Healthcare (Amsterdam, Netherlands)
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The Veterans Health Administration (VA) primary care is organized as a Patient Centered Medical Home (PCMH) that is based on continuity management of patient panels by interdisciplinary "teamlets" consisting of primary care providers, nurses, and clerical associates. While the teamlets are envisioned as interdisciplinary in this model, teamlet members may continue to report separately to middle management supervisors within their respective disciplines. Little is known about the role of middle managers in medical home implementation; therefore, the study purpose is to examine and characterize teamlet members' perceptions of middle managers' role in primary care operations and teamlet functioning in an outpatient setting. ⋯ Within a multilevel system, frontline interdisciplinary staff continue to perceive the need for leadership by middle managers from their own professional disciplines for solving interdisciplinary problems, setting role-specific schedules and expectations, and fostering innovation. As such, greater focus on the structure and training of middle managers for participation in PCMH models is needed.
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In India, 90% of the rural population is estimated to lack access to safe, affordable, and timely surgical care. Surgical care in these settings is often characterized by limited resources. Provision of rural surgical care often requires novel approaches as compared to those in higher income urban sectors, specifically in areas of infrastructure, workforce, and blood. This consensus statement draws upon the wealth of experience held by India's rural surgeons to identify key problems and lay forth actionable solutions in the areas of surgical infrastructure, workforce, and blood supply.
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Improving the value of post-acute care at skilled nursing facilities (SNFs) has become a Medicare policy priority. Anecdotally, hospitals have responded by formally acquiring or pursuing tighter informal connections with SNFs. We evaluated the trend in connections between US acute care hospitals and Medicare-certified SNFs between 2000 and 2013 using vertical integration and two novel network-based measures (number of SNF partners, and discharge concentration). ⋯ Over one-third (39%) of hospitals were vertically integrated in 2000 compared to 8.2% in 2013. The number of SNF partners increased between 2000 and 2013, while hospitals' discharge concentration declined steadily. Additional work is needed to understand the implications of these trends.
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Medicare's Accountable Care Organization (ACO) programs introduced shared savings to traditional Medicare, which allow providers who reduce health care costs for their patients to retain a percentage of the savings they generate. ⋯ III.
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Our institution employs a Surgical Universal Protocol Preoperative Checklist in accordance with World Health Organization guidelines to promote patient safety. It is used in part to evaluate orthopaedic surgical equipment and implant readiness prior to the initiation of each surgical case. Our goal is to measure the preoperative checklist's efficacy in assessing orthopaedic equipment readiness preoperatively and its ability to prevent orthopaedic equipment failures (OEF). Our study focused on orthopaedic surgery cases as they require a large volume of equipment and implants for successful completion. These cases therefore present an appropriate medium to identify potential weakness in our institution's current surgical safety checklist (SSC). ⋯ Level IV.