Paper by Paul Grundy, Senator Kay R. Hagan, AARP President Jennie Chin Hansen and UCSF Dept of Family Med chair Kevin Grumbach on the moment to transform Primary care using the joint principles of the PCMH
Better to Best Patient Centered Medical HomePaul Grundy
Better to best -- consensus meeting between large employers, HHS, CMS, DOD OPM, hospitals, Primary care association, AMA, healthcare plans around the elements that add value in the Patient Centered medical home. coordination of care, access to care Health information technology and payment reform.
Advocacy Workshop, National Rx Drug Abuse Summit, April 2-4, 2013. Successful Strategies for Community Change - Part 2 presentation by Fred Wells Brason II and Connie M. Payne.
Better to Best Patient Centered Medical HomePaul Grundy
Better to best -- consensus meeting between large employers, HHS, CMS, DOD OPM, hospitals, Primary care association, AMA, healthcare plans around the elements that add value in the Patient Centered medical home. coordination of care, access to care Health information technology and payment reform.
Advocacy Workshop, National Rx Drug Abuse Summit, April 2-4, 2013. Successful Strategies for Community Change - Part 2 presentation by Fred Wells Brason II and Connie M. Payne.
John Middleton: A public health view on commissioningNuffield Trust
Dr John Middleton, Sandwell Primary Care Trust, offers a public health view on the challenges of commissioning in the context of the Government’s NHS reforms.
Running head A REVIEW OF KEY CURRENT HEALTHCARE ISSUES QUALITY A.docxtoddr4
Running head: A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM 1
A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Student's Name
Institution Affiliation
Date
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Healthcare regulations, funds, workload, and technology continue to complicate and inconvenient the U.S healthcare system. However, the quality and value of care tops. In the United States of America, despite significant healthcare transformation efforts, poor care lingers a considerable concern.
America is second to none in terms of healthcare expenditure across the globe. Ironically, evidence shows that its citizens do not receive the most appropriate care, or at least, which they need. For instance, Graban (2018) documents that preventive care is underutilized in the country, which is escalating the budget of managing advanced diseases. On the other hand, patients of chronic ailments such as diabetes, hypertension, and cardiac complications, do not also usually get treatments that are proven and effective (Wiler, Pines, & Ward, 2019). According to Strome (2019), this case is particularly true and event rampant to the persons that insured, uninsured, or under-insured. The lack of proper coordination of chronic diseases patients' care would only source more or exuberate poor healthcare. The unsurprising healthcare system's underlying fragmentation only fuels the issue given that many health care providers hardly have the payment support such related gears, necessary for effective communication and coordination to improve patient care.
While a significant number of patients miss medically necessary care, other clients get unnecessary or even unsafe attention. Research depicts terrific variations in hospital inpatient lengths of stay, specialists' visits, testing and procedures, and costs — not just by United States' unalike geographic areas, but from one health institution to another in the same town (Wiler, Pines, & Ward, 2019). Though limited, evidence on the most effective treatments and procedures, on the best way of informing providers about the efficacy of different treatments, and on the failures of detecting and reducing errors further underwrite the gaps care's quality and effectiveness (Strome, 2019). The concerns are especially pertinent to the Americans of the lower social classes as well as to those from diverse demographic and ethnic groups are usually frequent victims of a lot of incongruences in health and health care.
The implication of Poor Patient Care
Poor quality care impacts both patients and providers negatively. For patients, it reduces their survival changes, aggravates illnesses, and leads to unnecessary mortalities (Graban, 2018). To providers, such issu.
Running head A REVIEW OF KEY CURRENT HEALTHCARE ISSUES QUALITY A.docxhealdkathaleen
Running head: A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM 1
A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Student's Name
Institution Affiliation
Date
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Healthcare regulations, funds, workload, and technology continue to complicate and inconvenient the U.S healthcare system. However, the quality and value of care tops. In the United States of America, despite significant healthcare transformation efforts, poor care lingers a considerable concern.
America is second to none in terms of healthcare expenditure across the globe. Ironically, evidence shows that its citizens do not receive the most appropriate care, or at least, which they need. For instance, Graban (2018) documents that preventive care is underutilized in the country, which is escalating the budget of managing advanced diseases. On the other hand, patients of chronic ailments such as diabetes, hypertension, and cardiac complications, do not also usually get treatments that are proven and effective (Wiler, Pines, & Ward, 2019). According to Strome (2019), this case is particularly true and event rampant to the persons that insured, uninsured, or under-insured. The lack of proper coordination of chronic diseases patients' care would only source more or exuberate poor healthcare. The unsurprising healthcare system's underlying fragmentation only fuels the issue given that many health care providers hardly have the payment support such related gears, necessary for effective communication and coordination to improve patient care.
While a significant number of patients miss medically necessary care, other clients get unnecessary or even unsafe attention. Research depicts terrific variations in hospital inpatient lengths of stay, specialists' visits, testing and procedures, and costs — not just by United States' unalike geographic areas, but from one health institution to another in the same town (Wiler, Pines, & Ward, 2019). Though limited, evidence on the most effective treatments and procedures, on the best way of informing providers about the efficacy of different treatments, and on the failures of detecting and reducing errors further underwrite the gaps care's quality and effectiveness (Strome, 2019). The concerns are especially pertinent to the Americans of the lower social classes as well as to those from diverse demographic and ethnic groups are usually frequent victims of a lot of incongruences in health and health care.
The implication of Poor Patient Care
Poor quality care impacts both patients and providers negatively. For patients, it reduces their survival changes, aggravates illnesses, and leads to unnecessary mortalities (Graban, 2018). To providers, such issu ...
2016 16th population health colloquium: summary of proceedings Innovations2Solutions
This paper will discuss the four key ideas discussed at the Colloquium that will have important ramifications as healthcare organizations seek to implement population health strategies:
1. understanding and alleviating Patient fear is Key to Patient experience
2. the Case for a new Population Health Protection agenda as a means to drive down Healthcare Costs
3. using data and technology to improve Healthcare for older adults
4. engage Consumers in Wellness-based Population Health and thrive financially
Building Patient-Centeredness in the Real World: The Engaged Patient and the ...EngagingPatients
This paper examines the separate but intertwined ethical, economic and clinical concepts of patientcenteredness and how ACOs provide a structure for turning those concepts into a functioning reality.
In the coming years the United States will find themselves going through a number of changes within the Social Security Administration which will affect the Health Care Industry as we know it “Hospital size has long been an area of discussion and debate in the U.S. healthcare industry. Questions have consistently focused on cost management or efficiency in large versus small hospitals. A persistent question among researchers is whether efficiencies are associated with larger facilities through economies of scale, or if there are alternate scenarios that play a significant part in hospital cost and efficiency” (2009, JHM). Since the Affordable Health Care Act was established it made obtaining health care much more affordable and accessible, but at the same time there has to be some cut back.
Chapter 4 Where Do We Want to BePrevious sectionNext sectionWilheminaRossi174
Chapter 4 Where Do We Want to Be?
Previous section
Next section
Chapter 4
Where Do We Want to Be?
Even in a country that lacks an overall, cohesive health policy, it is useful to ask: How unhappy are we with our health care, and what do we want to change? Do not expect consistent responses from the American public. When the nation was debating the Clinton health plan, a number of organizations surveyed the public. Respondents reported they believed that the health care system was in trouble. At the same time, they expressed satisfaction with their own largely employer-financed health care programs. Public support for universal coverage was strong, but individuals did not want to pay higher taxes to support it (Peterson, 1995). An ABC New/Washington Post poll in October 1993 showed the following (Schick, 1995):
• 51% of the public favored the Clinton health plan.
• 59% thought that it was better than the existing system.
• Only 19% thought that their care would get better under it, and 34% thought worse care would result.
• However, 57% were against tax increases to pay for it, whereas 40% would be willing to pay.
The American public also appears to be split over the Patient Protection and Affordable Care Act (ACA) as a whole. Data about opposition to the act can be misleading, with a significant portion of opposition coming from people who believe the ACA did not go far enough. They would prefer a public option, for example, or a single-payer system. Overall, the public is
negative about the individual mandate and the employer mandate, but is much in favor of the insurance changes that have been implemented. People are confused about the insurance exchange provisions of the act as well. An April 2013 tracking poll found that “about half the public says they do not have enough information about the health reform law to understand how it will impact their own family, a share that rises among the uninsured and low-income households” (Kaiser Family Foundation, 2013). The same poll reported that 42% of respondents did not know that the ACA was still the law of the land. Twelve percent believed it had been repealed by Congress, 7% believed it had been overturned by the Supreme Court, and 23% didn’t know whether it was still in effect or not.
Americans report being in good health more than any other OECD country. Their complaints are mostly about financial risks and to some extent access and waiting. A 2010 study of six developed countries showed that Americans were satisfied with their doctors and the availability of effective care, but were also more likely to report that the system needed to be completely rebuilt (Papanicolas, Cylus, & Smith, 2013).
4.1 Alignment with the Rest of Society
Previous section
Next section
4.1 ALIGNMENT WITH THE REST OF SOCIETY
The democratic process is likely to generate many policy experiments as we cope with advancing technology, changing demographics, political pressures, and economic fluctuations. These exper ...
392Improving the 21st-CenturyHealth Care SystemA.docxrhetttrevannion
39
2
Improving the 21st-Century
Health Care System
As discussed in Chapter 1, the American health care system is in need of
major restructuring. This will not be an easy task, but the potential benefits are
great. To cross the divide between today’s system and the possibilities of tomor-
row, strong leadership and clear direction will be necessary. As a statement of
purpose for the health care system as a whole, the committee endorses and adopts
the phrasing of the Advisory Commission on Consumer Protection and Quality in
the Health Care Industry (1998).
Recommendation 1: All health care organizations, professional
groups, and private and public purchasers should adopt as their
explicit purpose to continually reduce the burden of illness, injury,
and disability, and to improve the health and functioning of the
people of the United States.
It is helpful to translate this general statement into a more specific agenda for
improvement—a list of performance characteristics that, if addressed and im-
proved, would lead to better achievement of that overarching purpose. To this
end, the committee proposes six specific aims for improvement. Health care
should be:
• Safe—avoiding injuries to patients from the care that is intended to help
them.
• Effective—providing services based on scientific knowledge to all who
could benefit and refraining from providing services to those not likely to benefit
(avoiding underuse and overuse).
Co
py
ri
gh
t
@
20
01
.
Na
ti
on
al
A
ca
de
mi
es
P
re
ss
.
Al
l
ri
gh
ts
r
es
er
ve
d.
M
ay
n
ot
b
e
re
pr
od
uc
ed
i
n
an
y
fo
rm
w
it
ho
ut
p
er
mi
ss
io
n
fr
om
t
he
p
ub
li
sh
er
,
ex
ce
pt
f
ai
r
us
es
p
er
mi
tt
ed
u
nd
er
U
.S
.
or
a
pp
li
ca
bl
e
co
py
ri
gh
t
la
w.
EBSCO : eBook Academic Collection (EBSCOhost) - printed on 5/31/2019 6:16 AM via SOUTHERN NEW
HAMPSHIRE UNIV
AN: 86916 ; Committee on Quality of Health Care in America, Institute of Medicine.; Crossing the
Quality Chasm : A New Health System for the 21st Century
Account: shapiro.main.ehost
40 CROSSING THE QUALITY CHASM
• Patient-centered—providing care that is respectful of and responsive to
individual patient preferences, needs, and values and ensuring that patient values
guide all clinical decisions.
• Timely—reducing waits and sometimes harmful delays for both those
who receive and those who give care.
• Efficient—avoiding waste, in particular waste of equipment, supplies,
ideas, and energy.
• Equitable—providing care that does not vary in quality because of per-
sonal characteristics such as gender, ethnicity, geographic location, and socio-
economic status.
Recommendation 2: All health care organizations, professional
groups, and private and public purchasers should pursue six major
aims; specifically, health care should be safe, effective, patient-cen-
tered, timely, efficient, and equitable.
The committee believes substantial improvements in safety, effectiveness,
patient-centeredness, timeline.
CASE 10The Strategies to Overcome and Prevent Obesity Alliance.docxtidwellveronique
CASE 10
The Strategies to Overcome and Prevent Obesity Alliance
ERICA BREESE, CASEY LANGWITH, CHRISTINE FERGUSON, GINAMARIE MANGIARACINA, AND ALLISON MAY ROSEN
A WEIGHTY ISSUE
Imagine a disease that affected two thirds of adults in the United States, with a prevalence that had doubled in the last 25 years and showed no sign of stopping its upward trend. One would expect any disease this widespread would receive national attention both in the media and policy arena. Policy makers would demand insurance coverage for treatment and prevention. The public would actively protect themselves and their families from contracting the disease or seek treatment if they contracted it. Physicians would screen for the disease regularly and have straightforward conversations with those who contracted the disease. The American public health and medical systems would be geared toward treating and preventing further spread of this disease.
Surprisingly, there is a disease that currently affects two thirds of the U.S. population, yet has not received the expected response. In 2009, 66.4% of the adult population in the United States was overweight or obese (body mass index ≥ 25),i which is more than twice the prevalence rate from 3 decades before.1,2 Adults are not the only ones affected; childhood obesity rates have also tripled in the last 30 years.3 Additionally, if the existing rates of increase continue, 86.3% of U.S. adults will be overweight and 51.1% will be obese by 2030.4 These are staggering numbers for any health condition, but especially one that is related to a multitude of chronic diseases, such as diabetes, hypertension, high cholesterol, stroke, heart disease, certain cancers, and arthritis.5 Beyond the individual health risks, overweight and obesity also contribute to increased health costs, both nationally and for individuals. For example, in 2008, medical spending attributable to obesity was estimated to have been $147 billion, accounting for 9.1% of annual medical spending.6
These statistics show obesity plays a major role in the U.S. healthcare system and affects the lives of millions of Americans. However, despite the extreme prevalence of obesity, the disease often does not receive adequate attention in the healthcare community. In 2010, First Lady Michelle Obama launched her Let’s Move campaign, which aims to reduce childhood obesity within a generation, helping to bring the issue of childhood obesity to the forefront. In contrast, adult obesity continues to garner little interest. Some groups, however, are focusing on this often overlooked area because they believe real change can be made. The Strategies to Overcome and Prevent (STOP) Obesity Alliance is a collaboration of consumer, provider, government, labor, business, health insurance, and quality-of-care organizations united to drive innovative and practical strategies that combat obesity. The alliance’s history is unique, demonstrating how partnerships among public relations te ...
John Middleton: A public health view on commissioningNuffield Trust
Dr John Middleton, Sandwell Primary Care Trust, offers a public health view on the challenges of commissioning in the context of the Government’s NHS reforms.
Running head A REVIEW OF KEY CURRENT HEALTHCARE ISSUES QUALITY A.docxtoddr4
Running head: A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM 1
A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Student's Name
Institution Affiliation
Date
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Healthcare regulations, funds, workload, and technology continue to complicate and inconvenient the U.S healthcare system. However, the quality and value of care tops. In the United States of America, despite significant healthcare transformation efforts, poor care lingers a considerable concern.
America is second to none in terms of healthcare expenditure across the globe. Ironically, evidence shows that its citizens do not receive the most appropriate care, or at least, which they need. For instance, Graban (2018) documents that preventive care is underutilized in the country, which is escalating the budget of managing advanced diseases. On the other hand, patients of chronic ailments such as diabetes, hypertension, and cardiac complications, do not also usually get treatments that are proven and effective (Wiler, Pines, & Ward, 2019). According to Strome (2019), this case is particularly true and event rampant to the persons that insured, uninsured, or under-insured. The lack of proper coordination of chronic diseases patients' care would only source more or exuberate poor healthcare. The unsurprising healthcare system's underlying fragmentation only fuels the issue given that many health care providers hardly have the payment support such related gears, necessary for effective communication and coordination to improve patient care.
While a significant number of patients miss medically necessary care, other clients get unnecessary or even unsafe attention. Research depicts terrific variations in hospital inpatient lengths of stay, specialists' visits, testing and procedures, and costs — not just by United States' unalike geographic areas, but from one health institution to another in the same town (Wiler, Pines, & Ward, 2019). Though limited, evidence on the most effective treatments and procedures, on the best way of informing providers about the efficacy of different treatments, and on the failures of detecting and reducing errors further underwrite the gaps care's quality and effectiveness (Strome, 2019). The concerns are especially pertinent to the Americans of the lower social classes as well as to those from diverse demographic and ethnic groups are usually frequent victims of a lot of incongruences in health and health care.
The implication of Poor Patient Care
Poor quality care impacts both patients and providers negatively. For patients, it reduces their survival changes, aggravates illnesses, and leads to unnecessary mortalities (Graban, 2018). To providers, such issu.
Running head A REVIEW OF KEY CURRENT HEALTHCARE ISSUES QUALITY A.docxhealdkathaleen
Running head: A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM 1
A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Student's Name
Institution Affiliation
Date
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Healthcare regulations, funds, workload, and technology continue to complicate and inconvenient the U.S healthcare system. However, the quality and value of care tops. In the United States of America, despite significant healthcare transformation efforts, poor care lingers a considerable concern.
America is second to none in terms of healthcare expenditure across the globe. Ironically, evidence shows that its citizens do not receive the most appropriate care, or at least, which they need. For instance, Graban (2018) documents that preventive care is underutilized in the country, which is escalating the budget of managing advanced diseases. On the other hand, patients of chronic ailments such as diabetes, hypertension, and cardiac complications, do not also usually get treatments that are proven and effective (Wiler, Pines, & Ward, 2019). According to Strome (2019), this case is particularly true and event rampant to the persons that insured, uninsured, or under-insured. The lack of proper coordination of chronic diseases patients' care would only source more or exuberate poor healthcare. The unsurprising healthcare system's underlying fragmentation only fuels the issue given that many health care providers hardly have the payment support such related gears, necessary for effective communication and coordination to improve patient care.
While a significant number of patients miss medically necessary care, other clients get unnecessary or even unsafe attention. Research depicts terrific variations in hospital inpatient lengths of stay, specialists' visits, testing and procedures, and costs — not just by United States' unalike geographic areas, but from one health institution to another in the same town (Wiler, Pines, & Ward, 2019). Though limited, evidence on the most effective treatments and procedures, on the best way of informing providers about the efficacy of different treatments, and on the failures of detecting and reducing errors further underwrite the gaps care's quality and effectiveness (Strome, 2019). The concerns are especially pertinent to the Americans of the lower social classes as well as to those from diverse demographic and ethnic groups are usually frequent victims of a lot of incongruences in health and health care.
The implication of Poor Patient Care
Poor quality care impacts both patients and providers negatively. For patients, it reduces their survival changes, aggravates illnesses, and leads to unnecessary mortalities (Graban, 2018). To providers, such issu ...
2016 16th population health colloquium: summary of proceedings Innovations2Solutions
This paper will discuss the four key ideas discussed at the Colloquium that will have important ramifications as healthcare organizations seek to implement population health strategies:
1. understanding and alleviating Patient fear is Key to Patient experience
2. the Case for a new Population Health Protection agenda as a means to drive down Healthcare Costs
3. using data and technology to improve Healthcare for older adults
4. engage Consumers in Wellness-based Population Health and thrive financially
Building Patient-Centeredness in the Real World: The Engaged Patient and the ...EngagingPatients
This paper examines the separate but intertwined ethical, economic and clinical concepts of patientcenteredness and how ACOs provide a structure for turning those concepts into a functioning reality.
In the coming years the United States will find themselves going through a number of changes within the Social Security Administration which will affect the Health Care Industry as we know it “Hospital size has long been an area of discussion and debate in the U.S. healthcare industry. Questions have consistently focused on cost management or efficiency in large versus small hospitals. A persistent question among researchers is whether efficiencies are associated with larger facilities through economies of scale, or if there are alternate scenarios that play a significant part in hospital cost and efficiency” (2009, JHM). Since the Affordable Health Care Act was established it made obtaining health care much more affordable and accessible, but at the same time there has to be some cut back.
Chapter 4 Where Do We Want to BePrevious sectionNext sectionWilheminaRossi174
Chapter 4 Where Do We Want to Be?
Previous section
Next section
Chapter 4
Where Do We Want to Be?
Even in a country that lacks an overall, cohesive health policy, it is useful to ask: How unhappy are we with our health care, and what do we want to change? Do not expect consistent responses from the American public. When the nation was debating the Clinton health plan, a number of organizations surveyed the public. Respondents reported they believed that the health care system was in trouble. At the same time, they expressed satisfaction with their own largely employer-financed health care programs. Public support for universal coverage was strong, but individuals did not want to pay higher taxes to support it (Peterson, 1995). An ABC New/Washington Post poll in October 1993 showed the following (Schick, 1995):
• 51% of the public favored the Clinton health plan.
• 59% thought that it was better than the existing system.
• Only 19% thought that their care would get better under it, and 34% thought worse care would result.
• However, 57% were against tax increases to pay for it, whereas 40% would be willing to pay.
The American public also appears to be split over the Patient Protection and Affordable Care Act (ACA) as a whole. Data about opposition to the act can be misleading, with a significant portion of opposition coming from people who believe the ACA did not go far enough. They would prefer a public option, for example, or a single-payer system. Overall, the public is
negative about the individual mandate and the employer mandate, but is much in favor of the insurance changes that have been implemented. People are confused about the insurance exchange provisions of the act as well. An April 2013 tracking poll found that “about half the public says they do not have enough information about the health reform law to understand how it will impact their own family, a share that rises among the uninsured and low-income households” (Kaiser Family Foundation, 2013). The same poll reported that 42% of respondents did not know that the ACA was still the law of the land. Twelve percent believed it had been repealed by Congress, 7% believed it had been overturned by the Supreme Court, and 23% didn’t know whether it was still in effect or not.
Americans report being in good health more than any other OECD country. Their complaints are mostly about financial risks and to some extent access and waiting. A 2010 study of six developed countries showed that Americans were satisfied with their doctors and the availability of effective care, but were also more likely to report that the system needed to be completely rebuilt (Papanicolas, Cylus, & Smith, 2013).
4.1 Alignment with the Rest of Society
Previous section
Next section
4.1 ALIGNMENT WITH THE REST OF SOCIETY
The democratic process is likely to generate many policy experiments as we cope with advancing technology, changing demographics, political pressures, and economic fluctuations. These exper ...
392Improving the 21st-CenturyHealth Care SystemA.docxrhetttrevannion
39
2
Improving the 21st-Century
Health Care System
As discussed in Chapter 1, the American health care system is in need of
major restructuring. This will not be an easy task, but the potential benefits are
great. To cross the divide between today’s system and the possibilities of tomor-
row, strong leadership and clear direction will be necessary. As a statement of
purpose for the health care system as a whole, the committee endorses and adopts
the phrasing of the Advisory Commission on Consumer Protection and Quality in
the Health Care Industry (1998).
Recommendation 1: All health care organizations, professional
groups, and private and public purchasers should adopt as their
explicit purpose to continually reduce the burden of illness, injury,
and disability, and to improve the health and functioning of the
people of the United States.
It is helpful to translate this general statement into a more specific agenda for
improvement—a list of performance characteristics that, if addressed and im-
proved, would lead to better achievement of that overarching purpose. To this
end, the committee proposes six specific aims for improvement. Health care
should be:
• Safe—avoiding injuries to patients from the care that is intended to help
them.
• Effective—providing services based on scientific knowledge to all who
could benefit and refraining from providing services to those not likely to benefit
(avoiding underuse and overuse).
Co
py
ri
gh
t
@
20
01
.
Na
ti
on
al
A
ca
de
mi
es
P
re
ss
.
Al
l
ri
gh
ts
r
es
er
ve
d.
M
ay
n
ot
b
e
re
pr
od
uc
ed
i
n
an
y
fo
rm
w
it
ho
ut
p
er
mi
ss
io
n
fr
om
t
he
p
ub
li
sh
er
,
ex
ce
pt
f
ai
r
us
es
p
er
mi
tt
ed
u
nd
er
U
.S
.
or
a
pp
li
ca
bl
e
co
py
ri
gh
t
la
w.
EBSCO : eBook Academic Collection (EBSCOhost) - printed on 5/31/2019 6:16 AM via SOUTHERN NEW
HAMPSHIRE UNIV
AN: 86916 ; Committee on Quality of Health Care in America, Institute of Medicine.; Crossing the
Quality Chasm : A New Health System for the 21st Century
Account: shapiro.main.ehost
40 CROSSING THE QUALITY CHASM
• Patient-centered—providing care that is respectful of and responsive to
individual patient preferences, needs, and values and ensuring that patient values
guide all clinical decisions.
• Timely—reducing waits and sometimes harmful delays for both those
who receive and those who give care.
• Efficient—avoiding waste, in particular waste of equipment, supplies,
ideas, and energy.
• Equitable—providing care that does not vary in quality because of per-
sonal characteristics such as gender, ethnicity, geographic location, and socio-
economic status.
Recommendation 2: All health care organizations, professional
groups, and private and public purchasers should pursue six major
aims; specifically, health care should be safe, effective, patient-cen-
tered, timely, efficient, and equitable.
The committee believes substantial improvements in safety, effectiveness,
patient-centeredness, timeline.
CASE 10The Strategies to Overcome and Prevent Obesity Alliance.docxtidwellveronique
CASE 10
The Strategies to Overcome and Prevent Obesity Alliance
ERICA BREESE, CASEY LANGWITH, CHRISTINE FERGUSON, GINAMARIE MANGIARACINA, AND ALLISON MAY ROSEN
A WEIGHTY ISSUE
Imagine a disease that affected two thirds of adults in the United States, with a prevalence that had doubled in the last 25 years and showed no sign of stopping its upward trend. One would expect any disease this widespread would receive national attention both in the media and policy arena. Policy makers would demand insurance coverage for treatment and prevention. The public would actively protect themselves and their families from contracting the disease or seek treatment if they contracted it. Physicians would screen for the disease regularly and have straightforward conversations with those who contracted the disease. The American public health and medical systems would be geared toward treating and preventing further spread of this disease.
Surprisingly, there is a disease that currently affects two thirds of the U.S. population, yet has not received the expected response. In 2009, 66.4% of the adult population in the United States was overweight or obese (body mass index ≥ 25),i which is more than twice the prevalence rate from 3 decades before.1,2 Adults are not the only ones affected; childhood obesity rates have also tripled in the last 30 years.3 Additionally, if the existing rates of increase continue, 86.3% of U.S. adults will be overweight and 51.1% will be obese by 2030.4 These are staggering numbers for any health condition, but especially one that is related to a multitude of chronic diseases, such as diabetes, hypertension, high cholesterol, stroke, heart disease, certain cancers, and arthritis.5 Beyond the individual health risks, overweight and obesity also contribute to increased health costs, both nationally and for individuals. For example, in 2008, medical spending attributable to obesity was estimated to have been $147 billion, accounting for 9.1% of annual medical spending.6
These statistics show obesity plays a major role in the U.S. healthcare system and affects the lives of millions of Americans. However, despite the extreme prevalence of obesity, the disease often does not receive adequate attention in the healthcare community. In 2010, First Lady Michelle Obama launched her Let’s Move campaign, which aims to reduce childhood obesity within a generation, helping to bring the issue of childhood obesity to the forefront. In contrast, adult obesity continues to garner little interest. Some groups, however, are focusing on this often overlooked area because they believe real change can be made. The Strategies to Overcome and Prevent (STOP) Obesity Alliance is a collaboration of consumer, provider, government, labor, business, health insurance, and quality-of-care organizations united to drive innovative and practical strategies that combat obesity. The alliance’s history is unique, demonstrating how partnerships among public relations te ...
CASE 10The Strategies to Overcome and Prevent Obesity AllianceTawnaDelatorrejs
CASE 10
The Strategies to Overcome and Prevent Obesity Alliance
ERICA BREESE, CASEY LANGWITH, CHRISTINE FERGUSON, GINAMARIE MANGIARACINA, AND ALLISON MAY ROSEN
A WEIGHTY ISSUE
Imagine a disease that affected two thirds of adults in the United States, with a prevalence that had doubled in the last 25 years and showed no sign of stopping its upward trend. One would expect any disease this widespread would receive national attention both in the media and policy arena. Policy makers would demand insurance coverage for treatment and prevention. The public would actively protect themselves and their families from contracting the disease or seek treatment if they contracted it. Physicians would screen for the disease regularly and have straightforward conversations with those who contracted the disease. The American public health and medical systems would be geared toward treating and preventing further spread of this disease.
Surprisingly, there is a disease that currently affects two thirds of the U.S. population, yet has not received the expected response. In 2009, 66.4% of the adult population in the United States was overweight or obese (body mass index ≥ 25),i which is more than twice the prevalence rate from 3 decades before.1,2 Adults are not the only ones affected; childhood obesity rates have also tripled in the last 30 years.3 Additionally, if the existing rates of increase continue, 86.3% of U.S. adults will be overweight and 51.1% will be obese by 2030.4 These are staggering numbers for any health condition, but especially one that is related to a multitude of chronic diseases, such as diabetes, hypertension, high cholesterol, stroke, heart disease, certain cancers, and arthritis.5 Beyond the individual health risks, overweight and obesity also contribute to increased health costs, both nationally and for individuals. For example, in 2008, medical spending attributable to obesity was estimated to have been $147 billion, accounting for 9.1% of annual medical spending.6
These statistics show obesity plays a major role in the U.S. healthcare system and affects the lives of millions of Americans. However, despite the extreme prevalence of obesity, the disease often does not receive adequate attention in the healthcare community. In 2010, First Lady Michelle Obama launched her Let’s Move campaign, which aims to reduce childhood obesity within a generation, helping to bring the issue of childhood obesity to the forefront. In contrast, adult obesity continues to garner little interest. Some groups, however, are focusing on this often overlooked area because they believe real change can be made. The Strategies to Overcome and Prevent (STOP) Obesity Alliance is a collaboration of consumer, provider, government, labor, business, health insurance, and quality-of-care organizations united to drive innovative and practical strategies that combat obesity. The alliance’s history is unique, demonstrating how partnerships among public relations te ...
2 8 5L e a r n I n g o b j e c t I v e sC H A P T E R.docxlorainedeserre
2 8 5
L e a r n I n g o b j e c t I v e s
C H A P T E R 1 0
Q U A L I T Y M A N A G E M E N T I N
T H E P H Y S I C I A N P R A C T I C E
Quality and reliability are system properties.
—W. Edwards Deming
➤ Articulate the nature of performance management.
➤ Describe the approaches to performance improvement.
➤ Appreciate the impact of variation on performance.
➤ Discuss the components of the Triple Aim.
➤ Describe process improvement.
In t r o d u c t I o n
One of the most important issues to address in the medical practice is the quality and
safety of the care provided to patients. The Institute of Medicine (IOM 2001), a presti-
gious branch of the National Institutes of Health, stated in its landmark report Crossing the
Quality Chasm: A New Health System for the 21st Century, “In its current form, habits, and
environment, American health care is incapable of providing the public with the quality
health care it expects and deserves.”
C
o
p
y
r
i
g
h
t
2
0
1
7
.
H
e
a
l
t
h
A
d
m
i
n
i
s
t
r
a
t
i
o
n
P
r
e
s
s
.
A
l
l
r
i
g
h
t
s
r
e
s
e
r
v
e
d
.
M
a
y
n
o
t
b
e
r
e
p
r
o
d
u
c
e
d
i
n
a
n
y
f
o
r
m
w
i
t
h
o
u
t
p
e
r
m
i
s
s
i
o
n
f
r
o
m
t
h
e
p
u
b
l
i
s
h
e
r
,
e
x
c
e
p
t
f
a
i
r
u
s
e
s
p
e
r
m
i
t
t
e
d
u
n
d
e
r
U
.
S
.
o
r
a
p
p
l
i
c
a
b
l
e
c
o
p
y
r
i
g
h
t
l
a
w
.
EBSCO Publishing : eBook Academic Collection (EBSCOhost) - printed on 4/16/2020 7:48 PM via SUNY CANTON
AN: 1839064 ; Wagner, Stephen L..; Fundamentals of Medical Practice Management
Account: s8846236.main.ehost
F u n d a m e n t a l s o f M e d i c a l P r a c t i c e M a n a g e m e n t2 8 6
Another historic IOM (2000) report, To Err Is Human: Building a Safer Health
System, indicated that a shocking number of people—an estimated 44,000 to 98,000 per
year—are harmed by the healthcare system. A more recent study found that this number
has increased since publication of the 2000 IOM report despite substantial efforts to
improve. Medical errors have now become the third leading cause of death in the United
States (Makary and Daniel 2016).
The complexity of medical service and the inconsistency with which these services
are delivered, not to mention the fragmented nature of the system, have led to a number
of quality concerns (Mosadeghrad 2014), including a lack of systematic approaches to care
delivery and quality improvement. Efforts to improve quality in the medical profession
have a long tradition of focusing on individual performance versus system performance.
Exhibit 10.1 illustrates the potential flaw in this thinking. The bell-shaped curve, P-1,
represents the overall performance of any given system. Curve P-2 illustrates an improved
system of performance where the median performance is moved from M-1 to M-2. If an
organization seeks to improve by only focusing on the low performers, it experiences only
a small improvement, shown as I-1. By improving th ...
There have been numerous efforts by payers and providers to improve patient access to high-functioning medical homes—an enhanced model of primary care that offers whole-person, comprehensive, ongoing, and coordinated patient- and familycentered care. Public payers, especially Medicaid, have been leaders in these efforts, with the hopes of preventing illness, reducing wasteful fragmentation, and averting the need for costly emergency department visits, hospitalizations, and institutionalizations. With the support of The Commonwealth Fund, the National Academy for State Health Policy (NASHP) has fostered these efforts through the Consortia to Advance Medical Homes for Medicaid and CHIP Participants.
Similar to The Multi-StakeholderPatient Centered Medical Home - Movement For Primary Care Renewal And Reform (20)
The Patient-Centered Medical Home in the Transformation From Healthcare to He...Paul Grundy
Surgeon General of the Navy VADM Matthew L. Nathan, MC USN
Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.
Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, Where patients take a leading role and responsibility. Objective: To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine
whether access, quality, and cost impacts differ by chronic condition status. Design, setting, and patients: This study
conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Results: Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care.
National Conference on Health and Domestic Violence. Plenary talk Paul Grundy
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
PCMH implementation, highly associated with important outcomes for both patients and providers. The rate of emergency department visits was significantly
lower in sites with more PCMH effective implementation. Efficient PCMH implementation favorably associated with patient satisfaction, staff burnout, quality of care, and use of health care services.
A systematic review of the challenges to implementation of the patient-centre...Paul Grundy
review the available literature to identify the major challenges and barriers to implementation and adoption of the patient-centred medical home (PCMH) model, topical in current Australian primary care reforms. documents the key challenges and barriers to implementing the PCMH model in United States family practice. It provides valuable
evidence for Australian clinicians, policymakers, and
organisations approaching adoption of PCMH elements
within reform initiatives in Australia.
"'I am proud that MaineCare has been working in partnership with other payers to advance payment reform through greater investment in primary care to both improve outcomes for patients and reduce preventable high cost spending in emergency departments and avoidable inpatient admissions.
– Mary C. Mayhew, Commissioner, Maine Department of Health & Human Services
Effective integration of specialty practices into medical neighborhoods is likely to require several important environmental precursors. First, a sound infrastructure
design can connect PCMHs to the spectrum of surrounding
specialty practices. An aligned information architecture
will be vital to adequate patient access, care coordination, and communication. Second, a patient centered
neighborhood will rely on an organizational culture that
supports shared learning and transparency of performance and cost data among participating practices. Third, payment incentives will have to be aligned around shared accountability for outcome and cost. Responsibility
for outcomes and total cost of care will have to rest not only with primary care clinicians, but also with specialists who perform(often expensive) procedures and specialty services.The launch of the NCQA’s PCSP recognition program is a sign of a new phase of delivery system reform
Summary -- Patient Centered Medical Home the Necessary Foundation for Accountable Care and Population Management.
In the next 10 years, we will be living in 1) mobile world 2) in the middle of an aging and chronic disease epidemic and 3) data. But , we will also have the ability to analyze data in a cognitive way this will do for doctors’ minds what X-ray and medical imaging have done for their vision. How? By turning data into actionable information. Take, for instance, IBM’s intelligent supercomputer, Watson. Watson can analyze the meaning and con-text of human language and quickly process vast amounts of information. With this in-formation, it can suggest options targeted to a patient’s specific circumstances.
We need the basic foundation to support this transformation a system integrator where data at the level of a patients flows and is held accountable and that model is the Patient Centered Medical Home. (PCMH) starts to happen when clinicians/ healers step up to comprehensive relationship based care empowered by tools to manage the data and communicate effectively. This move to PCMH level care requires the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system and all of that is power by data made into meaningful information.
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
The Patient-Centered Medical Home (PCMH) lies at the center of the effort to get at population health, integrated and coordinated care. PCMH is where the Primary care healer leads an organization that delivers clinician-led primary care, with comprehensive, accessible, holistic, coordinated, evidence-based coordination and management. In the USA this is now the standard in the US Veterans Administration and the US Military and under the ACA.
OVERVIEW -- Care by Design - Putting Care back into healthcare the University of Utah experience in building PCMH level care over the decade of 2001 to . 2011
Care by design magill lloyd successful turnaroundPaul Grundy
The University of Utah purchased a 100-clinician, 9-practice multispecialty primary care network in 1998. The university projected the network to earn a profit the first year of its ownership in a market with growing capitation; however, capitation declined and the network incurred up to a $21 million operating loss per year. This case study describes the financial turnaround of the network.
Care by design 2 bodenheimer teams 2 utah chapterPaul Grundy
Putting Care back into healthcare the University of Utah experience in building PCMH level care. this talks about the team base experice as written up in 2007 by Tom Bodenheimer.
New zealand cantabury timmins-ham-sept13Paul Grundy
This is a great example of a community in New Zealand of the interrogation of social services and healthcare. They are changing the demand curve and getting away from “we need more and more resources to see more patients”. The language we use, very deliberately, is “right care, right place, right time”. Once you start getting the whole
system to work as one system, it starts flushing out unnecessary expenditure. So you can do more and/or do it better.’ worth a read.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Urgency Of Problem
the 29 April 2009 House Committee on Ways and care. Sen. Orrin Hatch (R-UT), at a Senate Fi-
Means hearing, “Health Reform in the 21st Cen- nance Committee hearing in April 2009, stated,
tury.” IBM covers more than 450,000 employ- “The U.S. is first in providing rescue care, but
ees, dependents, and retirees in the United this care has little or no impact on the general
States, at a cost of $1.3 billion in 2008. population. We must put more focus on primary
The committee asked MacDonald what he con- care and preventive medicine. How do we trans-
sidered the single most important repair to the form the system to do this?”8 President Barack
health care system. He replied, “Strengthen pri- Obama shared similar concerns at a White House
mary care—transform it and pay differently us- forum, declaring, “We’re not producing enough
ing a model like the patient-centered medical primary care physicians.”9 Building an effective
home.” When MacDonald was asked to identify primary care workforce subsequently became
the next most important issue, he answered, “If one of the key recommendations for health
you don’t fix the first issue and do not have reform from former Senate Majority Leaders
a foundation of powerful primary care, then Howard Baker, Bob Dole, and Tom Daschle.10
you can do nothing else. …Primary care is foun- In drafting health reform bills in 2009, legis-
dational, but we need it to be smarter, with lators in the House and Senate included a variety
the tools and payment reform to allow it to be of measures to strengthen primary care, such as
better integrated, continuous, coordinated, and increases in Medicare and Medicaid fees for pri-
comprehensive.”6 mary care, medical home demonstration pro-
IBM has been a leader among U.S. corpora- grams, increased funding for National Health
tions in demonstrating its willingness to invest Service Corps primary care scholarships and
in revitalization of primary care. It has piloted loan repayment, incentives for recruiting stu-
new approaches to supporting and paying for dents into rural medicine, and a primary care
primary care with its contracting health plans; extension program to support practice improve-
made primary care visits and preventive services ment.With the enactment of health reform legis-
free of any cost sharing under its self-insured lation in March 2010, those steps now have the
plans; and spearheaded a national coalition of force of law behind them.
purchasers, provider organizations, and con- ▸▸ STATE GOVERNMENTS : State governments
sumer groups in the form of the Patient-Centered also have been spearheading innovations in pri-
Primary Care Collaborative. mary care. A leading state-level model is Com-
Government Perspective Public purchasers, munity Care of North Carolina. This program
contending with the same issues confronting links Medicaid and Children’s Health Insurance
private purchasers, are also leading initiatives Program (CHIP) enrollees to community-based
to invest in and redesign primary care. The na- primary care medical homes; provides technical
tion’s lagging clinical outcomes and high rates of assistance to improve chronic care; and employs
avoidable hospitalizations for patients with nurses, mental health workers, pharmacists, and
chronic conditions are particularly salient to other health professionals to collaborate in case
public purchasers. This is the case because pro- management for high-risk patients. In addition
grams such as Medicare and Medicaid cover a to operating on fee-for-service reimbursement,
disproportionate share of the population with the program pays primary care practices a per
chronic illnesses.7 member per month care coordination fee for
▸▸ MEDICARE : Medicare policies have effects each patient registered with the practice, in
that extend well beyond beneficiaries. Because the amount of $2.50 per month for children
Medicare is the largest single buyer of care, many and $5.00 for aged and disabled patients. Started
companies, such as IBM, buy health care the as a pilot program in 1998, Community Care of
same way Medicare does. Private payers often North Carolina now involves more than 1,300
base their physician fee schedules on the Medi- community-based practices, 4,500 primary care
care resource-based relative value scale, thereby clinicians, and 970,558 enrollees throughout
extending the widening gap in Medicare com- North Carolina. Evaluations have documented
pensation for primary care and specialty serv- that this model has improved quality and saved
ices. Medicare is also the dominant source of the state $400 million in 2008.11,12
funds for residency training, providing nearly Consumer Perspective Consumers experi-
$9 billion annually to hospitals for graduate ence frustration and adverse health outcomes
medical education with few requirements about as a result of fragmentation of care and difficulty
the distribution of funded residency positions gaining access to primary care. “Where Have All
between primary care and specialty fields. the Doctors Gone?” queried a headline in the
▸▸ FEDERAL GOVERNMENT : One of the few 2 September 2008 issue of AARP Today, relating
areas of bipartisan agreement in health reform the plight of seniors unable to find a primary care
has been to place more emphasis on primary physician.13 A Harris poll from that same month
2 H E ALT H AF FAI RS M AY 2 0 1 0 2 9 :5
3. found that 67 percent of U.S. adults rated as The Commonwealth Fund survey also impli-
extremely or very important “the ability to have cates U.S. primary care clinicians for not having
a relationship with a doctor who takes a whole- taken more ownership of improving aspects of
person approach to patient care (social, mental care more directly under their control. Only
and physical care) and who provides care for all 29 percent of U.S. primary care physicians re-
levels of health.”14 More than half, or 56 percent, ported that they had after-hours arrangements
reported “difficulty navigating the healthcare for their patients “to see a doctor or nurse with-
system for themselves and/or their family out going to the [emergency room].”17 The
members.” United States ranked the lowest among the
Testifying at a May 2009 Senate Finance Com- eleven nations surveyed on this metric.
mittee hearing, AARP president Jennie Chin Primary care physician organizations have en-
Hansen stated, “Effective practice models that dorsed getting their own medical house in order.
emphasize, encourage, and improve primary The American Academy of Family Physicians’
care should be expanded and incentives should Future of Family Medicine project called for
be created to encourage individuals to practice in new models of practice.18 The academy invested
primary care. …Strengthening the primary care resources to develop the TransforMED center to
workforce is an essential part of ensuring the facilitate and provide technical assistance for a
provision of quality affordable health care for national demonstration project of practice trans-
all.”15 formation. Other primary care physician organ-
There is an urgent need for solutions as access izations have mounted their own primary care
issues become more visible. More than thirty improvement programs.
consumer organizations, including AARP, the
AFL-CIO, Consumers Union, Families USA, the
NAACP, and the National Partnership for Building A Coalition For Renewal
Women and Families, have endorsed a statement And Reform
of principles, titled “The Medical Home from the Purchasers, consumers, and clinicians are form-
Consumer’s Perspective.”16 ing a coalition to renew and reform primary care.
Primary Care Clinician Perspective Pri- They are motivated by the shared beliefs that
mary care clinicians often feel undervalued primary care is vital to a well-functioning health
and overwhelmed. They experience a paradox: system and that the traditional focus of primary
Primary care is more important than ever in the care—care that is accessible, comprehensive,
twenty-first century, but the approach to deliv- and integrated and that fosters a healing rela-
ering it is stuck in the early twentieth century. A tionship over time in the context of family and
growing array of evidence-based interventions community—remains just as relevant today for
can be applied in primary care settings to prevent achieving high-value health care as when first
disease, manage chronic illness, and alleviate articulated decades ago.19,20
suffering. At the same time, the coordinating Need For Practice Redesign The call for re-
role of primary care has taken on added value form, and not simply renewal, derives from the
in proportion to the increasing complexity of belief that the form for delivering the traditional,
modern health care. And health information core primary care functions of first-contact
technology (IT) makes possible new ways to accessibility, comprehensiveness, coordination,
communicate with patients over space and time, and continuity must be retooled in the context of
integrate care, and measure and manage the care twenty-first-century health care. Dysfunctional
of a defined population of patients. practice models must be redesigned to better
Despite these advances, investment in primary meet the needs of patients and primary care cli-
care has lagged in the United States. This inat- nicians alike.
tention is seen not only in the widening gap in For example, primary care practices must
earnings between primary care physicians and adopt new methods to promote access, such as
specialists, but also in the undercapitalization of same-day “open access” appointment systems, as
primary care practices. A 2009 Commonwealth well as Web portals for secure e-mailing and com-
Fund survey found that fewer than half of pri- munication of laboratory results. The achieve-
mary care physicians in the United States had an ment of comprehensive, coordinated care for
electronic health record in their offices, com- patients with chronic illnesses requires team-
pared with more than 90 percent of primary care based models of primary care that can pro-
physicians in most European nations surveyed. actively intervene to avert deterioration of con-
U.S. primary care physicians were also much less ditions such as heart failure and asthma, activate
likely than their European counterparts to have patients in the self-management of their diabetes
practice teams that included nonphysicians to and other chronic illnesses, and use electronic
collaborate on chronic care management.17 registries to track key clinical metrics.21
M AY 20 1 0 2 9 :5 HEA LT H AFFA IR S 3
4. Urgency Of Problem
New Levels Of Agreement Renewal and re- The Future Of Primary Care Is Now
form of primary care in the United States Across the nation, examples can be found where
requires a new compact among purchasers, con- the future is already here for primary care.
sumers, and clinicians. Purchasers and consum- Whole Child Pediatrics Xavier Savilla oper-
ers must value primary care, invest resources to ates Whole Child Pediatrics near Tampa Bay,
revitalize the primary care infrastructure, sup- Florida, a solo practice providing services in En-
port innovative models of care, and provide glish and Spanish to patients insured by a variety
greater incentives for careers in primary care. of health plans, including Medicaid. Savilla re-
In return, primary care clinicians must accept gards his patients and their families as equal
greater accountability for performance stan- partners in his practice.
dards, be receptive to innovation and practice Whole Child Pediatrics has an electronic
redesign, and embrace a more patient-centered health record with a patient portal, and families
approach.22 Terms such as patient-centered medi- review the medical record at the end of each visit.
cal home and advanced primary care models have Parents of children in the practice serve on an
come into use to convey this spirit of renewal and advisory board for Whole Child Pediatrics. Chil-
reform of primary care.23 dren with asthma monitor their peak-flow tests
Shared Vision The goal of renewal and reform at home in tandem with an Internet-based self-
appear to be in sight, thanks to a shared vision management program. In the past two years,
among stakeholders for the future of primary only one of the asthmatics under Savilla’s care
care, and an unprecedented willingness of stake- has required hospitalization. Family ratings of
holders to work together. The catalyst for this the practice are exceptionally high.27
partnership has been the Patient-Centered Pri- Redlands Family Practice In Southern Cal-
mary Care Collaborative, a coalition of more than ifornia, Redlands Family Practice focuses on pa-
600 organizations, including large employers tients at the other end of the age spectrum. This
such as IBM, Boeing, GlaxoSmithKline, Good- private practice of three family physicians, a
year, and Whirlpool; consumer groups; unions; physician assistant, a registered nurse, and five
primary care clinician organizations; and other office staff was recently profiled in Health Affairs
groups, with a mission to “advance the patient- as a “medical home run” for its ability to improve
centered medical home.”1,24 care while lowering costs.28 Concentrating on
One of the collaborative’s first major achieve- enhanced care for elderly patients with chronic
ments was to overcome the historical divisions illnesses, the Redlands Family Practice model
between primary care specialty groups. In 2007 includes round-the-clock phone access, a team-
the American Academy of Family Physicians, oriented approach, proactive nursing outreach,
American Academy of Pediatrics, American Col- and careful selection of specialists for referral.
lege of Physicians, and American Osteopathic Medical Associates Clinic Of Dubuque In
Association, collectively representing about Dubuque, Iowa, a group of general internists
one-third of U.S. physicians, agreed on a set of working in a 100-physician, multispecialty
joint principles of the patient-centered medical group practice has implemented an innovative
home.25 team model that closely pairs physicians with
The collaborative has subsequently worked registered nurses and licensed practical nurses
to make language in the joint principles more to create practice efficiencies, improve the qual-
inclusive of nurse practitioners, physician assist- ity of physician-patient interaction, and promote
ants, and other nonphysician clinicians, agree- more timely access to care.29,30
ing to support nurse practitioner–led patient- Eleventh Street Family Health Services
centered medical home pilots that conform to Eleventh Street Family Health Services, a
legal and clinical standards.26 nurse-managed, full-service, open-access com-
Through a combination of conferences, re- munity health center, serves residents of four
ports and brochures, technical assistance, advo- public housing developments and the surround-
cacy, and coalition building, the collaborative ing community. Through the practice’s combi-
has played a critical role in advancing primary nation of “one-stop shopping” with state-of-the
care reform. The diversity of its member organ- art disease management protocols, a predomi-
izations gives it a distinctive legitimacy and in- nantly poor and minority urban population has
fluence. Its positions cannot be dismissed as achieved improved hypertension and diabetes
simply those of self-interested professional control.31
groups, or as a one-sided attempt by purchasers Group Health Cooperative Integrated deliv-
and health plans to impose an unpopular organi- ery systems are reengineering primary care on a
zational model on physicians and patients—the broader scale. In 2007 Group Health Cooperative
type of criticism leveled at managed care reforms of Puget Sound piloted an advanced primary care
in the 1990s. model at one of its Seattle sites. It entailed hiring
4 H E ALTH A FFAI RS M AY 2 0 1 0 2 9 :5
5. additional primary care physicians to reduce the demonstration programs.36 The Department of
number of patients cared for by each physician; Defense announced a policy in September 2009
lengthening the duration of in-person visits; requiring implementation of the medical home
using more planned telephone and e-mail en- as a “comprehensive primary care model to im-
counters; building more team-based chronic prove patient satisfaction and outcomes”37 for all
and preventive care; and promoting round-the- members of the military’s health care system.
clock access using modalities such as electronic Community Health Centers Federally
health record patient portals. A twelve-month, funded community health centers have also been
controlled evaluation found that quality and pa- making steady progress in practice redesign,
tient experiences improved, emergency depart- supported in part by Health Resources and Serv-
ment visits and hospitalizations for ambulatory ices Administration (HRSA) initiatives such as
care–sensitive conditions decreased, and physi- health center chronic care collaboratives. In
cian and staff ratings of the work environment December 2009, President Obama committed
improved.32 Group Health is currently spreading funds to support the next level of primary care
this model to all twenty-six of its primary care transformation at these health centers.38
clinics, serving 380,000 patients. Department Of Veterans Affairs One of the
Other Factors These examples represent the least-heralded “big wins” in primary care trans-
innovators and early adopters of new models of formation has been the reorganization of the
primary care. For these types of models to be- U.S. Department of Veterans Affairs (VA) sys-
come the norm, systematic action from payers tem. Although there is widespread recognition
and purchasers is needed to provide the financial that the VA has refashioned itself into a quality
incentives, resources, and technical support to leader, much less appreciated is the instrumen-
drive large-scale transformation of primary care. tal role of primary care in this transformation.
Indeed, payers and purchasers appear to be mov- The VA continues to reorient its delivery model
ing in this direction. More than thirty states have around primary care, investing in the primary
followed North Carolina’s lead in implementing care workforce and ambulatory care facilities
advanced primary care models for their Medicaid and supporting integrated care models with a
and CHIP programs.33 well-functioning electronic health record.39
Private and public payers are beginning to col-
laborate on regional, multipayer projects to
reach a critical mass of practices and the majority Challenges And Opportunities
of the patients in these practices.34 For example, The compelling case for primary care, the devel-
in 2009 the Hudson Valley and Adirondack re- opment of a coalition of diverse stakeholders to
gions of New York embarked on major primary advocate for primary care, the promising exam-
care reform initiatives involving most private ples of innovators implementing advanced mod-
health plans in each region and Medicaid and els of primary care, and the evidence that
including more than 700 primary care clinicians. purchasers and payers are beginning to invest
Health plans and the New York State govern- in more-systematic transformation of primary
ment are supporting the implementation of care all bode well for the renewal and reform
health IT in the participating practices and offer- of U.S. primary care. Will this movement be
ing enhanced care coordination payments to transformative, creating a renaissance in pri-
practices meeting National Committee for Qual- mary care, or will it falter at the stage of early
ity Assurance (NCQA) medical home recognition adopters and demonstrations?
standards.35 Need For More Resources One key driver of
National Health Reform With the enact- sustained change will be the dedication of more
ment into law of comprehensive health reform resources to primary care, to increase primary
in March 2010, the federal government’s engage- care compensation and to support and reward
ment in primary care renewal is likely to be enhanced models of primary care. Concerns
intensified. The American Recovery and Rein- about the high costs of health care in the United
vestment Act (ARRA) of 2009 provided as much States are likely to make this a zero-sum game for
as $29 billion in health IT funding by 2016. It also the most part. Many purchasers and payers ex-
targeted a substantial amount of these funds to pect that there will be offsetting savings in other
assist primary care practices in purchasing elec- health sectors for the additional investments
tronic health records and achieving meaningful made in primary care. However, this expectation
use of this technology. will present political and policy challenges. A
In September 2009, Health and Human Serv- recent Medicare fee schedule revision that mod-
ices Secretary Kathleen Sebelius announced that estly increased primary care fees and reduced
states could petition to have Medicare partici- fees for imaging and certain procedural services
pate in state-based, multipayer, primary care in cardiology and other fields was greeted
M AY 20 1 0 2 9 :5 HEA LT H AFFA IR S 5
6. Urgency Of Problem
warmly by primary care specialty societies but to other reforms, such as accountable care or-
was roundly criticized by several specialty soci- ganizations, to reorient incentives and values
eties. The recently enacted health reform legis- across all health care tiers.40
lation will also boost payment for primary care Questions also remain about whether wide-
under both Medicare and Medicaid. But how spread transformation can occur across the
much further policy makers will push to revalue small, independent offices and clinics where
fees from specialty to primary care remains to be most primary care is delivered in the United
determined. States.41,42 Currently, successful scaling-up of
Short-Term Savings In addition, many pub- new models of primary care is largely happening
lic and private purchasers that have agreed to pay in integrated delivery systems. In nations with
more for medical home pilot programs have robust primary care systems, single-payer or co-
done so with the expectation that these pro- ordinated all-payer systems have provided a
grams will yield a short-term return on invest- means of implementing systematic reform of
ment, in the form of reduced expenditures for primary care, such as systemwide rollout of elec-
emergency department visits and hospitaliza- tronic health records and payment reforms. The
tions. Although some of the early programs have more diverse payment and delivery systems in
shown such favorable results,32,34 many primary the United States make implementing such
care advocates believe that the economic benefits broad transformation more difficult.
of primary care accrue over the long term. They Importance Of Primary Care Despite these
say that it is unrealistic to expect primary care challenges, a consensus has emerged that pri-
reforms to yield short-term savings from year to mary care is “too important to fail.”43 The goal
year in the face of the many inflationary pres- of a more affordable, effective, equitable, and
sures affecting the health system. There is worry sustainable health system for the American peo-
that purchasers’ enthusiasm for primary care ple cannot be achieved without renewal and re-
reform will wane if short-term savings fail to form of primary care. Talk about the importance
materialize. of primary care is hardly new in the United
Better Medical ‘Neighborhood’ There is States, yet the nation’s health system has been
also concern that even the best medical home remarkably resistant to past efforts to reshape it
might not achieve its promise of better health on a solid foundation of primary care. The
care value if located in a medical “neighborhood” unprecedented coalescing of diverse stakehold-
of hospitals and other provider organizations ers around a forward-looking vision of revital-
that resist integration of care and responsible ized primary care augurs well for a far different
stewardship of health care resources. In that outcome than in the past. ▪
case, primary care renewal may need to be linked
NOTES
1 Sepulveda MJ, Bodenheimer T, pensive healthcare is not always the 9 Pear R. Shortage of doctors an ob-
Grundy P. Primary care: can it solve best healthcare, says OECD’s Health stacle to Obama goals. New York
employers’ health care dilemma? at a Glance [Internet]. Paris: OECD; Times. 2009 Apr 26.
Health Aff (Millwood). 2008;27(1): 2009 Aug [cited 2010 Jan 3]. Avail- 10 Baker H, Daschle T, Dole B. Crossing
151–8. able from: http://www.oecd.org/ our lines: working together to re-
2 Galvin RS, Delbanco S. Between a document/14/0,3343,en_2649_ form the U.S. health care system
rock and a hard place: understand- 34487_44216846_1_1_1_1,00.html [Internet]. Washington (DC): Bipar-
ing the employer mind-set. Health 6 MacDonald JR. Testimony before the tisan Policy Center; 2009 Jun [cited
Aff (Millwood). 2006;25(6): House Committee on Ways and 2010 Apr 1]. Available from: http://
1548–55. Means [Internet]. Washington (DC): www.bipartisanpolicy.org/sites/
3 Williams G. Aggressive medical care House of Representatives; 2009 Apr default/files/6.17_Crossing
can lead to more pain with no gain. [cited 2010 Apr 13]. Available from: %20Lines_0.pdf
Consumer Reports. 2008;73(7): http://waysandmeans.house.gov/ 11 Steiner BD, Denham AC, Askin E,
40–4. hearings/Testimony.aspx?TID=2149 Newton NP, Wroth T, Dobson LA.
4 Wolverson R, Nichols L, Van de 7 Bodenheimer T, Berry-Millett R. Community Care of North Carolina:
Water PN, Baron JF, Muggah A, Follow the money—controlling improving care through community
Miller T, et al. Squaring healthcare expenditures by improving care for health networks. Ann Fam Med.
with the economy [Internet]. Wash- patients needing costly services. N 2008;6(4):361–7.
ington (DC): Council on Foreign Engl J Med. 2009;361(16):1521–3. 12 Mercer. Executive summary, 2008
Relations; 2009 Dec 8 [cited 2010 8 Senate Finance Committee. Community Care of North Carolina
Apr 1]. Available from: http:// Reforming America’s health care evaluation [Internet]. Phoenix (AZ):
www.cfr.org/publication/20909/ delivery system. Senate Finance Mercer; [cited 2010 Apr 1]. Available
squaring_healthcare_with_the_ Committee Roundtable. Washington from: http://www.community
economy.html?breadcrumb= (DC): U.S. Senate; 2009 Apr 21 carenc.com/PDFDocs/Mercer
%2Fpublication%2Fpublication_ [cited 2010 Apr 13]. Available from: %20ABD%20Report%20SFY08.pdf
list%3Ftype%3Dinterview http://finance.senate.gov/hearings/ 13 Barry P. Where have all the doctors
5 Organization for Economic Co- hearing/?id=d85e499a-01ed-23b6- gone? AARP Today. 2008 Sep 2.
operation and Development. Ex- 7c6e-a200e6bee498 14 Harris Interactive. Patient centered
6 HE A LT H A FFA IRS M AY 2 0 10 2 9 :5
7. medical home election study [Inter- cians, American Academy of Pediat- 35 O’Brien M. Landmark health initia-
net]. Washington (DC): Patient- rics, American College of Physicians, tive announced in Adirondacks [In-
Centered Primary Care Collabora- American Osteopathic Association. ternet]. WTen News. 2009 Oct 13
tive; 2008 Sep 10 [cited 2010 Jan 3]. Joint principles of the patient cen- [cited 2010 Jan 3]. Available from:
Available from: http://www.pcpcc tered medical home [Internet]. http://www.wten.com/Global/
.net/files/Harris%20Poll Washington (DC): Patient-Centered story.asp?S=11304947
%20Findings%20Summary.pdf Primary Care Collaborative; 2007 36 White House [Internet]. Washington
15 Hansen JC. Testimony: expanding Feb [cited 2010 Jan 8]. Available (DC): White House. Press release,
coverage in health care reform [In- from: http://www.pcpcc.net/ Secretary Sebelius announces Medi-
ternet]. Washington (DC): AARP; content/joint-principles-patient- care to join state-based healthcare
2009 May 5 [cited 2010 Jan 8]. centered-medical-home delivery system reform initiatives;
Available from: http://www.aarp 26 Ginsburg J, Taylor T, Barr MS. Nurse 2009 Sep 16 [cited 2010 Jan 3].
.org/makeadifference/advocacy/ practitioners in primary care [In- Available from: http://
GovernmentWatch/HealthCare/ ternet]. Policy Monograph. Phila- www.hhs.gov/news/press/
articles/testimony_expanding_ delphia (PA): American College of 2009pres/09/20090916a.html
coverage_in_health_care_reform Physicians; 2009 [cited 2010 Apr 1]. 37 Office of the Assistant Secretary of
.html Available from: http://www Defense. Policy memorandum, im-
16 National Partnership for Women and .acponline.org/advocacy/where_ plementation of the “patient cen-
Families. Principles for patient and we_stand/policy/np_pc.pdf tered medical home” model of
family centered care: the medical 27 Sevilla XD. AAP Fellows help identify primary care in MTFs [Internet].
home from the consumer’s perspec- quality measures for children’s care. Washington (DC): Department of
tive [Internet]. Washington (DC): AAP News. 2009;30(12):4. Defense; 2009 Sep 18 [cited 2010
National Partnership; 2009 Mar 30 28 Milstein A, Gilbertson E. American Jan 3]. Available from: http://
[cited 2010 Jan 8]. Available from: medical home runs. Health Aff www.bethesda.med.navy.mil/
http://www.nationalpartnership (Millwood). 2009;28(5):1317–26. patient/health_care/medical_
.org/site/DocServer/Advocate_ 29 Sinsky CA. Improving office practice: services/internal_medicine/
Toolkit-Consumer _Principles_ working smarter, not harder. Fam PCMH%20Policy%20Memo
3-30-09.pdf?docID=4821 Pract Manag. 2006;13(10):28–34. %20-%20signed.pdf
17 Schoen C, Osborn R, Doty MM, 30 Okie S. Innovation in primary care— 38 White House [Internet]. Washington
Squires D, Peugh J, Applebaum S, staying one step ahead of burnout. N (DC): White House. Press release,
et al. A survey of primary care Engl J Med. 2008;359(22):2305–9. Remarks by the president on com-
physicians in eleven countries, 31 Gerrity P. The Eleventh Street Family munity health centers; 2009 Dec 9
2009: perspectives on care, costs, Health Services, Drexel University [cited 2010 Jan 3]. Available from:
and experiences. Health Aff (Mill- [Internet]. Washington (DC): http://www.whitehouse.gov/the-
wood). 2009;28:w1171–83. American Academy of Nursing; press-office/remarks-president-
18 Future of Family Medicine Project [cited 2010 Apr 1]. Available from: community-health-centers
Leadership Committee. The Future http://www.aannet.org/files/ 39 Shear J. Primary care medical home,
of Family Medicine: a collaborative public/11thStreetFamilyHelthSvcs_ Veterans Health Administration
project of the family medicine com- template.pdf [PowerPoint presentation on the
munity. Ann Fam Med. 2004; 32 Reid RJ, Fishman PA, Yu O, Ross TR, Internet]. Presented at: PCPCC An-
Suppl 2:S3–32. Tufano JT, Soman MP, et al. A nual Summit. 2009 Oct 22; Wash-
19 Institute of Medicine. Primary care: patient-centered medical home ington, DC. Available from: http://
America’s health in a new era. demonstration: a prospective, quasi- www.pcpcc.net/files/PCPCC-10-09-
Washington (DC): National Acad- experimental, before and after P1-Shear.ppt
emies Press; 1996. evaluation. Am J Manag Care. 40 Rittenhouse DR, Shortell S, Fisher E.
20 Starfield B. Primary care. New York 2009;15(9):e71–87. Primary care and accountable care—
(NY): Oxford University Press; 1998. 33 Kaye N, Takach M (National Acad- two essential elements of delivery-
21 Bodenheimer T, Grumbach K. Im- emy for State Health Policy; Port- system reform. N Engl J Med. 2009;
proving primary care: strategies and land, ME). Building medical homes 361:2301–3.
tools for a better practice. New York in state Medicaid and CHIP pro- 41 Nutting PA, William L, Miller WL,
(NY): Lange Medical Books– grams [Internet]. p 114. New York Crabtree BF, Jaen CR, Stewart EE,
McGraw-Hill; 2008. (NY): Commonwealth Fund; 2009 et al. Initial lessons from the first
22 Bodenheimer T. Primary care—will it Jun 23 [cited 2010 Jan 3]. Available national demonstration project on
survive? N Engl J Med. 2006;355 from: http://www.idph.state.ia.us/ practice transformation to a patient-
(9):861–4. hcr_committees/common/pdf/ centered medical home. Ann Fam
23 Rittenhouse DR, Shortell SM. The medical_home/090209_building_ Med. 2009;7:254–60.
patient-centered medical home: will programs.pdf 42 Grumbach K, Mold JW. A health care
it stand the test of health reform? 34 Patient-Centered Primary Care Col- cooperative extension service:
JAMA. 2009;301:2038–40. laborative. Proof in practice: a com- transforming primary care and
24 Patient-Centered Primary Care Col- pilation of patient centered medical community health. JAMA. 2009;301
laborative. Patient-Centered Primary home pilot and demonstration (24):2589–91.
Care Collaborative [Internet]. Wash- projects [Internet]. Washington 43 Meyers DS, Clancy CM. Primary care:
ington (DC): PCPCC; [cited 2010 (DC): PCPCC; 2009 [cited 2010 too important to fail. Ann Intern
Apr 1]. Available from: http://www Jan 9]. Available from: http://www Med. 2009;150(4):272–3.
.pcpcc.net/files/PCPCCbrochure.pdf .pcpcc.net/files/PilotGuidePip_0
25 American Academy of Family Physi- .pdf
M AY 2 0 1 0 29:5 H E ALT H AF FAI RS 7
8. Urgency Of Problem
ABOUT THE AUTHOR: PAUL GRUNDY
problem in not demanding systems of for International SOS, the world’s
payment and practice organization largest medical assistance company,
that encourage and enable the and for Adventist Health Systems, the
accessible and coordinated patient- second largest nonprofit medical
focused primary care we desire,” he center in the world. He went to
Paul Grundy has says. medical school at the University of
helped IBM lead the “There is no money paid for the California, San Francisco, and trained
way in transforming necessary investments in teams and at the Johns Hopkins University.
the health care
health information systems,” Grundy The son of Quaker missionaries, he
system.
continues. “Current payment methods grew up “in the poorest country in the
As global director of healthcare reward medical procedures and world—Sierra Leone,” he says. “This
transformation at IBM, Dr. Paul Grundy discourage spending time with upbringing helped instill in me a need
is trying to shift health care delivery patients in such essential activities as to stand up for transformation.”
around the world toward consumer- history-taking, diagnosis, and Individuals and small groups can
focused, primary care–based systems. prevention. This must change.” change history by practicing the laws
Yet his father’s death last year A social entrepreneur and speaker of social change—such as sharing a
brought home to him “why I fight so on global health care transformation, common purpose or intent.”
hard to change what we buy for our Grundy, 58, is president of the To Grundy’s way of thinking, in
employees, our parents, our children. I Patient-Centered Primary Care health care “less is often more.” At
saw how my father’s primary care Collaborative—a coalition he led IBM least the uninsured, he says, are
physician—based on how she was in creating in 2006, one dedicated to protected from unnecessary surgery,
paid—lacked the incentive and the advancing a new primary care model or other forms of overtreatment and
ability to coordinate my father’s care. called the patient-centered medical toxic care that the current health care
So much was done to him and not for home. He is an adjunct professor at system encourages. “The terrible truth
him. We can do better.” the University of Utah’s Department is that you can no longer count on the
IBM has led the way for other of Family and Preventive Medicine. professionalism of the doctor to do
corporations to transform the health Before joining IBM in 2000, Grundy the right thing. If money can be made
care system, after concluding that “we was a senior diplomat in the State off your body, most likely it will be.”
the buyers have been part of the Department and the medical director
8 H E ALT H AF FAI RS M AY 2 0 1 0 2 9 :5