Managing Health Care for Medicaid Recipients with Disabilities: Final Report on the Colorado Access Coordinated Care Pilot Program

Purpose The purpose of this paper is to identify the antecedents and outcomes of internal service quality (ISQ) in a health-care environment. The relationships among the heterogeneous health-care environment, coordinated care, perceived organisational support (POS), ISQ, internal customer satisfaction and patient-centred care were explored. Design/methodology/approach Based on a review of the literature, a structural model was developed. A 37-item questionnaire was circulated among service providers in the health-care system, including doctors, nurses and system staff, all over India. The random sampling method was adopted to collect data. A total of 238 valid responses were received. The data were analysed using structural equation modelling. Findings The results show that the heterogeneous environment, coordinated care and POS act as antecedents of ISQ, which drives internal customer satisfaction and patient centricity in health care. Research limitations/implications The paper contributes to the health-care literature by identifying the antecedents and consequences of ISQ and developing a structural relationship among ISQ, the heterogeneous health-care environment, coordinated care, POS, internal customer satisfaction and patient-centred care. Practical implications Hospital administrators may use various constructs of POS, ISQ and coordinated care to measure process and employee performance, which may aid the design of appropriate processes and improve employee selection. The constructs of patient centricity and internal customer satisfaction may be used as benchmarking tools to facilitate the formulation of immediate corrective actions and policies for future courses of action. Social implications This paper highlights how patient centricity may be achieved by focussing on ISQ, coordinated care processes and a facilitative internal environment. This understanding may aid the design of processes that in turn deliver health as a social good in an effective manner. Originality/value This paper extends past research on ISQ by showing that ISQ affects internal customer satisfaction and, in turn, the quality of service delivery in the system. In the health-care context, heterogeneity in patient needs, coordinated care and organisational support play crucial roles in determining ISQ, which in turn influences the level of patient-centred care.

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Pilot Program of Shared Assistance with Primary Care in Patients Living with HIV, and Satisfaction with The Healthcare Received

10.21203/rs.3.rs-576992/v1 ◽

2021 ◽

Author(s):

Melchor Riera ◽

Adria Ferre ◽

Alfredo Santos-Pinheiro ◽

Helem Hayde Vilchez ◽

Maria Luisa Martin-Peña ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Viral Load ◽

Hiv Infection ◽

Shared Care ◽

Hiv Care ◽

Pilot Program ◽

Art Adherence ◽

Primary Health

Abstract Background: There are few shared assistance programs with Primary Health Care (PHC) in PLWH. The aim was to develop a Pilot Program of shared HIV care in PLWH ensuring proper HIV control. Methods: Design: Prospective pilot project of a shared care intervention.Setting: HIV specialized outpatient consultations for HIV infection at Son Espases University Hospital which serves 2000 patients. Subjects: Patients who attended HIV specialized consultation between January 1st and June 30th, 2017. Intervention: Basal questionnaire on health services used by patients. HIV Training Program on HIV in Primary Health Care (PHC). Pilot Program of shared assistance (PPAC) with PHC. Main Outcomes: Maintenance of undetectable HIV viral load, antiretroviral therapy (ART) adherence, AIDS and non-AIDS events, loss of follow up, and satisfaction questionnaire. Results: The basal questionnaire was filled out by 918 patients, with 108 (11.7%) patients reporting neither knowing nor having been visited by their GP. A total of 93 patients were included in the PPAC, with a mean age of 49.9 years (SD 11.7), and an average of 14.6 years since the HIV diagnosis. Eleven patients were followed up for less than six months and were excluded from the analysis. Median follow-up during the PPAC of the remaining 82 patients was 728 days (IQR 370-1070). Sixteen patients dropped out of the PPAC (19.5%), three died, three were lost to follow up, one was withdrawn due to medical criteria, and nine withdrew voluntarily.No patient presented any AIDS defining events, although eight patients presented non-AIDS events. All the patients had undetectable viral load (VL) and average ART adherence was 99.4% (SD1.4). The patient’s satisfaction score with PPAC was 8.64 (SD2.5).Conclusion: It is possible to establish shared care programs with PHC in selected patients with HIV infection, thereby reducing hospital visits while maintaining good adherence and virological control and achieving high patient satisfaction.

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National Policy on CAM: The White House Commission Report

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2003.tb00086.x ◽

2003 ◽

Vol 31 (2) ◽

pp. 251-261 ◽

Cited By ~ 2

Author(s):

Kathleen M. Boozang

Keyword(s):

Health Care ◽

Alternative Medicine ◽

Complementary And Alternative Medicine ◽

National Policy ◽

Final Report ◽

White House ◽

Health Care Professions ◽

Commission Report ◽

Policy Proposals ◽

Complementary And Alternative

In March 2000, President William Clinton signed Executive Order 13,147, establishing the White House Commission on Complementary and Alternative Medicine, to develop public policy proposals geared toward maximizing “the benefits to Americans of complementary and alternative medicine.” Disconcertingly, the Commission's charge presumed the safety and efficacy of complementary and alternative medicine (CAM). In so doing, it placed the proverbial cart before the horse by setting the Commission on a mission to “address education and training of health care practitioners in CAM; [coordinate] research to increase knowledge about CAM products; [provide] reliable and useful information on CAM to health care professions, and [provide] guidance on the appropriate access to and delivery of CAM.”The Commission's final report (“Commission Report”), issued in March 2002, similarly skirts the fundamental question of whether evidence exists that CAM interventions are safe or offer sufficient benefit to justify their proliferation.

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Measures of Treatment Workload for Patients With Breast Cancer

JCO Clinical Cancer Informatics ◽

10.1200/cci.18.00122 ◽

2019 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Alex C. Cheng ◽

Mia A. Levy

Keyword(s):

Breast Cancer ◽

Health Care ◽

Health Care Organizations ◽

Coordinated Care ◽

Electronic Health Record Data ◽

Tumor Registry ◽

Patients With Cancer ◽

Record Data ◽

Chemotherapy Protocol ◽

The Impact

PURPOSE Patients with breast cancer spend a large amount of time and effort receiving treatment. When the number of health care tasks exceeds a patient’s ability to manage that workload, they could become overburdened, leading to decreased plan adherence. We used electronic health record data to retrospectively assess dimensions of treatment workload related to outpatient encounters, commuting, and admissions. METHODS Using tumor registry and scheduling data, we evaluated the sensitivity of treatment workload measures to detect expected differences in breast cancer treatment burden by stage. We evaluated the impact of the on-body pegfilgrastim injector on the treatment workload of patients undergoing a specific chemotherapy protocol. RESULTS As hypothesized, patients with higher stage cancer experienced higher treatment workload. Over the first 18 months after diagnosis, patients with stage III disease spent a median of 81 hours (interquartile range [IQR], 39 to 113 hours) in outpatient clinics, commuted 61 hours (IQR, 32 to 86 hours), and spent $1,432 (IQR, $690 to $2,552) in commuting costs. In contrast, patients with stage I disease spent a median of 29 hours (IQR, 18 to 46 hours in clinic), commuted for 34 hours (IQR, 19 to 55 hours), and spent $834 (IQR, $389 to $1,649) in commuting costs. In addition, we substantiated claims that the pegfilgrastim on-body injector was effective in reducing some dimensions of workload such as unique appointment days. CONCLUSION Treatment workload measures capture an important dimension in the experience of patients with cancer. Patients and health care organizations can use workload measures to plan and allocate resources, leading to higher quality and better coordinated care.

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Using visualisation methods to analyse referral networks within community health care among patients aged 65 years and over

Health Informatics Journal ◽

10.1177/1460458218824717 ◽

2019 ◽

Vol 26 (1) ◽

pp. 354-375

Author(s):

Ryan Palmer ◽

Martin Utley ◽

Naomi J Fulop ◽

Stephen O’Connor

Keyword(s):

Health Care ◽

Community Health ◽

Health Care Services ◽

Single Point ◽

Community Health Care ◽

Coordinated Care ◽

Care Services ◽

Referral Networks ◽

Community Provider ◽

Multiple Services

Community health care services are considered integral to overcoming future problems in health care. However, this sector faces its own challenges, such as how to organise services to provide coordinated care given: their physical distribution, patients using multiple services, increased patient use and differing patient needs. The aim of this work was to explore, analyse and understand patterns in community referrals for patients aged 65 years and over, and their use of multiple services through data visualisation. Working with a large community provider, these methods helped researchers and service managers to investigate questions that were otherwise difficult to answer from raw data. Each map focuses on a different characteristic of community referrals: patients reusing services, concurrent uses of different services and patterns of subsequent referrals. We apply these methods to routine patient data and discuss their implications in designing of a single point of access – a service for streamlining referrals.

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