scholarly journals Improving Patient Care Through Workspace Renovation and Redesign: A Lean Approach

2020 ◽  
Vol 52 (6) ◽  
pp. 435-439
Author(s):  
Tommy Koonce ◽  
Dana Neutze
Keyword(s):  
Primary Care ◽  
Health Care ◽  
North Carolina ◽  
Physical Space ◽  
Effective Strategy ◽  
On Demand ◽  
The Us ◽  
The University ◽  
Improving Patient Care ◽  
Improve Patient

Background and Objectives: At a time when the US health care system needs greater access to comprehensive, on-demand primary care, the University of North Carolina Family Medicine Center found itself struggling to meet patient demands within the confines of an outdated facility. Clinic leadership sought to redesign the physical space to expand capacity, integrate other members of the care team, support extended hours of operation, and improve patient experience. Methods: Clinic leadership employed experienced lean coaches to train our entire department in lean methodology, to implement a comprehensive approach to redesigning our workflows, and to use those perfected workflows to redesign and renovate our new clinical workspace. Results: Upon completion of the renovation and redesign, the clinic experienced significant growth in patient volumes (24%) and unprecedented improvement in patient satisfaction (89th to 92nd percentile). Conclusions: Lean methodology proved to be an effective strategy for analyzing our current workflows and use of physical space. Moreover, lean strategies proved vital for redesigning and renovating our clinic.

scholarly journals Dissemination of Evidence-Based Recommendations for Sickle Cell Disease to Primary Care and Emergency Department Providers in North Carolina: A Cost Benefit Analysis

2021 ◽  
Vol 8 (1) ◽  
pp. 18-28
Author(s):  
Paula Tanabe ◽  
Audrey L. Blewer ◽  
Emily Bonnabeau ◽  
Hayden B. Bosworth ◽  
Denise H. Clayton ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
North Carolina ◽  
Sickle Cell Disease ◽  
Cost Benefit ◽  
Care Utilization ◽  
Evidence Based ◽  
Cell Disease ◽  
Ed Visits

Background: Sickle cell disease (SCD) is a genetic condition affecting primarily individuals of African descent, who happen to be disproportionately impacted by poverty and who lack access to health care. Individuals with SCD are at high likelihood of high acute care utilization and chronic pain episodes. The multiple complications seen in SCD contribute to significant morbidity and premature mortality, as well as substantial costs to the healthcare system. Objectives: SCD is a complex chronic disease resulting in the need for primary, specialty and emergency care. Many providers do not feel prepared to care for individuals with SCD, despite the existence of evidence-based guidelines. We report the development of a SCD toolbox and the dissemination process to primary care and emergency department (ED) providers in North Carolina (NC). We report the effect of this dissemination on health-care utilization, cost of care, and overall cost-benefit. Methods: The SCD toolbox was adapted from the National Heart, Lung, and Blood Institute recommendations. Toolbox training was provided to quality improvement specialists who then disseminated the toolbox to primary care providers (PCPs) affiliated with the only NC managed care coordination system and ED providers. Tools were made available in paper, online, and in app formats to participating managed care network practices (n=1800). Medicaid claims data were analyzed for total costs and benefits of the toolbox dissemination for a 24-month pre- and 18-month post-intervention period. Results: There was no statistically significant shift in the number of outpatient specialty visits, ED visits or hospitalizations. There was a small decrease in the number of PCP visits in the post-implementation period. The dissemination resulted in a net cost-savings of $361 414 ($14.03 per-enrollee per-month on average). However, the estimated financial benefit associated with the dissemination of the SCD toolbox was not statistically significant. Conclusions: Although we did not find the expected shift to increased PCP visits and decreased ED visits and hospitalizations, there were many lessons learned.

scholarly journals UNDERSTANDING DEMENTIA PREVALENCE AND HEALTH CARE USE PATTERNS IN RURAL NORTH CAROLINA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S904-S905
Author(s):  
Amanda N Grant ◽  
Tsai-Ling Liu ◽  
Nigel L Rozario ◽  
Deanna A Mangieri ◽  
Jennifer M Woodward ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
North Carolina ◽  
Health Care Use ◽  
Health Care Needs ◽  
Care Needs ◽  
Dementia Prevalence ◽  
Care Services ◽  
Dementia Patients ◽  
Acute Care Services

Abstract Rural and remote communities have limited access to high quality dementia care, prompting a need for innovative solutions to meet the health care needs of affected older adults. As part of a study aimed at implementing a telehealth intervention for primary care patients with dementia in two rural North Carolina counties, we examined baseline dementia prevalence and compared health care use between patients with and without dementia. Electronic health records from January 2018 to December 2018 were examined for 2,288 patients aged 65 or older. A zero-inflated Poisson regression model was used to compare healthcare use between patients with and without dementia adjusting for patients’ demographic and clinical characteristics. Dementia prevalence was 8.7% based on diagnosis codes. Most patients with dementia were women (70%), not married (55%), Medicare-insured (78%), and had more comorbidities (mean: 2±2) than non-dementia patients. Dementia patients had a significantly higher number of primary care visits, emergency department visits, inpatient visits, and preventable hospitalizations than patients without dementia (risk ratio = 1.1, 1.8, 2.18, and 1.3, respectively; all P< 0.05). Dementia burden was higher among women and use of acute care services by patients with dementia in this rural setting was higher than patients without the disease, similar to urban settings. These findings suggest opportunities to improve care coordination and access to resources to help reduce the need for acute care services among patients with dementia and can help tailor interventions to address the health care needs of this group.

Implementation of Nurse-Initiated Rapid HIV Testing at High-Prevalence Primary Care Sites Within the US Veterans Affairs Health Care System

2013 ◽  
Vol 40 (4) ◽  
pp. 341-345 ◽  
Author(s):  
Henry D. Anaya ◽  
Jaimi N. Butler ◽  
Jeffrey L. Solomon ◽  
Herschel Knapp ◽  
Tuyen Hoang ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Hiv Testing ◽  
Health Care System ◽  
Veterans Affairs ◽  
Rapid Hiv Testing ◽  
High Prevalence ◽  
The Us ◽  
Us Veterans ◽  
Care System

scholarly journals Work stress of primary care physicians in the US, UK and German health care systems

2010 ◽  
Vol 71 (2) ◽  
pp. 298-304 ◽  
Author(s):  
Johannes Siegrist ◽  
Rebecca Shackelton ◽  
Carol Link ◽  
Lisa Marceau ◽  
Olaf von dem Knesebeck ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Work Stress ◽  
Primary Care Physicians ◽  
Health Care Systems ◽  
German Health ◽  
The Us ◽  
Care Systems

Satisfaction with Primary Health Care and Confidence in General Practitioners: An Exploratory Comparison of US and UK Students

1993 ◽  
Vol 6 (2) ◽  
pp. 89-98
Author(s):  
Bodo B. Schlegelmilch ◽  
James M. Carman
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Systems ◽  
Primary Care Providers ◽  
Care Providers ◽  
Primary Health ◽  
The Us ◽  
Care Systems ◽  
The Uk ◽  
Oriented System

This paper explores attitudes of university students towards two differently organised health services, ie the National Health Service in the UK and the more market oriented system in the US and analyses the level of confidence placed in primary care providers (GPs/family physicians) in both systems. Although major differences in the perception of the two health care systems are identified, hardly any differences emerge between the two countries in terms of the confidence patients place in their primary care providers.

scholarly journals On the Road to Discover My Mayan Voice

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Dina Hernandez
Keyword(s):  
United States ◽  
North Carolina ◽  
Health Program ◽  
The United States ◽  
Migrant Farmworker ◽  
The Road ◽  
Good Samaritan ◽  
The Us ◽  
On The Road ◽  
The University

Dina Hernandez is from Morganton, NC where she lives with her husband of three years and their dog, Bandit. She recently graduated from the University of North Carolina at Greensboro with a BA in Spanish (June ‘19). She currently works as a Spanish interpreter at the Good Samaritan Clinic and as a Tele-behavioral Health Coordinator for the Migrant Farmworker Health Program. Her parents are originally from Huehuetenango, Guatemala and speak Akateko. They migrated to the United States in the 70s and from there have created a family here in the US with their five children. Dina is the youngest of her siblings.

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