Annals of family medicine
-
Annals of family medicine · Jul 2006
Challenges of change: a qualitative study of chronic care model implementation.
The Chronic Care Model (CCM) provides a conceptual framework for transforming health care for patients with chronic conditions; however, little is known about how to best design and implement its specifics. One large health care organization that tried to implement the CCM in primary care provided an opportunity to study these issues. ⋯ These findings highlight specific organizational challenges with health care transformation in the absence of a blueprint more specific than the CCM. Effective models of organizational change and detailed examples of proven, feasible care changes still need to be demonstrated if we are to transform care as called for by the Institute of Medicine.
-
Annals of family medicine · Jul 2006
Syndromic surveillance for emerging infections in office practice using billing data.
We wanted to evaluate the feasibility of conducting syndromic surveillance in a primary care office using billing data. ⋯ This preliminary study showed the feasibility of implementing syndromic surveillance in an office setting at a low cost and with minimal staff effort. Although many implementation issues remain, further development of syndromic surveillance systems should include primary care offices.
-
Annals of family medicine · May 2006
Vaginal birth after cesarean in California: before and after a change in guidelines.
In 1999 the American College of Obstetricians and Gynecologists (ACOG) adopted more-restrictive guidelines for vaginal birth after cesarean delivery (VBAC). This study assesses trends in VBAC in California and compares neonatal and maternal mortality rates among women attempting VBAC delivery or undergoing repeat cesarean delivery before and after this guideline revision. ⋯ Neonatal and maternal mortality rates did not improve despite increasing rates of repeat cesarean delivery during the years after the ACOG 1999 VBAC guideline revision. Women with infants weighing > or =1,500 g encountered similar neonatal and maternal mortality rates with VBAC or repeat cesarean delivery.
-
Annals of family medicine · May 2006
The US Medical Liability System: evidence for legislative reform.
Despite state and federal efforts to implement medical malpractice reform, there is limited evidence on which to base policy decisions. The National Practitioner Data Bank (NPDB) offers an opportunity to evaluate the effects of previous malpractice tort reforms on malpractice payments and premiums. ⋯ Significant reductions in malpractice payments could be realized if total or noneconomic damage caps were operating nationally. Hard noneconomic damage and total damage caps could yield lower premiums. If tied to a comprehensive plan for reform, the money saved could be diverted to implement alternative approaches to patient compensation or be used to achieve other systems reform benefiting patients, employers, physicians, and hospitals.