The Journal of ambulatory care management
-
The electronic medical record has evolved from a digital representation of individual patient results and documents to information of large scale and complexity. Big Data refers to new technologies providing management and processing capabilities, targeting massive and disparate data sets. ⋯ For groups of patients, Big Data offers the promise of large-scale analysis of outcomes, patterns, temporal trends, and correlations. The evolution of Big Data analytics moves us from description and reporting to forecasting, predictive modeling, and decision optimization.
-
J Ambul Care Manage · Jul 2014
Conceptual errors in the CMS refusal to make socioeconomic adjustments in readmission and other quality measures.
The Centers for Medicaid & Medicare Services has made a policy decision that socioeconomic factors should not be adjusted for in its various quality measures and point both to arguments made by the National Quality Forum and to analysis of the distributions of quality results to support this view. We present counterarguments to this viewpoint and use the results reported by the Centers for Medicaid & Medicare Services to support its position to demonstrate that adjustments are necessary. We further argue that the incentives for providers to improve performance would not be weakened by including socioeconomic factor adjustments.
-
J Ambul Care Manage · Apr 2014
Why do we observe a limited impact of primary care access measures on clinical quality indicators?
The study assessed the effects of enhanced primary care access and continuity on clinical quality in a large, multipayer, multispecialty ambulatory care organization with fee-for-service provider incentives. The difference-in-differences estimates indicate that access to own primary care physician is a statistically significant predictor of improved clinical quality, although the effect size is small such that clinical significance may be negligible. Reduced time for own primary care physician appointment and increased enrollment in electronic personal health record are positive predictors of chronic disease management processes and preventive screening but are inconsistently associated with clinical outcomes. Challenges in identifying relationships between access and quality outcomes in a real-world setting are also discussed.
-
J Ambul Care Manage · Jan 2014
Comparative StudyComparison of emergency nurses association Emergency Severity Triage and Australian emergency mental health triage systems for the evaluation of psychiatric patients.
The use of a triage system in the emergency department allows for the ability to reliably assign patients for treatment within a short amount of time in order to prioritize and treat on the basis of patients injury and illness. A 5 point triage system has been shown to have the highest correlation with effective resource utilizations, lower time to be seen and treatment times, and admission or release outcomes for patients. ⋯ This article compares one physical and one specific mental illness-based triage system to measure the differences in times to be seen by a physician. It found that the specialized psychiatric triage system decreased wait times and allowed symptoms to be addressed sooner for patients presenting with psychiatric complaints.