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 ...

Integrating a palliative approach into the management of chronic, life-threatening diseases: Who, How and When?

Palliative care has a great deal to offer individuals and families faced with chronic, life-threatening illnesses. Medical advances means that many people will live many  years with these illnesses; however, most will eventually die of these diseases  and should have the right and support to make  informed decisions about their care at the end-of-life. rather than dimming people’s hope, frankdiscussions about the prognosis and trajectory of these illnesses can help people enhance theirquality of both living and dying with these diseases.

Over the past 15 years, canada has made progress in providing high quality palliative care —particularly in the ...

Integrating palliative care into primary care for patients with chronic, life-limiting conditions.

As longevity increases, individuals with chronic, life-limiting conditions will live longer with disease burden and functional decline. Nurse practitioners can integrate symptom management, early decision-making, and supportive care into the primary care setting to improve quality of life and decrease economic and emotional impact at the end of life.

Perceptions of health managers and professionals about mental health and primary care integration in Rio de Janeiro: a mixed methods study

Community-based primary mental health care is recommended in low and middle-income countries. The Brazilian Health System has been restructuring primary care by expanding its Family Health Strategy. Due to mental health problems, psychosocial vulnerability and accessibility, Matrix Support teams are being set up to broaden the professional scope of primary care. This paper aims to analyse the perceptions of health professionals and managers about the integration of primary care and mental health.

Impact of Patient-Centered Care Innovations on Access to Providers, Ambulatory Care Utilization, and Patient Clinical Indicators in the Veterans Health Administration

The Veterans Health Administration piloted patient-centered care (PCC) innovations beginning in 2010 to improve patient and provider experience and environment in ambulatory care. We use secondary data to look at longitudinal trends, evaluate system redesign, and identify areas for further quality improvement.

METHODS:

This was a retrospective, observational study using existing secondary data from multiple US Department of Veteran Affairs sources to evaluate changes in veteran and facility outcomes associated with PCC innovations at 2 innovation and matched comparison sites between FY 2008-2010 (pre-PCC innovations) and FY 2011-2012 (post-PCC innovations). Outcomes included access to primary care providers (PCPs); primary, specialty ...

Organizational Context and Capabilities for Integrating Care: A Framework for Improvement

Interventions aimed at integrating care have become widespread in healthcare; however, there is significant variability in their success. Differences in organizational contexts and associated capabilities may be responsible for some of this variability.

Purpose: This study develops and validates a conceptual framework of organizational capabilities for integrating care, identifies which of these capabilities may be most important, and explores the mechanisms by which they influence integrated care efforts. 

Methods: The Context and Capabilities for Integrating Care (CCIC) Framework was developed through a literature review, and revised and validated through interviews with leaders and care providers engaged in integrated care networks ...

Promoting Policy, Systems, and Environment Change to Prevent Chronic Disease: Lessons Learned From the King County Communities Putting Prevention to Work Initiative.

Initiatives that convene community stakeholders to implement policy, systems, environment, and infrastructure (PSEI) change have become a standard approach for promoting community health. To assess the PSEI changes brought about by the King County, Washington, Communities Putting Prevention to Work initiative and describe how initiative structures and processes contributed to making changes.

Effect of care management program structure on implementation: a normalization process theory analysis

Care management in primary care can be effective in helping patients with chronic disease improve their health status, however, primary care practices are often challenged with implementation. Further, there are different ways to structure care management that may make implementation more or less successful. Normalization process theory (NPT) provides a means of understanding how a new complex intervention can become routine (normalized) in practice. In this study, we used NPT to understand how care management structure affected how well care management became routine in practice.

The Value of Continuity between Primary Care and Surgical Care in Colon Cancer

Improving continuity between primary care and cancer care is critical for improving cancer outcomes and curbing cancer costs. A dimension of continuity, we investigated how regularly patients receive their primary care and surgical care for colon cancer from the same hospital and whether this affects mortality and costs.Receiving primary care and surgical care at the same hospital, compared to different hospitals, was associated with lower costs but still similar survival among stage I-III colon cancer patients. Nonetheless, health care policy which encourages further integration between primary care and cancer care in order to improve outcomes and decrease costs will ...

CMMI’s New Comprehensive Primary Care Plus: Its Promise And Missed Opportunities

The Center for Medicare and Medicaid Innovation (CMMI) has recently announced an initiative called Comprehensive Primary Care Plus (CPC+), evolved from the previous Comprehensive Primary Care (CPP) initiative. The initiative mainly consists on paying a fee to those primary care practices willing to introduce organizational changes centered in five primary care functions:  (1) access and continuity; (2) care management; (3) comprehensiveness and coordination; (4) patient and caregiver engagement; and, (5) planned care and population health.

In this post, the authors outline some of the promises and downsides of the PCC+. On the bright side, the authors analyse how financial incentives ...