◽  
Janet Friedman ◽  
Rita Schmitt
Keyword(s):  
Asthma Management ◽  
Primary Care Providers ◽  
School Nurse ◽  
Normal Lung ◽  
Complementary Alternative Medicine ◽  
Care Providers ◽  
Current Trends ◽  
Management Plans ◽  
Children With Asthma

Death rates from asthma have increased or remained stable over the past decade despite increased knowledge about the pathophysiology and improved treatment of the disease, a fact that is both puzzling and disconcerting. Some children with asthma experience severe and life-interfering exacerbations separated by long periods of normal lung function and no symptoms. Asthma management plans are developed by primary care providers and the family. School nurses implement and monitor the child’s response to the plan. Therefore, the school nurse needs current information about asthma management. Part I of this two-part series describes the pathophysiology of asthma and the types, risk factors, and current trends in management of the disease. The role of the school nurse in asthma management is outlined, including how he or she can influence environmental factors that precipitate asthma symptoms or exacerbations. Part II will discuss the role of the school nurse in pharmacologic management of asthma. Complementary alternative medicine for asthma management will be described, as well as health teaching for the child with asthma and their family.

Use of lumbar ultrasonography to detect occult spinal dysraphism

2012 ◽  
Vol 9 (3) ◽  
pp. 274-279 ◽  
Author(s):  
Joshua J. Chern ◽  
Jennifer L. Kirkman ◽  
Chevis N. Shannon ◽  
R. Shane Tubbs ◽  
Jeffrey D. Stone ◽  
...  
Keyword(s):  
Congenital Anomalies ◽  
Spinal Dysraphism ◽  
Retrospective Chart Review ◽  
Primary Care Providers ◽  
Care Providers ◽  
Occult Spinal Dysraphism ◽  
Fetal Ultrasonography ◽  
Tertiary Referral Center ◽  
Private Practitioners ◽  
Skin Tag

Object Various cutaneous stigmata and congenital anomalies are accepted as sufficient reasons to perform lumbar ultrasonography as a screening tool to rule out occult spinal dysraphism (OSD). The purpose of this study was to correlate presenting cutaneous findings with lumbar ultrasonography results based on a large number of lumbar ultrasonography tests obtained by regional primary care providers. Methods Over the course of 5 years, 1273 infants underwent lumbar ultrasonography screening at a major pediatric tertiary referral center. Of these infants, 1116 had adequate documentation for retrospective chart review. Referral sources included urban academic, urban private practice, and surrounding rural private practitioners. Presence of cutaneous stigmata and/or congenital anomalies and lumbar ultrasonography results were reviewed for all patients. When present, surgical findings were reviewed. Results A total of 943 infants were referred for presumed cutaneous stigmata, the most common of which was a sacral dimple (638 patients [68%]) followed by hairy patch (96 patients [10%]). Other reported cutaneous findings included hemangioma, deviated gluteal fold, skin tag, and skin discoloration. In comparison, 173 patients presented with congenital anomalies, such as imperforate anus (56 patients [32%]) and tracheoesophageal fistula/esophageal atresia (37 patients [21%]), most of which were detected prenatally by fetal ultrasonography. A total of 17 infants underwent surgical exploration. Occult spinal dysraphism was diagnosed in 7 infants in the cutaneous stigmata group and in 10 infants in the group with congenital abnormalities. None of the cutaneous stigmata as recorded were found to be indicative of the presence of OSD. Conclusions Cutaneous markers as currently defined by general practitioners are not useful markers for predicting OSD. The vast majority of findings on lumbar ultrasonography studies performed under these circumstances will be negative.

Examining the role of treatment complexity in survivorship care planning.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 242-242
Author(s):  
Nicole Marie Mahr ◽  
Karen Marie de Sola-Smith ◽  
Janice Bell
Keyword(s):  
Primary Care Providers ◽  
Additional Treatment ◽  
Care Quality ◽  
Future Research ◽  
Special Focus ◽  
Survivorship Care ◽  
Care Providers ◽  
Long Term Effects ◽  
Lower Odds ◽  
Care Plans

242 Background: The cancer survivor population will reach 19M by 2025, increasing demand on primary care providers to manage late and long-term effects of treatment. To improve care quality, the IOM recommends survivorship care plans (SCPs) that include two components: a treatment summary (TS) detailing disease and treatment characteristics; and evidence based follow up care instructions (FCI). SCPs remain underutilized despite evidence they enhance physician communication, increase self-efficacy and improve health outcomes of cancer survivors. Little is known about treatment related and socio-demographic factors associated with receipt of SCPs and their components. The purpose of this study was to examine the relationship between care complexity, operationalized as multiple cancers or treatments, and survivor reported SCP receipt. Methods: This was a secondary analysis of data collected in the 2012 LIVESTRONG Survey for People Affected by Cancer, an online self-selection survey. Descriptive statistics and multivariate regression were used to examine relationships between survivor characteristics and SCP receipt among 3,599 respondents. Results: Half (52%) of survivors received a complete SCP. Care complexity was significantly associated with lower odds of SCP receipt. Each additional treatment modality lowered odds of receipt by 8% (95% CI 0.86-0.99). Survivors with multiple diagnoses had 19% lower odds of receipt than those with single diagnoses (CI 0.68-0.95). Other predictors of SCP receipt were being female (OR 0.56; 95% CI 0.48-0.65), having at least a bachelor’s degree (OR 0.77; CI 0.60-0.99), age over 66 years (OR 1.38; CI 1.01-1.89), and race of “other” (OR 1.56; CI 1.14-2.13). Similar results were found for receipt of TS alone. Conclusions: Only 52% of survivors received SCPs as recommended by the IOM. Increased case complexity was associated with lower odds of SCP receipt, suggesting patients at highest risk are least likely to receive coordination. Results indicate the need to identify and eliminate barriers to SCP implementation, with special focus on high risk patients. Future research should investigate these findings in diverse populations and identify specific characteristics associated with SCP receipt.

The Impact of Primary Care Dual-Management on Quality of Care

2011 ◽  
Vol 3 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Peter J. Kaboli ◽  
Daniel M. Shivapour ◽  
Michael S. Henderson ◽  
Areef Ishani ◽  
Mary E. Charlton
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Hemoglobin A1c ◽  
Ldl Cholesterol ◽  
Primary Care Providers ◽  
Care Quality ◽  
Care Providers ◽  
Dual Management ◽  
The Impact

Background: Discontinuity is common in US healthcare. Patients access multiple systems of care and in the nation’s largest integrated healthcare system, Veteran’s Administration (VA) patients frequently use non-VA primary care providers. The impact of this “dual-management” on quality is unknown. The authors’ objective was to identify dual-management and associations with markers of care quality for hypertension and associated conditions. Methods: Data was collected via surveys and chart reviews of primary care patients with hypertension from six VA clinics in Iowa and Minnesota. Clinical measures abstracted included the following: goal blood pressure (BP) and use of guideline-concordant therapy, low-density lipoprotein (LDL) cholesterol, hemoglobin A1C, and body mass index (BMI). Dual-management data was obtained through self-report. Results: Of 189 subjects (mean age = 66), 36% were dual-managed by non-VA providers. There was no difference in hypertension quality of care measures by dual-management status. A total of 51% were at BP goal and 58% were on guideline-concordant therapy. Dual-managed patients were more likely to use thiazide diuretics (43% vs 29%; P = .03) and angiotensin receptor blockers (13% vs 3%; P < .01), but less likely to use angiotensin-converting enzyme inhibitors (43% vs 61%; P = .02). There was no difference in LDL cholesterol (97.1 mg/dl vs 100.1 mg/dl; P = .55), hemoglobin A1C (7% vs 6%; P = .74), or BMI (29.8 vs 30.9; P = .40) for dual-managed versus VA managed patients, respectively. Conclusions: Although dual-management may decrease continuity, VA/private sector dual-management did not impact quality of care, though some medication differences were observed. With the high prevalence of dual-management, future work should further address quality and evaluate redundancy of services.

The Effect of Triage Assessments on Identifying Inflammatory Arthritis and Reducing Rheumatology Wait Times in Ontario

2019 ◽  
Vol 47 (3) ◽  
pp. 461-467 ◽  
Author(s):  
Vandana Ahluwalia ◽  
Sydney Lineker ◽  
Raquel Sweezie ◽  
Mary J. Bell ◽  
Tetyana Kendzerska ◽  
...  
Keyword(s):  
Usual Care ◽  
Inflammatory Arthritis ◽  
Retrospective Chart Review ◽  
Wait Time ◽  
Primary Care Providers ◽  
Educational Process ◽  
Wait Times ◽  
Control Group ◽  
Care Providers ◽  
Improve Access

Objective.We evaluated the influence of triage assessments by extended role practitioners (ERP) on improving timeliness of rheumatology consultations for patients with suspected inflammatory arthritis (IA) or systemic autoimmune rheumatic diseases (SARD).Methods.Rheumatologists reviewed primary care providers’ referrals and identified patients with inadequate referral information, so that a decision about priority could not be made. Patients were assessed by an ERP to identify those with IA/SARD requiring an expedited rheumatologist consult. The time from referral to the first consultation was determined comparing patients who were expedited to those who were not, and to similar patients in a usual care control group identified through retrospective chart review.Results.Seven rheumatologists from 5 communities participated in the study. Among 177 patients who received an ERP triage assessment, 75 patients were expedited and 102 were not. Expedited patients had a significantly shorter median (interquartile range) wait time to rheumatologist consult: 37.0 (24.5–55.5) days compared to non-expedited patients [105 (71.0–135.0) days] and controls [58.0 (24.0–104.0) days]. Accuracy comparing the ERP identification of IA/SARD to that of the rheumatologists was fair (κ 0.39, 95% CI 0.25–0.53).Conclusion.Patients triaged and expedited by ERP experienced shorter wait times compared to usual care; however, some patients with IA/SARD were missed and waited longer. Our findings suggest that ERP working in a triage role can improve access to care for those patients correctly identified with IA/SARD. Further research needs to identify an ongoing ERP educational process to ensure the success of the model.

Determinants of survivorship care plan implementation in U.S. cancer programs.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 78-78 ◽  
Author(s):  
Sarah Birken ◽  
Deborah Mayer ◽  
Bryan Weiner ◽  
Allison Mary Deal
Keyword(s):  
Cancer Survivors ◽  
Negative Relationship ◽  
Primary Care Providers ◽  
Care Quality ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Care Providers ◽  
Program Type ◽  
Adoption And Implementation

78 Background: The Institute of Medicine recommended and many professional societies require survivorship care plan (SCP) use to facilitate cancer survivors’ transition from treatment to follow-up care. Rates of SCP adoption (plans to use SCPs) and implementation (current use) in US cancer programs remain unclear. Our objectives were to (1) assess rates of SCP adoption and implementation and (2) determine what distinguishes cancer programs that have implemented SCPs from those that have not moved beyond adoption. Methods: We surveyed employees knowledgeable about SCP adoption and implementation in a nationally representative sample of 100 US cancer programs. Data were analyzed using descriptive and bivariate statistics. Results: The response rate was 80%. Ninety-six percent of programs adopted SCPs, but only 45% implemented SCPs. Among programs that implemented, SCP use remains inconsistent: Use is restricted primarily to breast (81.58%) and colorectal (55.26%) cancer survivors; in 58.33% of these programs, less than a quarter of providers has ever used SCPs; and SCPs are seldom delivered to survivors or their primary care providers. Employees in many programs indicated that SCPs were adopted because of the belief that SCPs would improve care quality and the release of professional society guidelines; however, neither of these factors influenced SCP implementation. Few quality markers (e.g., NCI-designated program type; Commission on Cancer membership) influenced SCP implementation. Determinants of SCP implementation included teaching hospital program type (p = .04) and NCCCP membership (p = .009). Freestanding facility type had a negative relationship with SCP implementation (p = .02). Conclusions: Given inconclusive evidence of SCPs’ effectiveness in improving care coordination and patient outcomes, many scholars have recently advocated for research to promote SCPs’ effectiveness. These efforts may be in vain if SCPs are not more routinely implemented. Efforts should be targeted at enabling programs to implement quality improvement tools. Future research should determine what promotes SCP implementation among teaching hospitals and NCCCP members, and what inhibits freestanding facilities from implementing SCPs.

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