The Permanente journal最新文献

{"title":"Call for Papers: Improving Health Care Access.","authors":"","doi":"10.7812/TPP/25.098","DOIUrl":"10.7812/TPP/25.098","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333925","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":"The Evolution of the Kaiser Permanente Southern California Regional Virtual Medical Center.","authors":"Khang A Nguyen, Nicolaas Versteeg, Eleanor Morales, Rebecca Hilton","doi":"10.7812/TPP/25.005","DOIUrl":"10.7812/TPP/25.005","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"96-97"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664363","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":"The Impact of Payment Reform on Medicaid Access and Quality: A National Survey of Physicians.","authors":"Jubi Yl Lin, Joseph H Joo, Lingmei Zhou, Rachna Goswami, Joshua M Liao","doi":"10.7812/TPP/24.121","DOIUrl":"10.7812/TPP/24.121","url":null,"abstract":"<p><strong>Introduction: </strong>Addressing health inequity should involve improving access and quality of care for individuals with low income. In the United States, programs that involve accountable care incentives and broader risk adjustment are poised to help address these issues. However, there is limited understanding of perspectives among physicians as key stakeholders in determining access and quality.</p><p><strong>Methods: </strong>The authors surveyed physicians about how they perceived accountable care incentives and broader risk adjustment (greater inclusion of clinical, social, and behavioral risk factors) would impact access and quality for patients with low income insured through Medicaid.</p><p><strong>Results: </strong>Low Medicaid reimbursement rates and inadequate adjustment for patients' clinical, social, and behavioral risk factors were major factors why physicians reported not seeing Medicaid patients in their clinical practices. Many physicians believed that accountable care incentives and changes in risk adjustment would help facilitate higher quality of care for Medicaid patients, while the minority of physicians believed that accountable care organizations could ultimately improve the value of care beyond managed care organizations.</p><p><strong>Discussion: </strong>Policymakers could incorporate behavioral, social, and equity-related factors into risk adjustment and consider ways to incorporate accountable care incentives into existing and new entities in Medicaid.</p><p><strong>Conclusion: </strong>The majority of physicians believed that the care of Medicaid patients would improve under accountable care incentives and broader risk adjustment. Understanding physician perspectives is important for contextualizing policy about how payment reforms could affect access and quality of care for Medicaid patients.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"41-47"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796188","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":"Models of Care in Hospital Medicine: An Analysis of Advance Practitioner Utilization Using Monte Carlo Methods.","authors":"Rohit Sharma, Noora Akram, Michael Madden","doi":"10.7812/TPP/24.159","DOIUrl":"10.7812/TPP/24.159","url":null,"abstract":"<p><strong>Introduction: </strong>Physicians are facing a constant shortage, with market estimates of shortfalls only projected to increase as the population of the United States ages and health care employment needs increase. A lack of physicians has led to a steady increase in the number and scope of advanced practice practitioners (APPs) in the United States. Nurse practitioners and physician assistants have increased, in terms of percentage of the practitioner workforce, with varying degrees of autonomy. The authors describe a model of APPs to determine whether indirect supervision vs direct supervision is fiscally optimum in hospital medicine departments.</p><p><strong>Methods: </strong>The authors utilized R software in R Studio to simulate, via Monte Carlo methods, APP-independent and supervised models of care. Publicly available salary data were used as the foundation to generate the models. The data were then used to simulate typical care teams of APPs and physicians in hospital medicine, while utilizing typical billing practices.</p><p><strong>Discussion: </strong>Analysis of the models of care generated demonstrated that APPs, given the current payer reimbursements, are an integral part of the hospital medicine care team. A range of scenarios are accounted for. This research demonstrates that direct supervision has a lower cost per work relative value unit cost to the employer, as opposed to indirect supervision.</p><p><strong>Conclusion: </strong>APPs will only continue to increase their share of billed visits. In the setting of a hospital medicine workflow, given current payer and salary constraints, direct supervision is recommended to optimize the care team from a fiduciary perspective.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"48-53"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035714","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":"Impact of Early vs Delayed Anterior Cruciate Ligament Reconstruction on Tibiofemoral Laxity.","authors":"Virginia Xie, Jacob Ghahremani, Tanya Watarastaporn, Michael Chapek, McKenzie Culler, Andrew Zogby, Daniel Hagaman, Aditya Manoharan, Andrew Fithian, Najeeb Khan","doi":"10.7812/TPP/24.113","DOIUrl":"10.7812/TPP/24.113","url":null,"abstract":"<p><strong>Introduction: </strong>Optimal timing of anterior cruciate ligament reconstruction (ACLR) remains controversial. This study evaluated the impact of timing of ACLR on rates of revision, return to the operating room, and pre- and postoperative tibiofemoral laxity.</p><p><strong>Methods: </strong>A retrospective review was performed from January 1, 2010, to December 31, 2015, and included patients ≥ 16 years of age with no history of prior ipsilateral or contralateral knee surgery who underwent primary arthroscopic ACLR. Patients were categorized as early ACLR (< 6 months postinjury) or delayed ACLR (≥ 6 months). Pre- and postoperative manual-maximum differences (MMDs) based on KT-1000 testing and postoperative pivot shift were examined.</p><p><strong>Results: </strong>A total of 611 patients met inclusion criteria (n = 198 early ACLR and n = 413 delayed ACLR). Compared to the early ACLR group, patients receiving delayed ACLR had a lower preoperative MMD (mean 6.55 vs 7.27 mm). Postoperative MMD, as measured by a single physical therapist, was not significantly different for early vs delayed reconstruction. Logistic regression controlling for age, graft type, and postoperative laxity revealed that delayed ACLR was associated with lower odds of return to the operating room (odds ratio = 0.523, <i>P</i> = .045).</p><p><strong>Conclusion: </strong>Delayed ACLR was associated with a lower return to the operating room and no difference in postoperative MMD.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"21-29"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701651","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":"Methodological Techniques to Estimate the Sensitivity of the Agency for Healthcare Research and Quality Patient Safety Indicators.","authors":"Daniel J Tancredi, Patricia A Zrelak, Garth H Utter, Jeffrey J Geppert, Patrick S Romano","doi":"10.7812/TPP/24.180","DOIUrl":"10.7812/TPP/24.180","url":null,"abstract":"<p><strong>Background: </strong>Little is known about how comprehensively the Agency for Healthcare Research and Quality's patient safety indicators (PSIs) capture true complications. Therefore, the authors sought to assess the PSIs' sensitivity using a novel sampling and analytic strategy tailored for unusual events to ensure adequate capture of false negative cases.</p><p><strong>Methods: </strong>The authors retrospectively reviewed hospitalization records not flagged by 7 selected PSIs, oversampling those with specific diagnosis or procedure codes suggesting an unreported complication, with a special interest in PSI 09 (Postoperative Hemorrhage or Hematoma) and PSI 10 (Postoperative Physiologic and Metabolic Derangement). The authors evaluated data from 27 hospitals in 11 states between 2006 and 2009. For each PSI, the authors determined the negative predictive value (NPV), accounting for sampling weights, and used previous estimates of positive predictive value (PPV) and incidence to estimate sensitivity.</p><p><strong>Results: </strong>For PSI 09, 32 of 281 abstracted records (including 30 of 116 high-risk records) were falsely negative (NPV 99.73%; 97.5%, confidence interval [CI], 98.96-99.94); the estimated sensitivity was 40% (95% CI, 12-76). For PSI 10, 3 of 230 records (including 3 of 108 high-risk records) were falsely negative (NPV 99.92%; 97.5% CI, 99.28-99.99); the sensitivity was 53% (95% CI, 9-92). The estimated sensitivity of other PSIs varied (19%-100%).</p><p><strong>Conclusions: </strong>The sensitivity of several Agency for Healthcare Research and Quality PSIs, estimated from a sample of hospitalizations enriched with records suggesting an unreported complication, varied widely. Although the 2-stage complex stratified sampling design (using weights based on sampling probabilities) allows estimation of the sensitivity of hospital outcome measures, large sample sizes are still required for unusual events.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"54-63"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013852","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":"Editor-in-Chief's Response to \"The Evolution of the Kaiser Permanente Southern California Regional Virtual Medical Center\".","authors":"G Richard Holt","doi":"10.7812/TPP/25.023","DOIUrl":"10.7812/TPP/25.023","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"98"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664361","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":"Introduction to Issue 29:2 by the Editor-in-Chief.","authors":"G Richard Holt","doi":"10.7812/TPP/25.084","DOIUrl":"https://doi.org/10.7812/TPP/25.084","url":null,"abstract":"","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":"29 2","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302828","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":"Assessment of Misinterpretation of Regulation by Compliance Professionals: A Multimethod Study.","authors":"Jeffrey Panzer, Lindsey E Carlasare, Maggie Hamielec, Christine A Sinsky, Jodi Simon","doi":"10.7812/TPP/24.086","DOIUrl":"10.7812/TPP/24.086","url":null,"abstract":"<p><strong>Background: </strong>The volume and complexity of administrative regulations, standards, and associated tasks contribute to administrative burden in health care. Misinterpretation and misapplication of regulations impede efficiency and contribute to professional dissatisfaction.</p><p><strong>Objectives: </strong>The authors aimed to 1) understand the compliance professional role, training, and background; 2) uncover their perspectives toward documentation and administrative burden; and 3) identify common regulatory misconceptions by compliance professionals.</p><p><strong>Methods: </strong>In June 2023, the authors surveyed a sample of professionals serving in compliance roles listed within the directory of a national network of federally qualified health centers. Data were collected through REDCap. Follow-up interviews were completed with 4 participants between September and November of 2023. Descriptive statistics were calculated for all quantitative variables; interview transcripts were analyzed using rapid qualitative analysis. Methodological triangulation was employed to identify themes across survey and interview responses.</p><p><strong>Results: </strong>About one-third (5/16, 31%) of compliance professionals had formal training. The majority (15/16, 94%) agreed or strongly agreed that \"If a clinician's action is not documented it is not 'done.'\" Compliance professionals' perceptions of regulatory adherence in clinical scenarios showed high variability, with some participants noting noncompliance in situations where there were no regulatory infractions. Participants perceived administrative burden and waste in health care but diverged in their views of whether they have a role in protecting clinicians from administrative burden.</p><p><strong>Conclusions: </strong>This study reveals inaccuracies in compliance professionals' interpretations of regulations and standards and suggests a gap between written regulations and interpretation at the organizational level. This overinterpretation may create unnecessary work for physicians and their teams.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"3-11"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543545","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":"Choice of Corticosteroid Is Associated With the Possibility of Subsequent Surgery for Trigger Finger: A Retrospective Cohort Study.","authors":"Todd A Theman, Bradley Frueh, Brandon Horton, Lawrence Cai, Julie A Schmittdiel","doi":"10.7812/TPP/24.151","DOIUrl":"10.7812/TPP/24.151","url":null,"abstract":"<p><strong>Introduction: </strong>Trigger finger is one of the most common conditions treated by hand surgeons. Although corticosteroid injection is a common first-line treatment, there is no consensus regarding the most effective type of steroid.</p><p><strong>Methods: </strong>The authors performed a retrospective cohort study of patients with a diagnosis of trigger finger within Kaiser Permanente Northern California, a large, community-based, integrated health system with a comprehensive electronic medical record. Patients were potentially exposed to 4 different steroid regimens: betamethasone, dexamethasone, methylprednisolone, and triamcinolone. The primary outcome was the possibility of subsequent trigger finger surgery following initial corticosteroid treatment.</p><p><strong>Results: </strong>Among 20,141 patients with an injection for trigger finger diagnosis, 1668 (8.3%) had a trigger finger release procedure following injection. Compared with patients injected with triamcinolone, dexamethasone patients had a hazard ratio of 4.12 for surgery (95% confidence interval [CI], 3.06-5.54), betamethasone patients had a hazard ratio of 2.40 (95% CI, 1.86-3.10), and methylprednisolone had a hazard ratio of 1.77 (95% CI, 1.32-2.37).</p><p><strong>Discussion: </strong>This large, retrospective observational study suggests that the type of corticosteroid used for trigger finger may influence the possibility of subsequent surgery.</p><p><strong>Conclusions: </strong>This information may inform corticosteroid choice for treating trigger finger, but findings should be confirmed in a prospective study.</p>","PeriodicalId":23037,"journal":{"name":"The Permanente journal","volume":" ","pages":"64-69"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080119","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}