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Cruz MJB, Santos ADFD, Macieira C, Abreu DMXD, Machado ATGDM, Andrade EIG. Avaliação da coordenação do cuidado na atenção primária à saúde: comparando o PMAQ-AB (Brasil) e referências internacionais. CAD SAUDE PUBLICA 2022; 38:e00088121. [DOI: 10.1590/0102-311x00088121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 08/09/2021] [Indexed: 11/22/2022] Open
Abstract
Resumo: O objetivo deste estudo foi comparar os resultados obtidos para a coordenação do cuidado a partir do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), com os parâmetros adotados pelo Atlas de Medidas de Coordenação do Cuidado e pelo Observatório Europeu de Políticas e Sistemas de Saúde. Foi realizado estudo transversal, com base no banco de dados do 3º ciclo do PMAQ-AB. Foram criadas três tipologias de coordenação do cuidado: PMAQ-AB, Atlas e Observatório. O teste qui-quadrado foi aplicado para comparar as proporções; os testes de Kruskal-Wallis e de Nemenyi para verificar e identificar eventuais diferenças entre as tipologias. O nível de significância foi de 5%. Foram avaliadas 35.350 equipes que realizaram alguma atividade de coordenação do cuidado. Observou-se diferença significativa (p < 0,001), entre os níveis de coordenação, com maior percentual entre o nível alto e médio nos três instrumentos, PMAQ-AB (56,07% e 38,35%), Atlas (52,63% e 40,66%) e o Observatório (44,82% e 43,98%). Na comparação dos indicadores, houve diferença significativa (p < 0,001) entre as tipologias. Para o Brasil, na tipologia PMAQ-AB, todos os estratos exibiram maior percentual entre o nível alto e médio; no Atlas, o estrato 1 destacou-se no nível médio (43,81%) e, no Observatório, predominou o nível alto. Na comparação dos indicadores por estratos, pelo menos um estrato diferiu dos demais (p < 0,001). O 6 se distinguiu dos demais (p < 0,001), e o 1 diferiu de todos (p < 0,001), exceto do 2 (p > 0,05). Os níveis de coordenação do cuidado diferenciaram-se entre os instrumentos utilizados. Altos e médios níveis foram identificados, demonstrando a necessidade de estudos adicionais.
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Fort MP, Reid M, Russell J, Santos CJ, Running Bear U, Begay RL, Smith SL, Morrato EH, Manson SM. Diabetes Prevention and Care Capacity at Urban Indian Health Organizations. Front Public Health 2021; 9:740946. [PMID: 34900897 PMCID: PMC8661087 DOI: 10.3389/fpubh.2021.740946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
American Indian and Alaska Native (AI/AN) people suffer a disproportionate burden of diabetes and cardiovascular disease. Urban Indian Health Organizations (UIHOs) are an important source of diabetes services for urban AI/AN people. Two evidence-based interventions-diabetes prevention (DP) and healthy heart (HH)-have been implemented and evaluated primarily in rural, reservation settings. This work examines the capacity, challenges and strengths of UIHOs in implementing diabetes programs. Methods: We applied an original survey, supplemented with publicly-available data, to assess eight organizational capacity domains, strengths and challenges of UIHOs with respect to diabetes prevention and care. We summarized and compared (Fisher's and Kruskal-Wallis exact tests) items in each organizational capacity domain for DP and HH implementers vs. non-implementers and conducted a thematic analysis of strengths and challenges. Results: Of the 33 UIHOs providing services in 2017, individuals from 30 sites (91% of UIHOs) replied to the survey. Eight UIHOs (27%) had participated in either DP (n = 6) or HH (n = 2). Implementers reported having more staff than non-implementers (117.0 vs. 53.5; p = 0.02). Implementers had larger budgets, ~$10 million of total revenue compared to $2.5 million for non-implementers (p = 0.01). UIHO strengths included: physical infrastructure, dedicated leadership and staff, and community relationships. Areas to strengthen included: staff training and retention, ensuring sufficient and consistent funding, and data infrastructure. Conclusions: Strengthening UIHOs across organizational capacity domains will be important for implementing evidence-based diabetes interventions, increasing their uptake, and sustaining these interventions for AI/AN people living in urban areas of the U.S.
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Affiliation(s)
- Meredith P Fort
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Margaret Reid
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jenn Russell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Cornelia J Santos
- Environmental Studies-Indigenous Sustainability Studies Program, Bemidji State University, Bemidji, MN, United States
| | - Ursula Running Bear
- Department of Population Health, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Rene L Begay
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Savannah L Smith
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elaine H Morrato
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, United States
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Allen CG, Cotter MM, Smith RA, Watson L. Successes and challenges of implementing a lung cancer screening program in federally qualified health centers: a qualitative analysis using the Consolidated Framework for Implementation Research. Transl Behav Med 2021; 11:1088-1098. [PMID: 33289828 PMCID: PMC8248958 DOI: 10.1093/tbm/ibaa121] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In recent years, studies have shown that low-dose computed tomography (LDCT) is a safe and effective way to screen high-risk adults for lung cancer. Despite this, uptake remains low, especially in limited-resource settings. The American Cancer Society (ACS) partnered with two federally qualified health centers and accredited screening facilities on a 2 year pilot project to implement an LDCT screening program. Both sites attempted to develop a referral program and care coordination practices to move patients through the screening continuum and identify critical facilitators and barriers to implementation. Evaluators conducted key informant interviews (N = 46) with clinical and administrative staff, as well as regional ACS staff during annual site visits. The Consolidated Framework for Implementation Research guided our analysis of factors associated with effective implementation and improved screening outcomes. One study site established a sustainable lung screening program, while the other struggled to overcome significant implementation barriers. Increased time spent with patients, disruption to normal workflows, and Medicaid reimbursement policies presented challenges at both sites. Supportive, engaged leaders and knowledgeable champions who provided clear implementation guidance improved staff engagement and were able to train, guide, and motivate staff throughout the intervention. A slow, stepwise implementation process allowed one site's project champions to pilot test new processes and resolve issues before scaling up. This pilot study provides critical insights into the necessary resources and steps for successful lung cancer screening program implementation in underserved settings. Future efforts can build upon these findings and identify and address possible facilitators and barriers to screening program implementation.
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Affiliation(s)
- Caitlin G Allen
- Department of Behavioral Science and Health Education,
Rollins School of Public Health, Emory University, Atlanta, GA,
USA
| | - Megan M Cotter
- Population Sciences Department, American Cancer Society,
Inc., Atlanta, GA, USA
| | - Robert A Smith
- Prevention and Early Detection Team, American Cancer
Society, Inc., Atlanta, GA, USA
| | - Lesley Watson
- Strategy and Analytics Team, American Cancer Society
Cancer Action Network, Inc., Washington, DC, USA
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Najafi B, Mishra R. Harnessing Digital Health Technologies to Remotely Manage Diabetic Foot Syndrome: A Narrative Review. ACTA ACUST UNITED AC 2021; 57:medicina57040377. [PMID: 33919683 PMCID: PMC8069817 DOI: 10.3390/medicina57040377] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 12/15/2022]
Abstract
About 422 million people worldwide have diabetes and approximately one-third of them have a major risk factor for diabetic foot ulcers, including poor sensation in their feet from peripheral neuropathy and/or poor perfusion to their feet from peripheral artery disease. The current healthcare ecosystem, which is centered on the treatment of established foot disease, often fails to adequately control key reversible risk factors to prevent diabetic foot ulcers leading to unacceptable high foot disease amputation rate, 40% recurrence of ulcers rate in the first year, and high hospital admissions. Thus, the latest diabetic foot ulcer guidelines emphasize that a paradigm shift in research priority from siloed hospital treatments to innovative integrated community prevention is now critical to address the high diabetic foot ulcer burden. The widespread uptake and acceptance of wearable and digital health technologies provide a means to timely monitor major risk factors associated with diabetic foot ulcer, empower patients in self-care, and effectively deliver the remote monitoring and multi-disciplinary prevention needed for those at-risk people and address the health care access disadvantage that people living in remote areas. This narrative review paper summarizes some of the latest innovations in three specific areas, including technologies supporting triaging high-risk patients, technologies supporting care in place, and technologies empowering self-care. While many of these technologies are still in infancy, we anticipate that in response to the Coronavirus Disease 2019 pandemic and current unmet needs to decentralize care for people with foot disease, we will see a new wave of innovations in the area of digital health, smart wearables, telehealth technologies, and “hospital-at-home” care delivery model. These technologies will be quickly adopted at scale to improve remote management of diabetic foot ulcers, smartly triaging those who need to be seen in outpatient or inpatient clinics, and supporting acute or subacute care at home.
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Parchman ML, Anderson ML, Coleman K, Michaels LA, Schuttner L, Conway C, Hsu C, Fagnan LJ. Assessing quality improvement capacity in primary care practices. BMC FAMILY PRACTICE 2019; 20:103. [PMID: 31345167 PMCID: PMC6657073 DOI: 10.1186/s12875-019-1000-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/18/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Healthy Hearts Northwest (H2N) is a study of external support strategies to build quality improvement (QI) capacity in primary care with a focus on cardiovascular risk factors: appropriate aspirin use, blood pressure control, and tobacco screening/cessation. METHODS To guide practice facilitator support, experts in practice transformation identified seven domains of QI capacity and mapped items from a previously validated medical home assessment tool to them. A practice facilitator (PF) met with clinicians and staff in each practice to discuss each item on the Quality Improvement Capacity Assessment (QICA) resulting in a practice-level response to each item. We examined the association between the QICA total and sub-scale scores, practice characteristics, a measure of prior experience with managing practice change, and performance on clinical quality measures (CQMs) for the three cardiovascular risk factors. RESULTS The QICA score was associated with prior experience managing change and moderately associated with two of the three CQMs: aspirin use (r = 0.16, p = 0.049) and blood pressure control (r = 0.18, p = 0.013). Rural practices and those with 2-5 clinicians had lower QICA scores.. CONCLUSIONS The QICA is useful for assessing QI capacity within a practice and may serve as a guide for both facilitators and primary care practices in efforts to build this capacity and improve measures of clinical quality. TRIAL REGISTRATION This trial is registered with www.clinicaltrials.gov Identifier# NCT02839382, retrospectively registered on July 21, 2016.
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Affiliation(s)
- Michael L. Parchman
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Ste 1600, Seattle, WA 98101 USA
| | - Melissa L. Anderson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Ste 1600, Seattle, WA 98101 USA
| | - Katie Coleman
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Ste 1600, Seattle, WA 98101 USA
| | - Le Ann Michaels
- Oregon Rural Practice Research Network, Oregon Health Sciences University, Portland, OR USA
| | | | - Cullen Conway
- Oregon Rural Practice Research Network, Oregon Health Sciences University, Portland, OR USA
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Ste 1600, Seattle, WA 98101 USA
| | - Lyle J. Fagnan
- Oregon Rural Practice Research Network, Oregon Health Sciences University, Portland, OR USA
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Grandes G, Bully P, Martinez C, Gagnon MP. Validity and reliability of the Spanish version of the Organizational Readiness for Knowledge Translation (OR4KT) questionnaire. Implement Sci 2017; 12:128. [PMID: 29126428 PMCID: PMC5681775 DOI: 10.1186/s13012-017-0664-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Organizational readiness to change healthcare practice is a major determinant of successful implementation of evidence-based interventions. However, we lack of comprehensive, valid, and reliable instruments to measure it. We assessed the validity and reliability of the Spanish version of the Organizational Readiness for Knowledge Translation (OR4KT) questionnaire in the context of the implementation of the Prescribe Vida Saludable III project, which seeks to strengthen health promotion and chronic disease prevention in primary healthcare organizations of the Osakidetza (Basque Health Service, Spain). METHODS A cross-sectional study was conducted including 127 professionals from 20 primary care centers within Osakidetza. They filled in the OR4KT questionnaire twice in a 15- to 30-day period to test repeatability. In addition, we used the Survey of Organizational Attributes for Primary Care (SOAPC) and we documented the number of healthcare professionals who formally engaged in the Prescribe Vida Saludable III project within each participating center to assess concurrent validity. RESULTS Cronbach's alpha for the overall OR4KT was .95, and the overall repeatability coefficient was 6.95%, both excellent results. Confirmatory factor analysis supported the underlying theoretical structure of 6 dimensions and 23 sub-dimensions. There were positive moderate-to-high internal correlations between these six dimensions, and there was evidence of good concurrent validity (correlation coefficient of .76 with SOAPC, and .80 with the proportion of professionals engaged by center). A score higher than 64 (out of 100) would be indicative of an organization with high level of readiness to implement the intervention (sensitivity = .75, specificity = 1). CONCLUSIONS The Spanish version of the OR4KT exhibits very strong reliability and good validity, although it needs to be validated in a larger sample and in different implementation contexts.
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Affiliation(s)
- Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Luis Power 18, 4a planta, E-48014, Bilbao, Spain. .,BioCruces Health Research Institute, Plaza de Cruces 12, E-48903, Barakaldo, Bizkaia, Spain.
| | - Paola Bully
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Luis Power 18, 4a planta, E-48014, Bilbao, Spain.,BioCruces Health Research Institute, Plaza de Cruces 12, E-48903, Barakaldo, Bizkaia, Spain
| | - Catalina Martinez
- Primary Care Research Unit of Bizkaia, Basque Health Service-Osakidetza, Luis Power 18, 4a planta, E-48014, Bilbao, Spain.,BioCruces Health Research Institute, Plaza de Cruces 12, E-48903, Barakaldo, Bizkaia, Spain
| | - Marie-Pierre Gagnon
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Centre, QC, Québec, G1V 0A6, Canada.,Faculty of Nursing, Université Laval, 2325 Rue de l'Université, Ville de Québec, QC, G1V 0A6, Canada
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Demiris G, Kneale L. Informatics Systems and Tools to Facilitate Patient-centered Care Coordination. Yearb Med Inform 2017; 10:15-21. [PMID: 26293847 DOI: 10.15265/iy-2015-003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION There is a growing international focus on patient- centered care. A model designed to facilitate this type of care in the primary care setting is the patient-centered medical home. This model of care strives to be patient-focused, comprehensive, team-based, coordinated, accessible, and focused on quality and safety of care. OBJECTIVE The objective of this paper is to identify the current status and future trends of patient-centered care and the role of informatics systems and tools in facilitating this model of care. METHODS In this paper we review recent scientific literature of the past four years to identify trends and state of current evidence when it comes to patient-centered care overall, and more specifically medical homes. RESULTS There are several studies that indicate growth and development in seven informatics areas within patient-centered care, namely clinical decision support, registries, team care, care transitions, personal health records, telehealth, and measurement. In some cases we are still lacking large randomized clinical trials and the evidence base is not always solid, but findings strongly indicate the potential of informatics to support patient-centered care. CONCLUSION Current evidence indicates that advancements have been made in implementing and evaluating patient-centered care models. Technical, legal, and practical challenges still remain. Further examination of the impact of patient-centered informatics tools and systems on clinical outcomes is needed.
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Affiliation(s)
- G Demiris
- George Demiris PhD, FACMI, University of Washington, BNHS Box 357266, Seattle, WA, 98195, USA, Tel: +1 206 221 3866, Fax: +1 206 543 4771, E-mail:
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Soley-Bori M, Benzer JK, Burgess JF. Longitudinal Analysis of Quality of Diabetes Care and Relational Climate in Primary Care. Health Serv Res 2017; 53:1042-1064. [PMID: 28294310 DOI: 10.1111/1475-6773.12675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess the influence of relational climate on quality of diabetes care. DATA SOURCES/STUDY SETTING The study was conducted at the Department of Veterans Affairs (VA). The VA All Employee Survey (AES) was used to measure relational climate. Patient and facility characteristics were gathered from VA administrative datasets. STUDY DESIGN Multilevel panel data (2008-2012) with patients nested into clinics. DATA COLLECTION/EXTRACTION METHODS Diabetic patients were identified using ICD-9 codes and assigned to the clinic with the highest frequency of primary care visits. Multiple quality indicators were used, including an all-or-none process measure capturing guideline compliance, the actual number of tests and procedures, and three intermediate continuous outcomes (cholesterol, glycated hemoglobin, and blood pressure). PRINCIPAL FINDINGS The study sample included 327,805 patients, 212 primary care clinics, and 101 parent facilities in 2010. Across all study years, there were 1,568,180 observations. Clinics with the highest relational climate were 25 percent more likely to provide guideline-compliant care than those with the lowest relational climate (OR for a 1-unit increase: 1.02, p-value <.001). Among insulin-dependent diabetic veterans, this effect was twice as large. Contrary to that expected, relational climate did not influence intermediate outcomes. CONCLUSIONS Relational climate is positively associated with tests and procedures provision, but not with intermediate outcomes of diabetes care.
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Affiliation(s)
- Marina Soley-Bori
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA.,Department of Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA.,Health Care Financing and Payment Program (HCFP), RTI International, Waltham, MA
| | - Justin K Benzer
- Department of Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA.,Department of Veterans Affairs Central Texas Healthcare System, VISN 17 Center of Excellence for Research on Returning Veterans, Waco, TX.,Department of Health Policy and Management, Texas A&M University School of Public Health, College Station, TX
| | - James F Burgess
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA.,Department of Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA
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Malkani S, Keitz SA, Harlan DM. Redesigning Diabetes Care: Defining the Role of Endocrinologists Among Alternative Providers. Curr Diab Rep 2016; 16:121. [PMID: 27766581 DOI: 10.1007/s11892-016-0818-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The current diabetes epidemic threatens to overwhelm the healthcare system unless we redesign how diabetes care is delivered. The number of endocrinologists is grossly inadequate to provide care for all individuals with diabetes, but with the appropriate utilization of the primary care workforce and alternative healthcare providers working together in teams, effective diabetes care can be provided to all. We propose a patient-centered, goal-based approach with resources devoted to care coordination, measurement of outcomes, appropriate use of technology, and measurement of patient satisfaction. Financial incentives to healthcare systems and providers need to be based on defined outcome measures and reducing long-term total medical expenditures, rather than reimbursement based on number of visits and lengthy documentation. Endocrinologists have a responsibility in setting up effective diabetes care delivery systems within their organizations, in addition to delivering diabetes care and serving as a resource for the educational needs for other medical professionals in the community. There are major challenges to implementing such systems, both at the financial and organizational levels. We suggest a stepwise implementation of discrete components based on the local priorities and resources and provide some examples of steps we have taken at our institution.
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Affiliation(s)
- Samir Malkani
- Diabetes Center of Excellence, UMass Medical School, AC4-127, 55 Lake Avenue, Worcester, MA, 01655, USA.
| | - Sheri A Keitz
- Department of Medicine, UMass Medical School, 55 Lake Avenue, Worcester, MA, 01655, USA
| | - David M Harlan
- Diabetes Center of Excellence, UMass Medical School, AC4-127, 55 Lake Avenue, Worcester, MA, 01655, USA
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Affiliation(s)
- Malathi Srinivasan
- Division of General Internal Medicine, Department of Medicine, Davis School of Medicine, University of California, 4150 V. Street, Suite 2400, Sacramento, CA, 95817, USA,
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Capsule commentary on Weeks et al., measuring primary care organizational capacity for diabetes care coordination: the diabetes care coordination readiness assessment. J Gen Intern Med 2014; 29:178. [PMID: 24018630 PMCID: PMC3889931 DOI: 10.1007/s11606-013-2614-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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