Annals of family medicine
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Annals of family medicine · Sep 2014
The family physician's perceived role in preventing and guiding hospital admissions at the end of life: a focus group study.
Family physicians play a pivotal role in providing end-of-life care and in enabling terminally ill patients to die in familiar surroundings. The purpose of this study was to explore the family physicians' perceptions of their role and the difficulties they have in preventing and guiding hospital admissions at the end of life. ⋯ Family physicians face many different and complex roles and difficulties in preventing and guiding hospital admissions at the end of life. Enhancing the family physician's role as a gatekeeper to hospital services, offering the physicians more end-of-life care training, and developing or expanding initiatives to support them could contribute to a lower proportion of hospital admissions at the end of life.
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Annals of family medicine · Sep 2014
Cost, utilization, and quality of care: an evaluation of illinois' medicaid primary care case management program.
In 2006, Illinois established Illinois Health Connect (IHC), a primary care case management program for Medicaid that offered enhanced fee-for-service, capitation payments, performance incentives, and practice support. Illinois also implemented a complementary disease management program, Your Healthcare Plus (YHP). This external evaluation explored outcomes associated with these programs. ⋯ The Illinois Medicaid IHC and YHP programs were associated with substantial savings, reductions in inpatient and emergency care, and improvements in quality measures. This experience is not typical of other states implementing some, but not all, of these same policies. Although specific features of the Illinois reforms may have accounted for its better outcomes, the limited evaluation design calls for caution in making causal inferences.
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Caring for patients is an act of interpretation: we labor to understand the significance of a particular symptom and, when we have reached a diagnosis, we convert our medical jargon into plain language for the benefit of the patient. Caring for patients of limited English proficiency-a population that needs a very literal form of interpretation-underscores this lesson. Working with predominantly Spanish-speaking patients has shown me the importance of bearing witness to patients' struggles and has brought me to realize that good physicians must work to forge a common language with all their patients, not only with those who do not speak English.