Nejm Catalyst Innovations in Care Delivery最新文献

{"title":"Silos and Shortages Challenge Transitions Between Care Settings","authors":"K. Lam, C. Blauwet","doi":"10.1056/cat.23.0095","DOIUrl":"https://doi.org/10.1056/cat.23.0095","url":null,"abstract":"","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75214338","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}

{"title":"In-Basket Reduction: A Multiyear Pragmatic Approach to Lessen the Work Burden of Primary Care Physicians","authors":"Jane F. Fogg, C. Sinsky","doi":"10.1056/cat.22.0438","DOIUrl":"https://doi.org/10.1056/cat.22.0438","url":null,"abstract":"","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76230431","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}

{"title":"Hospital Leaders Highlight the Many Challenges to Care Transitions","authors":"Jon Bees","doi":"10.1056/cat.23.0105","DOIUrl":"https://doi.org/10.1056/cat.23.0105","url":null,"abstract":"","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74008323","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}

{"title":"VA Health Connect: A Clinical Contact Center Designed to Enhance Access and Quality of Care for Veterans","authors":"S. Kirsh, Christine Rovinski-Wagner, Sara Brass, Katherine M. Williams, Maria Bouchard, K. Kizer","doi":"10.1056/cat.22.0292","DOIUrl":"https://doi.org/10.1056/cat.22.0292","url":null,"abstract":"The Covid-19 pandemic dramatically catalyzed use of telehealth and other virtual care modalities. Now, as virtual care delivery has become more widely accepted and increasingly used as a primary mode of care delivery, clinical contact centers (CCCs) are emerging as an important venue for access to a growing array of virtual care and other services. The Veterans Affairs Health System (VHS) has found that its call centers, which were historically used to offer patients inbound telephonic communication, have provided a foundation for regional CCCs using technology to offer patients bidirectional, multichannel communication (e.g., voice, video, text, chat) that improves health care accessibility, care coordination, and patient communication. In addition, the VHS has used the CCCs to leverage resources across care settings when managing public health emergencies. In May 2020, the VHS's Office of Veterans Access to Care led an initiative to modernize and consolidate the 87 individual Veterans Affairs Medical Center (VAMC) call centers into 18 regional CCCs serving all 171 VAMCs. Although still a work in progress, the Veterans Affairs CCC initiative — branded VA Health Connect — has expanded access to primary care, pharmacy services, emergency medicine, and mental health services. VA Health Connect is now responding to more than 40 million inquiries per year, with improvements in speed to answer, abandonment rates, and first-contact resolution. The authors describe some lessons learned in the implementation of VA Health Connect about how to involve people, processes, and technology to enhance patient services. The application of human-centered design can inform technology adoption and configuration of multichannel (omnichannel) communications. Critical to the success of VA Health Connect has been the incorporation of change management, effective mechanisms for deploying care delivery technology, and the importance of standardized data for performance improvement and organizational learning.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"82 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83967053","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}

{"title":"How to Heal the Emerging Problems of Health Care","authors":"E. Prewitt, N. Mohta, L. Gordon, Thomas H. Lee","doi":"10.1056/cat.23.0107","DOIUrl":"https://doi.org/10.1056/cat.23.0107","url":null,"abstract":"","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90815718","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}

{"title":"Decarbonizing Health Care: Engaging Leaders in Change","authors":"V. S. Lee, K. Gerwig, E. Hough, K. Mate, Robert Biggio, R. Kaplan","doi":"10.1056/cat.22.0433","DOIUrl":"https://doi.org/10.1056/cat.22.0433","url":null,"abstract":"","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"173 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78991633","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}

{"title":"Fostering Enhanced Integration Between Early Education and Pediatric Primary Care to Support Whole-Child Health","authors":"Ryan Padrez, N. Iyer, Paul Espinas, Kapil R. Dhingra","doi":"10.1056/cat.22.0216","DOIUrl":"https://doi.org/10.1056/cat.22.0216","url":null,"abstract":"","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"11 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73031970","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}

{"title":"Addressing Health-Related Social Needs Through Systematic Screening and Integration of a Social Care Technology Platform","authors":"Eugenia R. McPeek Hinz, C. Avery, Sara Johnson, Connor D Drake, Susan E. Spratt","doi":"10.1056/cat.22.0324","DOIUrl":"https://doi.org/10.1056/cat.22.0324","url":null,"abstract":"","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77104162","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}

{"title":"Implementation Support for a Social Risk Screening and Referral Process in Community Health Centers.","authors":"Rachel Gold,&nbsp;Jorge Kaufmann,&nbsp;Erika K Cottrell,&nbsp;Arwen Bunce,&nbsp;Christina R Sheppler,&nbsp;Megan Hoopes,&nbsp;Molly Krancari,&nbsp;Laura M Gottlieb,&nbsp;Meg Bowen,&nbsp;Julianne Bava,&nbsp;Ned Mossman,&nbsp;Nadia Yosuf,&nbsp;Miguel Marino","doi":"10.1056/CAT.23.0034","DOIUrl":"https://doi.org/10.1056/CAT.23.0034","url":null,"abstract":"<p><p>Evidence is needed about how to effectively support health care providers in implementing screening for social risks (adverse social determinants of health) and providing related referrals meant to address identified social risks. This need is greatest in underresourced care settings. The authors tested whether an implementation support intervention (6 months of technical assistance and coaching study clinics through a five-step implementation process) improved adoption of social risk activities in community health centers (CHCs). Thirty-one CHC clinics were block-randomized to six wedges that occurred sequentially. Over the 45-month study period from March 2018 to December 2021, data were collected for 6 or more months <i>preintervention</i>, the 6-month <i>intervention period</i>, and 6 or more months <i>postintervention</i>. The authors calculated clinic-level monthly rates of social risk screening results that were entered at in-person encounters and rates of social risk-related referrals. Secondary analyses measured impacts on diabetes-related outcomes. Intervention impact was assessed by comparing clinic performance based on whether they <i>had</i> versus <i>had not yet</i> received the intervention in the preintervention period compared with the intervention and postintervention periods. In assessing the results, the authors note that five clinics withdrew from the study for various bandwidth-related reasons. Of the remaining 26, a total of 19 fully or partially completed all 5 implementation steps, and 7 fully or partially completed at least the first 3 steps. Social risk <i>screening</i> was 2.45 times (95% confidence interval [CI], 1.32-4.39) higher during the intervention period compared with the preintervention period; this impact was not sustained postintervention (rate ratio, 2.16; 95% CI, 0.64-7.27). No significant difference was seen in social risk <i>referral</i> rates during the intervention or postintervention periods. The intervention was associated with greater blood pressure control among patients with diabetes and lower rates of diabetes biomarker screening postintervention. All results must be interpreted considering that the Covid-19 pandemic began midway through the trial, which affected care delivery generally and patients at CHCs particularly. Finally, the study results show that adaptive implementation support was effective at temporarily increasing social risk screening. It is possible that the intervention did not adequately address barriers to sustained implementation or that 6 months was not long enough to cement this change. Underresourced clinics may struggle to participate in support activities over longer periods without adequate resources, even if lengthier support is needed. As policies start requiring documentation of social risk activities, safety-net clinics may be unable to meet these requirements without adequate financial and coaching/technical support.</p>","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"4 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10161727/pdf/nihms-1885926.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9486703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care’s New Emphasis on Social Determinants of Health","authors":"Seth A. Berkowitz","doi":"10.1056/cat.23.0070","DOIUrl":"https://doi.org/10.1056/cat.23.0070","url":null,"abstract":"","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78543079","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}