The Journal of ambulatory care management
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J Ambul Care Manage · Apr 2011
Randomized Controlled TrialTelecare management of pain and depression in patients with cancer: patient satisfaction and predictors of use.
Pain and depression are 2 of the most common and disabling cancer-related symptoms. In the Indiana Cancer Pain and Depression trial, 202 cancer patients with pain and/or depression were randomized to the intervention group and received centralized telecare management augmented by automated symptom monitoring (ASM). ⋯ Adherence was also generally good, although several predictors of fewer ASM reports and nurse calls were identified. Only a minority of ASM reports triggered a nurse call, suggesting the efficiency of coupling clinician-delivered telecare management with automated monitoring.
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J Ambul Care Manage · Jan 2010
CommentGuiding principles for payment system reform: commentary on "Achieving cost control, care coordination, and quality improvement through incremental payment system reform".
The focus of healthcare payment reform must be on the "value equation"--improving the quality of care while reducing or controlling costs. Adhering to key principles related to value will yield successful payment transformation and result in more coordinated care and improved patient outcomes. Actionable data and information for setting goals and measuring progress is an essential element.
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J Ambul Care Manage · Jul 2009
The impact of the electronic health record on an academic pediatric primary care center.
Many hospitals and practices are transitioning to electronic health records (EHR), but there is little information on the impact on patient care in a busy pediatric academic setting. The objective of this study was to determine the impacts of EHR on documentation, clinical processes, billing, ancillary staff responsibilities, scheduling, and cycle time. A descriptive study to assess the impact of EHR implementation and subsequent use on documentation, clinical processes, and patient access and flow was performed in a large urban academic pediatric primary care health center. ⋯ EHR implementation improved documentation of patient care, improved clinical processes, and resulted in increased revenue. However, the implementation of the EHR also led to short-term decreased appointment availability and a persistent longer cycle time. Ongoing information system training support is a key for maintaining efficiency due to the large number of new learners.
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Emergency department (ED) overcrowding by low-acuity patients is a recognized problem. There is little in the literature on why patients with minor problems and an established primary care physician (PCP) present to the ED. ⋯ Inability to schedule a rapid clinic/office appointment, advice by PCP to utilize the ED, and high self-perceived severity of illness were the primary reasons for ED usage. Increased patient education about the range of conditions appropriate for care in the PCP office and more availability of office appointments could potentially decrease the ED usage by patients with low-acuity problems.