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Westfall MY. The Dude and the Dance. J Palliat Med 2023; 26:1588-1589. [PMID: 37955884 DOI: 10.1089/jpm.2023.0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Affiliation(s)
- Matthew Y Westfall
- Department of Internal Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
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Westfall MY. "You Will Miss Your Grandmother's Funeral": Surviving Medical School, Just in Time to Burnout. Med Sci Educ 2020; 30:561-563. [PMID: 34457701 PMCID: PMC8368529 DOI: 10.1007/s40670-019-00890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The abounding negativity of my first year of medical school was best exemplified by a preparatory class entitled "How to Survive the Spring Semester." Physician burnout is an epidemic that may begin in the classrooms and cadaver labs of medical schools with scare tactics, fatalistic messaging, and a pervasive "culture of burnout." Medical education's axiom-"if I suffered through it, so should you"-is a persistent disservice to students who must survive medical school, just in time to burnout as physicians. I wonder if combating physician burnout could start with medical schools, which must stop sowing the seeds of burnout in students. Medical educators can start by reevaluating the words and tone they strike with the physicians of the future.
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Affiliation(s)
- Matthew Y. Westfall
- Virginia Commonwealth University School of Medicine, 1714 W Cary St. #3, Richmond, VA 23220 USA
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Chien AT, Toomey SL, Kuo DZ, Van Cleave J, Houtrow AJ, Okumura MJ, Westfall MY, Petty CR, Quinn JA, Kuhlthau KA, Schuster MA. Care Quality and Spending Among Commercially Insured Children With Disabilities. Acad Pediatr 2019; 19:291-299. [PMID: 29932986 DOI: 10.1016/j.acap.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 04/16/2018] [Accepted: 06/10/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To identify opportunities to improve care value for children with disabilities (CWD), we examined CWD prevalence within a commercially insured population and compared outpatient care quality and annual health plan spending levels for CWD relative to children with complex medical conditions without disabilities; children with chronic conditions that are not complex; and children without disabling, complex, or chronic conditions. METHODS This cross-sectional study comprised 1,118,081 person-years of Blue Cross Blue Shield Massachusetts data for beneficiaries aged 1 to 19years old during 2008 to 2012. We combined the newly developed and validated Children with Disabilities Algorithm with the Pediatric Medical Complexity Algorithm to identify CWD and non-CWD subgroups. We used 14 validated or National Quality Forum-endorsed measures to assess outpatient care quality and paid claims to examine annual plan spending levels and components. RESULTS CWD constituted 4.5% of all enrollees. Care quality for CWD was between 11% and 59% for 8 of 14 quality measures and >80% for the 6 remaining measures and was generally comparable to that for non-CWD subgroups. Annual plan spending among CWD was a median and mean 23% and 53% higher than that for children with complex medical conditions without disabilities, respectively; CWD mean and median values were higher than for all other groups as well. CONCLUSIONS CWD were prevalent in our commercially insured population. CWD experienced suboptimal levels of care, but those levels were comparable to non-CWD groups. Improving the care value for CWD involves a deeper understanding of what higher spending delivers and additional aspects of care quality.
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Affiliation(s)
- Alyna T Chien
- Division of General Pediatrics, Department of Medicine; Department of Pediatrics, Harvard Medical School.
| | - Sara L Toomey
- Division of General Pediatrics, Department of Medicine; Department of Pediatrics, Harvard Medical School
| | - Dennis Z Kuo
- Division of General Pediatrics, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY
| | - Jeanne Van Cleave
- Department of Pediatrics, School of Medicine, University of Colorado Denver, Anschutz Medical Campus , Aurora, Colo
| | - Amy J Houtrow
- Division of Pediatric Rehabilitation Medicine, Children's Hospital of Pittsburgh; Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine , Pittsburgh, Pa
| | - Megumi J Okumura
- Division of General Pediatrics, University of California San Francisco Benioff Children's Hospital; Division of General Pediatrics, Department of Pediatrics, University of California San Francisco School of Medicine , San Francisco
| | | | - Carter R Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital
| | | | - Karen A Kuhlthau
- Department of Pediatrics, Harvard Medical School; Division of General Academic Pediatrics, Massachusetts General Hospital for Children , Boston, Mass
| | - Mark A Schuster
- Division of General Pediatrics, Department of Medicine; Department of Pediatrics, Harvard Medical School; Kaiser Permanente School of Medicine , Pasadena, Calif
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Stockwell DC, Landrigan CP, Toomey SL, Westfall MY, Liu S, Parry G, Coopersmith AS, Schuster MA. Racial, Ethnic, and Socioeconomic Disparities in Patient Safety Events for Hospitalized Children. Hosp Pediatr 2018; 9:1-5. [PMID: 30509900 DOI: 10.1542/hpeds.2018-0131] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Previous studies have revealed racial/ethnic and socioeconomic disparities in quality of care and patient safety. However, these disparities have not been examined in a pediatric inpatient environment by using a measure of clinically confirmed adverse events (AEs). In this study, we do so using the Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool. METHODS GAPPS was applied to medical records of randomly selected pediatric patients discharged from 16 hospitals in the Pediatric Research in Inpatient Settings Network across 4 US regions from January 2007 to December 2012. Disparities in AEs for hospitalized children were identified on the basis of patient race/ethnicity (black, Latino, white, or other; N = 17 336 patient days) and insurance status (public, private, or self-pay/no insurance; N = 19 030 patient days). RESULTS Compared with hospitalized non-Latino white children, hospitalized Latino children experienced higher rates of all AEs (Latino: 30.1 AEs per 1000 patient days versus white: 16.9 AEs per 1000 patient days; P ≤ .001), preventable AEs (Latino: 15.9 AEs per 1000 patient days versus white: 8.9 AEs per 1000 patient days; P = .002), and high-severity AEs (Latino: 12.6 AEs per 1000 patient days versus white: 7.7 AEs per 1000 patient days; P = .02). Compared with privately insured children, publicly insured children experienced higher rates of preventable AEs (public: 12.1 AEs per 1000 patient days versus private: 8.5 AEs per 1000 patient days; P = .02). No significant differences were observed among other groups. CONCLUSIONS The GAPPS analysis revealed racial and/or ethnic and socioeconomic disparities in rates of AEs experienced by hospitalized children across a broad range of geographic and hospital settings. Further investigation may reveal underlying mechanisms of these disparities and could help hospitals reduce harm.
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Affiliation(s)
- David C Stockwell
- Children's National Medical Center, Washington, District of Columbia.,Division of Critical Care Medicine, Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Christopher P Landrigan
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sara L Toomey
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Matthew Y Westfall
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Shanshan Liu
- Institutional Centers for Clinical and Translational Research and
| | - Gareth Parry
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Institute for Healthcare Improvement, Cambridge, Massachusetts; and
| | - Ari S Coopersmith
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Kaiser Permanente School of Medicine, Pasadena, California
| | - Mark A Schuster
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; .,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Kaiser Permanente School of Medicine, Pasadena, California
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Abstract
Long-term cancer survivorship care is a relatively new and rapidly advancing field of research. Increasing cancer survivorship rates have created a huge population of long-term cancer survivors whose cancer-specific needs challenge healthcare infrastructure and highlight a significant deficit of knowledge and guidelines in transitional care from treatment to normalcy/prolonged survivorship. As the paradigm of cancer care has changed from a fixation on the curative to the maintenance on long-term overall quality of life, so to, has the delineation of responsibility between oncologists and primary care physicians (PCPs). As more patients enjoy long-term survival, PCPs play a more comprehensive role in cancer care following acute treatment. To this end, this annotated bibliography was written to provide PCPs and other readers with an up-to-date and robust base of knowledge on long-term cancer survivorship, including definitions and epidemiological information as well as specific considerations and recommendations on physical, psychosocial, sexual, and comorbidity needs of survivors. Additionally, significant information is included on survivorship care, specifically Survivorship Care Plans (SPCs) and their evolution, utilization by oncologists and PCPs, and current gaps, as well as an introduction to patient navigation programs. Given rapid advancements in cancer research, this bibliography is meant to serve as current baseline reference outlining the state of the science.
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Affiliation(s)
- Matthew Y Westfall
- High Plains Research Network, University of Colorado at Denver, Aurora, CO
| | - Linda Overholser
- Department of Medicine, University of Colorado at Denver, Aurora, CO
| | - Linda Zittleman
- High Plains Research Network, University of Colorado at Denver, Aurora, CO
| | - John M Westfall
- High Plains Research Network, University of Colorado at Denver, Aurora, CO ; Colorado HealthOP, Denver, CO
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