Browsing by Subject "Primary Health Care"
Now showing 1 - 15 of 15
- Results Per Page
- Sort Options
Item Barriers to population-wide lipid management and new tools for success(2023-02-24) Navar, Ann MarieItem The biggest winner: tools for successful weight management in primary care(2014-10-03) Turer, Christy BolingItem Item Home based primary care: an economic(2018-07-27) Jamshed, NamirahItem How can a safety net be the catalyst for creating a healthier community?(2012-09-11) Anderson, Ron J.The Parkland Health & Hospital System is one of the Nation's largest and most complicated safety net institutions. It provides care for over 40,000 admissions, 12,000 deliveries and 1.3 million outpatient and ED visits per year. It is a Level 1 Trauma and Burn Center, a Level 3 Neonatal Unit (one of the largest in the US), and it is part of the UTSW campus NCI designation for Cancer Care. Parkland has achieved many firsts as an innovator of the safety net, but must now rise to the challenges of "moving upstream" to invest in prevention, health promotion, earlier interventions in primary care, and care management in a fashion that is lead by a spirit of servant leadership, evidence based practice (competency) and the ethical tenets of beneficience, nonmaleficience, promotion of autonomy, distributive and social justice. The next evolutionary steps for Parkland involve collaboration with our competitors (so-called Co-optician) through a 1115 Medicaid Waiver to find and address gaps in service delivery for our most vulnerable residents. It requires the discipline to study health disparities, population health outcomes and the impact of the socioeconomic determinants of health. We have and will continue to use appreciate inquiry, dialogue and "deep listening" to guide us so as to avoid paternalism or exploitation and get the community's buy-in and participation. Enormous strength, innovation and vitality can come from the community's partnership with the safety net to effect health delivery reform at the local and regional level. We can, and must, do better by being better stewards of scarce resources, by putting quality and safety in both process and outcome at the forefront of our efforts. These efforts must be patient and community centered, not just provider centered to achieve an accountable, sustainable and affordable future.Item Investigation of Practice Facilitator Workflows for Enrollment Enhancement in ICD-Pieces Study(2018-03-22) Sakai, Mark; Reed, W. Gary; Vazquez, Miguel A.; Oliver, GeorgeBACKGROUND: Care for patients with multi-morbidities is challenging and often suboptimal. Earlier detection of patients with coexisting Chronic Kidney Disease (CKD), diabetes and hypertension served by our health care systems will allow us to institute appropriate care for the right patient at the right time with the right intervention thereby providing the greatest benefit. Implementation of interventions to treat CKD, diabetes, and hypertension and to treat associated conditions should reduce cardiovascular mortality and morbidity, improve clinical status, and reduce hospitalization and costs. A collaborative model approach to care for patients with multiple chronic conditions using the unique and novel technology platform provided by Pieces (Parkland intelligent e-coordination and evaluation system) is being investigated via pragmatic clinical trial. OBJECTIVE: The main hypothesis is that patients with CKD, hypertension and diabetes who receive care with a collaborative model of primary care-subspecialty care enhanced by novel information technology (Pieces) will have fewer hospitalizations, readmissions, CV events and deaths than patients receiving standard medical care. METHODS: The study employs a prospective stratified cluster randomization design involving four healthcare systems which are the stratum: Parkland Healthcare Systems, Texas Health Resources (THR), North Texas Veterans Affairs, and ProHealth Connecticut. Each of the four healthcare systems are unique in the populations that they serve, the electronic medical records that they utilize, and the qualifications of the practice facilitators that they employ. Practice facilitators at each of the participating sites received training on how to leverage the enhanced resources provided by Pieces. The practice facilitators are a crucial link that ensure consistent incorporation of Pieces technology into the care of patients selected for the intervention group of the study. The four unique practice facilitator workflows were diagrammed and proofed for accuracy. Challenges in the process identified by the practice facilitator were also cataloged. Similarities and differences noted in the workflows allowed the identification of the highest yield areas for improvement. Comparison of each of the four unique workflows to the original, "generic" workflow as well as to each other helped identify challenges consistent across all of the systems as well as ones unique to each system. RESULTS: The major challenge identified by each practice facilitator was the accuracy of the generated confirmed and candidate patient lists that they have been receiving. This led to decreased patient enrollments and resulted in the practice facilitators performing a manual survey of each patient. The inaccuracy of the lists was an indictment of the patient selection algorithm and leads one to question if all candidate patients were being identified. Other challenges identified by every practice facilitator included initial resistance from PCPs, missed appointments, and obtaining labs prior to appointments. Individually, each practice facilitator identified challenges that were unique to their situation. These challenges included the inability to sign lab orders, high overall workloads for pharmacists, and the inability to determine if PCPs had taken note of protocol recommendations. CONCLUSION: Investigation and comparison of the practice facilitator workflows at each of the four healthcare systems aided in the identification of shortfalls and challenges that have hindered the patient enrollment process. These workflows will be useful in future pragmatic studies that utilize the EMR in the identification of a patient population. It is also generally instructive for studies that seek to utilize EMRs to identify patient populations. Despite the theoretical efficacy of informatics application in healthcare, there is still much progress to be made in this arena. Nevertheless, the study as a whole will be an important part of the growing collection of pragmatic trials due to their increased external validity compared to traditional explanatory trials. It will also ultimately be a valuable learning tool in the construct and execution of future pragmatic trials and hopefully demonstrate that a collaborative model of primary care-subspecialty care that leverages information technology can improve the quality of patient care.Item It's just not the same: the crisis of sickle cell disease(2021-07-23) Nero, AleciaItem Love it? hate it? it's complicated: electronic medical record user experience(2020-02-14) Chu, LingItem [News](1984-07-30) Williams, AnnItem Rethinking diabetes screening and case finding strategies in clinical practice: who's really at risk?(2016-08-26) Bowen, MichaelItem Safety of Essential Surgery Performed by Non-Physicians in Low and Middle Income Countries(2016-04-04) Sliz, Emily; Mihalic, Angela; Gibson, John; Ramanathan, AparnaBACKGROUND: A lack of surgically trained providers in low and middle income countries (LMICs) is a major contributor to high morbidity and mortality from surgical conditions in these settings. Some countries train non-physician clinicians (NPCs) in surgery to help solve this problem. The World Health Organization recommends this practice in some cases, although data on its safety is limited. HYPOTHESIS: Complication rates of NPCs and physicians practicing essential surgery in LMICs are similar. METHODS: A literature search using PubMed and OvidMEDLINE identified studies reporting complication rates of NPCs when performing essential surgery in LMICs. RESULTS: I identified 28 articles and 2 abstracts reporting the complication rates of 57,578 procedures performed by NPC and MD surgeons in LMICs, as well as 4 systematic reviews and/or meta-analyses on the safety of NPC surgery. Studies came from 4 world regions and the majority were from sub-Saharan Africa. Studies addressed 5 areas: major general surgery (13,253 procedures), medical male circumcision (14,248 procedures, 70% in adults), emergency obstetric surgery (18,853 procedures), tubal ligation (7,179 procedures) and first-trimester abortion (4,045 procedures). Complication and mortality rates for NPC and MD surgeons were similar when performing a variety of general surgery procedures, tubal ligation, and abortion. One out of 7 studies on circumcision found increased complications when NPCs performed the procedure. One out of seven studies found increased maternal and perinatal mortality when NPCs performed emergency obstetric surgery, although these differences were not found in meta-analysis. Meta-analysis did find increased rates of wound healing problems and wound infection in patients of NPCs after obstetric surgery. The majority of studies in this review are limited by factors related to study design. CONCLUSION: NPC surgeons contribute significantly to surgical practice in at least 7 LMICs, all in sub-Saharan Africa. In the majority of cases, NPC and MD surgeons had similar complication rates when performing essential surgery. In areas with large unmet need for surgical care, NPC providers offer a significant mortality and morbidity benefit by increasing access. More research is needed to define the scope of NPC surgical practice that will maximize this benefit and to develop the proper supervision and support mechanisms that MDs must provide to these clinicians.Item So we have Alzheimer's Disease.: Now what? The primary care of patients with AD(2006-03-30) Rubin, Craig D.Item [Southwestern News](2003-02-03) Horton, RachelItem Transitions of care in cystic fibrosis(2021-06-11) Cohen, LeahItem Update in sickle cell disease(2022-02-25) Rambally, Siayareh