“On the Margins and Not the Mainstream": Case Selection for the Implementation of Community based Primary Health Care in Canada and New Zealand

Healthcare system reforms are pushing beyond primary care to more holistic, integrated models of community based primary health care (CBPHC) to better meet the needs of the population. In order to scale up and spread successful models of care it is important to study what works and why. The first step is to select "appropiate" cases to study. In this commentary, this study reflect the difficulty in identifying "successful" models to study, the value of drawing on clinical and organisational networks and experts, and the association between policy context and ease of case selection. Such insights have important implications for ...

The role of informatics in patient-centered care and personalized medicine

This article covers the critical role that laboratory information systems, electronic medical records, and digital imaging plays in patient-centered personalized medicine. The value of integrated diagnostic reports, clinical decision support, and the use of whole-slide imaging to better evaluate cytology samples destined for molecular testing is discussed. This article also highlights the barriers to the widespread adoption ot these disruptive technologies due to regulatory obstacles, limited commercial solutions, poor interoperability, andlack of standardization. 

User-Centered Design of a Tablet Waiting Room Tool for Complex Patients to Prioritize Discussion Topics for Primary Care Visits.

Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by the limited time allotted to primary care visits.

OBJECTIVE:

Our aim was to employ a user-centered design process to create a tablet tool for use by patients for visit discussion prioritization.

METHODS:

We employed user-centered design methods to create a tablet-based waiting room tool that enables complex patients to identify and set discussion topic priorities for their primary care visit. In an iterative design process, we completed one-on-one interviews with 40 patients and their 17 primary care ...

Integrating primary care providers in the care of cancer survivors: gaps in evidence and future opportunities

Since the release of the Institute of Medicine report: From cancer patient to cancer survivor: lost in transition, in 2005, there has been a national call in the USA to provide coordinated, comprehensive care for cancer survivors, with an emphasis on the role of primary care. Several models of care have been described, which focus on primary care providers (PCPs) as receiving cancer survivors who are transferred after successful treatment, and who are given specific types of information from oncology-based care (eg, survivorship care plans), and not as active members of the cancer survivorship team. They provide recommendations for education ...

Optimising the community-based aproach to health care improvement comparative case studies of the clinical community model in practice

Community-based approaches to healthcare improvement are receiving increasing attention. Such approaches could offer an infrastructure for efficient knowledge-sharing and a potent means of influencing behaviours, but their potential is yet to be optimised. After briefly reviewing challenges to community based approaches this study describes in detail the clinical community model. Through exploring clinical communities in practice, they seek to identify practical lessons for optimising this community-based approach to healthcare improvement. 

Achieving Health Equity: A Guide for Health Care Organizations

This white paper provides guidance on how health care organizations can reduce health disparities related to racial or ethnic group, religion; socioeconomics status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity, geographic location; or other characteristics historically linked to discrimination or exclusion. 

It includes: 

-A framework, with five key components, for health care organizations to improve health equity in the communities they serve

- Guideance for measuring health equity

- A case study of one health care organization that has strategically integrated work to improve health equity throughout their system

- A self- assessment tool for health ...

4 Steps to Sustaining Improvement in Health Care

Leading health care organizations recognize that improving care isn´t enough; having a systematic approach to sustaining improvement is equally important.

To learn how to build systems that sustain improvement, the Institute for Healthcare Improvement studied health care organizations that were able to achieve standout results and ten build on them- organizations such as Intermountain Healthcare in Salt Lake City; Saskatoon Health Region in Saskatchewan, Canada; and Virginia Mason Health System in Seattle. These high-performing health systems affered a key insight: To sustain change, you need a strong strategy for engaging and standardizing the work of frontline managers. From their ...

Community health center provider ability to identify, treat and account for the social determinants of health: a card study

The social determinants of health (SDH) are conditions that shape the overall health of an individual on a continuous basis. As momentum for addressing social factors in primary care settings grows, provider ability to identify, treat and assess these factors remains unknown. Community health centers care for over 20- million of America´s highest risk populations. This study at three centers evaluates provider ability to identify, treat and code for the SDH.

The results suggest simple methods of identification may be sufficient. The addition of searchable codes and reimbursements may improve the way social factors are addressed for individuals and ...

How do we know? An assessment of integrated community case management data quality in four districts of Malawi

The World Health Organization contracted annual data quality assessments of Rapid Access Expansion (RAcE) proyects to review integrated community case management (iCCM) data quality and the monitoring and evaluation (M&E) system for iCCM, adn to suggest ways to improve data quality. 

This data quality assessment illuminates where an otherwise strong M&E system for iCCM fails to ensure some aspects of data quality. Prioritizing data management with documented protocols, additional training and approaches to create efficient supervision practices may improve iCCM data quality. 

Zero to 50,000 — The 20th Anniversary of the Hospitalist

Twenty years ago, were describe the emergence of a new type of specialist that is called a "Hospitalist". Since then, the number of hospitalists has grown from a few hundred to more  than 50.000- making this new field substantially larger than any subspecialty of internal medicine, about the same size as pediatrics, and in fact larger than any specialty except general internal medicine and family medicine. Approximately 75% of U.S hospitals, including all highly ranked academic health centers, now have hospitalists. The field´s rapid growth has both reflected and contributed to the evolution of clinical practice over ...