Physician Attitudes Toward Regionalization of Adult Critical Care 1.6.09
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The document reports the results of a national survey of 569 intensivist physicians regarding their attitudes toward regionalization of adult critical care. 59% saw their role as mainly receiving patients, while 30% saw it as mainly sending patients. Most physicians felt regionalization would improve survival rates, but many had concerns about unintended consequences. Key barriers to implementation identified included the need for strong central authority, strain on families, overwhelming capacity at large hospitals, and financial strain. Potential solutions included common IT platforms, clinical trials demonstrating benefits, and objective transfer criteria.
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![[object Object],[object Object],[object Object],[object Object],[object Object],Results Physician attitudes toward regionalization of adult critical care: results of a national survey Jeremy M. Kahn MD MS, Rebecca J. Asch BA, Theodore J. Iwashyna MD PhD, Kevin Haynes PharmD MSCE, Gordon D. Rubenfeld MD MS, Derek C. Angus MD MPH, David A. Asch MD MBA Table 1. Physician attitudes toward regionalization of adult critical care ,[object Object],[object Object],[object Object],Division of Pulmonary, Allergy & Critical Care, Leonard Davis Institute of Health Economics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia PA; Division of Pulmonary and Critical Care, University of Michigan School of Medicine, Ann Arbor, MI; Sunnybrook Health Sciences Centre, Toronto ON; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh PA Table 2. Rankings of barriers to regionalization and potential solutions * P < 0.001 for all comparisons * Percent responding “agree” or “strongly agree” Funding: Society of Critical Care Medicine Vision Grant ,[object Object],Background ,[object Object],Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Methods ,[object Object],[object Object],[object Object],Conclusions ,[object Object],[object Object],Limitations ,[object Object],[object Object],Policy Implications All respondents By perceived role * Receive Send N 569 333 169 Effect on patient load Increase Decrease No change 41% 11% 49% 68% 1% 32% 2% 35% 63% Effect on personal income Increase Decrease No change 30% 13% 58% 51% 6% 43% 3% 29% 68% Effect on patient survival Increase Decrease No change Unsure 52% 2% 12% 34% 59% 1% 12% 29% 46% 5% 12% 38% Effect on heath care efficiency Increase Decrease No change 66% 12% 22% 73% 8% 5% 65% 15% 20% Mean % agree * Perceived barriers Need for strong central authority 3.7 64 Personal strain on families 3.6 66 Overwhelm capacity at large hospitals 3.5 55 Financial strain on large hospitals 3.0 33 Physicians unwilling to relinquish income 2.9 31 Family opposition to transfer 2.8 30 Risk of interhospital transport 2.8 27 Negative impact on quality at small hospitals 2.7 24 MDs unwilling to relinquish autonomy 2.5 21 Potential solutions Common IT platforms within regions 4.3 86 Clinical trial showing benefit 4.2 81 Objective criteria for transfer 4.2 87 Becoming a referral hospital voluntary 3.2 45 Financial incentives to source hospitals 3.1 42 Financial incentives to source MDs 3.0 33](https://image.slidesharecdn.com/kahnjeremy-physicianattitudestowardregionalizationofadultcriticalcare-1-6-09-100819090748-phpapp01/85/Physician-Attitudes-Toward-Regionalization-of-Adult-Critical-Care-1-6-09-1-320.jpg)
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NGS-based diagnostic testing compared to single-marker genetic testing (SMGT), has the potential to improve testing efficiency and to identify more cancer patients who could benefit from targeted therapies, but the impact on outcomes and total costs of care is uncertain. Recent studies using simulation modeling informed with data from the Flatiron Health database, representing curated electronic health record-derived clinical information from 191 oncology practices, has shown only moderate cost effectiveness of NGS vs. SGMT for patients with advanced non-small cell lung cancer (aNSCLC). The data suggests, however, that efforts to increase the proportion of patients who receive targeted therapies would improve the cost-effectiveness of NGS. To effectively inform access and reimbursement policy decisions there is a need to examine the NGS value proposition from the perspective of all stakeholders.
Author(s) and affiliation(s): Lotte Steuten (Office of Health Economics, London, UK); Bernardo Goulart (Fred Hutchinson Cancer Research Center, Seattle, WA, US & Seattle Cancer Care Alliance, Seattle, WA, US); Neal J. Meropol (Flatiron Health, New York, NY, US & Case Western Reserve University, Cleveland, OH, US); Daryl Pritchard (Personalized Medicine Coalition, Washington, DC, US); and Scott D. Ramsey (Fred Hutchinson Cancer Research Center, Seattle, WA, US)
Event: ISPOR 2019
Location: New Orleans, LA, United States
Date: 20/05/2019
Implementing psychosocial care into routine practice: making it easy
1. This document discusses implementing a clinical pathway for screening and managing anxiety and depression in cancer patients. It outlines barriers to implementation and strategies to address them.
2. A key barrier is that screening alone does not improve outcomes; a clear clinical pathway and institutional support are needed. The pathway was developed through stakeholder consultation and specifies screening, assessment, referral, and treatment steps.
3. Barriers to implementing the pathway include lack of resources, responsibility issues, staff and patient reluctance. The proposed study will test intensive versus basic strategies to promote pathway uptake, including online training, automated screening/referral systems, and patient/staff educational resources. The goal is to improve psychosocial outcomes for cancer patients.
850 keynote savage_using his laptop
Digital medicine technologies like ingestible sensors and connected digital platforms have the potential to revolutionize healthcare by improving medication adherence and returning patients to the center of their own care. Preliminary clinical studies show these digital medicines can achieve near-perfect adherence rates even in high-risk patient groups and lead to significantly improved health outcomes, such as getting 98% of hypertension patients to their blood pressure goal after 12 weeks. The data from these connected digital platforms also enables more effective care by healthcare teams through targeted interventions and recommendations informed by real-time medication ingestion and response insights. As the technologies continue to miniaturize and costs reduce per Moore's Law, digital medicines may help address the worldwide problem of poor medication adherence and its huge impacts on patient
The Effect of Multi Disciplinary Care 3.26.09
This study examined the effect of multidisciplinary care teams on mortality in intensive care units. The study analyzed over 100,000 patients admitted to 112 hospitals. Hospitals with high-intensity staffing and daily multidisciplinary rounds had lower 30-day mortality compared to those without. Multidisciplinary care was associated with lower odds of mortality, even after accounting for physician staffing models. The presence of multidisciplinary care teams may help explain the survival benefits of intensivist physician staffing in intensive care units.
James Presentation - Holbrook et al
The study tested an electronic diabetes tracker shared between patients and providers to improve diabetes care. Patients in the intervention group had access to the tracker and decision support. They saw greater improvements in monitoring of diabetes factors and clinical outcomes like blood pressure and HbA1c levels compared to the control group. However, it is unclear if the improvements were due to the decision support, reminders, or more frequent provider visits in the intervention group.
2 amaddeo donisi tedeschi cephos enmesh 2015
This document summarizes a systematic review of pre-discharge factors associated with readmission after psychiatric hospitalization. The review identified 59 studies meeting inclusion criteria. Several patient characteristics were analyzed as potential predictors of readmission, including demographic factors, clinical diagnoses and history, and length of hospital stay. Length of stay and history of prior admissions most consistently predicted increased readmission risk across studies. However, results were not always consistent and many relationships require further investigation.
ASAM Poster_Final_Print1
This study evaluated the impact of integrating a substance abuse treatment program into population-based behavioral health care. The program identified individuals at risk for medical issues from substance use disorders and engaged them in treatment. Participants had 16% fewer ER visits and 67% fewer hospitalizations after treatment compared to before. Healthcare costs for participants dropped 46% on average after treatment. The findings suggest integrating substance abuse treatment programs into population health strategies can increase enrollment in treatment and reduce costs.
HL7: Clinical Decision Support
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The challenge of the end of-life discussion housestaff 2014
The document discusses end-of-life care for cancer patients in the United States. It finds that about 1/3 of patients with poor prognosis cancer spend their last days in hospitals and intensive care units. About 10% receive aggressive life-sustaining treatments near death. Use of hospice care varies widely between regions and hospitals, with some providing little or no hospice support. Early discussions about end-of-life care can help patients receive less aggressive care near death that aligns with their goals and values, and helps caregivers cope after death. However, patients have difficulty accepting terminal prognoses, and interventions simply providing prognostic information have not impacted care received or understanding on their own. A long-term process
Transformation In Chronic Disease Management Through Technology: Improving Pr...
June 22, 2009 presentation to Cambridge Health Network at King's Fund by Molly Joel Coye, MD, MPH, Founder and CEO Health Technology Center
Geriatric oncology 2019
1) Geriatric assessment is important for elderly cancer patients to evaluate multiple health domains beyond just cancer and avoid under or overtreatment.
2) Assessments can identify issues like frailty, nutrition, mood, functionality that require management to optimize outcomes and quality of life during cancer treatment.
3) A multidisciplinary approach including nutrition support, exercise interventions, and comprehensive management of geriatric conditions can improve survival and reduce complications in elderly cancer patients.
Reasons Underlying Inter Hospital Transfers to an Academic Medical Intensive ...
Reasons Underlying Inter Hospital Transfers to an Academic Medical Intensive ...Leonard Davis Institute of Health Economics
This study examined the reasons for transferring 138 critically ill patients from outside hospitals to an academic medical intensive care unit (MICU) over an 8-month period. Surveys of accepting physicians, referring physicians, patients, and families found varying opinions on the reasons for transfer. Experience and reputation of the accepting hospital were endorsed more by patients/families than physicians. There was moderate agreement between physicians on survival, experience, and family requests as major reasons for transfer. Reasons for transfer were complex with differing perspectives between stakeholders.Medical errors, negligence, and litigation
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- Only a small percentage (around 1-2%) of medical errors result in negligent injuries. Of those negligent injuries, only 10-13% result in malpractice claims.
- Common reasons for malpractice litigation include needing money, believing there was a cover up, or wanting information or revenge. However, the system rarely identifies or holds providers accountable for substandard care
Quill eol policy
The document discusses several key points about palliative care:
1) Palliative care aims to relieve suffering and improve quality of life for patients with advanced illnesses alongside medical treatment.
2) Two studies found that early palliative care led to improved quality of life and mood, less aggressive end-of-life care, and longer survival times for cancer patients.
3) A study of Medicaid patients found that palliative care consultations reduced hospital costs without reducing quality of care.
Role & Challenges in Cancer Treatment in Private Practice (1).pptx
Join me as I share the challenges I encountered in managing cancer patients in a private hospital in northern Sarawak. The talk uncovers various common limitations encountered in the management of cancer patients and was delivered to an audience of mainly general and subspecialty surgeons from Sarawak, Brunei and even peninsular Malaysia.
teamLift-ppt-v1
This document discusses predicting medication adherence through predictive modeling. It begins by outlining the problem of medication non-adherence and its impacts. It then describes the methodology used, which involved blending data from Medicare, drug information databases, and census data to derive predictors and classify patients based on adherence. Regression and decision tree models with 45 predictors were able to predict medication adherence days and classify patients as adherent or non-adherent. The inferences from the models supported the hypothesis that public health, personal, and medication factors influence non-adherence. The document concludes by discussing interventions like behavioral, financial, and clinical approaches that can be tailored to individuals to improve adherence.
Steve Shortell: Integrated care: Policy and evidence
This document discusses integrated care and provides evidence in support of more integrated models of care delivery. It makes three key points:
1) Current healthcare systems often fail to provide integrated care for patients with chronic conditions who require care from both primary physicians and hospitals. Effective coordination of this care can result in better outcomes and lower costs.
2) Integrated delivery systems (IDS) that provide coordinated, team-based care show promise in improving quality of care and health outcomes, especially for patients with chronic conditions. The Veterans Health Administration and Kaiser Permanente are cited as examples of high performing IDS models.
3) Evidence suggests that use of elements of the Chronic Care Model, such as patient registries, self
Similar to Physician Attitudes Toward Regionalization of Adult Critical Care 1.6.09 (20)
Computer Decision Support Systems and Electronic Health Records: Am J Pub Hea...
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THE CLINICAL AND ECONOMIC VALUE OF GENETIC SEQUENCING IN CANCER CARE
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Implementing psychosocial care into routine practice: making it easy
Implementing psychosocial care into routine practice: making it easy
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The challenge of the end of-life discussion housestaff 2014
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Transformation In Chronic Disease Management Through Technology: Improving Pr...
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Reasons Underlying Inter Hospital Transfers to an Academic Medical Intensive ...
Role & Challenges in Cancer Treatment in Private Practice (1).pptx
Role & Challenges in Cancer Treatment in Private Practice (1).pptx
Steve Shortell: Integrated care: Policy and evidence
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This study analyzed insurance claims data from before and after the implementation of the Federal Mental Health Parity and Addiction Equity Act to examine the effects of parity on substance use disorder treatment. The results showed:
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This study analyzed data from 658 insured pregnant women in a Midwestern county to compare risks and outcomes between those who did and did not utilize the emergency department (ED) during their peripartum period. The study found that 218 women (33%) visited the ED at least once during this time. ED users were more likely to experience psychosocial risks like postpartum depression and smoking, have poorer birth outcomes like prematurity, and have inadequate prenatal care. After adjusting for demographic factors, ED use was associated with a higher likelihood of postpartum depression, smoking during pregnancy, unstable housing, delayed prenatal care initiation, and missing a postpartum visit.Non-Medically Indicated Delivery Prior to 39 Weeks Gestation in United State...
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This study explored a broader range of adverse childhood experiences reported by low-income adults from Philadelphia compared to those measured in previous research. The researchers conducted focus groups with 119 participants who generated a list of childhood stressors across 10 domains. The most commonly reported experiences were issues within family relationships, community safety threats, personal victimization, and economic hardship. The study concludes that considering a wider range of adversities is important for understanding health impacts on low-income urban populations.The Intersection of Attitudes and Organizational Factors by Provider Type in ...
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This document summarizes a mixed-methods study examining the relationship between mental health therapists' attitudes towards evidence-based practices (EBPs), perceptions of organizational factors, and degree status. The study found that doctoral-level therapists with positive attitudes reported more autonomy, while those with less positive attitudes reported requirements to use CBT and lack of time. Non-doctoral therapists reported lack of resources, space, funding, and regular client access as barriers. Managerial support was a facilitator for all therapists. The study provides insight into implementation challenges faced in community clinics from front-line perspectives.Doulas to fill the gap: a proposed model of doula delivery of cognitive-behav...
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Most internists found more similarities than differences in caring for young adults with intellectual and developmental disabilities (I/DD) and elderly adults with dementia. Both populations require longer office visits and more staffing resources due to complex health histories. Obtaining records and coordinating care can be difficult for both. Reliance on advocates, community services for transportation and supervision, and vulnerability to insurance changes are also similarities. While specific diseases differ, models for geriatric care could potentially address supervision and caretaking needs for adults with I/DD. Strengthening safety net services would help low-income families and elderly patients with dementia or I/DD.Is the quality of case management in a medical home associated with patient s...
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This study analyzed survey data from 50,698 individuals in Southeastern Pennsylvania between 2002-2010 to compare HIV testing rates to other routine health screenings. It found that HIV testing rates were lower than for other conditions. Those receiving care at community health clinics, emergency rooms, or with no primary care had higher odds of receiving an HIV test compared to private clinics. While community health clinics performed similarly to private clinics on other screenings, emergency rooms and no primary care had lower rates. The study suggests primary care physicians may neglect appropriate HIV screening of patients despite adhering to other screening guidelines.High Value Cost Conscious Care: Is it Rationing or Rational Care? 1_11_13
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LDI Charles Leighton Memorial Lecture with Mark Chassin, MD 5_4_12
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Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
Ageing, the Elderly, Gerontology and Public Health
Ageing, the Elderly, Gerontology and Public Health