Nejm Catalyst Innovations in Care Delivery最新文献

Plugging Public Health Data into the Health IT Ecosystem to Protect National Health 将公共卫生数据纳入卫生信息技术生态系统，保护国民健康

Nejm Catalyst Innovations in Care Delivery Pub Date : 2024-07-17 DOI: 10.1056/CAT.24.0129

Jennifer E. Layden, Matthew J. Swain, Niall Brennan, Micky Tripathi

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Knocking Down Public Health and Health Care Silos: An Innovative Covid-19 Health Equity Response 打破公共卫生和医疗保健的隔阂：创新的 Covid-19 健康公平对策

Nejm Catalyst Innovations in Care Delivery Pub Date : 2024-07-17 DOI: 10.1056/CAT.24.0118

Ingrid Johansen, Mohammed Selim, Mark Jackson, Carolina Ramirez Rattray

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Independent Care Navigators for the Mental Health Maze 心理健康迷宫的独立护理导航员

Nejm Catalyst Innovations in Care Delivery Pub Date : 2023-10-18 DOI: 10.1056/cat.23.0231

Judith E. Klein, Benedict J. Carey, Elyn R. Saks, P. Murali Doraiswamy

{"title":"Independent Care Navigators for the Mental Health Maze","authors":"Judith E. Klein, Benedict J. Carey, Elyn R. Saks, P. Murali Doraiswamy","doi":"10.1056/cat.23.0231","DOIUrl":"https://doi.org/10.1056/cat.23.0231","url":null,"abstract":"SummaryThe nonprofit organization INclude – the Mental Health Initiative has developed and deployed an independent, data-backed navigation service in North Carolina and provides insights and lessons learned from its first year of operation as a pilot. The Mental Health GPS model starts with the traditional peer-run warmline for people who may just want to talk or learn about available, suited resources. It then enhances this basic support with sophisticated human and database resources to provide an independent navigation service delivered by peer support specialists who possess both relevant life experience and clinical knowledge/fluency, and are backed by a vetted list of mental health providers to ensure guidance to apt services. The GPS is not designed to be a crisis hotline for imminent life-and-death circumstances, but instead to help a person navigate the mental health system and effectively avert a crisis. In the 1-year pilot, the Mental Health GPS service received 2,384 calls or texts, almost all generated by Internet searches on smartphones. The themes most often associated with caller concerns were work/personal (41.6%), depression (11.7%), and general anxiety (7.2%).","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"875 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135885233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Using Publicly Reported Global Hospital Rankings to Improve Dissemination of Patient-Reported Outcome Measures (PROMs) 利用公开报告的全球医院排名改善患者报告结果测量(PROMs)的传播

Nejm Catalyst Innovations in Care Delivery Pub Date : 2023-10-18 DOI: 10.1056/cat.23.0097

David W. Bates, Jens Deerberg-Wittram, Gregory Katz, Katharina Braeger, Lena S. Hirsch, Gary S. Kaplan, Lukas Kwietniewski, Christoph A. Meier, Camila Plaza de Laifer, Eyal Zimlichman

{"title":"Using Publicly Reported Global Hospital Rankings to Improve Dissemination of Patient-Reported Outcome Measures (PROMs)","authors":"David W. Bates, Jens Deerberg-Wittram, Gregory Katz, Katharina Braeger, Lena S. Hirsch, Gary S. Kaplan, Lukas Kwietniewski, Christoph A. Meier, Camila Plaza de Laifer, Eyal Zimlichman","doi":"10.1056/cat.23.0097","DOIUrl":"https://doi.org/10.1056/cat.23.0097","url":null,"abstract":"SummaryPatient-reported outcome measures (PROMs) represent an essential element of value-based care in health care sectors worldwide by transferring the quality definition from process- to outcome-based indicators that focus on the patients’ needs. However, the adoption rate of PROMs in hospitals is still low. To address this challenge and to account for the growing importance of value-based health care, Newsweek and Statista developed a PROMs implementation survey along with a global board of medical experts to determine the current state of PROMs implementation in hospitals. The results of this survey were incorporated into the 2023 editions of Newsweek’s World’s Best Specialized Hospitals and World’s Best Hospitals rankings. The inclusion of PROMs adds a patient outcome–focused dimension that overcomes methodologic limitations and improves the comprehensiveness of these rankings. Furthermore, the public reporting of clinical outcomes such as PROMs serves as a catalyst to improve the quality of care. In this article, the authors describe what they believe is the increasing relevance of value-based health care and PROMs, the process of developing and launching the PROMs implementation survey, and its incorporation into hospital rankings to improve the value of care for patients on a global level.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135884953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Improving the Value of Health Care and Accelerating Care Delivery Transformation 提高医疗保健价值，加快医疗服务转型

Nejm Catalyst Innovations in Care Delivery Pub Date : 2023-10-18 DOI: 10.1056/cat.23.0320

Edward Prewitt, Namita Seth Mohta, Lisa Gordon, Thomas H. Lee

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Post-Acute Care Struggles with Staffing Shortages 急症后护理与人员短缺的斗争

Nejm Catalyst Innovations in Care Delivery Pub Date : 2023-10-18 DOI: 10.1056/cat.23.0318

Thomas Schaaf

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Implementing an Automated Prediction Model to Improve Prescribing of HIV Preexposure Prophylaxis 应用自动预测模型改进HIV暴露前预防处方

Nejm Catalyst Innovations in Care Delivery Pub Date : 2023-10-18 DOI: 10.1056/cat.23.0215

Douglas S. Krakower, Michael Lieberman, Miguel Marino, Jun Hwang, Kenneth H. Mayer, Julia L. Marcus

{"title":"Implementing an Automated Prediction Model to Improve Prescribing of HIV Preexposure Prophylaxis","authors":"Douglas S. Krakower, Michael Lieberman, Miguel Marino, Jun Hwang, Kenneth H. Mayer, Julia L. Marcus","doi":"10.1056/cat.23.0215","DOIUrl":"https://doi.org/10.1056/cat.23.0215","url":null,"abstract":"SummaryAntiretroviral preexposure prophylaxis (PrEP) is nearly 100% effective at decreasing HIV acquisition but is underused in priority populations. Primary care clinicians need tools to help them identify persons likely to benefit from PrEP use and prescribe it when appropriate. The researchers developed and validated an automated decision support tool with interactive alerts in the electronic health record to increase PrEP discussions and prescribing in primary care. They piloted the tool at three federally qualified health centers and assessed feasibility, acceptance by clinicians, and preliminary impact on PrEP care. Of 33,803 patients who visited the pilot clinics from July 2022 through January 2023, providers received PrEP alerts at the point of care for 2.2% of patients, demonstrating feasibility. Although numbers of PrEP prescriptions remained low, the proportion of all patients with new PrEP prescriptions was 4.5 times higher at pilot clinics compared with matched control clinics (0.09% vs. 0.02%). Implementation of the decision support tool was associated with a statistically nonsignificant 5.5% increase in HIV tests per 100 patients. In qualitative interviews, providers said the tool facilitated PrEP discussions with patients, particularly for those patients who would not have initiated discussions because of stigma. The researchers found that acceptance, use, and impact of machine-learning models for PrEP depends on collaborating with and building trust among providers, including blending a data-driven approach to identifying patients at increased risk for HIV acquisition with providers’ traditional decision-making framework. These approaches could be useful for health care organizations seeking to implement automated prediction models across all areas of medicine.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135883595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Post-Acute Care Faces a Perfect Storm of Challenges 急症后护理面临一系列挑战

Nejm Catalyst Innovations in Care Delivery Pub Date : 2023-10-18 DOI: 10.1056/cat.23.0321

Jonathan Bees

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Intake Hospitalist: A New Role to Maximize the Safety and Efficiency of Interhospital Transfers 住院医师:一个新的角色，以最大限度地提高医院间转院的安全性和效率

Nejm Catalyst Innovations in Care Delivery Pub Date : 2023-10-18 DOI: 10.1056/cat.23.0198

Michael Jesse Hendricks, Alexandra Wiggins, Stephanie A. C. Halvorson, Matthias Johannes Merkel

{"title":"Intake Hospitalist: A New Role to Maximize the Safety and Efficiency of Interhospital Transfers","authors":"Michael Jesse Hendricks, Alexandra Wiggins, Stephanie A. C. Halvorson, Matthias Johannes Merkel","doi":"10.1056/cat.23.0198","DOIUrl":"https://doi.org/10.1056/cat.23.0198","url":null,"abstract":"SummaryThe interhospital transfer process is complex and susceptible to logistic errors, inefficiencies, and patient harm. Historically, hospitalists at Oregon Health & Science University (OHSU) were responsible for managing incoming Medicine transfer requests in addition to concurrent clinical and teaching duties. Transfer patients sometimes arrived unprepared for planned interventions, lacking necessary records, or clinically unstable. Others were transferred without a clear need for a higher level of care. In response, OHSU created the Intake Hospitalist role — a dedicated and specially trained hospitalist without other clinical and educational duties, who manages all direct admissions, intrahospital transfers of service, and interhospital transfer requests to the Medicine service. The goal of the Intake Hospitalist program is to improve the quality and safety of the transfer process and accept the “right patient, at the right time, to the right place.” The role was implemented in January 2021 and has led to appreciable improvements in patient safety, standardization, bed utilization, and physician experience. Notably, the authors found the cost of this program has been offset by the indirect financial savings created through backfill of inpatient beds with higher-complexity patients. The Intake Hospitalist has proven so successful that OHSU developed similar roles for the ICUs and Pediatrics during high-demand situations. The authors believe this model could be successful at other large academic centers.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135824389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Accelerating Care Delivery Transformation — The CMS Innovation Center’s Role in the Next Decade 加速医疗服务转型——CMS创新中心在未来十年中的作用

Nejm Catalyst Innovations in Care Delivery Pub Date : 2023-10-18 DOI: 10.1056/cat.23.0228

Elizabeth Fowler, Noemi Rudolph, Kate Davidson, Bruce Finke, Shannon Flood, Susannah M. Bernheim, Purva Rawal

{"title":"Accelerating Care Delivery Transformation — The CMS Innovation Center’s Role in the Next Decade","authors":"Elizabeth Fowler, Noemi Rudolph, Kate Davidson, Bruce Finke, Shannon Flood, Susannah M. Bernheim, Purva Rawal","doi":"10.1056/cat.23.0228","DOIUrl":"https://doi.org/10.1056/cat.23.0228","url":null,"abstract":"SummaryOver the past decade, the U.S. Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMS Innovation Center) has tested more than 50 payment models with a range of participants and value-based payment features. Value-based payment models can provide the necessary flexibility to support care delivery that better addresses people’s health and health-related social needs. This transformation of the delivery system, supported by value-based payment models, can drive better care, improve outcomes, and lower costs. The impact of CMS Innovation Center models has largely focused on financial impacts, with varied results in terms of total health care cost reduction. There has been less focus on the extent to which payment models have enabled care delivery transformation. To inform the development of a new framework to better assess the impacts of payment models and to drive care delivery transformation, the CMS Innovation Center undertook a retrospective review and synthesis of select models to assess if — and which — care delivery changes have been observed. The review indicated demonstrable evidence of enhanced care delivery in several areas, such as care coordination, team-based care, and leveraging data to risk-stratify patients, among other strategies. Three broad themes are shared among the more successful efforts. (1) Participants across models used common care coordination and other strategies to deliver person-centered care, (2) practice changes enabled by value-based care models showed evidence of tailoring care to local needs, and (3) care delivery trends and changes extend beyond the CMS Innovation Center models. This article summarizes those findings, which are informing the development of a new framework to accelerate care transformation.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135884640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0