scholarly journals Population Health Management in Diabetes Care: Combining Clinical Audit, Risk Stratification, and Multidisciplinary Virtual Clinics in a Community Setting to Improve Diabetes Care in a Geographically Defined Population. An Integrated Diabetes Care Pilot in the North East Locality, Oxfordshire, UK

2020 ◽  
Vol 20 (4) ◽  
Author(s):  
O. Kozlowska ◽  
S. Attwood ◽  
A. Lumb ◽  
G. D. Tan ◽  
R. Rea
Keyword(s):  
Risk Stratification ◽  
Population Health ◽  
Diabetes Care ◽  
Health Management ◽  
Clinical Audit ◽  
Community Setting ◽  
Audit Risk ◽  
North East ◽  
The North ◽  
Improve Diabetes Care

scholarly journals A clinical audit into the adherence of foot health management standards of rheumatoid arthritis compared to the foot health management standards of diabetes mellitus in North-East London

2021 ◽  
Author(s):  
Christopher Joyce ◽  
Rizwan Rajak
Keyword(s):  
Rheumatoid Arthritis ◽  
Diabetic Foot ◽  
Health Management ◽  
Clinical Audit ◽  
Poor Compliance ◽  
Foot Health ◽  
North East ◽  
Management Standards ◽  
Audit Data ◽  
Health Standards

Abstract Objectives Rheumatoid arthritis (RA) has an affinity to smaller joints, thus its effect on the foot/ankle is widely known. Despite this, there is lack of adherence to foot management standards by podiatrists. This research aimed to audit the adherence of these standards and compare them to well-established management standard adherence in the diabetic foot. Methods In this clinical audit, data was obtained via six National Health Service (NHS) podiatry departments in North-East London on service provision, management, treatment and professional development on both RA and diabetic foot health via foot management clinical audit tools. Descriptive analyses were conducted analysed to identify patterns and trends, with set standard compliance conditions calculated on Net Promotor Score ® (NPS) metric to allow for multi-comparison. Results All areas of RA foot health management were found to have poor compliance when compared to diabetes foot health management. When using NPS, no trust audited meet the majority of foot health standards in RA; with only two having a positive score (meeting the minimum standards) compared to all trusts posting a positive NPS on diabetes foot health standards. Conclusions Our results indicate that poor compliance into RA foot health standards is prevalent across the audited region and may be resulting in worsening foot outcomes despite a paradigm shift in other areas of RA management. Enhanced training and knowledge is required for better adherence to the standards set out and improve a foot health management in RA.

scholarly journals Guidelines for ethno-centric psychosocial management of diabetes mellitus in India: The north east consensus group statement

2013 ◽  
Vol 01 (01) ◽  
pp. 009-014
Author(s):  
Sanjay Kalra ◽  
Manash Baruah ◽  
Salam Ranabir ◽  
Ningthoujam Singh ◽  
Asit Choudhury ◽  
...  
Keyword(s):  
Diabetes Care ◽  
Diabetes Management ◽  
Group Discussion ◽  
Cultural Issues ◽  
North East ◽  
The North ◽  
North Eastern ◽  
Health Related ◽  
Practical Guidelines ◽  
Cultural Interventions

AbstractRecently published guidelines on Psychosocial Management of Diabetes in India provide evidence-based recommendations for the whole nation. However, they do not fully address the myriad socio-cultural issues prevalent in the North Eastern states. The eight North Eastern states of India house 45 million people, belonging to 220 ethnic groups who speak an equal number of dialects, and follow distinctly unique cultures, which impact health-related behavior. Such diversity is difficult to cover in any national guideline. This lacuna makes it necessary to have a document, which addresses the specific needs and requirements of diabetes care professionals in the North-east of India. This consensus statement aims to highlight evidence- and experience-based strategies for psychosocial management of diabetes, based upon the unique ethnographic constitution of this part of the country. It is based upon the results of a daylong focused group discussion, held at Sonapur, Assam, on 9th February 2013, involving key opinion leaders from most North-eastern states, including all geographical divisions of Assam. Recommendations are classified into three domains: General, psychological, and socio-cultural, and graded by the weight they should have in clinical practice. Eighteen recommendations of varying strength are made, to help professionals identify the psycho-socio-cultural determinants of diabetes, and to explore the role of psycho-socio-cultural interventions in devising support strategies for people with diabetes and their families. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management in the North-east and help achieve a qualitative improvement in diabetes care. The guidelines may also be useful for diabetes care professionals working with other indigenous groups across the world.

scholarly journals Informatics strategies for risk stratification in population health management

2017 ◽  
Author(s):  
◽  
Lincoln Sheets
Keyword(s):  
Machine Learning ◽  
Risk Stratification ◽  
Population Health ◽  
Healthcare Costs ◽  
Health Management ◽  
Area Under The Curve ◽  
Population Health Management ◽  
Interpretable Machine Learning ◽  
Risk Patients ◽  
Improve Health

Risk analysis and population health management can improve health outcomes, but improved risk stratification is needed to manage healthcare costs. Analysis of 157 publications on translational implementations of "risk stratification in population health management of chronic disease" showed a consensus that population health management and risk stratification can improve outcomes, but found uncertainty over best methods for risk prediction and controversy over the cost savings. The consensus of another 85 publications on the methodologies of "data mining for predictive healthcare analytics" was that clinically interpretable machine learning techniques are more appropriate than "black box" techniques for structured big data sources in healthcare, and the "area under the curve" of a prediction model's sensitivity versus one-minus-specificity is a standard and reliable way to measure the model's discrimination. This study used clinically interpretable machine-learning algorithms, combined with simple but powerful data analytic techniques such as cost analysis and data visualization, to evaluate and improve risk stratification for a managed patient population. This study retrospectively observed 10,000 mid-Missouri Medicare and Medicaid patients between 2012 and 2014. Cost and utilization analyses, statistical clustering, contrast mining, and logistic regression were used to identify patients within a managed population at risk for higher healthcare costs, demonstrate longitudinal changes in risk stratification, and characterize detailed differences between high-risk and low-risk patients. The two highest risk stratification tiers comprised only 21% of patients but accounted for 43% of prospective charges. Patients in the most expensive sub-cluster of the most expensive risk tier were nearly twice as costly as high-risk patients on average. Combining contrast mining with logistic regression predicted the most expensive 5% of patients with 84% accuracy, as measured by area under the curve. All the strategies used in this study, from the simplest to the most sophisticated, produced useful insights. By predicting the small number of patients who will incur the majority of healthcare expenses in terms that are clinically interpretable, these methods can support population health managers in focusing preventive and longitudinal care more effectively. These models, and similar models developed by integrating diverse informatics strategies, could improve health outcomes, delivery, and costs.

scholarly journals Population-based management of diabetes care - approach and solutions used in the North East Locality Oxfordshire, UK Pilot

2018 ◽  
Vol 18 (s2) ◽  
pp. 396
Author(s):  
Olga Kozlowska ◽  
Rustam Rea ◽  
Garry D Tan ◽  
Alistair Lumb ◽  
Stephen Attwood
Keyword(s):  
Diabetes Care ◽  
Population Based ◽  
North East ◽  
The North ◽  
Care Approach

scholarly journals Bridging the impactibility gap in population health management: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052455
Author(s):  
Andi Orlowski ◽  
Sally Snow ◽  
Heather Humphreys ◽  
Wayne Smith ◽  
Rebecca Siân Jones ◽  
...  
Keyword(s):  
Systematic Review ◽  
Risk Stratification ◽  
Population Health ◽  
Health Management ◽  
Care Quality ◽  
Health Conditions ◽  
Clinical Judgement ◽  
Qualitative Synthesis ◽  
Population Health Management ◽  
Hospitalised Patients

ObjectivesAssess whether impactibility modelling is being used to refine risk stratification for preventive health interventions.DesignSystematic review.SettingPrimary and secondary healthcare populations.PapersArticles published from 2010 to 2020 on the use or implementation of impactibility modelling in population health management, reported with the terms ‘intervenability’, ‘amenability’, and ‘propensity to succeed’ (PTS) and associated with the themes ‘care sensitivity’, ‘characteristic responders’, ‘needs gap’, ‘case finding’, ‘patient selection’ and ‘risk stratification’.InterventionsQualitative synthesis to identify themes for approaches to impactibility modelling.ResultsOf 1244 records identified, 20 were eligible for inclusion. Identified themes were ‘health conditions amenable to care’ (n=6), ‘PTS modelling’ (n=8) and ‘comparison or combination with clinical judgement’ (n=6). For the theme ‘health conditions amenable to care’, changes in practice did not reduce admissions, particularly for ambulatory care sensitive conditions, and sometimes increased them, with implementation noted as a possible issue. For ‘PTS modelling’, high costs and needs did not necessarily equate to high impactibility and targeting a larger number of individuals with disorders associated with lower costs had more potential. PTS modelling seemed to improve accuracy in care planning, estimation of cost savings, engagement and/or care quality. The ‘comparison or combination with clinical judgement’ theme suggested that models can reach reasonable to good discriminatory power to detect impactable patients. For instance, a model used to identify patients appropriate for proactive multimorbid care management showed good concordance with physicians (c-statistic 0.75). Another model employing electronic health record scores reached 65% concordance with nurse and physician decisions when referring elderly hospitalised patients to a readmission prevention programme. However, healthcare professionals consider much wider information that might improve or impede the likelihood of treatment impact, suggesting that complementary use of models might be optimum.ConclusionsThe efficiency and equity of targeted preventive care guided by risk stratification could be augmented and personalised by impactibility modelling.

Ras al Khaimah: further archaeological discoveries

Antiquity ◽  
1976 ◽  
Vol 50 (200) ◽  
pp. 216-222
Author(s):  
Beatrice De Cardi
Keyword(s):  
United Arab Emirates ◽  
The State ◽  
Focused Attention ◽  
North East ◽  
The North ◽  
History Of ◽  
The City

Ras a1 Khaimah is the most northerly of the seven states comprising the United Arab Emirates and its Ruler, H. H. Sheikh Saqr bin Mohammad al-Qasimi, is keenly interested in the history of the state and its people. Survey carried out there jointly with Dr D. B. Doe in 1968 had focused attention on the site of JuIfar which lies just north of the present town of Ras a1 Khaimah (de Cardi, 1971, 230-2). Julfar was in existence in Abbasid times and its importance as an entrep6t during the sixteenth and seventeenth centuries-the Portuguese Period-is reflected by the quantity and variety of imported wares to be found among the ruins of the city. Most of the sites discovered during the survey dated from that period but a group of cairns near Ghalilah and some long gabled graves in the Shimal area to the north-east of the date-groves behind Ras a1 Khaimah (map, FIG. I) clearly represented a more distant past.

Lichens in the North-East regions of Cyprus

1999 ◽  
Vol 110 (5-6) ◽  
pp. 455-463 ◽  
Author(s):  
S. Güvenç ◽  
Ş Öztürk
Keyword(s):  
North East ◽  
The North
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