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Sample records for albany medical center

  1. History of the Department of Surgery at Albany Medical Center.

    PubMed

    Conti, David J; Lempert, Neil; Stain, Steven C

    2013-03-01

    Surgeons have always played an integral role in the history of the Albany Medical Center and Albany Medical College. In addition to supporting vital patient care and teaching programs, the Department of Surgery has played an important administrative role providing the college with five deans. The origins of the Department of Surgery reach back to 1910 when the American Medical Association-sponsored Flexner report proposed dramatic changes in the structure and format of medical education in the United States. In response to the recommendations of the report, the medical center restructured its faculty and curriculum to meet the demands of a rapidly advancing profession. One result of this reorganization was the formation of the Department of Surgery in 1912. Dr. Arthur Elting was named the first Chair of the Department in 1915. This report will review the history of the Department, focusing on the eight surgeons who have served as Chair.

  2. Radiology engineering at the Albany Medical Center: five year's experience.

    PubMed

    Hack, S N; Heiss, J; Martinichio, M J

    1987-01-01

    A Radiology Engineering program was initiated in the Department of Radiology at the Albany Medical Center, Albany, New York, in the summer of 1981. The program has been successful in attaining its goals of containing costs, providing minimal equipment downtime, and giving high-quality service. This report presents the job functions and duties that the department found necessary to provide this level of service. In addition, two techniques for managing malfunction and service reports, techniques for scheduling PM's and service calls, and software management tools that assist the department with service are described.

  3. The Albany Medical College Ventilator Walker.

    PubMed

    Smith, T; Forrest, G; Evans, G; Johnson, R K; Chandler, N

    1996-12-01

    This report describes the design and use of a wheeled walker that can accommodate a ventilator and oxygen tanks. It is constructed of aluminum tubing. The front of the walker has receptacles to support a Mark 7 Bird Ventilator and oxygen tanks. The back end of the walker has a bench seat that is lifted to allow entry into the walker. The seat provides rigidity and stability to the frame of the walker. The walker has been used in the Medical Intensive Care Unit of the Albany Medical Center to facilitate early ambulation of patients who are ventilator dependent or who require a portable source of oxygen to begin ambulation training.

  4. High temperature corrosion research at the Albany Research Center

    SciTech Connect

    Covino, Bernard S., Jr.; Holcomb, Gordon R.; Russell, James H.; Cramer, Stephen D.; Bullard, Sophie J.; Ziomek-Moroz, Margaret; Matthes, Steven A.; Chinn, R.E.

    2002-01-01

    The Severe Environment Corrosion and Erosion Research Facility (SECERF) at the Albany Research Center is operational. SECERF consists of 6 modules that share the availability of up to 10 different gases to produce environments for high temperature corrosion and erosion research. Projects to be conducted in the modules include: corrosion sensors for fossil energy systems, thermal gradient effects on high temperature corrosion, the development of sulfidation resistant alloys, determination of the effects of ash on the corrosion of metals and alloys in coal and waste combustion and coal gasification environments, high temperature erosion-corrosion of metals, and molten slag effects on refractories. Results from two areas, the effect of ash deposits on alloy corrosion and thermal gradient effects on the corrosion of metals, will be highlighted. Ash produced in coal gasifiers, coal combustors, and waste combustors, when deposited on metal surfaces, provides sites for corrosion attack and contributes chemical species that participate in the corrosion reaction. Results are presented for the corrosion of 304L stainless steel, that was either uncoated or coated with ash or with ash containing NaCl or Na2SO4, in air-water vapor mixtures at 600 C. The presence of high heat fluxes and temperature gradients in many fossil energy systems creates the need for an understanding of their effects on corrosion and oxidation. Such information would be useful for both improved alloy design and for better translation of isothermal laboratory results to field use. Temperature gradients in a solid oxide result in two changes that modify diffusion within the oxide. The first is when a gradient in point defect concentration is created within the oxide, for example, where more vacancies are expected at a higher temperature. The second change is when the presence of a temperature gradient biases the diffusion jump of an atom. Results of tests are presented for cobalt with metal surface

  5. Jupiter Oxygen Corporation/Albany Research Center Crada Progress Report, September

    SciTech Connect

    Turner, Paul C.; Schoenfield, Mark

    2004-09-13

    The Albany Research Center (ARC) has developed a new Integrated Pollutant Removal (IPR) process for fossil-fueled boilers. Pursuant to a cooperative research and development agreement (CRADA) with Jupiter Oxygen Corporation, ARC currently is studying the IPR process as applied to the oxygen fuel technology developed by Jupiter. As discussed further below, these two new technologies are complementary. This interim report summarizes the study results to date and outlines the potential activities under the next phase of the CRADA with Jupiter.

  6. Refractory Research Group - U.S. DOE, Albany Research Center [Institution Profile

    SciTech Connect

    Bennett, James P.

    2004-09-01

    The refractory research group at the Albany Research Center (ARC) has a long history of conducting materials research within the U.S. Bureau of Mines, and more recently, within the U.S. Dept. of Energy. When under the U.S. Bureau of Mines, research was driven by national needs to develop substitute materials and to conserve raw materials. This mission was accomplished by improving refractory material properties and/or by recycling refractories using critical and strategic materials. Currently, as a U.S. Dept of Energy Fossil Energy field site, research is driven primarily by the need to assist DOE in meeting its vision to develop economically and environmentally viable technologies for the production of electricity from fossil fuels. Research at ARC impacts this vision by: • Providing information on the performance characteristics of materials being specified for the current generation of power systems; • Developing cost-effective, high performance materials for inclusion in the next generation of fossil power systems; and • Solving environmental emission and waste problems related to fossil energy systems. A brief history of past refractory research within the U.S. Bureau of Mines, the current refractory research at ARC, and the equipment and capabilities used to conduct refractory research at ARC will be discussed.

  7. The Albany Two-Way Radio Conferences, 1955-1981: a retrospective look at a program providing interactive continuing medical education at a distance.

    PubMed

    Tulgan, Henry

    2014-01-01

    Despite early widespread recognition of the necessity of continuing medical education (CME) for practicing physicians and surgeons, medical schools and national medical organizations were slow to mobilize to address the need. One pioneering program, developed by the Albany Medical College in New York, not only provided CME, but did so in a live distance education format that allowed for interaction between the participants and the faculty presenters. The Albany Program commenced in 1955 using what was then state-of-the-art technology; it exemplified principles and practices that can be seen as the precursors for the distance education approaches used to reach physicians today. This short article describes the contributions of the Albany Two-Way Radio Conferences and places them in the context of developments in national organizations and policies in the 20th century.

  8. Satellite medical centers project

    NASA Astrophysics Data System (ADS)

    Aggarwal, Arvind

    2002-08-01

    World class health care for common man at low affordable cost: anywhere, anytime The project envisages to set up a national network of satellite Medical centers. Each SMC would be manned by doctors, nurses and technicians, six doctors, six nurses, six technicians would be required to provide 24 hour cover, each SMC would operate 24 hours x 7 days. It would be equipped with the Digital telemedicine devices for capturing clinical patient information and investigations in the form of voice, images and data and create an audiovisual text file - a virtual Digital patient. Through the broad band connectivity the virtual patient can be sent to the central hub, manned by specialists, specialists from several specialists sitting together can view the virtual patient and provide a specialized opinion, they can see the virtual patient, see the examination on line through video conference or even PCs, talk to the patient and the doctor at the SMC and controlle capturing of information during examination and investigations of the patient at the SMC - thus creating a virtual Digital consultant at the SMC. Central hub shall be connected to the doctors and consultants in remote locations or tertiary care hospitals any where in the world, thus creating a virtual hub the hierarchical system shall provide upgradation of knowledge to thedoctors in central hub and smc and thus continued medical education and benefit the patient thru the world class treatment in the smc located at his door step. SMC shall be set up by franchisee who shall get safe business opportunity with high returns, patients shall get Low cost user friendly worldclass health care anywhere anytime, Doctors can get better meaningful selfemplyment with better earnings, flexibility of working time and place. SMC shall provide a wide variety of services from primary care to world class Global consultation for difficult patients.

  9. Liquid Metal Processing and Casting Experiences at the U.S. Department of Energy's Albany Research Center

    SciTech Connect

    Jablonski, Paul D.; Turner, Paul C.

    2005-09-01

    In this paper we will discuss some of the early pioneering work as well as some of our more recent research. The Albany Research Center (ARC) has been involved with the melting and processing of metals since it was established in 1942. In the early days, hardly anything was known about melting refractory or reactive metals and as such, virtually everything had to be developed in-house. Besides the more common induction heated air-melt furnaces, ARC has built and/or utilized a wide variety of furnaces including vacuum arc remelt ingot and casting furnaces, cold wall induction furnaces, electric arc furnaces, cupola furnaces and reverberatory furnaces. The melt size of these furnaces range from several grams to a ton or more. We have used these furnaces to formulate custom alloys for wrought applications as well as for such casting techniques as spin casting, investment casting and lost foam casting among many. Two early spin-off industrializations were Wah Chang (wrought zirconium alloys for military and commercial nuclear applications) and Oremet (both wrought and cast Ti). Both of these companies are now part of the ATI Allegheny Ludlum Corporation.

  10. The Rensselaer Polytechnic Institute-Albany Medical College Six-Year Biomedical Program

    ERIC Educational Resources Information Center

    Kanter, Gerald S.

    1969-01-01

    Accelerated biomedical program permits qualified students to complete requirements for both B.S. and M.D. Degrees within six calendar years. Curriculum designed to prepare students for careers in medical practice, research, or academic medicine. (IR)

  11. Albany 2.0

    2012-10-29

    New to version 2.0 of Albany is the development of equations sets for specific application areas. These are independent research and development efforts that have chosen to use Albany as their software deployment vehicle. Because of synergies between the projects, they remain in the same code repository and are all releasing together as the Albany software.

  12. Kennedy Space Center Medical Operations and Medical Kit

    NASA Technical Reports Server (NTRS)

    Scarpa, Philip

    2011-01-01

    This slide presentation reviews the emergency medical operations at Kennedy Space center, the KSC launch and landing contingency modes, the triage site, the medical kit, and the medications available.

  13. Patient-Centered Medical Homes in 2016.

    PubMed

    Tayloe, David T

    2016-01-01

    There is much information in the medical literature concerning the medical home concept. Each medical practice must utilize that literature to devise a system of care-a patient-centered medical home-that best meets the needs of patients, families, and practice staff. This article is Goldsboro Pediatrics' attempt to describe its system of care, its patient-centered medical home. PMID:27422953

  14. Reengineering Academic Medical Centers: Reengineering Academic Values?

    ERIC Educational Resources Information Center

    Korn, David

    1996-01-01

    Discussion of academic medical centers (AMCs) looks at: change due to heavy federal funding in recent decades; adverse consequences, including deemphasis on education in favor of research and clinical service delivery, and discrepancies between AMC internal and external labor markets; and challenges to medical education in research, education, and…

  15. Focus on: New England Medical Center Medical Engineering Department.

    PubMed

    Harrington, D P

    1988-01-01

    The New England Medical Center can be traced back to 1796 when the Boston Dispensary opened the first HMO. Now, the center complex covers four city blocks, offers 47 medical residency programs, has over $20 million in funded research, and includes a medical school, dental school, and the Human Nutrition Research Center. The Medical Engineering Department began in 1971 as a joint venture between the center and Tufts University. Operated on a "fee-for-service" basis, the department consists of nine people in medical engineering and an additional four in radiology engineering. The department performs quality assurance and preventive maintenance work, along with as-needed repairs, throughout the center on an equipment roster that includes over 1,200 computer terminals and printers, 58 intensive care beds, and 200+ I.V. pumps. Specialized equipment allows the department to perform audiology repairs. Future goals include integrating the radiology repair staff into the medical engineering group, improving the group's productivity, and eliminating some of the existing service contracts. PMID:10290856

  16. Skylab Medical Data Center and Archives

    NASA Technical Reports Server (NTRS)

    Spross, F. R.

    1974-01-01

    The founding of the Skylab medical data center and archives as a central area to house medical data from space flights is described. Skylab program strip charts, various daily reports and summaries, experiment reports and logs, status report on Skylab data quality, raw data digital tapes, processed data microfilm, and other Skylab documents are housed in the data center. In addition, this memorandum describes how the data center acted as a central point for the coordination of preflight and postflight baseline data and how it served as coordinator for all data processing through computation and analysis. Also described is a catalog identifying Skylab medical experiments and all related data currently archived in the data center.

  17. The Manned Spacecraft Center and medical technology

    NASA Technical Reports Server (NTRS)

    Johnston, R. S.; Pool, S. L.

    1974-01-01

    A number of medically oriented research and hardware development programs in support of manned space flights have been sponsored by NASA. Blood pressure measuring systems for use in spacecraft are considered. In some cases, complete new bioinstrumentation systems were necessary to accomplish a specific physiological study. Plans for medical research during the Skylab program are discussed along with general questions regarding space-borne health service systems and details concerning the Health Services Support Control Center.

  18. Patient Experience in Health Center Medical Homes.

    PubMed

    Cook, Nicole; Hollar, Lucas; Isaac, Emmanuel; Paul, Ludmilla; Amofah, Anthony; Shi, Leiyu

    2015-12-01

    The Human Resource and Services Administration, Bureau of Primary Health Care Health Center program was developed to provide comprehensive, community-based quality primary care services, with an emphasis on meeting the needs of medically underserved populations. Health Centers have been leaders in adopting innovative approaches to improve quality care delivery, including the patient centered medical home (PCMH) model. Engaging patients through patient experience assessment is an important component of PCMH evaluation and a vital activity that can help drive patient-centered quality improvement initiatives. A total of 488 patients from five Health Center PCMHs in south Florida were surveyed in order to improve understanding of patient experience in Health Center PCMHs and to identify quality improvement opportunities. Overall patients reported very positive experience with patient-centeredness including being treated with courtesy and respect (85 % responded "always") and communication with their provider in a way that was easy to understand (87.7 % responded "always"). Opportunities for improvement included patient goal setting, referrals for patients with health conditions to workshops or educational programs, contact with the Health Center via phone and appointment availability. After adjusting for patient characteristics, results suggest that some patient experience components may be modified by educational attainment, years of care and race/ethnicity of patients. Findings are useful for informing quality improvement initiatives that, in conjunction with other patient engagement strategies, support Health Centers' ongoing transformation as PCMHs. PMID:26026275

  19. Albany v 1.0

    SciTech Connect

    2011-01-14

    The Albany code is a general purpose finite element code for solving partial differential equations (PDEs). Albany is a research code that demonstrates how a PDE code can be built by interfacing many of the open-source software libraries that are released under Sandia's Trilinos project. Part of the mission of Albany is to be a testbed for new Trilinos libraries, to refine their methods, usability, and interfaces. Albany also serves as a demonstration code on how to build an application code against an installed Trilinos project. Because of this, Albany is a desirable starting point for new code development efforts that wish to make heavy use of Trilinos. The physics solved in Albany are currently only very academic problems, such as heat transfer, linear elasticity, and nonlinear elasticity. Albany includes hooks to optimization and uncertainty quantification algorithms, including those in the Dakota toolkit.

  20. Albany v 1.0

    2011-01-14

    The Albany code is a general purpose finite element code for solving partial differential equations (PDEs). Albany is a research code that demonstrates how a PDE code can be built by interfacing many of the open-source software libraries that are released under Sandia's Trilinos project. Part of the mission of Albany is to be a testbed for new Trilinos libraries, to refine their methods, usability, and interfaces. Albany also serves as a demonstration code onmore » how to build an application code against an installed Trilinos project. Because of this, Albany is a desirable starting point for new code development efforts that wish to make heavy use of Trilinos. The physics solved in Albany are currently only very academic problems, such as heat transfer, linear elasticity, and nonlinear elasticity. Albany includes hooks to optimization and uncertainty quantification algorithms, including those in the Dakota toolkit.« less

  1. U.S. Geological Survey Georgia Water Science Center and Albany Water, Gas, and Light Commission Cooperative Water Program-Summary of Activities, July 2005 through June 2006

    USGS Publications Warehouse

    Gordon, Debbie W.

    2006-01-01

    The U.S. Geological Survey (USGS) has been working with the Albany Water, Gas, and Light Commission to monitor ground-water quality and availability since 1977. This report presents the findings for July 2005 through June 2006 and summarizes the ground-water and surface-water conditions for 2005. Water levels in 14 wells were continuously monitored in Dougherty County, Georgia. Water levels in 12 of those wells were above normal, one was normal, and one was below normal. Ground-water samples collected from the Upper Floridan aquifer indicate that nitrate levels have increased in 13 wells and decreased in two wells from a year earlier. A sample also was collected from the Flint River. A trilinear diagram showing the percent composition of selected major cations and anions indicates that the ground-water quality of the Upper Floridan aquifer at the Albany wellfield is distinctly different from the water quality of the Flint River. To improve the understanding of the ground-water flow system and nitrate movement in the Upper Floridan aquifer, the USGS is developing a ground-water flow model in the southwest Albany area, Georgia.

  2. The Biomedical Engineer in the Medical Center

    ERIC Educational Resources Information Center

    Furst, Emanuel

    1973-01-01

    Discusses the roles of engineers in medical centers, including technical support, instrument control and safety for the hospital, and teaching and research tasks. Indicates that engineering education should take responsibilities to prepare them to understand the human relations and organizational characteristics of their environment through course…

  3. Marketing the academic medical center group practice.

    PubMed

    Eudes, J A; Divis, K L

    1992-01-01

    From a marketing perspective, there are many differences between private and academic medical center (AMC) group practices. Given the growing competition between the two, write John Eudes and Kathy Divis, it is important for the AMC group practice to understand and use these differences to develop a competitive market advantage.

  4. Television documentaries lifting hospital, medical center profiles.

    PubMed

    Rees, T

    2001-01-01

    The nation's hospitals and medical centers are enjoying the legacy of TV audiences' addiction to medical dramas. Cable television has met the challenge with documentary coverage of real live hospitals. The medium offers many benefits and few disadvantages for those marketing managers with the courage to welcome camera crews. Lynn Hopkins Cantwell is director of public relations and marketing for Children's National Medical Center, Washington, D.C., which was covered in a seven-instrument "Lifeline" documentary for the Discovery Channel. James G. Gosky is director of communications for The MetroHealth System, Cleveland, which was the subject of two installments of "Trauma: Life in th ER," produced for the Learning Channel. These marketing pros describe the myriad details they faced when their respective hospitals went "on camera." Among the key factors were good communications with all constituents, attention to detail, and follow-up. PMID:11209289

  5. Medical Center Farmers Markets: A Strategic Partner in the Patient-Centered Medical Home

    PubMed Central

    Rovniak, Liza S.; Kraschnewski, Jennifer L.; Morrison, Kathy J.; Dillon, Judith F.; Bates, Beth Y.

    2013-01-01

    Background The number of medical center–based farmers markets has increased in the past decade, but little is known about how such organizations contribute to the preventive health goals of the patient-centered medical home. Community Context In 2010, we started a seasonal farmers market at Penn State Hershey Medical Center to help support the institution’s commitment to the medical home. Methods We obtained descriptive data on the farmers market from hospital and market records and tracking information on the market’s Facebook and Twitter sites. We computed summary measures to characterize how the market has begun to meet the 6 standards of the 2011 National Committee for Quality Assurance’s report on the medical home. Outcome During the 2010 and 2011 seasons, 146 medical center volunteers from 40 departments formed 23 interprofessional teams that spent an average of 551 volunteer hours per season at the market, providing health screenings (n = 695) and speaking to customers (n = 636) about preventive health. Fifty-five nonmedical community health partners provided 208 hours of service at the market alongside medical center staff. Market programming contributed to 5 regional preventive health partnerships and created opportunities for interprofessional mentoring, student leadership, data management, development of social media skills, and grant-writing experience. The market contributed to all 6 medical home standards outlined by the National Committee for Quality Assurance. Interpretation Medical center markets can support medical home standards. With systematic tracking of the health effects and integration with electronic medical health records, markets hold potential to contribute to comprehensive patient-centered care. PMID:23906327

  6. 3. OVERALL VIEW OF THE MEDICAL CENTER (ESPECIALLY BUILDING 2 ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. OVERALL VIEW OF THE MEDICAL CENTER (ESPECIALLY BUILDING 2 & BUILDING 1) FROM THE 'CAMPUS' GROUNDS; LOOKING NW. (Harms) - Veterans Administration Medical Center, Old State Route 13 West, Marion, Williamson County, IL

  7. 2. OVERALL VIEW OF THE MEDICAL CENTER (ESPECIALLY BUILDING 1) ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. OVERALL VIEW OF THE MEDICAL CENTER (ESPECIALLY BUILDING 1) FROM THE 'CAMPUS' GROUNDS; LOOKING SW. (Harms) - Veterans Administration Medical Center, Old State Route 13 West, Marion, Williamson County, IL

  8. 4. OVERALL VIEW OF THE MEDICAL CENTER (ESPECIALLY BUILDING 2 ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. OVERALL VIEW OF THE MEDICAL CENTER (ESPECIALLY BUILDING 2 & BUILDING 1) FROM THE 'CAMPUS' GROUNDS; LOOKING NE. (Harms) - Veterans Administration Medical Center, Old State Route 13 West, Marion, Williamson County, IL

  9. Stubbs v. North Memorial Medical Center.

    PubMed

    1989-11-14

    Bonnie Stubbs had cosmetic surgery performed as an outpatient at North Memorial Medical Center. The doctor took "before" and "after" photographs of the surgery which were then used in promotional material without Stubbs' consent. Stubbs alleged that the use of the photographs invaded her privacy, caused her emotional distress, and violated her rights under Minnesota's Patients' Bill of Rights. The trial court found no right to relief. The Minnesota Court of Appeals ruled that Stubbs may have a right to relief on the principle that an implied contract was breached between Stubbs and the physician. The Court of Appeals remanded the case for further proceedings in that light.

  10. NASA Johnson Space Center Medical Licensing Opportunities

    NASA Technical Reports Server (NTRS)

    Hernandez-Moya, Sonia

    2009-01-01

    This presentation reviews patented medical items that are available for licensing in the areas of Laboratory Technologies, Medical Devices, Medical Equipment and other technologies that are of interest to the medical community.

  11. Jackson Park Hospital Green Building Medical Center

    SciTech Connect

    William Dorsey; Nelson Vasquez

    2010-03-31

    Jackson Park Hospital completed the construction of a new Medical Office Building on its campus this spring. The new building construction has adopted the City of Chicago's recent focus on protecting the environment, and conserving energy and resources, with the introduction of green building codes. Located in a poor, inner city neighborhood on the South side of Chicago, Jackson Park Hospital has chosen green building strategies to help make the area a better place to live and work. The new green building houses the hospital's Family Medicine Residency Program and Specialty Medical Offices. The residency program has been vital in attracting new, young physicians to this medically underserved area. The new outpatient center will also help to allure needed medical providers to the community. The facility also has areas designated to women's health and community education. The Community Education Conference Room will provide learning opportunities to area residents. Emphasis will be placed on conserving resources and protecting our environment, as well as providing information on healthcare access and preventive medicine. The new Medical Office Building was constructed with numerous energy saving features. The exterior cladding of the building is an innovative, locally-manufactured precast concrete panel system with integral insulation that achieves an R-value in excess of building code requirements. The roof is a 'green roof' covered by native plantings, lessening the impact solar heat gain on the building, and reducing air conditioning requirements. The windows are low-E, tinted, and insulated to reduce cooling requirements in summer and heating requirements in winter. The main entrance has an air lock to prevent unconditioned air from entering the building and impacting interior air temperatures. Since much of the traffic in and out of the office building comes from the adjacent Jackson Park Hospital, a pedestrian bridge connects the two buildings, further

  12. [Medical controlling as medical economical service center. Successful concept for orthopedics and trauma surgery centers?].

    PubMed

    Auhuber, T C; Hoffmann, R

    2015-01-01

    The management of patients from administrative admission through the orthopedic-surgical treatment to completion of the billing is complex. Additional challenges originate from the necessity to treat patients in both outpatient and inpatient departments and in more than one medical sector. A superior coordination is essential for a successful cooperation of the various procedures of controlling. The model of a medical controlling department as a service center with effective competence in the management of service and cost, functions as a successful solution to the problem. Central elements of a successful medical economical case management are a well-defined assignment of tasks and definitions of intersections, the integration of health professionals and administrative employees, the utilization of software for process control and the implementation of inlier controlling.

  13. 1. AERIAL VIEW, LOOKING WEST OF 'THE BIRMINGHAM MEDICAL CENTER,' ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. AERIAL VIEW, LOOKING WEST OF 'THE BIRMINGHAM MEDICAL CENTER,' WITH HILLMAN HOSPITAL, THE FIVE-STORY BUILDING (CENTER RIGHT AT 20TH STREET AND SIXTH AVENUE SOUTH), JEFFERSON TOWER (CENTER LEFT AT 20TH STREET AND SEVENTH AVENUE SOUTH, AND THE MANY HOSPITALS AND TEACHING FACILITIES OF THE UNIVERSITY OF ALABAMA AT BIRMINGHAM MEDICAL CENTER. - Hillman Hospital, 600 Block Westside Twentieth Street South, Birmingham, Jefferson County, AL

  14. A sustainable medical center in Texas

    SciTech Connect

    Pfeiffer, P.L.; Miller, B.

    1999-07-01

    The purpose of this presentation is to demonstrate how one can successfully integrate many sustainable features into the construction and operation of a mid-sized medical clinic located in the hot/humid piney woods of east Texas for a moderate increase over normal construction costs. The subject project, known as The Texas Specialist Center, has enjoyed the predicted energy and green building results. It is a 6,300 square foot stand alone clinic located in Lufkin, Texas for a client with multiple chemical sensitivities. Green features include passive solar design for heating and cooling, enhanced natural ventilation (including the use of natural thermal siphons within the building), cool communities site planning (to reduce the urban heat island effect), extensive use of daylighting and energy-efficient artificial lighting, photovoltaics to provide security system and computer operations back-up, careful attention to material selections for low toxicity and high indoor air quality, use of regionally appropriate building materials and systems, an extensive rainwater collection system, and xeriscape landscaping principals. It was constructed in 1996 and has been under full operation for two years. Actual energy consumption data will be presented and the above Green design strategies will be elaborated upon.

  15. Clinical career ladders: Hamot Medical Center.

    PubMed

    Meyer, J D; Chrymko, M M; Kelly, W N

    1989-11-01

    The clinical career ladder program for pharmacists at Hamot Medical Center (HMC), a 500-bed not-for-profit community teaching hospital, is described. Between 1980 and 1989 a career ladder at HMC evolved from an idea to an established program with parallel administrative, business, and clinical tracks. The development of the career ladder mirrored the growth of clinical programs and the diversification of pharmaceutical services. A formal plan for a clinical ladder was developed when the first satellite pharmacy opened in 1984. An entry-level pharmacist at HMC starts with a six-month period during which he or she learns the drug distribution system and prepares for several certification tests. The employee is then promoted to staff pharmacist. Staff pharmacists are promoted to clinical pharmacist II (CP II) upon meeting requirements for competence in a broad range of clinical skills and knowledge. Candidates for the position of clinical pharmacist specialist (CP I) must have either a minimum of three years of experience as a CP II or a Pharm.D. degree and have established an area of clinical expertise. A CP I can progress to assistant and associate director positions as vacancies occur. The clinical ladder has enhanced job satisfaction and encouraged the development of clinical practitioners who provide improved care. Problems have included time constraints, competition for positions, and management of incentives. A parallel career ladder program with a clinical track has enhanced the growth of pharmacy practice at HMC and improved the quality of pharmaceutical care.

  16. Children's Medications: A Guide for Schools and Day Care Centers.

    ERIC Educational Resources Information Center

    Bates, Richard D.; Nahata, Milap C.

    Noting the lack of reference sources available on the use of medications in schools and day care centers, this book was created to help school and day care center personnel become more aware of the medicine being given to children at home and at school. Using detailed medication charts, the book answers questions about how to administer medicines…

  17. Assessing the Academic Medical Center as a Supportive Learning Community

    ERIC Educational Resources Information Center

    Gannon, Sam C.

    2011-01-01

    Academic medical centers are well-known for their emphasis on teaching, research and public service; however, like most large, bureaucratic organizations, they oftentimes suffer from an inability to learn as an organization. The role of the research administrator in the academic medical center has grown over time as the profession itself has…

  18. The Stanford University Medical Center and the Federal Government.

    ERIC Educational Resources Information Center

    Rosenzweig, Robert M.; And Others

    The Stanford University Medical Center consists of three main units: a medical school, a set of outpatient clinics, and a hospital. Financing of the center's functions cannot be carried out without federal support, and a network of relationships with government agencies has emerged. The impact of these relationships was discussed with key…

  19. An Artist in the University Medical Center. Review.

    ERIC Educational Resources Information Center

    James, A. Everette, Jr.

    1991-01-01

    Reviews "An Artist in the University Medical Center" (M. Lesser, New Orleans: Tulane University Press, 1989), in which the artist captures the human side of the complex Tulane Medical Center in New Orleans (Louisiana). The interplay of drawings, etchings, watercolors, and prose conveys traditions of nurturing in the hospital. (SLD)

  20. [Medical centers--methods, purpose and benefits].

    PubMed

    Schrappe, Matthias

    2007-01-01

    The German hospital sector is characterized by a profound deficit in organizational integration. The implementation of centers as one way to improve the situation is complicated by the heterogeneity of the concept and understanding of the term "center". The author proposes to distinguish between functional, divisional and process-oriented centers. In German hospitals where the transition from functional to divisional organization is under way matrix elements can be expected to be introduced into organizational practice. Process-oriented centers like breast centers represent matrix components by simultaneously applying functional and process-oriented perspectives. Matrix components map the complexity of clinical structures, but increase coordination and management load and should be applied only to a limited number of care processes.

  1. Johnson Space Center Health and Medical Technical Authority

    NASA Technical Reports Server (NTRS)

    Fogarty, Jennifer A.

    2010-01-01

    1.HMTA responsibilities: a) Assure program/project compliance with Agency health and medical requirements at identified key decision points. b) Certify that programs/projects comply with Agency health and medical requirements prior to spaceflight missions. c) Assure technical excellence. 2. Designation of applicable NASA Centers for HMTA implementation and Chief Medical Officer (CMO) appointment. 3. Center CMO responsible for HMTA implementation for programs and projects at the center. JSC HMTA captured in "JSC HMTA Implementation Plan". 4. Establishes specifics of dissenting opinion process consistent with NASA procedural requirements.

  2. [SOROKA UNIVERSITY MEDICAL CENTER: THE ROAD TO LEADERSHIP IN QUALITY OF MEDICAL CARE, SERVICE AND RESEARCH].

    PubMed

    Davidson, Ehud; Sheiner, Eyal

    2016-02-01

    Soroka University Medical Center is a tertiary hospital, and the sole medical center in the Negev, the southern part of Israel. Soroka has invested in quality, service and research. The region has developed joint programs in order to advance the quality of medical care whilst optimizing the utilization of available resources. In this editorial we describe the path to leadership in quality of medical care, service and research.

  3. [SOROKA UNIVERSITY MEDICAL CENTER: THE ROAD TO LEADERSHIP IN QUALITY OF MEDICAL CARE, SERVICE AND RESEARCH].

    PubMed

    Davidson, Ehud; Sheiner, Eyal

    2016-02-01

    Soroka University Medical Center is a tertiary hospital, and the sole medical center in the Negev, the southern part of Israel. Soroka has invested in quality, service and research. The region has developed joint programs in order to advance the quality of medical care whilst optimizing the utilization of available resources. In this editorial we describe the path to leadership in quality of medical care, service and research. PMID:27215117

  4. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), south side. - Fitzsimons General Hospital, Tubercular Ward, Southwest Corner of East Bushnell Avenue & South Page Street, Aurora, Adams County, CO

  5. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover). - Fitzsimons General Hospital, Storehouse, East Harlow Avenue, immediately South of Building 201, Aurora, Adams County, CO

  6. Photocopy of print in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of print in the Fitzsimons Army Medical Center Real Property Book (green cloth cover), probably south side. - Fitzsimons General Hospital, Female Dormitory, Southeast Corner of West McCloskey Avenue & North Seventh Street, Aurora, Adams County, CO

  7. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover), south and east sides. - Fitzsimons General Hospital, Storage Sheds, Northeast Corner of West Pennington Avenue & North Eighth Street, Aurora, Adams County, CO

  8. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover). - Fitzsimons General Hospital, Ambulent Tubercular Ward, Southeast Corner of East Bushnell Avenue & South Hickey Street, Aurora, Adams County, CO

  9. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), east and south sides. - Fitzsimons General Hospital, Workshop Building, East Harlow Avenue, immediately East of Building No. 529, Aurora, Adams County, CO

  10. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), probably south and west sides. - Fitzsimons General Hospital, Nurses' Quarters, Southeast Corner of West McAfee Avenue & South Hickey Street, Aurora, Adams County, CO

  11. Photocopy of photograph from Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph from Fitzsimons Army Medical Center real property book (green cloth cover), south and west sides. - Fitzsimons General Hospital, Gymnasium, Northeast Corner of East Harlow Avenue & North Page Street, Aurora, Adams County, CO

  12. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), showing south and west sides. - Fitzsimons General Hospital, Salvage Building, Northeast Corner of East I Avenue & North Page Street, Aurora, Adams County, CO

  13. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth clover), west side. - Fitzsimons General Hospital, Motor Transport Dispatcher's Office, Northeast Corner of East Harlow Avenue & North Tenth Street, Aurora, Adams County, CO

  14. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), west and north sides of the southern wing. - Fitzsimons General Hospital, Laundry, Southeast corner of East Harlow Avenue & South Twelfth Street, Aurora, Adams County, CO

  15. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover). - Fitzsimons General Hospital, Artesian Well, East McCloskey Avenue, East of Building No. 231, Aurora, Adams County, CO

  16. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), east and north sides. - Fitzsimons General Hospital, Wagon Shed with Office, Southeast Corner of East J Avenue & North Tenth Street, Aurora, Adams County, CO

  17. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover), probably south and west sides. - Fitzsimons General Hospital, Utilities Storeroom, West Pennington Avenue, East of Building No. 145, Aurora, Adams County, CO

  18. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover) south and east sides. - Fitzsimons General Hospital, Nurses' Garage, East of Building No. 121, Aurora, Adams County, CO

  19. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover), looking east. - Fitzsimons General Hospital, Tennis Courts, Northeast Corner of East McCloskey Avenue & North Hickey Street, Aurora, Adams County, CO

  20. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), showing south side. - Fitzsimons General Hospital, Laboratory Annex, Northwest Corner of East McCloskey Avenue & North Twelfth Street, Aurora, Adams County, CO

  1. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover) - Fitzsimons General Hospital, Quartermaster Store House, Northwest Corner of East I Avenue & North Twelfth Street, Aurora, Adams County, CO

  2. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), east and south sides. - Fitzsimons General Hospital, Pharmacy & Prophylactic Station, Northwest Corner of West McAfee Avenue & South Eighth Street, Aurora, Adams County, CO

  3. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover), south side. - Fitzsimons General Hospital, Office Building, Northwest Corner of West McCloskey Avenue & North Tenth Street, Aurora, Adams County, CO

  4. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), south side. - Fitzsimons General Hospital, Infirmary, Northwest Corner of East Bushnell Avenue & South Page Street, Aurora, Adams County, CO

  5. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover), south sides. - Fitzsimons General Hospital, Officer Recreation Building, West Harlow Avenue, immediately East of Building 118, Aurora, Adams County, CO

  6. Photocopy of photograph from the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph from the Fitzsimons Army Medical Center real property book (green cloth cover), showing east side and north sides. - Fitzsimons General Hospital, Transformer House, North Page Street, immediately North of Building No. 217, Aurora, Adams County, CO

  7. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), showing south and west sides. - Fitzsimons General Hospital, Power House, Northwest Corner of East Harlow Avenue & North Page Street, Aurora, Adams County, CO

  8. Photocopy of photograph from the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph from the Fitzsimons Army Medical Center real property book (green cloth cover), showing east side. - Fitzsimons General Hospital, Transformer House, North Page Street, immediately North of Building No. 216, Aurora, Adams County, CO

  9. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), north side. - Fitzsimons General Hospital, Administration Building, Southeast Corner of West McAfee Avenue & South Eighth Street, Aurora, Adams County, CO

  10. Photocopy of print from the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of print from the Fitzsimons Army Medical Center Real Property Book (green cloth cover). - Fitzsimons General Hospital, Tool House, West Pennington Avenue, North of Building No. 140, Aurora, Adams County, CO

  11. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover), south and east sides. - Fitzsimons General Hospital, Nurses Quarters No. 3, Northwest Corner of West Harlow Avenue & North Seventh Street, Aurora, Adams County, CO

  12. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), showing south and east sides. - Fitzsimons General Hospital, Ice Plant, Southwest Corner of East I Avenue & North Thirteenth Street, Aurora, Adams County, CO

  13. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), showing southwest corner of building 732. - Fitzsimons General Hospital, Storehouses, Northwest Corner of East Harlow Avenue & North Thirteenth Street, Aurora, Adams County, CO

  14. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), showing west side. - Fitzsimons General Hospital, Fire Equipment House, North Page Street, North of Building No. 228, Aurora, Adams County, CO

  15. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover), south and east sides. - Fitzsimons General Hospital, Post Exchange Garage, North Eighth Street, North of Building No. 143, Aurora, Adams County, CO

  16. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover), probably south side. - Fitzsimons General Hospital, Officers' Garage, West Pennington Avenue, West of Building 129, Aurora, Adams County, CO

  17. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover). - Fitzsimons General Hospital, Greenhouse, West Pennington Avenue, East of Building No. 139, Aurora, Adams County, CO

  18. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover). - Fitzsimons General Hospital, Semi-Infirmary Turbercular Ward, Northwest Corner of Charlie Kelly Boulevard & South Hickey Street, Aurora, Adams County, CO

  19. Photocopy of photograph from the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph from the Fitzsimons Army Medical Center real property book (green cloth cover), probably southwest side. - Fitzsimons General Hospital, Operating Pavilion, West McAfee Avenue, East of Building No. 507, Aurora, Adams County, CO

  20. Photocopy of photograph from the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph from the Fitzsimons Army Medical Center real property book (green cloth cover). - Fitzsimons General Hospital, Semi-Infirmary Tubercular Ward, Southeast Corner of East Harlow Avenue & South Page Street, Aurora, Adams County, CO

  1. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover). - Fitzsimons General Hospital, Post Exchange Garage, Northwest Corner of West Pennington Avenue & North Eighth Street, Aurora, Adams County, CO

  2. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), south and east sides. - Fitzsimons General Hospital, Nurses' Quarters, Southwest Corner of West Harlow Avenue, & South Eighth Street, Aurora, Adams County, CO

  3. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover), east side. - Fitzsimons General Hospital, Shops Building, Northwest Corner of West Pennington Avenue, & North Tenth Street, Aurora, Adams County, CO

  4. Medical Informatics in Academic Health Science Centers.

    ERIC Educational Resources Information Center

    Frisse, Mark E.

    1992-01-01

    An analysis of the state of medical informatics, the application of computer and information technology to biomedicine, looks at trends and concerns, including integration of traditionally distinct enterprises (clinical information systems, financial information, scholarly support activities, infrastructures); informatics career choice and…

  5. Characterizing customers at medical center farmers’ markets1

    PubMed Central

    Kraschnewski, Jennifer L.; George, Daniel R.; Rovniak, Liza S.; Monroe, Diana L.; Fiordalis, Elizabeth; Bates, Erica

    2014-01-01

    Approximately 100 farmers’ markets operate on medical center campuses. Although these venues can uniquely serve community health needs, little is known about customer characteristics and outreach efforts. Intercept survey of markets and market customers between August 2010-October 2011 at three medical centers in different geographic regions of the US: Duke University Medical Center, Cleveland Clinic, and Penn State Hershey Medical Center were conducted. Markets reported serving 180–2000 customers per week and conducting preventive medicine education sessions and community health programs. Customers (n=585) across markets were similar in sociodemographic characteristics – most were middle-aged, white, and female, who were employees of their respective medical center. Health behaviors of customers were similar to national data. The surveyed medical center farmers’ markets currently serve mostly employees; however, markets have significant potential for community outreach efforts in preventive medicine. If farmers’ markets can broaden their reach to more diverse populations, they may play an important role in contributing to community health. PMID:24421001

  6. DOE Center of Excellence in Medical Laser Applications. Final report

    SciTech Connect

    Jacques, S.L. )

    1998-01-01

    An engineering network of collaborating medical laser laboratories are developing laser and optical technologies for medical diagnosis and therapy and are translating the engineering into medical centers in Portland, OR, Houston, TX, and Galveston, TX. The Center includes the University of Texas M.D. Anderson Cancer Center, the University of Texas-Austin, Texas A and M University, Rice University, the University Texas Medical Branch-Galveston, Oregon Medical Laser Center (Providence St. Vincent Medical Center, Oregon Health Sciences University, and Oregon Graduate Institute, Portland, OR), and the University of Oregon. Diagnostics include reflectance, fluorescence, Raman IR, laser photoacoustics, optical coherence tomography, and several new video techniques for spectroscopy and imaging. Therapies include photocoagulation therapy, laser welding, pulsed laser ablation, and light-activated chemotherapy of cancer (photodynamic therapy, or PDT). Medical applications reaching the clinic include optical monitoring of hyperbilirubinemia in newborns, fluorescence detection of cervical dysplasia, laser thrombolysis of blood clots in heart attack and brain stroke, photothermal coagulation of benign prostate hyperplasia, and PDT for both veterinary and human cancer. New technologies include laser optoacoustic imaging of breast tumors and hemorrhage in head trauma and brain stroke, quality control monitoring of dosimetry during PDT for esophageal and lung cancer, polarization video reflectometry of skin cancer, laser welding of artificial tissue replacements, and feedback control of laser welding.

  7. Jackson Park Hospital Green Building Medical Center

    SciTech Connect

    Dorsey, William; Vasquez, Nelson

    2010-05-01

    Jackson Park Hospital completed the construction of a new Medical Office Building on its campus this spring. The new building construction has adopted the City of Chicago's recent focus on protecting the environment, and conserving energy and resources, with the introduction of green building codes. Located in a poor, inner city neighborhood on the South side of Chicago, Jackson Park Hospital has chosen green building strategies to help make the area a better place to live and work.

  8. 77 FR 834 - Noise Exposure Map Update for Albany International Airport, Albany, NY

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-06

    ... Federal Aviation Administration Noise Exposure Map Update for Albany International Airport, Albany, NY... County Airport Authority (ACAA), for Albany International Airport, under the provisions of 49 U.S.C... Protection Specialist, Federal Aviation Administration, New York Airports District Office, 600 Old...

  9. Business models for academic medical center cyclotron operations.

    PubMed

    LeGarde, Caroline; Bledsoe, Martin L; Wahl, Richard L

    2005-06-01

    A cyclotron facility may provide a significant strategic advantage for an academic medical center that desires to build a strong research program in nuclear medicine. Such a facility may provide an advantage in obtaining support from the National Institutes of Health. A nuclear medicine research program often requires the production of short-lived radioisotopes for clinical patients. Combining the research program with a commercial production and distribution program can increase the synergies and efficiencies of an organization. This article describes various business models that combine research, clinical, and commercial operations to align an academic medical center's cyclotron program operation to its goals and resources. By coordinating these three functions, an academic medical center may be able to support extensive research capabilities that would otherwise be unattainable.

  10. The Six Sigma initiative at Mount Sinai Medical Center.

    PubMed

    Chassin, Robert

    2008-01-01

    Lean Six Sigma, in various forms, has been used widely in many Fortune 500 companies. Motorola, General Electric, Sony, American Express, and Bechtel all use Six Sigma to improve quality and performance. While the impact of this methodology has been documented extensively by the press in manufacturing and transactional settings, less evidence is available regarding its utility in health care environments. Mount Sinai Medical Center initiated a Six Sigma program in 2000 to determine its applicability and value in a large academic medical center. This article discusses Mount Sinai Medical Center's experience adapting this methodology to improve both patient care and business processes and outcomes. We present an overview of Six Sigma, and offer examples of projects undertaken using this data-driven approach to performance improvement. Lastly, the article provides insights and lessons learned regarding this organization-wide experience.

  11. Consumerism: forcing medical practices toward patient-centered care.

    PubMed

    Ozmon, Jeff

    2007-01-01

    Consumerism has been apart of many industries over the years; now consumerism may change the way many medical practices deliver healthcare. With the advent of consumer-driven healthcare, employers are shifting the decision-making power to their employees. Benefits strategies like health savings accounts and high-deductible insurance plans now allow the patients to control how and where they spend their money on medical care. Practices that seek to attract the more affluent and informed consumers are beginning to institute patient-centered systems designs that invite patients to actively participate in their healthcare. This article will outline the changes in the healthcare delivery system facing medical practices, the importance of patient-centered care, and six strategies to implement to change toward more patient-centered care.

  12. 49 CFR 372.201 - Albany, NY.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... section, thence along the western and northern boundary of Cohoes to the Mohawk River thence along such... 49 Transportation 5 2014-10-01 2014-10-01 false Albany, NY. 372.201 Section 372.201 Transportation... TERMINAL AREAS Commercial Zones § 372.201 Albany, NY. The zone adjacent to, and commercially a part...

  13. 49 CFR 372.201 - Albany, NY.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... section, thence along the western and northern boundary of Cohoes to the Mohawk River thence along such... 49 Transportation 5 2010-10-01 2010-10-01 false Albany, NY. 372.201 Section 372.201 Transportation... TERMINAL AREAS Commercial Zones § 372.201 Albany, NY. The zone adjacent to, and commercially a part...

  14. 49 CFR 372.201 - Albany, NY.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... section, thence along the western and northern boundary of Cohoes to the Mohawk River thence along such... 49 Transportation 5 2011-10-01 2011-10-01 false Albany, NY. 372.201 Section 372.201 Transportation... TERMINAL AREAS Commercial Zones § 372.201 Albany, NY. The zone adjacent to, and commercially a part...

  15. 49 CFR 372.201 - Albany, NY.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... section, thence along the western and northern boundary of Cohoes to the Mohawk River thence along such... 49 Transportation 5 2012-10-01 2012-10-01 false Albany, NY. 372.201 Section 372.201 Transportation... TERMINAL AREAS Commercial Zones § 372.201 Albany, NY. The zone adjacent to, and commercially a part...

  16. Effects of the Growth of Managed Care on Academic Medical Centers and Graduate Medical Education.

    ERIC Educational Resources Information Center

    Gold, Marsha R.

    1996-01-01

    Ways in which the proliferation of competitive health care financing and service delivery systems based on managed care affects the financial support available to academic medical centers (AMCs), especially graduate medical education programs, are discussed. Analysis is based on case studies of AMCs. Trends, potential conflicts, and areas for…

  17. Effectively implementing FDA medication alerts utilizing patient centered medical home clinical pharmacists.

    PubMed

    Arenz, Barbara J; Diez, Heidi L; Bostwick, Jolene R; Kales, Helen C; Zivin, Kara; Dalack, Gregory W; Fluent, Tom E; Standiford, Connie J; Stano, Claire; Mi Choe, Hae

    2016-03-01

    FDA medication alerts can be successfully implemented within patient centered medical home (PCMH) clinics utilizing clinical pharmacists. Targeted selection of high-risk patients from an electronic database allows PCMH pharmacists to prioritize assessments. Trusting relationships between PCMH clinical pharmacists and primary care providers facilitates high response rates to pharmacist recommendations. This health system approach led by PCMH pharmacists provides a framework for proactive responses to FDA safety alerts and medication related quality measure improvement. PMID:27001101

  18. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), south and west sides of buildings no. 719, now the north wing of building no. 508. - Fitzsimons General Hospital, Nurses' Mess & Kitchen, Nurses' Recreation, West McAfee Avenue, North of Building 507, Aurora, Adams County, CO

  19. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover). Photograph taken before Sept. 29, 1934 when the revised Real Property form on building 257 was completed. - Fitzsimons General Hospital, Building 257, North side of East O'Neill Avenue, between Tenth & Twelfth Streets, Aurora, Adams County, CO

  20. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), south side. - Fitzsimons General Hospital, Red Cross Building, South Eighth Street Bounded by West McAfee Avenue on South & West Harlow Avenue on North, Aurora, Adams County, CO

  1. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover). Photograph taken before Sept 29, 1934 when the revised Real Property form on building 255 was completed. - Fitzsimons General Hopital, Building 255, North side of East O'Niell Avenue, between Tenth & Twelfth Streets, Aurora, Adams County, CO

  2. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), east and south sides of building no. 715, now the south wing of building no. 508. - Fitzsimons General Hospital, Nurses' Mess & Kitchen, Nurses' Recreation, West McAfee Avenue, North of Building 507, Aurora, Adams County, CO

  3. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), showing part of east side and most of north side. - Fitzsimons General Hospital, Quartermaster's Storehouse, Southwest Corner of East I Avenue & North Twelfth Street, Aurora, Adams County, CO

  4. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), south and north sides. - Fitzsimons General Hospital, Physiotherapy & Electrocardiograph Department Building, North of Building No. 516, East of corridor connecting Building No. 511 to Building No. 515, Aurora, Adams County, CO

  5. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property Book (green cloth cover). Photograph of south side before perpendicular wing added. - Fitzsimons General Hospital, Carpenter Shop Building, Southwest Corner of West I Avenue, & North Tenth Street, Aurora, Adams County, CO

  6. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), north and east sides of the east/west wing. - Fitzsimons General Hospital, General Mess & Kitchen, Southwest Corner of East McAfee Avenue & South Twelfth Street, Aurora, Adams County, CO

  7. Photocopy of photograph in the Fitzsimons Army Medical Center Real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center Real Property Book (green cloth cover). Photograph taken before Sept. 29, 1934 when the revised Real Property form on building 256 was completed. - Fitzsimons General Hospital, Building 256, North side of East O'Niell Avenue, between Tenth & Twelfth Streets, Aurora, Adams County, CO

  8. Photocopy of photograph in Fitzsimons Army Medical Center Real Property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center Real Property book (green cloth cover), showing east and most of south sides. - Fitzsimons General Hospital, Assembly Hall School, Northeast Corner of West McCloskey Avenue & North Tenth Street, Aurora, Adams County, CO

  9. Photocopy of photograph in the Fitzsimons Army Medical Center real ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in the Fitzsimons Army Medical Center real property book (green cloth cover), probably west and north sides. - Fitzsimons General Hospital, Officer Patient's Mess & Kitchen, Northeast Corner of West McAfee Avenue & South Hickey Street, Aurora, Adams County, CO

  10. The 'Adventist advantage'. Glendale Adventist Medical Center distinguishes itself.

    PubMed

    Botvin, Judith D

    2002-01-01

    Glendale Adventist Medical Center, Glendale, Calif., adopted an image-building campaign to differentiate the 450-bed hospital from its neighbors. This included the headline "Adventist Advantage," used in a series of sophisticated ads, printed in gold. In all their efforts, marketers consider the sensibilities of the sizable Armenian, Korean, Hispanic and Chinese populations. PMID:12134406

  11. Photocopy of post card from Fitzsimons Army Medical Center Public ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of post card from Fitzsimons Army Medical Center Public Affairs Office, building 120. Photograph by Rocky Mountain photo. CO was no copyrighted and is , therefore, in the public domain. - Fitzsimons General Hospital, Memorial Tablet, West McAfee, South of Building No. 524, Aurora, Adams County, CO

  12. Claretian Medical Center Task Analysis. Worker Education Program.

    ERIC Educational Resources Information Center

    Union of Needletrades, Industrial and Textile Employees.

    This task analysis for positions at the Claretian Medical Center in southeast Chicago was developed to improve communication and customer service in the workplace. The task analysis was prepared through clinic tours, employee interviews, and supervisor questionnaires. It is used for the purpose of curriculum development for onsite instruction in…

  13. Early experiences with big data at an academic medical center.

    PubMed

    Halamka, John D

    2014-07-01

    Beth Israel Deaconess Medical Center (BIDMC), an academic health care institution affiliated with Harvard University, has been an early adopter of electronic applications since the 1970s. Various departments of the medical center and the physician practice groups affiliated with it have implemented electronic health records, filmless imaging, and networked medical devices to such an extent that data storage at BIDMC now amounts to three petabytes and continues to grow at a rate of 25 percent a year. Initially, the greatest technical challenge was the cost and complexity of data storage. However, today the major focus is on transforming raw data into information, knowledge, and wisdom. This article discusses the data growth, increasing importance of analytics, and changing user requirements that have shaped the management of big data at BIDMC.

  14. The checklist: BEST medical center employment requirements 2015.

    PubMed

    Cohen, Philip R; Kurzrock, Razelle

    2015-01-01

    Dr. Ida Lystic, a newly minted gastroenterologist, has accepted a job at the Byron Edwards & Samuel Thompson (BEST) Medical Center. On her first day, after six months of preliminary paper work, she completes multiple checklists mandated by the center: dress code, employee health, and class checklists. Her open-toe pumps have been replaced by disposable paper booties and her polished fingernails have been covered with blue latex-free gloves. Nicotine screening (the use of which is prohibited not only while at work at the BEST Medical Center, but also while at home) was performed, and she had a mask fitting for tuberculosis. Her next two weeks were to be occupied with over 70 hours of required classes; however, after receiving a mandatory flu shot, she became sick and missed the first week of classes, and so her start date for seeing patients is delayed by two months. Although she was hired because she received the outstanding fellow award at the place where she trained (the OTHER--Owen T. Henry and Eugene Rutherford--Medical Center), her competence needs to be documented by a junior faculty member who is assigned to do this for all incoming physicians, including the world-renowned, new center director. The human resources manager smirks as she indicates that no one meets their relative value unit (RVU) work targets at BEST, and so Dr. Lystic must prepay for all the paperwork/tests. While Dr. Ida Lystic and "the BEST Medical Center" are creations of the authors' imagination, most of the items on her checklists are real. PMID:26051067

  15. An Architecture for Continuous Data Quality Monitoring in Medical Centers.

    PubMed

    Endler, Gregor; Schwab, Peter K; Wahl, Andreas M; Tenschert, Johannes; Lenz, Richard

    2015-01-01

    In the medical domain, data quality is very important. Since requirements and data change frequently, continuous and sustainable monitoring and improvement of data quality is necessary. Working together with managers of medical centers, we developed an architecture for a data quality monitoring system. The architecture enables domain experts to adapt the system during runtime to match their specifications using a built-in rule system. It also allows arbitrarily complex analyses to be integrated into the monitoring cycle. We evaluate our architecture by matching its components to the well-known data quality methodology TDQM.

  16. [Patient-centered medicine for tuberculosis medical services].

    PubMed

    Fujita, Akira; Narita, Tomoyo

    2012-12-01

    The 2011 edition of Specific Guiding Principles for Tuberculosis Prevention calls for a streamlined medical services system capable of providing medical care that is customized to the patient's needs. The new 21st Century Japanese version of the Directly Observed Treatment Short Course (DOTS) expands the indication of DOTS to all tuberculosis (TB) patients in need of treatment. Hospital DOTS consists of comprehensive, patient-centered support provided by a DOTS care team. For DOTS in the field, health care providers should select optimal administration support based on patient profiles and local circumstances. In accordance with medical fee revisions for 2012, basic inpatient fees have been raised and new standards for TB hospitals have been established, the result of efforts made by the Japanese Society for Tuberculosis and other associated groups. It is important that the medical care system be improved so that patients can actively engage themselves as a member of the team, for the ultimate goal of practicing patient-centered medicine. We have organized this symposium to explore the best ways for practicing patient-centered medicine in treating TB. It is our sincere hope that this symposium will lead to improved medical treatment for TB patients. 1. Providing patient-centered TB service via utilization of collaborative care pathway: Akiko MATSUOKA (Hiroshima Prefectural Tobu Public Health Center) We have been using two types of collaborative care pathway as one of the means of providing patient-centered TB services since 2008. The first is the clinical pathway, which is mainly used by TB specialist doctors to communicate with local practitioners on future treatment plan (e.g. medication and treatment duration) of patients. The clinical pathway was first piloted in Onomichi district and its use was later expanded to the whole of Hiroshima prefecture. The second is the regional care pathway, which is used to share treatment progress, test results and other

  17. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover), apparently showing west side of building 732. In 1921, buildings 732 and 733 were combined and it is assumed that this photograph, which was taken after 1921, shows the section added to make buildings 732 and 733 once continuous building. - Fitzsimons General Hospital, Storehouses, Northwest Corner of East Harlow Avenue & North Thirteenth Street, Aurora, Adams County, CO

  18. Photocopy of photograph from Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph from Fitzsimons Army Medical Center real property book (green cloth cover), showing building 225's west and a north sides. This photograph is included because it shows how the west side of building 221 looked before the corridor between buildings 220 and 221 was added and because building 225 was built to the same plan as building 221. - Fitzsimons General Hospital, Hospital Corps Barracks, East Harlow Street, East of Building No. 220, Aurora, Adams County, CO

  19. Energy use baselining study for the National Naval Medical Center

    SciTech Connect

    Parker, G.B.; Halverson, M.A.

    1992-04-01

    This report provides an energy consumption profile for fourteen buildings at the National Naval Medical Center (NNMC) in Bethesda, Maryland. Recommendations are also made for viable energy efficiency projects funded with assistance from the servicing utility (Potomic Electric Power Company) in the form of rebates and incentives available in their Demand Side Management (DSM) program and through Shared Energy Savings (SES) projects. This report also provides estimates of costs and potential energy savings of the recommended projects.

  20. Residency Surgical Training at an Independent Academic Medical Center.

    PubMed

    Jones, Jeremiah; Sidwell, Richard A

    2016-02-01

    Independent academic medical centers have been training surgeons for more than a century; this environment is distinct from university or military programs. There are several advantages to training at a community program, including a supportive learning environment with camaraderie between residents and faculty, early and broad operative experience, and improved graduate confidence. Community programs also face challenges, such as resident recruitment and faculty engagement. With the workforce needs for general surgeons, independent training programs will continue to play an integral role.

  1. Best practice in unbilled account management: one medical center's story.

    PubMed

    Menaker, Debra; Miller, Joshua

    2016-02-01

    After implementing its new electronic health record, a large metropolitan academic medical center (AMC) decided to optimize its supporting business systems, beginning with billing. By identifying problems and taking the following corrective actions immediately, the AMC significantly reduced the number and average age of its unbilled accounts: Realigning system automation to improve routing efficiency. Facilitating interdisciplinary collaboration to better identify and correct the root causes of issues. Ensuring transparent data reporting by setting up different ways of viewing the underlying information. PMID:26999975

  2. Task centered visualization of Electronic Medical Record flow sheet.

    PubMed

    Xie, Zhong; Gregg, Peggy; Zhang, Jiajie

    2003-01-01

    Usability problem of Electronic Medical Record (EMR) systems is a major hurdle for their acceptance. In this study we used the methodology of Human-Centered Distributed Information Design (HCDID) to compare and evaluate Flow Sheet module of two commercial EMR systems. After which we tried to develop usable interface of a flow sheet using visualization, focusing on task-representation mapping during design and development.

  3. Succession planning in an academic medical center nursing service.

    PubMed

    Barginere, Cynthia; Franco, Samantha; Wallace, Lynne

    2013-01-01

    Succession planning is of strategic importance in any industry. It ensures the smooth transition from leader to leader and the ability of the organization to maintain the forward momentum as well as meet its operational and financial goals. Health care and nursing are no exception. In the complex and challenging world of health care today, leadership is critical to an organization's success and leadership succession is a key strategy used to ensure continuity of leadership and development of talent from within the organization. At Rush University Medical Center, a 667-bed academic medical center providing tertiary care to adults and children, the need for a focus on succession planning for the nursing leadership team is apparent as key leaders come to the end of their careers and consider retirement. It has become apparent that to secure the legacy and continue the extraordinary history of nursing excellence, care must be taken to grow talent from within and take the opportunity to leverage the mentoring opportunities before the retirement of many key leaders. To ensure a smooth leadership transition, nursing leadership and human resources partner at Rush University Medical Center to implement a systematic approach to leadership succession planning. PMID:23222756

  4. Succession planning in an academic medical center nursing service.

    PubMed

    Barginere, Cynthia; Franco, Samantha; Wallace, Lynne

    2013-01-01

    Succession planning is of strategic importance in any industry. It ensures the smooth transition from leader to leader and the ability of the organization to maintain the forward momentum as well as meet its operational and financial goals. Health care and nursing are no exception. In the complex and challenging world of health care today, leadership is critical to an organization's success and leadership succession is a key strategy used to ensure continuity of leadership and development of talent from within the organization. At Rush University Medical Center, a 667-bed academic medical center providing tertiary care to adults and children, the need for a focus on succession planning for the nursing leadership team is apparent as key leaders come to the end of their careers and consider retirement. It has become apparent that to secure the legacy and continue the extraordinary history of nursing excellence, care must be taken to grow talent from within and take the opportunity to leverage the mentoring opportunities before the retirement of many key leaders. To ensure a smooth leadership transition, nursing leadership and human resources partner at Rush University Medical Center to implement a systematic approach to leadership succession planning.

  5. School-Based Health Centers and the Patient-Centered Medical Home. Position Statement

    ERIC Educational Resources Information Center

    National Assembly on School-Based Health Care, 2010

    2010-01-01

    The patient-centered medical home (PCMH) is an innovative care delivery model designed to provide comprehensive primary care services to people of all ages by fostering partnerships between patients, families, health care providers and the community. National Assembly on School-Based Health Care (NASBHC) recommends practices and policies that…

  6. 49 CFR 372.201 - Albany, NY.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Albany, N.Y., within which transportation by motor vehicle, in interstate or foreign commerce, not under... combined areas defined in paragraphs (b) and (c) of this section, and (e) All of any municipality...

  7. The role of housestaff in implementing medication reconciliation on admission at an academic medical center.

    PubMed

    Evans, Adam S; Lazar, Eliot J; Tiase, Victoria L; Fleischut, Peter; Bostwick, Susan B; Hripcsak, George; Liebowitz, Richard; Forese, Laura L; Kerr, Gregory

    2011-01-01

    Since 2006, the Joint Commission has required all hospitals to have a process in place for medication reconciliation (MR). Although it has been shown that MR decreases medical errors, achieving compliance has proven difficult for many health care institutions. This article describes a housestaff-championed intervention of a "hard stop" for on-admission MR orders that led to a statistically significant increase in compliance that was sustained at 6 months after intervention. Academic medical centers, which comprise large numbers of housestaff, can improve compliance with on-admission MR by engaging housestaff in the development of solutions and in communication to their peers, leading to sustained results. PMID:20501865

  8. Decline of clinical research in academic medical centers.

    PubMed

    Meador, Kimford J

    2015-09-29

    Marked changes in US medical school funding began in the 1960s with progressively increasing revenues from clinical services. The growth of clinical revenues slowed in the mid-1990s, creating a funding crisis for US academic health care centers, who responded by having their faculty increase their clinical duties at the expense of research activities. Surveys document the resultant stresses on the academic clinician researcher. The NIH provides greater funding for basic and translational research than for clinical research, and the new Patient-Centered Outcomes Research Institute is inadequately funded to address the scope of needed clinical research. An increasing portion of clinical research is funded by industry, which leaves many important clinical issues unaddressed. There is an inadequate supply of skilled clinical researchers and a lack of external support for clinical research. The impact on the academic environment in university medical centers is especially severe on young faculty, who have a shrinking potential to achieve successful academic careers. National health care research funding policies should encourage the right balance of life-science investigations. Medical universities need to improve and highlight education on clinical research for students, residents, fellows, and young faculty. Medical universities also need to provide appropriate incentives for clinical research. Without training to ensure an adequate supply of skilled clinical researchers and a method to adequately fund clinical research, discoveries from basic and translational research cannot be clinically tested and affect patient care. Thus, many clinical problems will continue to be evaluated and treated with inadequate or even absent evidence-based knowledge.

  9. Decline of clinical research in academic medical centers

    PubMed Central

    2015-01-01

    Marked changes in US medical school funding began in the 1960s with progressively increasing revenues from clinical services. The growth of clinical revenues slowed in the mid-1990s, creating a funding crisis for US academic health care centers, who responded by having their faculty increase their clinical duties at the expense of research activities. Surveys document the resultant stresses on the academic clinician researcher. The NIH provides greater funding for basic and translational research than for clinical research, and the new Patient-Centered Outcomes Research Institute is inadequately funded to address the scope of needed clinical research. An increasing portion of clinical research is funded by industry, which leaves many important clinical issues unaddressed. There is an inadequate supply of skilled clinical researchers and a lack of external support for clinical research. The impact on the academic environment in university medical centers is especially severe on young faculty, who have a shrinking potential to achieve successful academic careers. National health care research funding policies should encourage the right balance of life-science investigations. Medical universities need to improve and highlight education on clinical research for students, residents, fellows, and young faculty. Medical universities also need to provide appropriate incentives for clinical research. Without training to ensure an adequate supply of skilled clinical researchers and a method to adequately fund clinical research, discoveries from basic and translational research cannot be clinically tested and affect patient care. Thus, many clinical problems will continue to be evaluated and treated with inadequate or even absent evidence-based knowledge. PMID:26156509

  10. Establishing a pediatric hospitalist program at an Academic Medical Center.

    PubMed

    Ponitz, K; Mortimer, J; Berman, B

    2000-04-01

    Academic medical centers have been challenged to respond to a rapidly changing and increasingly competitive health care environment. The Pediatric Consultation and Referral Service (PCRS) at Rainbow Babies & Children's Hospital (RB&C)/University Hospitals of Cleveland was established in 1993 with the goal of providing rapid access to community-based physicians for the referral of patients requiring urgent hospitalization within the broad scope of general pediatrics. We describe our initial 3-year experience in the planning, implementation, and evaluation of a pediatric hospitalist program. PCRS provided care to 2,740 patients during the first 3 years of operation, 63% (1,716) of whom were under age 3 years. Leading primary diagnoses in order of decreasing frequency were asthma, pneumonia, bronchiolitis, febrile illness, gastroenteritis, seizures, croup, apnea, and cellulitis. Third-party payer mix was: Medicaid 42%, managed care 42%, indemnity insurance 10%, self-pay 6%, and Bureau for Children with Medical Handicaps 1%. From survey data, referring physicians and pediatric residents assessed perceptions of access, collegiality, and quality of care in a highly favorable manner. Subspecialty colleagues perceived access and collegiality very favorably but rated quality of care substantially lower than referring physicians and residents did. Our experience demonstrates that a pediatric hospitalist program is logistically and economically feasible and may contribute to the patient care, education, and research missions of academic medical centers. A well-structured program can provide community physicians with excellent access and support collegial relationships. Beyond increasing a medical center's patient referral base, a hospitalist program can potentially enhance the esteem of the discipline of general pediatrics and, it is hoped, promote general pediatrics as a viable career option for trainees. PMID:10791134

  11. Design for Medical Education. The Development and Planning of a Medical College and Care Center.

    ERIC Educational Resources Information Center

    Peery, Thomas M.; Green, Alan C.

    Planning and design procedures which one medical education center employed in translating its educational objectives, philosophy and techniques into laboratory, classroom and clinic facilities are described. Basic planning considerations included--(1) determination of the curriculum, (2) facility utilization rate, (3) housing of research…

  12. The Prescribed Pediatric Center: A Medical Day Treatment Program for Children with Complex Medical Conditions.

    ERIC Educational Resources Information Center

    Ruppert, Elizabeth S.; Karst, Thomas O.; Brogan, Mark G.

    1998-01-01

    The Prescribed Pediatric Center (Toledo, Ohio) is a community-based, multidisciplinary program for infants and children with chronic, complex medical conditions. This article describes program beginnings; the planning process; and the program's growth, development, and components. Initial program evaluation indicates positive effects on some…

  13. A cryptologic based trust center for medical images.

    PubMed Central

    Wong, S T

    1996-01-01

    OBJECTIVE: To investigate practical solutions that can integrate cryptographic techniques and picture archiving and communication systems (PACS) to improve the security of medical images. DESIGN: The PACS at the University of California San Francisco Medical Center consolidate images and associated data from various scanners into a centralized data archive and transmit them to remote display stations for review and consultation purposes. The purpose of this study is to investigate the model of a digital trust center that integrates cryptographic algorithms and protocols seamlessly into such a digital radiology environment to improve the security of medical images. MEASUREMENTS: The timing performance of encryption, decryption, and transmission of the cryptographic protocols over 81 volumetric PACS datasets has been measured. Lossless data compression is also applied before the encryption. The transmission performance is measured against three types of networks of different bandwidths: narrow-band Integrated Services Digital Network, Ethernet, and OC-3c Asynchronous Transfer Mode. RESULTS: The proposed digital trust center provides a cryptosystem solution to protect the confidentiality and to determine the authenticity of digital images in hospitals. The results of this study indicate that diagnostic images such as x-rays and magnetic resonance images could be routinely encrypted in PACS. However, applying encryption in teleradiology and PACS is a tradeoff between communications performance and security measures. CONCLUSION: Many people are uncertain about how to integrate cryptographic algorithms coherently into existing operations of the clinical enterprise. This paper describes a centralized cryptosystem architecture to ensure image data authenticity in a digital radiology department. The system performance has been evaluated in a hospital-integrated PACS environment. PMID:8930857

  14. Pain management experience at a central Taiwan medical center.

    PubMed

    Tsao, Shao-Lun; Hsieh, Yi-Jer

    2015-06-01

    Pain management is typically more developed in western countries compared to Asia. From the accreditation standard of the Joint Commission International (JCI), there is a broad scope for pain management. In 2008, our medical center established the pain management policy, and the goal is to be a pain-free medical facility. The Framework of Pain Management Policy including: 1. the rights of patients and family members 2. Employee education 3. Assessment of pain (screening, evaluating, monitoring) 4. Patient care of pain. After implementation of pain management program, the compliance of pain assessment, the analysis of pain score before and after pain management and the analysis of Pain Management Index (PMI), all showed improvement in pain management program. The consumption of opioids usage steadily increased from 2010 to 2014. The success of our pain management program implementation could be attributed to the clear pain management policy, the firm support of higher leadership, the cooperation of IT department, and the quality control.

  15. An Integrated Model of Care: A Visit to The SPARK Center, a Program of Boston Medical Center

    ERIC Educational Resources Information Center

    Griest, Christa

    2010-01-01

    This article features The SPARK Center, a program of Boston Medical Center, located in Mattapan, Massachusetts. The Center has pioneered a whole-child approach to address the multi-dimensional needs of Boston's most at-risk children, recognizing that vulnerable children need more than educational supports to flourish. The Center's integrated model…

  16. Photocopy of photograph in Fitzsimons Army Medical Center real property ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Photocopy of photograph in Fitzsimons Army Medical Center real property book (green cloth cover). In that book, this photograph appears for building 706 was renumbered 353 and subsequently 202. The building in the photograph resembles building 204 more than it does building 202, but all Fitzsimons Real Property records indicate that the building in the photograph, showing west side, is early photograph of building 202. - Fitzsimons General Hospital, Motor Transport Garage, Northwest Corner of East Harlow Avenue, & North Twelfth Street, Aurora, Adams County, CO

  17. International accreditation of ambulatory surgical centers and medical tourism.

    PubMed

    McGuire, Michael F

    2013-07-01

    The two forces that have driven the increase in accreditation of outpatient ambulatory surgery centers (ASC's) in the United States are reimbursement of facility fees by Medicare and commercial insurance companies, which requires either accreditation, Medicare certification, or state licensure, and state laws which mandate one of these three options. Accreditation of ASC's internationally has been driven by national requirements and by the competitive forces of "medical tourism." The three American accrediting organizations have all developed international programs to meet this increasing demand outside of the United States. PMID:23830758

  18. International accreditation of ambulatory surgical centers and medical tourism.

    PubMed

    McGuire, Michael F

    2013-07-01

    The two forces that have driven the increase in accreditation of outpatient ambulatory surgery centers (ASC's) in the United States are reimbursement of facility fees by Medicare and commercial insurance companies, which requires either accreditation, Medicare certification, or state licensure, and state laws which mandate one of these three options. Accreditation of ASC's internationally has been driven by national requirements and by the competitive forces of "medical tourism." The three American accrediting organizations have all developed international programs to meet this increasing demand outside of the United States.

  19. Case study: a data warehouse for an academic medical center.

    PubMed

    Einbinder, J S; Scully, K W; Pates, R D; Schubart, J R; Reynolds, R E

    2001-01-01

    The clinical data repository (CDR) is a frequently updated relational data warehouse that provides users with direct access to detailed, flexible, and rapid retrospective views of clinical, administrative, and financial patient data for the University of Virginia Health System. This article presents a case study of the CDR, detailing its five-year history and focusing on the unique role of data warehousing in an academic medical center. Specifically, the CDR must support multiple missions, including research and education, in addition to administration and management. Users include not only analysts and administrators but clinicians, researchers, and students. PMID:11452578

  20. Cancer Research Institute, Loma Linda University Medical Center

    SciTech Connect

    1994-08-01

    The Department of Energy (DOE) has prepared an Environmental Assessment (EA) DOE/EA-0975, evaluating the construction, equipping and operation of the Cancer Research Institute (CRI) at the Loma Linda University Medical Center (LLUMC) on its campus in Loma Linda, California. Based on the analysis in the EA, the DOE has determined that the proposed action does not constitute a major federal action significantly affecting the quality of the human environment within the meaning of the National Environmental Policy Act of 1969 (NEPA). Therefore, the preparation of an Environmental Impact Statement is not required. This document describes alternatives, the affected environment and environmental consequences of the proposed action.

  1. Evaluation of intravenous medication errors with smart infusion pumps in an academic medical center.

    PubMed

    Ohashi, Kumiko; Dykes, Patricia; McIntosh, Kathleen; Buckley, Elizabeth; Wien, Matt; Bates, David W

    2013-01-01

    While some published research indicates a fairly high frequency of Intravenous (IV) medication errors associated with the use of smart infusion pumps, the generalizability of these results are uncertain. Additionally, the lack of a standardized methodology for measuring these errors is an issue. In this study we iteratively developed a web-based data collection tool to capture IV medication errors using a participatory design approach with interdisciplinary experts. Using the developed tool, a prevalence study was then conducted in an academic medical center. The results showed that the tool was easy to use and effectively captured all IV medication errors. Through the prevalence study, violation errors of hospital policy were found that could potentially place patients at risk, but no critical errors known to contribute to patient harm were noted.

  2. IAIMS at Columbia-Presbyterian Medical Center: accomplishments and challenges.

    PubMed Central

    Roderer, N K; Clayton, P D

    1992-01-01

    The concept of "one-stop information shopping" is becoming a reality at Columbia-Presbyterian Medical Center. Our goal is to provide access from a single workstation to clinical, research, and library resources; university and hospital administrative systems; and utility functions such as word processing and mail. We have created new organizational units and installed a network of workstations that can access a variety of resources and systems on any of seventy-two different host computers/servers. In November 1991, 2,600 different individuals used the clinical information system, 700 different individuals used the library resources, and 900 different individuals used hospital administrative systems via the network. Over the past four years, our efforts have cost the equivalent of $23 million or approximately 0.5% of the total medical center budget. Even small improvements in productivity and in the quality of work of individuals who use the system could justify these expenditures. The challenges we still face include the provision of additional easy-to-use applications and development of equitable methods for financial support. PMID:1326368

  3. Photodynamic research at Baylor University Medical Center Dallas, Texas

    NASA Astrophysics Data System (ADS)

    Gulliya, Kirpal S.; Matthews, James Lester; Sogandares-Bernal, Franklin M.; Aronoff, Billie L.; Judy, Millard M.

    1993-03-01

    We received our first CO2 laser at Baylor University Medical Center in December 1974, following a trip to Israel in January of that year. Discussion with the customs office of the propriety of charging an 18% import tax lasted for nine months. We lost that argument. Baylor has been using lasers of many types for many procedures since that time. About ten years ago, through the kindness of Tom Dougherty and Roswell Park, we started working with photodynamic therapy, first with hematoporphyrin I and later with dihematoporphyrin ether (II). In February 1984, we were invited to a conference at Los Alamos, New Mexico, U.S.A. on medical applications of the free electron laser as part of the Star Wars Program. A grant application from Baylor was approved that November, but funding did not start for many months. This funding contributed to the development of a new research center as part of Baylor Research Institute. Many of the projects investigated at Baylor dealt with applications of the free electron laser (FEL), after it became available. A staff was assembled and many projects are still ongoing. I would like to outline those which are in some way related to photodynamic therapy.

  4. Publications in academic medical centers: technology-facilitated culture clash.

    PubMed

    Berner, Eta S

    2014-05-01

    Academic culture has a set of norms, expectations, and values that are sometimes tacit and sometimes very explicit. In medical school and other health professions educational settings, probably the most common norm includes placing a high value on peer-reviewed research publications, which are seen as the major evidence of scholarly productivity. Other features of academic culture include encouraging junior faculty and graduate students to share their research results at professional conferences and lecturing with slides as a major way to convey information. Major values that faculty share with journal editors include responsible conduct of research and proper attribution of others' words and ideas. Medical school faculty also value technology and are often quick to embrace technological advances that can assist them in their teaching and research. This article addresses the effects of technology on three aspects of academic culture: education, presentations at professional meetings, and research publications.The technologies discussed include online instruction, dissemination of conference proceedings on the Internet, plagiarism-detection software, and new technologies deployed by the National Center for Biotechnology Information, the home of PubMed. The author describes how the ease of deploying new technologies without faculty changing their norms and behavior in the areas of teaching and research can lead to conflicts of values among key stakeholders in the academic medical community, including faculty, journal editors, and professional associations. The implications of these conflicts and strategies for managing them are discussed.

  5. An analytics approach to designing patient centered medical homes.

    PubMed

    Ajorlou, Saeede; Shams, Issac; Yang, Kai

    2015-03-01

    Recently the patient centered medical home (PCMH) model has become a popular team based approach focused on delivering more streamlined care to patients. In current practices of medical homes, a clinical based prediction frame is recommended because it can help match the portfolio capacity of PCMH teams with the actual load generated by a set of patients. Without such balances in clinical supply and demand, issues such as excessive under and over utilization of physicians, long waiting time for receiving the appropriate treatment, and non-continuity of care will eliminate many advantages of the medical home strategy. In this paper, by using the hierarchical generalized linear model with multivariate responses, we develop a clinical workload prediction model for care portfolio demands in a Bayesian framework. The model allows for heterogeneous variances and unstructured covariance matrices for nested random effects that arise through complex hierarchical care systems. We show that using a multivariate approach substantially enhances the precision of workload predictions at both primary and non primary care levels. We also demonstrate that care demands depend not only on patient demographics but also on other utilization factors, such as length of stay. Our analyses of a recent data from Veteran Health Administration further indicate that risk adjustment for patient health conditions can considerably improve the prediction power of the model.

  6. Publications in academic medical centers: technology-facilitated culture clash.

    PubMed

    Berner, Eta S

    2014-05-01

    Academic culture has a set of norms, expectations, and values that are sometimes tacit and sometimes very explicit. In medical school and other health professions educational settings, probably the most common norm includes placing a high value on peer-reviewed research publications, which are seen as the major evidence of scholarly productivity. Other features of academic culture include encouraging junior faculty and graduate students to share their research results at professional conferences and lecturing with slides as a major way to convey information. Major values that faculty share with journal editors include responsible conduct of research and proper attribution of others' words and ideas. Medical school faculty also value technology and are often quick to embrace technological advances that can assist them in their teaching and research. This article addresses the effects of technology on three aspects of academic culture: education, presentations at professional meetings, and research publications.The technologies discussed include online instruction, dissemination of conference proceedings on the Internet, plagiarism-detection software, and new technologies deployed by the National Center for Biotechnology Information, the home of PubMed. The author describes how the ease of deploying new technologies without faculty changing their norms and behavior in the areas of teaching and research can lead to conflicts of values among key stakeholders in the academic medical community, including faculty, journal editors, and professional associations. The implications of these conflicts and strategies for managing them are discussed. PMID:24667517

  7. Focus on: SUNY Health Center at Brooklyn Scientific & Medical Instrumentation Center.

    PubMed

    Ben-Zvi, S

    1988-01-01

    The Scientific and Medical Instrumentation Center (SMIC) is the clinical engineering program serving the State University of New York's Health Science Center at Brooklyn. SMIC is a separate department within the center's 354-bed University Hospital, and provides many instrumentation support services for the hospital and the center's Basic Sciences Division. Now in its 24th year, SMIC developed the nation's first mandatory initial checkout program for patient care equipment, and in 1973 published the results of a funded pilot preventive maintenance program; this served as a model for the start-up of other PM programs in hospitals across the country and overseas. Today, this 35-person department is primarily responsible for some 7,000 units used in over 60 University Hospital departments and clinics. With its interdisciplinary expertise, SMIC also provides the hospital with many other instrumentation services, including prepurchase evaluation and review, and on-site emergency instrumentation service. SMIC also develops unique devices and instruments for the center's researchers, from the prototype stage through to final construction, and may modify instruments for increased safety and efficacy. PMID:10286254

  8. Spectrum of tablet computer use by medical students and residents at an academic medical center

    PubMed Central

    2015-01-01

    Introduction. The value of tablet computer use in medical education is an area of considerable interest, with preliminary investigations showing that the majority of medical trainees feel that tablet computers added value to the curriculum. This study investigated potential differences in tablet computer use between medical students and resident physicians. Materials & Methods. Data collection for this survey was accomplished with an anonymous online questionnaire shared with the medical students and residents at Southern Illinois University School of Medicine (SIU-SOM) in July and August of 2012. Results. There were 76 medical student responses (26% response rate) and 66 resident/fellow responses to this survey (21% response rate). Residents/fellows were more likely to use tablet computers several times daily than medical students (32% vs. 20%, p = 0.035). The most common reported uses were for accessing medical reference applications (46%), e-Books (45%), and board study (32%). Residents were more likely than students to use a tablet computer to access an electronic medical record (41% vs. 21%, p = 0.010), review radiology images (27% vs. 12%, p = 0.019), and enter patient care orders (26% vs. 3%, p < 0.001). Discussion. This study shows a high prevalence and frequency of tablet computer use among physicians in training at this academic medical center. Most residents and students use tablet computers to access medical references, e-Books, and to study for board exams. Residents were more likely to use tablet computers to complete clinical tasks. Conclusions. Tablet computer use among medical students and resident physicians was common in this survey. All learners used tablet computers for point of care references and board study. Resident physicians were more likely to use tablet computers to access the EMR, enter patient care orders, and review radiology studies. This difference is likely due to the differing educational and professional demands placed on

  9. Spectrum of tablet computer use by medical students and residents at an academic medical center.

    PubMed

    Robinson, Robert

    2015-01-01

    Introduction. The value of tablet computer use in medical education is an area of considerable interest, with preliminary investigations showing that the majority of medical trainees feel that tablet computers added value to the curriculum. This study investigated potential differences in tablet computer use between medical students and resident physicians. Materials & Methods. Data collection for this survey was accomplished with an anonymous online questionnaire shared with the medical students and residents at Southern Illinois University School of Medicine (SIU-SOM) in July and August of 2012. Results. There were 76 medical student responses (26% response rate) and 66 resident/fellow responses to this survey (21% response rate). Residents/fellows were more likely to use tablet computers several times daily than medical students (32% vs. 20%, p = 0.035). The most common reported uses were for accessing medical reference applications (46%), e-Books (45%), and board study (32%). Residents were more likely than students to use a tablet computer to access an electronic medical record (41% vs. 21%, p = 0.010), review radiology images (27% vs. 12%, p = 0.019), and enter patient care orders (26% vs. 3%, p < 0.001). Discussion. This study shows a high prevalence and frequency of tablet computer use among physicians in training at this academic medical center. Most residents and students use tablet computers to access medical references, e-Books, and to study for board exams. Residents were more likely to use tablet computers to complete clinical tasks. Conclusions. Tablet computer use among medical students and resident physicians was common in this survey. All learners used tablet computers for point of care references and board study. Resident physicians were more likely to use tablet computers to access the EMR, enter patient care orders, and review radiology studies. This difference is likely due to the differing educational and professional demands placed on

  10. A special issue on the patient-centered medical home.

    PubMed

    Blount, Alexander

    2010-12-01

    This special issue on the Patient-Centered Medical Home (PCMH) reflects its times. At the present time, the PCMH is an aspirational model with a few pilots functioning well around the country. How long the current period of idealism, fueled by the energy of early adopters, the consensus of diverse stakeholders, and the dollars of the Affordable Care Act will continue is anybody's guess. Representing the thinking of some of the best minds in the field, the articles in this issue have an aspirational and idealistic tone as much as a descriptive and analytic one. A year ago the balance would have been tipped more toward idealism and model building and a year from now it would, in all likelihood, tip more toward model description and analysis. The authors in this volume have been personally responsible for helping to move behavioral health to a more central position in the PCMH model. PMID:21299276

  11. An academic medical center's response to widespread computer failure.

    PubMed

    Genes, Nicholas; Chary, Michael; Chason, Kevin W

    2013-01-01

    As hospitals incorporate information technology (IT), their operations become increasingly vulnerable to technological breakdowns and attacks. Proper emergency management and business continuity planning require an approach to identify, mitigate, and work through IT downtime. Hospitals can prepare for these disasters by reviewing case studies. This case study details the disruption of computer operations at Mount Sinai Medical Center (MSMC), an urban academic teaching hospital. The events, and MSMC's response, are narrated and the impact on hospital operations is analyzed. MSMC's disaster management strategy prevented computer failure from compromising patient care, although walkouts and time-to-disposition in the emergency department (ED) notably increased. This incident highlights the importance of disaster preparedness and mitigation. It also demonstrates the value of using operational data to evaluate hospital responses to disasters. Quantifying normal hospital functions, just as with a patient's vital signs, may help quantitatively evaluate and improve disaster management and business continuity planning.

  12. Definitive treatment of combat casualties at military medical centers.

    PubMed

    Andersen, Romney C; Frisch, H Michael; Farber, Gerald L; Hayda, Roman A

    2006-01-01

    More than 9,000 casualties have been evacuated during the current conflict, and more than 40,000 orthopaedic surgical procedures have been performed. The most severely injured patients are treated in the United States at military medical centers. Individualized reconstructive plans are developed, and patients are treated with state-of-the-art techniques. Rehabilitation includes the assistance of the physical medicine and rehabilitation, physical therapy, and occupational therapy services, as well as, when necessary, psychiatric or other services. The extreme challenges of treating war-related soft-tissue defects include neurovascular injuries, burns, heterotopic ossification, infection, prolonged recovery, and persistent pain. Such injuries do not allow full restoration of function. Because of such devastating injuries, and despite use of up-to-date methods, outcomes can be less than optimal.

  13. Lessons Learned from Implementing the Patient-Centered Medical Home

    PubMed Central

    Green, Ellen P.; Wendland, John; Carver, M. Colette; Hughes Rinker, Cortney; Mun, Seong K.

    2012-01-01

    The Patient-Centered Medical Home (PCMH) is a primary care model that provides coordinated and comprehensive care to patients to improve health outcomes. This paper addresses practical issues that arise when transitioning a traditional primary care practice into a PCMH recognized by the National Committee for Quality Assurance (NCQA). Individual organizations' experiences with this transition were gathered at a PCMH workshop in Alexandria, Virginia in June 2010. An analysis of their experiences has been used along with a literature review to reveal common challenges that must be addressed in ways that are responsive to the practice and patients' needs. These are: NCQA guidance, promoting provider buy-in, leveraging electronic medical records, changing office culture, and realigning workspace in the practice to accommodate services needed to carry out the intent of PCMH. The NCQA provides a set of standards for implementing the PCMH model, but these standards lack many specifics that will be relied on in location situations. While many researchers and providers have made critiques, we see this vagueness as allowing for greater flexibility in how a practice implements PCMH. PMID:22969797

  14. Development and implementation of a comprehensive strategic plan for medical education at an academic medical center.

    PubMed

    Schwartzstein, Richard M; Huang, Grace C; Coughlin, Christine M

    2008-06-01

    Despite their vital contributions to the training of future physicians, many academic teaching hospitals have grown operationally and financially distinct from affiliated medical schools because of divergent missions, contributing to the erosion of clinical training. Some institutions have responded by building hybrid organizations; others by creating large health care networks with variable relationships with the affiliated medical school. In this case, the authors wished to establish the future educational mission of their medical center as a core element of the institution by creating data-driven recommendations for reorganization, programs, and financing. They conducted a self-study of all constituents, the results of which confirmed the importance of education at their institution but also revealed the insufficiency of incentives for teaching. They underwent an external review by a committee of prominent educators, and they involved administrators at the hospital and the medical school. Together, these inputs composed an informed assessment of medical education at their teaching hospital, from which they developed and actualized an institution-wide strategic plan for education. Over the course of three years, they centralized the administrative structure for education, implemented programs that cross departments and reinforce the UME-GME continuum, and created transparency in the financing of medical education. The plan was purposefully aligned with the clinical and research strategic plans by supporting patient safety in programs and the professional development of faculty. The application of a rigorous strategic planning process to medical education at an academic teaching hospital can focus the mission, invigorate faculty, and lead to innovative programs.

  15. Centers of excellence: a medical measurement or marketing myth?

    PubMed

    Meyer, L C

    1996-01-01

    Managed care organizations, physician groups and hospital systems are all increasingly pressured to identify new modes of treatment that produce verifiable outcomes while reducing the revolving door pattern of health care for the chronically ill. Providers are also faced with creating systems of care to differentiate themselves from the competition in the marketplace. Disease-specific health management programs are being used to address both issues. When used properly, they can be promising tools in the battle to maintain health care quality while containing costs. Skillful balancing of these two important factors can ensure maximum value for both patients and payers. Are centers of excellence the critical pathway of the future? Or are they merely a marketing ploy to generate incremental growth and profitability for savvy business executives and medical group management entrepreneurs? This article provides an overview of the center of excellence concept, addresses its misuse in the industry and discusses the strategic and marketing implications for organizations considering this approach as a tool to demonstrate full accountability and meritorious outcomes.

  16. Albany State College Factbook, 1979-1980.

    ERIC Educational Resources Information Center

    Albany State Coll., GA.

    The fourth edition of the Albany State College Fact Book, developed by the Office of Institutional Research, provides detailed information about the college. The design of the publication provides necessary data in the preparation of grants and proposals and in responding to questionnaires seeking pertinent institutional data. Contents include:…

  17. 76 FR 31340 - Medicare Program; Notification of Closure of St. Vincent's Medical Center

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-31

    ... process for qualifying hospitals to apply to CMS to receive direct graduate medical education (GME) and indirect medical education (IME) FTE resident cap slots from the hospital that closed. The procedures we.... Vincent's Medical Center AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION:...

  18. Top 10 Lessons Learned from Electronic Medical Record Implementation in a Large Academic Medical Center.

    PubMed

    Rizer, Milisa K; Kaufman, Beth; Sieck, Cynthia J; Hefner, Jennifer L; McAlearney, Ann Scheck

    2015-01-01

    Electronic medical record (EMR) implementation efforts face many challenges, including individual and organizational barriers and concerns about loss of productivity during the process. These issues may be particularly complex in large and diverse settings with multiple specialties providing inpatient and outpatient care. This case report provides an example of a successful EMR implementation that emphasizes the importance of flexibility and adaptability on the part of the implementation team. It also presents the top 10 lessons learned from this EMR implementation in a large midwestern academic medical center. Included are five overarching lessons related to leadership, initial approach, training, support, and optimization as well as five lessons related to the EMR system itself that are particularly important elements of a successful implementation. PMID:26396558

  19. Top 10 Lessons Learned from Electronic Medical Record Implementation in a Large Academic Medical Center.

    PubMed

    Rizer, Milisa K; Kaufman, Beth; Sieck, Cynthia J; Hefner, Jennifer L; McAlearney, Ann Scheck

    2015-01-01

    Electronic medical record (EMR) implementation efforts face many challenges, including individual and organizational barriers and concerns about loss of productivity during the process. These issues may be particularly complex in large and diverse settings with multiple specialties providing inpatient and outpatient care. This case report provides an example of a successful EMR implementation that emphasizes the importance of flexibility and adaptability on the part of the implementation team. It also presents the top 10 lessons learned from this EMR implementation in a large midwestern academic medical center. Included are five overarching lessons related to leadership, initial approach, training, support, and optimization as well as five lessons related to the EMR system itself that are particularly important elements of a successful implementation.

  20. Top 10 Lessons Learned from Electronic Medical Record Implementation in a Large Academic Medical Center

    PubMed Central

    Rizer, Milisa K.; Kaufman, Beth; Sieck, Cynthia J.; Hefner, Jennifer L.; McAlearney, Ann Scheck

    2015-01-01

    Electronic medical record (EMR) implementation efforts face many challenges, including individual and organizational barriers and concerns about loss of productivity during the process. These issues may be particularly complex in large and diverse settings with multiple specialties providing inpatient and outpatient care. This case report provides an example of a successful EMR implementation that emphasizes the importance of flexibility and adaptability on the part of the implementation team. It also presents the top 10 lessons learned from this EMR implementation in a large midwestern academic medical center. Included are five overarching lessons related to leadership, initial approach, training, support, and optimization as well as five lessons related to the EMR system itself that are particularly important elements of a successful implementation. PMID:26396558

  1. Public Health Potential of Farmers’ Markets on Medical Center Campuses: A Case Study From Penn State Milton S. Hershey Medical Center

    PubMed Central

    Kraschnewski, Jennifer L.; Rovniak, Liza S.

    2011-01-01

    There are currently 7175 farmers’ markets in the United States, and these organizations are increasingly viewed as one facet of the solution to national health problems. There has been a recent trend toward establishing markets on medical center campuses, and such partnerships can augment a medical center's ability to serve community health. However, to our knowledge no studies have described the emergence of a market at a medical center, the barriers and challenges such an initiative has faced, or the nature of programming it may foster. We provide a qualitative description of the process of starting a seasonal, once-a-week, producers-only market at the Pennsylvania State Hershey Medical Center, and we call for greater public health attention to these emerging community spaces. PMID:22021298

  2. Public health potential of farmers' markets on medical center campuses: a case study from Penn State Milton S. Hershey Medical Center.

    PubMed

    George, Daniel R; Kraschnewski, Jennifer L; Rovniak, Liza S

    2011-12-01

    There are currently 7175 farmers' markets in the United States, and these organizations are increasingly viewed as one facet of the solution to national health problems. There has been a recent trend toward establishing markets on medical center campuses, and such partnerships can augment a medical center's ability to serve community health. However, to our knowledge no studies have described the emergence of a market at a medical center, the barriers and challenges such an initiative has faced, or the nature of programming it may foster. We provide a qualitative description of the process of starting a seasonal, once-a-week, producers-only market at the Pennsylvania State Hershey Medical Center, and we call for greater public health attention to these emerging community spaces.

  3. Patient-centered medical home cyberinfrastructure current and future landscape.

    PubMed

    Finkelstein, Joseph; Barr, Michael S; Kothari, Pranav P; Nace, David K; Quinn, Matthew

    2011-05-01

    The patient-centered medical home (PCMH) is an approach that evolved from the understanding that a well-organized, proactive clinical team working in a tandem with well-informed patients is better able to address the preventive and disease management needs in a guideline-concordant manner. This approach represents a fundamental shift from episodic acute care models and has become an integral part of health reform supported on a federal level. The major aspects of PCMH, especially pertinent to its information infrastructure, have been discussed by an expert panel organized by the Agency for Healthcare Research and Quality at the Informatics for Consumer Health Summit. The goal of this article is to summarize the panel discussions along the four major domains presented at the summit: (1) PCMH as an Evolving Model of Healthcare Delivery; (2) Health Information Technology (HIT) Applications to Support the PCMH; (3) Current HIT Landscape of PCMH: Challenges and Opportunities; and (4) Future HIT Landscape of PCMH: Federal Initiatives on Health Informatics, Legislation, and Standardization.

  4. Behavioral anchors: building a medical center on solid foundations.

    PubMed

    Doordan, Martin L; Stupak, Ronald J

    2005-01-01

    Construction of new facilities in the healthcare arena is an ongoing, almost daily, occurrence. The desire to build wisely and effectively is evidenced at the Anne Arundel Medical Center which has attracted healthcare executives from all over the country who come to view, analyze, and experience the beauty, utility and interdependencies of the buildings and facilities that constitute "the AAMC campus." However, too often these executive visitors and benchmarking experts tend to focus on the technical, architectural, engineering, concrete aspects of the hospital, while naively overlooking and/or giving short shrift to the more critical behavioral dynamics of the construction process. The ultimate success of any building project requires a clear understanding by the leadership of "where people are coming from," so that both the design and the development of the final product can be brought under the synthesizing umbrella of patient care, clinical excellence, individual safety, and community responsibility. Not only must the leadership determine and drive the strategic thrust toward the final outcome; in addition, they must make sure that they allow significant colleagues to be actively, operationally, and symbolically engaged in a process that ends up in a structural outcome that everyone is proud to own, to see, and to inhabit. PMID:16521615

  5. [Merkel cell carcinoma experience in a reference medical center.

    PubMed

    Roesch-Dietlen, Federico; Devezé-Bocardi, Raúl; Ruiz-Juárez, Isabel; Grube-Pagola, Peter; Romero-Sierra, Graciela; Remes-Troche, José María; Silva-Cañetas, Carmen Sofía; Lozoya-López Escalera, Hilda

    2013-01-01

    Background: Merkel cell carcinoma is a rare tumor that occurs on areas exposed to ultraviolet light. It is usually asymptomatic and it is diagnosed late often. The treatment is surgical, associated with adjuvant radiotherapy. The objective was to present the experience in the management of Merkel cell carcinoma in a reference medical center. Methods: all patients with Merkel cell carcinoma treated at the Instituto de Investigaciones Médico-Biológicas of the Universidad Veracruzana during the period 2008 to 2011 were studied. Sex, age, evolution time, tumor localization, size, metastases and treatment were analyzed. Results: of 3217 patients treated, three cases were Merkel cell carcinoma (0.09 %), their age was 52.1 ± 14.17, male predominance of 66.67 %; the evolution time was of 29.66 ± 35.36 months; the tumour localization was on inguinal region, anterior chest and left arm; the noodle size was of 6.0 ± 5.19 cm; two patients had lymph node metastases. In two cases, resection and lymphadenectomy were performed. They all received radiation therapy and chemotherapy in one case. Histologically the medium variant predominated; immunohistochemistry was positive in the three cases. One patient died ten months after the study was done. Conclusions: our experience is similar with others authors, Merkel cell carcinoma is a rare tumor, usually diagnosed late, and it has poor survival.

  6. Behavioral anchors: building a medical center on solid foundations.

    PubMed

    Doordan, Martin L; Stupak, Ronald J

    2005-01-01

    Construction of new facilities in the healthcare arena is an ongoing, almost daily, occurrence. The desire to build wisely and effectively is evidenced at the Anne Arundel Medical Center which has attracted healthcare executives from all over the country who come to view, analyze, and experience the beauty, utility and interdependencies of the buildings and facilities that constitute "the AAMC campus." However, too often these executive visitors and benchmarking experts tend to focus on the technical, architectural, engineering, concrete aspects of the hospital, while naively overlooking and/or giving short shrift to the more critical behavioral dynamics of the construction process. The ultimate success of any building project requires a clear understanding by the leadership of "where people are coming from," so that both the design and the development of the final product can be brought under the synthesizing umbrella of patient care, clinical excellence, individual safety, and community responsibility. Not only must the leadership determine and drive the strategic thrust toward the final outcome; in addition, they must make sure that they allow significant colleagues to be actively, operationally, and symbolically engaged in a process that ends up in a structural outcome that everyone is proud to own, to see, and to inhabit.

  7. Do Patient-Centered Medical Homes Reduce Emergency Department Visits?

    PubMed Central

    David, Guy; Gunnarsson, Candace; Saynisch, Philip A; Chawla, Ravi; Nigam, Somesh

    2015-01-01

    Objective To assess whether adoption of the patient-centered medical home (PCMH) reduces emergency department (ED) utilization among patients with and without chronic illness. Data Sources Data from approximately 460,000 Independence Blue Cross patients enrolled in 280 primary care practices, all converting to PCMH status between 2008 and 2012. Research Design We estimate the effect of a practice becoming PCMH-certified on ED visits and costs using a difference-in-differences approach which exploits variation in the timing of PCMH certification, employing either practice or patient fixed effects. We analyzed patients with and without chronic illness across six chronic illness categories. Principal Findings Among chronically ill patients, transition to PCMH status was associated with 5–8 percent reductions in ED utilization. This finding was robust to a number of specifications, including analyzing avoidable and weekend ED visits alone. The largest reductions in ED visits are concentrated among chronic patients with diabetes and hypertension. Conclusions Adoption of the PCMH model was associated with lower ED utilization for chronically ill patients, but not for those without chronic illness. The effectiveness of the PCMH model varies by chronic condition. Analysis of weekend and avoidable ED visits suggests that reductions in ED utilization stem from better management of chronic illness rather than expanding access to primary care clinics. PMID:25112834

  8. Center takes hard line with press. The missing infant incident at Columbia Trident Medical Center.

    PubMed

    Moore, P L

    1997-01-01

    When the body of a stillborn infant went missing from the Columbia Trident morgue, the press pounced. The hospital was accused of everything from neglect to a police-protected cover-up. Reporters stopped patients in the parking lot to ask them if they felt safe. Others used the incident to question Columbia's proposed merger with the local university medical center. In response, Columbia Trident initiated a strict policy that prohibits the press from showing up unannounced and stridently protects the rights of patients and employees. The case provokes questions about the role of public relations professionals in an age of sensationalism. When is withholding information justified and when is it an obstruction of justified inquiry? How far is too far for the press? PMID:10165816

  9. Nonstandard Programs: the University of Pittsburgh Medical Center's next frontier in graduate medical education.

    PubMed

    Kroboth, Frank J; Zerega, W Dennis; Patel, Rita M; Barnes, Barbara E; Webster, Marshall W

    2011-02-01

    The University of Pittsburgh Medical Center has seen continuous growth in the number and types of graduate training programs not accredited by the Accreditation Council for Graduate Medical Education (ACGME), the American Board of Medical Specialties, or the American Osteopathic Association. For the purposes of ensuring best educational products and of controlling unrecognized competition with our accredited programs, a sequential process of centralized oversight of these nonstandard programs was undertaken. The first step involved programs whose fellows were hired and tracked like accredited fellows (i.e., not instructors). The basic process began with consensus among leadership, writing of policy with consultation as necessary, establishment of a registry of programs and graduates, and a committee to allow sharing of best practices and dissemination of policy. The second step applied the same process to instructor-level programs. Whereas the previous group of programs was made subject to ACGME regulations, more latitude in duty hours and progressive responsibility were allowed for instructor programs. The final step, in progress, is extending a similar but modified approach to short-duration clinical experiences and observerships. The outcomes of these efforts have been the creation of a centralized organizational structure, policies to guide this structure, an accurate registry of a surprising number of training programs, and a rolling record of all graduates from these programs. Included in the process is a mechanism that ensures that core program directors and department chairs specifically review the impact of new programs on core programs before allowing their creation.

  10. Walking the Tightrope: Directing a Student Health Center at a Research Institution with an Academic Medical Center

    ERIC Educational Resources Information Center

    Christmas, William A.

    2008-01-01

    Reporting lines for directors of student health centers (SHCs) at colleges and universities are a matter of continuing interest for those of us who must follow them. SHC directors at institutions with academic medical centers face a greater number of reporting choices that also have the potential of being more politically charged. The author…

  11. Family-centered maternity care for deaf refugees: the patient-centered medical home in action.

    PubMed

    Balachandra, Shirish K; Carroll, Jennifer K; Fogarty, Colleen T; Finigan, Elizabeth G

    2009-12-01

    The intersection of 2 underserved populations-refugees and deaf individuals-presents novel challenges to health care systems and has not been described previously. A patient-centered medical home (PCMH) is uniquely equipped to provide outstanding primary care to disadvantaged groups. As an illustrative case study, we present our experience applying principles of the PCMH to address an extremely challenging clinical situation: providing high-quality maternity care to a recently immigrated Vietnamese refugee couple lacking formal language skills. We describe how enhanced access, continuity, coordination, and cultural appropriateness can facilitate favorable outcomes in even daunting circumstances. By collaborating with multiple interpreters, the health center staff, and the extended family, we effectively mobilized an expanded system of care to ensure informed consent and shared decision making, ultimately culminating in a successful labor and vaginal delivery. Through organizational and individual commitment to the tenets of the PCMH, we demonstrate the particular strengths of family medicine training sites in caring for similar patients and families with complex cultural and linguistic barriers to care.

  12. Enriching Patient-Centered Medical Homes Through Peer Support

    PubMed Central

    Daaleman, Timothy P.; Fisher, Edwin B.

    2015-01-01

    Peer supporters are recognized by various designations—community health workers, promotores de salud, lay health advisers—and are community members who work for pay or as volunteers in association with health care systems or nonprofit community organizations and often share ethnicity, language, and socioeconomic status with the mentees that they serve. Although emerging evidence demonstrates the efficacy of peer support at the community level, the adoption and implementation of this resource into patient-centered medical homes (PCMHs) is still under development. To accelerate that integration, this article addresses three major elements of peer support interventions: the functions and features of peer support, a framework and programmatic strategies for implementation, and fiscal models that would support the sustained viability of peer support programs within PCMHs. Key functions of peer support include assistance in daily management of health-related behaviors, social and emotional support, linkage to clinical care, and longitudinal or ongoing support. An organizational model of innovation implementation provides a useful framework for determining how to implement and evaluate peer support programs in PCMHs. Programmatic strategies that can be useful in developing peer support programs within PCMHs include peer coaching or mentoring, group self-management training, and programs designed around the telephone and information technology. Fiscal models for peer support programs include linkages with hospital or health care systems, service- or community-based nonprofit organizations, and partnerships between health care systems and community groups. Peer support promises to enrich PCMHs by activating patients in their self-care, providing culturally sensitive outreach, and opening the way for partnerships with community-based organizations. PMID:26304975

  13. Accountable care organization readiness and academic medical centers.

    PubMed

    Berkowitz, Scott A; Pahira, Jennifer J

    2014-09-01

    As academic medical centers (AMCs) consider becoming accountable care organizations (ACOs) under Medicare, they must assess their readiness for this transition. Of the 253 Medicare ACOs prior to 2014, 51 (20%) are AMCs. Three critical components of ACO readiness are institutional and ACO structure, leadership, and governance; robust information technology and analytic systems; and care coordination and management to improve care delivery and health at the population level. All of these must be viewed through the lens of unique AMC mission-driven goals.There is clear benefit to developing and maintaining a centralized internal leadership when it comes to driving change within an ACO, yet there is also the need for broad stakeholder involvement. Other important structural features are an extensive primary care foundation; concomitant operation of a managed care plan or risk-bearing entity; or maintaining a close relationship with post-acute-care or skilled nursing facilities, which provide valuable expertise in coordinating care across the continuum. ACOs also require comprehensive and integrated data and analytic systems that provide meaningful population data to inform care teams in real time, promote quality improvement, and monitor spending trends. AMCs will require proven care coordination and management strategies within a population health framework and deployment of an innovative workforce.AMC core functions of providing high-quality subspecialty and primary care, generating new knowledge, and training future health care leaders can be well aligned with a transition to an ACO model. Further study of results from Medicare-related ACO programs and commercial ACOs will help define best practices.

  14. Accountable care organization readiness and academic medical centers.

    PubMed

    Berkowitz, Scott A; Pahira, Jennifer J

    2014-09-01

    As academic medical centers (AMCs) consider becoming accountable care organizations (ACOs) under Medicare, they must assess their readiness for this transition. Of the 253 Medicare ACOs prior to 2014, 51 (20%) are AMCs. Three critical components of ACO readiness are institutional and ACO structure, leadership, and governance; robust information technology and analytic systems; and care coordination and management to improve care delivery and health at the population level. All of these must be viewed through the lens of unique AMC mission-driven goals.There is clear benefit to developing and maintaining a centralized internal leadership when it comes to driving change within an ACO, yet there is also the need for broad stakeholder involvement. Other important structural features are an extensive primary care foundation; concomitant operation of a managed care plan or risk-bearing entity; or maintaining a close relationship with post-acute-care or skilled nursing facilities, which provide valuable expertise in coordinating care across the continuum. ACOs also require comprehensive and integrated data and analytic systems that provide meaningful population data to inform care teams in real time, promote quality improvement, and monitor spending trends. AMCs will require proven care coordination and management strategies within a population health framework and deployment of an innovative workforce.AMC core functions of providing high-quality subspecialty and primary care, generating new knowledge, and training future health care leaders can be well aligned with a transition to an ACO model. Further study of results from Medicare-related ACO programs and commercial ACOs will help define best practices. PMID:24979282

  15. Manatí Medical Center Sepsis Management Epidemiological Study.

    PubMed

    Morales Serrano, Tamara; Ramos, Shirley; Lara Gonzalez, Yanira; Torres Colberg, Heileene; Vera Quiñones, Alexis; Miranda Santiago, Roberto; Amill, Samuel; Otero, Marielys; Cintron, Vielka; Villarreal Morales, Martha Lissete

    2015-01-01

    Sepsis is the combination of infection and physiological changes known as the systemic inflammatory response syndrome. There have been improvements in mortality rates and outcomes of septic patients based on "Surviving Sepsis Campaign" guidelines. Current management of sepsis at our Institution follows no specific mandatory protocols. This study aimed to verify the incidence and outcome of sepsis in Manati Medical Center, Puerto Rico. An observational retrospective study was conducted. All the Emergency Department admissions from May 1/ to October 31/ 2013 were screened for sepsis per ICD-9 code. For all included patients, demographic and clinical data at ED admission were collected. During this period 8931 patients were admitted and 148 met criteria for sepsis and related conditions. The overall mortality rate was 43.91%. Mortality increased with age, from 10.52% among ≤ 44 years old to 68.75% in those ≥ 85 years old. The main infection sources were respiratory (32.66%) and urinary tract (24.62%). Mean age among non-survivors was 10.8 years higher than the survivor group (95% Cl 5.2-1 6.5, p < 0.05). Multivariate analysis showed an increased fatality rate associated to severity of sepsis (HR 1.33; 95% Cl; 1.03-1.72, p = 0.02) and the APACHE2 score (HR 1.05; 95% Cl, 1.01-1.09 p = 0.03). Our data suggests that sepsis is an important problem to consider. We strongly encourage an institutional standardized protocol to diminish the mortality impact. Our results will allow adequate preventive strategies to improve early diagnosis, mortality rates and outcomes of septic patients.

  16. Allocation of Biomedical Research Support Grant at The George Washington University Medical Center.

    ERIC Educational Resources Information Center

    Leonard, Fred; And Others

    1984-01-01

    The Biomedical Research Support Grant (BRSG) at The George Washington University Medical Center funds pilot projects submitted by the faculty. The procedures for allocating BRSG funds, their distribution in Medical Center departments, and their effect on attracting extramural funding over a five-year period are discussed.

  17. The Patient-Centered Medical Neighborhood: Transformation of Specialty Care.

    PubMed

    Spatz, Christin; Bricker, Patricia; Gabbay, Robert

    2014-01-01

    The growing need for coordinated care of those with medically complex diseases is becoming more important in today's health care system, wherein reimbursement changes are driving methods to improve quality and cost. This article discusses the 6 key processes that, according to the American College of Physicians, define an effective medical neighborhood; the evidence supporting the need for this coordinated system; and pilot medical neighborhood strategies being implemented.

  18. 76 FR 59407 - Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-26

    ... Scientific and Medical Literature and Information on Non-Standardized Allergenic Extracts in the Diagnosis... scientific and medical literature and information concerning the use of non-standardized allergenic extracts... ``Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and...

  19. Walking the tightrope: directing a student health center at a research institution with an academic medical center.

    PubMed

    Christmas, William A

    2008-01-01

    Reporting lines for directors of student health centers (SHCs) at colleges and universities are a matter of continuing interest for those of us who must follow them. SHC directors at institutions with academic medical centers face a greater number of reporting choices that also have the potential of being more politically charged. The author describes his experience at 2 such institutions and offers some cautious advice.

  20. Roles of Medical Record and Statistic Staff on Research at the Tawanchai Center.

    PubMed

    Pattaranit, Rumpan; Chantachum, Vasana; Lekboonyasin, Orathai; Pradubwong, Suteera

    2015-08-01

    The medical record and statistic staffs play a crucial role behind the achievements of treatment and research of physicians, nurses and other health care professionals. The medical record and statistic staff are in charge of keeping patient medical records; creating databases; presenting information; sorting patient's information; providing patient medical records and related information for various medical teams and researchers; Besides, the medical record and statistic staff have collaboration with the Center of Cleft Lip-Palate, Khon Kaen University in association with the Tawanchai Project. The Tawanchai Center is an organization, involving multidisciplinary team which aims to continuing provide care for patients with cleft lip and palate and craniofacial deformities who need a long term of treatment since newborns until the age of 19 years. With support and encouragement from the Tawanchai team, the medical record and statistic staff have involved in research under the Tawanchai Centre since then and produced a number of publications locally and internationally.

  1. Advanced practice nursing students in the patient-centered medical home: preparing for a new reality.

    PubMed

    Swartwout, Kathryn; Murphy, Marcia Pencak; Dreher, Melanie C; Behal, Raj; Haines, Alison; Ryan, Mary; Ryan, Norman; Saba, Mary

    2014-01-01

    Driven by reimbursement incentives for increased access, improved quality and reduced cost, the patient-centered medical home model of health care delivery is being adopted in primary care practices across the nation. The transition from traditional primary care models to patient-centered medical homes presents many challenges, including the assembly of a well-prepared, interprofessional provider team to achieve effective, well-coordinated care. In turn, advanced practice nursing education programs are challenged to prepare graduates who are qualified for practice in the new reality of health care reform. This article reviews the patient-centered medical home model and describes how one college of nursing joined 7 primary care physician practices to prepare advanced practice nursing students for the new realities of health care reform while supporting each practice in its transition to the patient-centered medical home. PMID:24720942

  2. Joint marketing cites excellence: Fairview-University Medical Center advertises cooperatively with University of Minnesota Physicians.

    PubMed

    Botvin, Judith D

    2004-01-01

    Fairview-University Medical Center and University of Minnesota Physicians, both in Minneapolis, are enjoying the benefits of a co-branded advertising campaign. It includes print ads, brochures, and other marketing devices.

  3. Master's Level Graduate Training in Medical Physics at the University of Colorado Health Sciences Center.

    ERIC Educational Resources Information Center

    Ibbott, Geoffrey S.; Hendee, William R.

    1980-01-01

    Describes the master's degree program in medical physics developed at the University of Colorado Health Sciences Center. Required courses for the program, and requirements for admission are included in the appendices. (HM)

  4. Nonpsychiatric Medication Interventions Initiated by a Postgraduate Year 2 Psychiatric Pharmacy Resident in a Patient-Centered Medical Home

    PubMed Central

    Williams, Andrew M.

    2014-01-01

    Objective: Studies have demonstrated the benefits of incorporating comprehensive medication management into primary care, but no study describes the types of nonpsychiatric medication–related interventions provided by a psychiatric pharmacist while providing comprehensive medication management. Method: A chart review of Center for Community Health patients enrolled in the University of Southern California Psychiatric Pharmacy Clinic, Los Angeles, between July 1, 2013, and January 10, 2014, was conducted. Progress notes were reviewed to collect medication recommendations and interventions. The number and types of interventions were compared between groups based on substance abuse history, comorbid medical conditions, number of psychiatric diagnoses, and number of medications. An anonymous survey was distributed to primary care providers (PCPs) regarding perceptions and attitudes toward a postgraduate year 2 psychiatric pharmacy resident’s interventions pertaining to nonpsychiatric medications. Results: 177 nonpsychiatric medication interventions were documented. Fifty interventions required PCP approval, and 45% of those were accepted. Having a diagnosis of diabetes (P < .0001), hypertension (P < .0001), gastroesophageal reflux disease (P < .0001), ≥ 9 medications (P < .0001), or ≥ 5 medical diagnoses (P < .0001) were all associated with an increased mean number of interventions. Of the PCPs, 66% viewed the psychiatric pharmacist as a resource for addressing medical interventions by providing drug information. The PCPs were agreeable to having a psychiatric pharmacist provide drug information and monitor the patient but reported mixed opinions on whether a psychiatric pharmacist should comanage nonpsychiatric conditions. Conclusions: Psychiatric pharmacists can successfully collaborate with PCPs in primary care clinics to provide comprehensive medication management that optimizes pharmacotherapy for patients with medical and psychiatric conditions. Continued

  5. Development of a Patient-Centered Antipsychotic Medication Adherence Intervention

    ERIC Educational Resources Information Center

    Pyne, Jeffrey M.; Fischer, Ellen P.; Gilmore, LaNissa; McSweeney, Jean C.; Stewart, Katharine E.; Mittal, Dinesh; Bost, James E.; Valenstein, Marcia

    2014-01-01

    Objective: A substantial gap exists between patients and their mental health providers about patient's perceived barriers, facilitators, and motivators (BFMs) for taking antipsychotic medications. This article describes how we used an intervention mapping (IM) framework coupled with qualitative and quantitative item-selection methods to…

  6. Labors of love: the transformation of care in the Non-Medical Attendant program at Walter Reed Army Medical Center.

    PubMed

    Wool, Zoë H; Messinger, Seth D

    2012-03-01

    In this paper, we explore the Non-Medical Attendant program at Walter Reed Army Medical Center in Washington, DC, which subsidizes the presence of war-injured soldiers' family members as they live for months or even years at Walter Reed during treatment and rehabilitation. We elaborate the ambiguities of the program and draw on ethnographic research to demonstrate how the program's vagaries combine with the context of an overburdened military medical system and the more familiar strains of family caregiving to place family members in a gray zone of care where the line between labors of love and institutionally compensated work is blurred. PMID:22574390

  7. DOE Center of Excellence in Medical Laser Applications. Final report, December 1, 1994--November 30, 1997

    SciTech Connect

    Jacques, S.L.

    1998-01-01

    An engineering network of collaborating medical laser laboratories are developing laser and optical technologies for medical diagnosis and therapy and are translating the engineering into medical centers in Portland OR, Houston TX, and Galveston TX. The Center includes the University of Texas M.D. Anderson Cancer Center, the University of Texas-Austin, Texas A and M University, Rice University, the University Texas Medical Branch-Galveston, Oregon Medical Laser Center (Providence St. Vincent Medical Center, Oregon Health Sciences University, and Oregon Graduate Institute, Portland, OR), and the University of Oregon. Diagnostics include reflectance, fluorescence, Raman IR, laser photoacoustics, optical coherence tomography, and several new video techniques for spectroscopy and imaging. Therapies include photocoagulation therapy, laser welding, pulsed laser ablation, and light-activated chemotherapy of cancer (photodynamic therapy, or PDT). Medical applications reaching the clinic include optical monitoring of hyperbilirubinemia in newborns, fluorescence detection of cervical dysplasia, laser thrombolysis of blood clots in heart attack and brain stroke, photothermal coagulant of benign prostate hyperplasia, and PDT for both veterinary and human cancer. New technologies include laser optoacoustic imaging of breast tumors and hemorrhage in head trauma and brain stroke, quality control monitoring of dosimetry during PDT for esophageal and lung cancer, polarization video reflectometry of skin cancer, laser welding of artificial tissue replacements, and feedback control of laser welding.

  8. PROJECT HEAD START MEDICAL--A GUIDE FOR DIRECTION OF CHILD DEVELOPMENT CENTERS.

    ERIC Educational Resources Information Center

    Office of Economic Opportunity, Washington, DC.

    HEALTH SERVICES OF PROJECT HEAD START CHILD DEVELOPMENT CENTERS PROVIDE--A MEDICAL EVALUATION OF EACH CHILD INCLUDING MEDICAL HISTORY, DEVELOPMENTAL ASSESSMENT, AND PHYSICAL EXAMINATION, SCREENING TESTS FOR VISION, HEARING, SPEECH, AND TUBERCULOSIS, LABORATORY TESTS OF URINE FOR ALBUMIN AND TESTS OF SUGAR AND BLOOD FOR ANEMIA, DENTAL ASSESSMENT,…

  9. Student Views of the Community Served by an Inner City Medical Center.

    ERIC Educational Resources Information Center

    Fernandes, David R.; Imperato, Pascal James

    1980-01-01

    A survey of second-year medical students at the State University of New York Downstate Medical Center in Brooklyn was conducted to obtain their views of the surrounding community, which has been transformed from a middle class to a poverty neighborhood. The respondents expressed concern about crime, pollution, and crowding. (Author/JMD)

  10. The Volume and Mix of Inpatient Services Provided by Academic Medical Centers.

    ERIC Educational Resources Information Center

    Moy, Ernest; And Others

    1996-01-01

    A study examined trends in the volume and type of inpatient clinical diagnoses, common medical services, and specialized services in academic medical centers (AMCs)--integrated and independent, other teaching hospitals, and nonteaching hospitals. Results indicate that despite rapid change in the health care environment, little change has occurred…

  11. Managing Information in the Academic Medical Center: Building an Integrated Information Environment.

    ERIC Educational Resources Information Center

    Fuller, Sherrilynne; And Others

    1995-01-01

    A program designed by the National Library of Medicine and the Association of American Medical Colleges to help academic medical centers develop appropriate information systems is described. The characteristics of such an integrated information environment, technical and organizational structures necessary for creating it, and the librarian's role…

  12. Medication Adherence among Adolescents in a School-Based Health Center

    ERIC Educational Resources Information Center

    Mears, Cynthia J.; Charlebois, Nicole M.; Holl, Jane L.

    2006-01-01

    School-based health centers are an integral part of the health care delivery system for low-income children. Medication adherence for these patients may be challenging because the student is often responsible for bringing home the prescription and receiving the instructions. This study assesses medication fill, initiation, and adherence rates…

  13. A midwifery-led in-hospital birth center within an academic medical center: successes and challenges.

    PubMed

    Perdion, Karen; Lesser, Rebecca; Hirsch, Jennifer; Barger, Mary; Kelly, Thomas F; Moore, Thomas R; Lacoursiere, D Yvette

    2013-01-01

    The University of California San Diego Community Women's Health Program (CWHP) has emerged as a successful and sustainable coexistence model of women's healthcare. The cornerstone of this midwifery practice is California's only in-hospital birth center. Located within the medical center, this unique and physically separate birth center has been the site for more than 4000 births. With 10% cesarean delivery and 98% breast-feeding rates, it is an exceptional example of low-intervention care. Integrating this previously freestanding birth center into an academic center has brought trials of mistrust and ineffectual communication. Education, consistent leadership, and development of multidisciplinary guidelines aided in overcoming these challenges. This collaborative model provides a structure in which residents learn to be respectful consultants and appreciate differences in medical practice. The CWHP and its Birth Center illustrates that through persistence and flexibility a collaborative model of maternity services can flourish and not only positively influence new families but also future generations of providers. PMID:24096338

  14. Equipment for nuclear medical centers, production capabilities of Rosatom enterprises

    NASA Astrophysics Data System (ADS)

    Gavrish, Yu. N.; Koloskov, S. A.; Smirnov, V. P.; Strokach, A. P.

    2015-12-01

    Analysis of the capabilities of the State Corporation Rosatom enterprises on the development and production of diagnostic and therapeutic equipment for nuclear medicine centers is presented. Prospects of the development of accelerator equipment for the production of a wide range of radioisotope products are shown, and the trends of its development are determined. A comparative analysis of the technical parameters of domestic tomographs and devices for brachytherapy with foreign counterparts is given.

  15. Equipment for nuclear medical centers, production capabilities of Rosatom enterprises

    SciTech Connect

    Gavrish, Yu. N.; Koloskov, S. A.; Smirnov, V. P.; Strokach, A. P.

    2015-12-15

    Analysis of the capabilities of the State Corporation Rosatom enterprises on the development and production of diagnostic and therapeutic equipment for nuclear medicine centers is presented. Prospects of the development of accelerator equipment for the production of a wide range of radioisotope products are shown, and the trends of its development are determined. A comparative analysis of the technical parameters of domestic tomographs and devices for brachytherapy with foreign counterparts is given.

  16. Implementing a medication safety and poison prevention program at a senior center.

    PubMed

    Gershman, Jennifer A

    2013-10-01

    The Institute for Safe Medication Practices encourages pharmacists to assist in preventing medication misuse. The purpose of this article is to discuss a medication-safety education session conducted by a pharmacy professor, the faculty advisor to the American Society of Consultant Pharmacists university student chapter and students in a pharmacovigilance rotation, which was conducted at a local senior center. The author attended a train-the-trainer Webinar and then educated the pharmacy students. Participants at the senior center were taught about poison prevention, drug interactions, and appropriate drug disposal through an interactive format. We plan to continue the medication safety program at the senior center as a longitudinal project to promote patient safety. Pharmacists should be encouraged to play an active role in community outreach programs.

  17. The role of a medical education center in location decisions of practicing physicians.

    PubMed

    Buesching, D; Glasser, M

    1983-03-01

    The role of a medical education center in the decisions of physicians on where to practice was examined for all physicians locating in Rockford, Illinois, during 1978-1980. Questions were asked concerning faculty status, factors influencing practice location decisions, and perceived advantages of association with a medical education center. The results indicated that a majority of the 57 responding physicians did take the center into account when deciding to locate in Rockford; however, location in a mid-sized city and an opportunity for joint practice proved to be more influential factors than the possibility of a faculty appointment. Thus, while seldom the prime factor, the possibility of a faculty appointment. Thus, while seldom the prime factor, the medical education center was an important secondary factor and perhaps provided the margin of influence necessary to decide to locate in Rockford for those physicians inclined toward a smaller community.

  18. Factors associated with a patient-centered medical home among children with behavioral health conditions.

    PubMed

    Knapp, Caprice; Woodworth, Lindsey; Fernandez-Baca, Daniel; Baron-Lee, Jacqueline; Thompson, Lindsay; Hinojosa, Melanie

    2013-11-01

    At some point in their lives, nearly one-half of all American children will have a behavioral health condition. Many will not receive the care they need from a fragmented health delivery system. The patient-centered medical home is a promising model to improve their care; however, little evidence exists. Our study aim was to examine the association between several behavioral health indicators and having a patient-centered medical home. 91,642 children's parents or guardians completed the 2007 National Survey of Children's Health. An indicator for patient-centered medical home was included in the dataset. Descriptive statistics, bivariate tests, and multivariate regression models were used in the analyses. Children in the sample were mostly Male (52 %), White (78 %), non-Hispanic (87 %), and did not have a special health care need (80 %). 6.2 % of the sample had at least one behavioral health condition. Conditions ranged from ADHD (6 %) to Autism Spectrum Disorder (ASD) (1 %). Frequency of having a patient-centered medical home also varied for children with a behavioral health condition (49 % of children with ADHD and 33 % of children with ASD). Frequency of having a patient-centered medical home decreased with multiple behavioral health conditions. Higher severity of depression, anxiety, and conduct disorder were associated with a decreased likelihood of a patient-centered medical home. Results from our study can be used to target patient-centered medical home interventions toward children with one or more behavioral health conditions and consider that children with depression, anxiety, and conduct disorder are more vulnerable to these disparities.

  19. [Research code at the Academic Medical Center in Amsterdam: useful].

    PubMed

    Vermeulen, M

    2002-08-31

    At the Academic Medical Centre (AMC) of the University of Amsterdam, the Netherlands, it was decided to set up a research code committee. The first thing that was done was to define what were considered the most relevant types of scientific misconduct: falsification, plagiarism and invasion of privacy. The committee decided that prevention is better than cure and therefore developed a guideline for desirable behaviour, i.e. how to act scientifically with care and integrity, instead of a guideline on what not to do. The committee also proposed an ombudsman whose services are available to all participants in research in the AMC, and to whom misconduct can be reported. The research code is a loose-leaf system, since new issues will come to the fore and included issues will need to be changed. This committee has created a code that provides a firm basis for scientific integrity within the AMC.

  20. Underserved patients' perspectives on patient-centered primary care: does the patient-centered medical home model meet their needs?

    PubMed

    Mead, Holly; Andres, Ellie; Regenstein, Marsha

    2014-02-01

    The patient-centered medical home (PCMH) has gained significant interest as a delivery system model that can improve health care quality while reducing costs. This study uses focus groups to investigate underserved, chronically ill patients' preferences for care and develops a patient-centered framework of priorities. Seven major priorities were identified: (a) communication and partnership, (b) affordable care, (c) coordinated care, (d) personal responsibility, (e) accessible care, (f) education and support resources, and (g) the essential role of nonphysician providers in supporting their care. Using the framework, we analyzed the PCMH joint principals as developed by U.S. medical societies to identify where the PCMH model could be improved to better meet the needs of these patients. Four of the seven patient priorities were identified as not present in or supported by current PCMH joint principles. The study discusses how the PCMH model can better address the needs of low-income, disadvantaged patients.

  1. Outsourcing your medical practice call center: how to choose a vendor to ensure regulatory compliance.

    PubMed

    Johnson, Bill

    2014-01-01

    Medical practices receive hundreds if not thousands of calls every week from patients, payers, pharmacies, and others. Outsourcing call centers can be a smart move to improve efficiency, lower costs, improve customer care, ensure proper payer management, and ensure regulatory compliance. This article discusses how to know when it's time to move to an outsourced call center, the benefits of making the move, how to choose the right call center, and how to make the transition. It also provides tips on how to manage the call center to ensure the objectives are being met.

  2. Improving Medication Knowledge among Older Adults with Heart Failure: A Patient-Centered Approach to Instruction Design

    ERIC Educational Resources Information Center

    Morrow, Daniel G.; Weiner, Michael; Young, James; Steinley, Douglas; Deer, Melissa; Murray, Michael D.

    2005-01-01

    Purpose: We investigated whether patient-centered instructions for chronic heart failure medications increase comprehension and memory for medication information in older adults diagnosed with chronic heart failure. Design and Methods: Patient-centered instructions for familiar and unfamiliar medications were compared with instructions for the…

  3. Milton v. Cary Medical Center, 22 February 1988.

    PubMed

    1988-01-01

    In Maine, the parents of a viable fetus brought a wrongful death action charging a hospital and physician with negligence resulting in the death of the fetus. The Court held that, for the purposes of the state's wrongful death statute, a fetus is not a person and that the action could not be maintained. In 1988, other US courts reached the following decisions: 1) a viable fetus is not a human being as defined by the aggravated vehicular homicide statute of Kansas (State vs. Trudell); 2) there is no cause of action in Illinois by or on the behalf of a fetus, subsequently born alive, against its mother for unintentional infliction of prenatal injuries (Stallman vs. Youngquist); 3) a mother has a medical malpractice cause of action in Florida for negligent or intentional tortious injury to a subsequently stillborn fetus, as living tissue of her body (Singleton vs. Ranz); 4) a fetus is not a person within the meaning of the Oklahoma's state assault and battery statute (State vs. Harbert); 5) an unborn child is an "eligible insured person" within the meaning of personal injury protection endorsement of an insurance policy in New Jersey (Sobeck vs. Centennial Insurance Co.); 6) the infliction of injuries on a fetus who was born alive, but died as a result of such injuries, is within the federal statutory definition of murder (US vs. Spencer); 7) the parents of an unborn fetus cannot recover damages for loss of society in Illinois (Denham vs. Burlington Northern Railroad Company); 8) an unborn child is included within the meaning of "insured" in an insurance policy in Florida (McNamara vs. Seibert); 9) absent physical injury to the mother, a mother may not recover for emotional psychic harm suffered as the result of a stillborn child in New York (McLean vs. Lilling); 10) damages for loss of society, comfort, and companionship can be recovered in an action for the wrongful death of an unborn child in North Dakota (Hopkins vs. McBane); 11) a fetus is not a person within the

  4. Managing information in the academic medical center: building an integrated information environment.

    PubMed

    Fuller, S; Braude, R M; Florance, V; Frisse, M E

    1995-10-01

    The strategic importance of integrated information systems and resources for academic medical centers should not be underestimated. Ten years ago, the National Library of Medicine in collaboration with the Association of Academic Medical Centers initiated the Integrated Advanced Information Management System (IAIMS) program to assist academic medical centers in defining a process for addressing deficiencies in their information environments. The authors give a brief history of the IAIMS program, and they describe both the characteristics of an integrated information environment and the technical and organizational structures necessary to create such an environment. Strategies some institutions have used to implement integrated information systems are also outlined. Finally, the authors discuss the role of librarians in integrated information system design.

  5. Results of an Institutional LGBT Climate Survey at an Academic Medical Center.

    PubMed

    Chester, Sean D; Ehrenfeld, Jesse M; Eckstrand, Kristen L

    2014-12-01

    The purpose of this study was to characterize the climate and culture experienced by lesbian, gay, bisexual, and transgender (LGBT) employees and students at one large academic medical center. An anonymous, online institutional climate survey was used to assess the attitudes and experiences of LGBT employees and students. There were 42 LGBT and 14 non-LGBT survey participants. Results revealed that a surprisingly large percentage of LGBT individuals experienced pressure to remain "closeted" and were harassed despite medical center policies of non-discrimination. Continuing training, inclusive policies and practices, and the development of mechanisms to address LGBT-specific harassment are necessary for improving institutional climate. PMID:26789861

  6. Selecting a commercial clinical information system: an academic medical center's experience.

    PubMed

    Wong, E T; Abendroth, T W

    1994-01-01

    Choosing a commercial clinical information system to meet the information needs of patient care, research, education, administration, finance, and ongoing changes of the healthcare system of an academic medical center is a challenging task. For the past six months, The Milton S. Hershey Medical Center undertook this task through (i) establishing a task force, (ii) assessing end-user information needs, (iii) understanding future institutional development and strategies, (iv) conceptualizing the ideal system, (v) identifying a short list of vendors, (vi) sending RFIs to vendors, (vii) visiting vendors' headquarters, (viii) technical review, (ix) reference calls, (x) using consultation services, (xi) on-site demonstration, and (xii) visiting the vendor's clients. PMID:7950008

  7. Results of an Institutional LGBT Climate Survey at an Academic Medical Center.

    PubMed

    Chester, Sean D; Ehrenfeld, Jesse M; Eckstrand, Kristen L

    2014-12-01

    The purpose of this study was to characterize the climate and culture experienced by lesbian, gay, bisexual, and transgender (LGBT) employees and students at one large academic medical center. An anonymous, online institutional climate survey was used to assess the attitudes and experiences of LGBT employees and students. There were 42 LGBT and 14 non-LGBT survey participants. Results revealed that a surprisingly large percentage of LGBT individuals experienced pressure to remain "closeted" and were harassed despite medical center policies of non-discrimination. Continuing training, inclusive policies and practices, and the development of mechanisms to address LGBT-specific harassment are necessary for improving institutional climate.

  8. Selecting a commercial clinical information system: an academic medical center's experience.

    PubMed

    Wong, E T; Abendroth, T W

    1994-01-01

    Choosing a commercial clinical information system to meet the information needs of patient care, research, education, administration, finance, and ongoing changes of the healthcare system of an academic medical center is a challenging task. For the past six months, The Milton S. Hershey Medical Center undertook this task through (i) establishing a task force, (ii) assessing end-user information needs, (iii) understanding future institutional development and strategies, (iv) conceptualizing the ideal system, (v) identifying a short list of vendors, (vi) sending RFIs to vendors, (vii) visiting vendors' headquarters, (viii) technical review, (ix) reference calls, (x) using consultation services, (xi) on-site demonstration, and (xii) visiting the vendor's clients.

  9. Medical student socio-demographic characteristics and attitudes toward patient centered care: Do race, socioeconomic status and gender matter? A report from the Medical Student CHANGES study

    PubMed Central

    Hardeman, Rachel R.; Burgess, Diana; Phelan, Sean; Yeazel, Mark; Nelson, David; van Ryn, Michelle

    2015-01-01

    Objective To determine whether attitudes toward patient-centered care differed by socio-demographic characteristics (race, gender, socioeconomic status) among a cohort of 3191 first year Black and White medical students attending a stratified random sample of US medical schools. Methods This study used baseline data from Medical Student CHANGES, a large national longitudinal cohort study of medical students. Multiple logistic regression was used to assess the association of race, gender and SES with attitudes toward patient-centered care. Results Female gender and low SES were significant predictors of positive attitudes toward patient-centered care. Age was also a significant predictor of positive attitudes toward patient-centered care such that students older than the average age of US medical students had more positive attitudes. Black versus white race was not associated with attitudes toward patient-centered care. Conclusions New medical students' attitudes toward patient-centered care may shape their response to curricula and the quality and style of care that they provide as physicians. Some students may be predisposed to attitudes that lead to both greater receptivity to curricula and the provision of higher-quality, more patient-centered care. Practice implications Medical school curricula with targeted messages about the benefits and value of patient-centered care, framed in ways that are consistent with the beliefs and world-view of medical students and the recruitment of a socioeconomically diverse sample of students into medical schools are vital for improved care. PMID:25499003

  10. Patient centered primary care is associated with patient hypertension medication adherence.

    PubMed

    Roumie, Christianne L; Greevy, Robert; Wallston, Kenneth A; Elasy, Tom A; Kaltenbach, Lisa; Kotter, Kristen; Dittus, Robert S; Speroff, Theodore

    2011-08-01

    There is increasing evidence that patient centered care, including communication skills, is an essential component to chronic illness care. Our aim was to evaluate patient centered primary care as a determinant of medication adherence. We mailed 1,341 veterans with hypertension the Short Form Primary Care Assessment Survey (PCAS) which measures elements of patient centered primary care. We prospectively collected each patient's antihypertensive medication adherence for 6 months. Patients were characterized as adherent if they had medication for >80%. 654 surveys were returned (50.7%); and 499 patients with complete data were analyzed. Antihypertensive adherence increased as scores in patient centered care increased [RR 3.18 (95% CI 1.44, 16.23) bootstrap 5000 resamples] for PCAS score of 4.5 (highest quartile) versus 1.5 (lowest quartile). Future research is needed to determine if improving patient centered care, particularly communication skills, could lead to improvements in health related behaviors such as medication adherence and health outcomes.

  11. A division of medical communications in an academic medical center's department of medicine.

    PubMed

    Drazen, Jeffrey M; Shields, Helen M; Loscalzo, Joseph

    2014-12-01

    Excellent physician communication skills (physician-to-patient and patient-to-physician) have been found to have a positive impact on patient satisfaction and may positively affect patient health behaviors and health outcomes. Such skills are also essential for accurate, succinct, and clear peer-to-peer (physician-to-physician), physician-to-lay-public, and physician-to-media communications. These skills are not innate, however; they must be learned and practiced repeatedly. The Division of Medical Communications (DMC) was created within the Department of Medicine at Brigham and Women's Hospital as an intellectual home for physicians who desire to learn and teach the wide variety of skills needed for effective communication.In this Perspective, the authors provide an overview of the key types of medical communications and share the DMC model as an innovative approach to providing expert guidance to physicians and physicians-in-training as they develop, practice, and refine their communication skills. Current DMC projects and programs include a Volunteer Patient Teaching Corps, which provides feedback to medical students, residents, and faculty on communication skills; a controlled trial of a modified team-based learning method for attending rounds; expert coaching in preparation for presentations of all types (e.g., grand rounds; oral presentations or poster presentations on basic science, clinical, or medical education research); sessions on speaking to the media and running a meeting well; and courses on writing for publication. Objective assessment of the impact of each of these interventions is planned.

  12. A Human-Centered Approach to Medical Informatics for Medical Students, Residents, and Practicing Clinicians.

    ERIC Educational Resources Information Center

    Stahlhut, Richard W.; Gosbee, John W.; Gardner-Bonneau, Daryle J.

    1997-01-01

    Describes development of a curriculum in medical information science that focuses on practical problems in clinical medicine rather than details of information technology. Design was guided by identification of six key clinical challenges that must be addressed by practitioners in the near future and by examination of past failures of informatics…

  13. Hurricane Katrina: medical response at the Houston Astrodome/Reliant Center Complex.

    PubMed

    Gavagan, Thomas F; Smart, Kieran; Palacio, Herminia; Dyer, Carmel; Greenberg, Stephen; Sirbaugh, Paul; Fishkind, Avrim; Hamilton, Douglas; Shah, Umair; Masi, George; Ivey, R Todd; Jones, Julie; Chiou-Tan, Faye Y; Bloodworth, Donna; Hyman, David; Whigham, Cliff; Pavlik, Valory; Feigin, Ralph D; Mattox, Kenneth

    2006-09-01

    On September 1, 2005, with only 12 hours notice, various collaborators established a medical facility--the Katrina Clinic--at the Astrodome/Reliant Center Complex in Houston. By the time the facility closed roughly two weeks later, the Katrina Clinic medical staff had seen over 11,000 of the estimated 27,000 Hurricane Katrina evacuees who sought shelter in the Complex. Herein, we describe the scope of this medical response, citing our major challenges, successes, and recommendations for conducting similar efforts in the future.

  14. [Urgency and acuity judgment systems before medical care (emergency telephone consultation center #7119, JTAS etc.)].

    PubMed

    Ishikawa, Hideki; Yoshida, Masashi; Sakamoto, Tetsuya

    2016-02-01

    Currently growing the demand of the emergency medical care in Japan, sharing the concept about medical urgency is needed in the whole society in order to maintain the emergency medical systems as social resources. The present conditions and challenges are outlined: Emergency Telephone Consultation Center in Tokyo Fire Department (established in June 2007) and on-site triage as representatives of "pre-hospital urgency determination systems", and JTAS (Japan Triage and Acuity System, introduced in April 2012) as a representative of "in-hospital, pre-examination urgency determination systems". PMID:26915257

  15. Three-Year Experience of an Academic Medical Center Ombuds Office

    PubMed Central

    Layde, Peter M.

    2016-01-01

    An ombuds is an individual who informally helps people or groups (visitors) resolve disputes and/or interpersonal conflicts as an alternative to formal dispute resolution mechanisms within an organization. Ombuds are nearly ubiquitous in many governmental, business, and educational settings but only recently have gained visibility at medical schools. Medical schools in the United States are increasingly establishing ombuds offices as part of comprehensive conflict management systems to address concerns of faculty, staff, students, and others. As of 2015, more than 35 medical schools in the United States have active ombuds Web pages. Despite the growing number of medical schools with ombuds offices, the literature on medical school ombuds offices is scant. In this article, the authors review the first three years of experience of the ombuds office at the Medical College of Wisconsin, a freestanding medical and graduate school with a large physician practice. The article is written from the perspective of the inaugural ombuds and the president who initiated the office. The authors discuss the rationale for, costs of, potential advantages of, and initial reactions of faculty, staff, and administration to having an ombuds office in an academic medical center. Important questions relevant to medical schools that are considering an ombuds office are discussed. The authors conclude that an ombuds office can be a useful complement to traditional approaches for conflict management, regulatory compliance, and identification of systemic issues. PMID:26675192

  16. Three-Year Experience of an Academic Medical Center Ombuds Office.

    PubMed

    Raymond, John R; Layde, Peter M

    2016-03-01

    An ombuds is an individual who informally helps people or groups (visitors) resolve disputes and/or interpersonal conflicts as an alternative to formal dispute resolution mechanisms within an organization. Ombuds are nearly ubiquitous in many governmental, business, and educational settings but only recently have gained visibility at medical schools. Medical schools in the United States are increasingly establishing ombuds offices as part of comprehensive conflict management systems to address concerns of faculty, staff, students, and others. As of 2015, more than 35 medical schools in the United States have active ombuds Web pages. Despite the growing number of medical schools with ombuds offices, the literature on medical school ombuds offices is scant. In this article, the authors review the first three years of experience of the ombuds office at the Medical College of Wisconsin, a freestanding medical and graduate school with a large physician practice. The article is written from the perspective of the inaugural ombuds and the president who initiated the office. The authors discuss the rationale for, costs of, potential advantages of, and initial reactions of faculty, staff, and administration to having an ombuds office in an academic medical center. Important questions relevant to medical schools that are considering an ombuds office are discussed. The authors conclude that an ombuds office can be a useful complement to traditional approaches for conflict management, regulatory compliance, and identification of systemic issues. PMID:26675192

  17. Evolution and Integration of Medical Laboratory Information System in an Asia National Medical Center

    NASA Astrophysics Data System (ADS)

    Cheng, Po-Hsun; Chen, Sao-Jie; Lai, Jin-Shin

    This work elucidates the evolution of three generations of the laboratory information system in the National Taiwan University Hospital, which were respectively implemented in an IBM Series/1 mini-computer, a client/server and a plug-and-play HL7 interface engine environment respectively. The experience of using the HL7 healthcare information exchange in the hospital information system, laboratory information system, and automatic medical instruments over the past two decades are illustrated and discussed. The latest design challenge in developing intelligent laboratory information services is to organize effectively distributed and heterogeneous medical instruments through the message gateways. Such experiences had spread to some governmental information systems for different purposes in Taiwan; besides, the healthcare information exchange standard, software reuse mechanism, and application service provider adopted in developing the plug-and-play laboratory information system are also illustrated.

  18. Which Sexual Abuse Victims Receive a Forensic Medical Examination?: The Impact of Children's Advocacy Centers

    ERIC Educational Resources Information Center

    Walsh, Wendy A.; Cross, Theodore P.; Jones, Lisa M.; Simone, Monique; Kolko, David J.

    2007-01-01

    Objective: This study examines the impact of Children's Advocacy Centers (CAC) and other factors, such as the child's age, alleged penetration, and injury on the use of forensic medical examinations as part of the response to reported child sexual abuse. Methods: This analysis is part of a quasi-experimental study, the Multi-Site Evaluation of…

  19. Impact on Academic Medical Center of Reduction Reimbursement of Indirect Research Costs.

    ERIC Educational Resources Information Center

    Kutina, Kenneth L.; And Others

    1985-01-01

    Using a system dynamics simulation model, the long-term economic impacts of federally funded research cutbacks on an academic medical center are analyzed. The significant negative multiplier effects, due to the required diversion of institutional funds, are indicative of those that any research-oriented university would experience. (Author/MLW)

  20. Strategic outsourcing of clinical services: a model for volume-stressed academic medical centers.

    PubMed

    Billi, John E; Pai, Chih-Wen; Spahlinger, David A

    2004-01-01

    Many academic medical centers have significant capacity constraints and limited ability to expand services to meet demand. Health care management should employ strategic thinking to deal with service demands. This article uses three organizational models to develop a theoretical framework to guide the selection of clinical services for outsourcing.

  1. View of Medical Support Room in Mission Control Center during Apollo 16

    NASA Technical Reports Server (NTRS)

    1972-01-01

    Dr. J.F. Zieglschmid, M.D., Mission Operations Control Room (MOCR) White Team Surgeon, is seated in the Medical Support Room in the Mission Control Center as he monitors crew biomedical data being received from the Apollo 16 spacecraft on the third day of the Apollo 16 lunar landing mission.

  2. A User-Centered Cooperative Information System for Medical Imaging Diagnosis.

    ERIC Educational Resources Information Center

    Gomez, Enrique J.; Quiles, Jose A.; Sanz, Marcos F.; del Pozo, Francisco

    1998-01-01

    Presents a cooperative information system for remote medical imaging diagnosis. General computer-supported cooperative work (CSCW) problems addressed are definition of a procedure for the design of user-centered cooperative systems (conceptual level); and improvement of user feedback and optimization of the communication bandwidth in highly…

  3. Program review of the USDA Center for Medical, Agricultural and Veterinary Entomology

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The USDA-ARS Center for Medical, Agricultural and Veterinary Entomology (CMAVE) has a history that starts in 1932 in Orlando to develop methods to control mosquitoes, including malaria vectors under conditions simulating those of the south Pacific jungles, and other insects affecting man and animals...

  4. WASTE MINIMIZATION OPPORTUNITY ASSESSMENT: OPTICAL FABRICATION LABORATORY - FITZSIMMONS ARMY MEDICAL CENTER

    EPA Science Inventory

    Under the Waste Reduction Evaluations at Federal Sites (WREAFS) program, RREL has taken the initiative to merge the experience and resources of the EPA with other Federal agencies. At the Fitzsimmons Army Medical Center (FAMC) in Aurora, Colorado, the Army and the EPA cooperated ...

  5. Miami-Dade Community College 1984 Institutional Self-Study. Volume VIII: Medical Center Campus Studies.

    ERIC Educational Resources Information Center

    Miami-Dade Community Coll., FL.

    Part of a systematic, in-depth assessment of Miami-Dade Community College's (MDCC's) educational programs, student support systems, and selected campus-level activities, this volume of the college's institutional self-study report examines the impact and effectiveness of the Medical Center Campus. The report contains the results of a campus study…

  6. Crossing the Great Divide: Adoption of New Technologies, Therapeutics and Diagnostics at Academic Medical Centers

    ERIC Educational Resources Information Center

    DeMonaco, Harold J.; Koski, Greg

    2007-01-01

    The role of new technology in healthcare continues to expand from both the clinical and financial perspectives. Despite the importance of innovation, most academic medical centers do not have a clearly defined process for technology assessment. Recognizing the importance of new drugs, diagnostics and procedures in the care of patients and in the…

  7. The History of SHSAAMc: Student Health Services at Academic Medical Centers

    ERIC Educational Resources Information Center

    Veeser, Peggy Ingram; Hembree, Wylie; Bonner, Julia

    2008-01-01

    This article presents an historical review of the organization known as Student Health Services at Academic Medical Centers (SHSAAMc). The authors discuss characteristics of health service directors as well as the history of meetings, discussion, and leadership. The focus of the group is the healthcare needs of health professions students at…

  8. 76 FR 14028 - Center for Devices and Radiological Health 510(k) Implementation: Online Repository of Medical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-15

    ... HUMAN SERVICES Food and Drug Administration Center for Devices and Radiological Health 510(k... Drug Administration (FDA) is announcing a public meeting entitled ``510(k) Implementation: Discussion... cleared medical devices. The CDRH Preliminary Internal Evaluations 510(k) Working Group Report of...

  9. Developing a Sustainable Research Culture in an Independent Academic Medical Center

    ERIC Educational Resources Information Center

    Joyce, Jeffrey N.

    2013-01-01

    Independent academic medical centers (IAMC) are challenged to develop and support a research enterprise and maintain primary goals of healthcare delivery and financial solvency. Strategies for promoting translational research have been shown to be effective at institutions in the top level of federal funding, but not for smaller IAMCs. The…

  10. Impact on Seniors of the Patient-Centered Medical Home: Evidence from a Pilot Study

    ERIC Educational Resources Information Center

    Fishman, Paul A.; Johnson, Eric A.; Coleman, Kathryn; Larson, Eric B.; Hsu, Clarissa; Ross, Tyler R.; Liss, David; Tufano, James; Reid, Robert J.

    2012-01-01

    Purpose: To assess the impact on health care cost and quality among seniors of a patient-centered medical home (PCMH) pilot at Group Health Cooperative, an integrated health care system in Washington State. Design and Methods: A prospective before-and-after evaluation of the experience of seniors receiving primary care services at 1 pilot clinic…

  11. Examining Health Information Technology Implementations: Case of the Patient-Centered Medical Home

    ERIC Educational Resources Information Center

    Behkami, Nima A.

    2012-01-01

    It has been shown that the use of Health Information Technology (HIT) is associated with reduced cost and increased quality of care. This dissertation examined the use of registries in Patient Centered Medical Home (PCMH) practices. A survey questionnaire was sent to a nationwide group of clinics certified for being a PCMH. They were asked to…

  12. Preparing Academic Medical Centers for the Clinical Learning Environment Review: Alliance of Independent Academic Medical Centers National Initiative IV Outcomes and Evaluation

    PubMed Central

    Wehbe-Janek, Hania; Markova, Tsveti; Polis, Rachael L.; Peters, Marguerite; Liu, Yang

    2016-01-01

    Background: Driven by changes to improve quality in patient care and population health while reducing costs, evolvement of the health system calls for restructuring health professionals' education and aligning it with the healthcare delivery system. In response to these changes, the Accreditation Council for Graduate Medical Education's Clinical Learning Environment Review (CLER) encourages the integration of health system leadership, faculty, and residents in restructuring graduate medical education (GME). Innovative approaches to achieving this restructuring and the CLER objectives are essential. Methods: The Alliance of Independent Academic Medical Centers National Initiative (NI) IV provided a multiinstitutional learning collaborative focused on supporting GME redesign. From October 2013 through March 2015, participants conducted relevant projects, attended onsite meetings, and participated in teleconferences and webinars addressing the CLER areas. Participants shared best practices, resources, and experiences. We designed a pre/post descriptive study to examine outcomes. Results: Thirty-three institutions completed NI IV, and at its conclusion, the majority reported greater CLER readiness compared with baseline. Twenty-two (88.0%) institutions reported that NI IV had a great impact on advancing their efforts in the CLER area of their project focus, and 15 (62.5%) reported a great impact in other CLER focus areas. Opportunities to share progress with other teams and the national group meetings were reported to contribute to teams' success. Conclusion: The NI IV learning collaborative prepared institutions for CLER, suggesting successful integration of the clinical and educational enterprises. We propose that national learning collaboratives of GME-sponsoring health systems enable advancement of their education mission, leading ultimately to better healthcare outcomes. This learning model may be generalizable to newfound programs for academic medical centers

  13. Is there a role for academic medical centers in emerging markets?

    PubMed

    Wiener, Charles M; Thompson, Steven J; Wu, Sandford; Chellappa, Mohan; Hasham, Salim

    2012-01-01

    Governments in emerging markets face mounting challenges in managing health spending, building capability and capacity, modernizing ageing infrastructure, and investing in skills and resources. One path to overcoming these challenges is to establish new public-private models of health care development and delivery based on United States academic medical centers, whose missions are to advance medical education and clinical delivery. Johns Hopkins Medicine is a participant in the collaboration developing between the Perdana University Hospital and the Perdana University Graduate School of Medicine in Malaysia. These two organizations comprise an academic health science center based on the United States model. The Perdana project provides constructive insights into the opportunities and challenges that governments, universities, and the private sector face when introducing new models of patient care that are integrated with medical education, clinical training, and biomedical research.

  14. An Advanced Pharmacy Practice Experience in a Student-Staffed Medication Therapy Management Call Center

    PubMed Central

    Hall, Anna M.; Roane, Teresa E.; Mistry, Reena

    2012-01-01

    Objective. To describe the implementation of an advanced pharmacy practice experience (APPE) in medication therapy management (MTM) designed to contribute to student pharmacists’ confidence and abilities in providing MTM. Design. Sixty-four student pharmacists provided MTM services during an APPE in a communication and care center. Assessment. Students conducted 1,495 comprehensive medication reviews (CMRs) identifying 6,056 medication-related problems. Ninety-eight percent of the students who completed a survey instrument (52 of 53) following the APPE expressed that they had the necessary knowledge and skills to provide MTM services. Most respondents felt that pharmacist participation in providing Medicare MTM could move the profession of pharmacy forward and that pharmacists will have some role in deciding the specific provisions of the Medicare MTM program (92% and 91%, respectively). Conclusion. Students completing the MTM APPE received patient-centered experiences that supplemented their confidence, knowledge, and skill in providing MTM services in the future. PMID:22919086

  15. Exploring variables among medical center employees with injuries: developing interventions and strategies.

    PubMed

    Brown, Norman DePaul; Thomas, Nancy I

    2003-11-01

    Data for this study were collected via retrospective chart review. The study shows the variables associated with work related injury (WRI) in Central Arkansas Veterans Healthcare System medical center employees from 1998 to 2000 in terms of age, gender, employment type, employment status, shift length, body mass index (BMI), workers' compensation claims prior to current employment, employee health and wellness activity attendance, lost time claims, medical/loss of productivity costs. Notable characteristics of injured employees included advancing age, female gender, long working hours, increased BMI, history of prior back and upper extremity injuries, no health and wellness activity attendance, and lost time with injury. Back and shoulder strain, falling accidents, and repetitive motion injuries were the most severe and costly injuries. Further study of medical center employees is warranted to determine risk factors for WRI and develop appropriate protective interventions and safety promotion strategies.

  16. Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the Wright Center for Graduate Medical Education teaching health center curriculum experience

    PubMed Central

    Palamaner Subash Shantha, Ghanshyam; Gollamudi, Lakshmi Rani; Sheth, Jignesh; Ebersole, Brian; Gardner, Katlyn J.; Nardella, Julie; Ruddy, Meaghan P.; Meade, Lauren

    2015-01-01

    Purpose. The effect of patient centered medical home (PCMH) curriculum interventions on residents’ self-reported and demonstrated knowledge, skills and attitudes in PCMH competency arenas (KSA) is lacking in the literature. This study aimed to assess the impact of PCMH curricular innovations on the KSA of Internal Medicine residents. Methods. Twenty four (24) Internal Medicine residents—12 Traditional (TR) track residents and 12 Teaching Health Center (THC) track residents—began training in Academic Year (AY) 2011 at the Wright Center for Graduate Medical Education (WCGME). They were followed through AY2013, covering three years of training. PCMH curricular innovations were focally applied July 2011 until May 2012 to THC residents. These curricular innovations were spread program-wide in May 2012. Semi-annual, validated PCMH Clinician Assessments assessing KSA were started in AY2011 and were completed by all residents. Results. Mean KSA scores of TR residents were similar to those of THC residents at baseline for all PCMH competencies. In May 2012, mean scores of THC residents were significantly higher than TR residents for most KSA. After program-wide implementation of PCMH innovations, mean scores of TR residents for all KSA improved and most became equalized to those of THC residents. Globally improved KSA scores of THC and TR residents were maintained through May 2014, with the majority of improvements above baseline and reaching statistical significance. Conclusions. PCMH curricular innovations inspired by Health Resources and Services Administration (HRSA’s) Teaching Health Center funded residency program expansion quickly and consistently improved the KSA of Internal Medicine residents. PMID:25699213

  17. Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the Wright Center for Graduate Medical Education teaching health center curriculum experience.

    PubMed

    Thomas-Hemak, Linda; Palamaner Subash Shantha, Ghanshyam; Gollamudi, Lakshmi Rani; Sheth, Jignesh; Ebersole, Brian; Gardner, Katlyn J; Nardella, Julie; Ruddy, Meaghan P; Meade, Lauren

    2015-01-01

    Purpose. The effect of patient centered medical home (PCMH) curriculum interventions on residents' self-reported and demonstrated knowledge, skills and attitudes in PCMH competency arenas (KSA) is lacking in the literature. This study aimed to assess the impact of PCMH curricular innovations on the KSA of Internal Medicine residents. Methods. Twenty four (24) Internal Medicine residents-12 Traditional (TR) track residents and 12 Teaching Health Center (THC) track residents-began training in Academic Year (AY) 2011 at the Wright Center for Graduate Medical Education (WCGME). They were followed through AY2013, covering three years of training. PCMH curricular innovations were focally applied July 2011 until May 2012 to THC residents. These curricular innovations were spread program-wide in May 2012. Semi-annual, validated PCMH Clinician Assessments assessing KSA were started in AY2011 and were completed by all residents. Results. Mean KSA scores of TR residents were similar to those of THC residents at baseline for all PCMH competencies. In May 2012, mean scores of THC residents were significantly higher than TR residents for most KSA. After program-wide implementation of PCMH innovations, mean scores of TR residents for all KSA improved and most became equalized to those of THC residents. Globally improved KSA scores of THC and TR residents were maintained through May 2014, with the majority of improvements above baseline and reaching statistical significance. Conclusions. PCMH curricular innovations inspired by Health Resources and Services Administration (HRSA's) Teaching Health Center funded residency program expansion quickly and consistently improved the KSA of Internal Medicine residents. PMID:25699213

  18. MiPLAN: a learner-centered model for bedside teaching in today's academic medical centers.

    PubMed

    Stickrath, Chad; Aagaard, Eva; Anderson, Mel

    2013-03-01

    Clinician educators and medical trainees face intense pressure to complete numerous patient care and teaching activities in a limited amount of time. To address the need for effective and efficient teaching methods for use in the inpatient setting, the authors used constructivist learning theory, the principles of adult learning, and their expertise as clinician educators to develop the MiPLAN model for bedside teaching. This three-part model is designed to enable clinical teachers to simultaneously provide care to patients while assessing learners, determining high-yield teaching topics, and providing feedback to learners.The "M" refers to a preparatory meeting between teacher and learners before engaging in patient care or educational activities. During this meeting, team members should become acquainted and the teacher should set goals and clarify expectations. The "i" refers to five behaviors for the teacher to adopt during learners' bedside presentations: introduction, in the moment, inspection, interruptions, and independent thought. "PLAN" is an algorithm to establish priorities for teaching subsequent to a learner's presentation: patient care, learners' questions, attending's agenda, and next steps.The authors suggest that the MiPLAN model can help clinical teachers gain more confidence in their ability to teach at the bedside and increase the frequency and quality of bedside teaching. They propose further research to assess the generalizability of this model to other institutions, settings, and specialties and to evaluate educational and patient outcomes. PMID:23348088

  19. MiPLAN: a learner-centered model for bedside teaching in today's academic medical centers.

    PubMed

    Stickrath, Chad; Aagaard, Eva; Anderson, Mel

    2013-03-01

    Clinician educators and medical trainees face intense pressure to complete numerous patient care and teaching activities in a limited amount of time. To address the need for effective and efficient teaching methods for use in the inpatient setting, the authors used constructivist learning theory, the principles of adult learning, and their expertise as clinician educators to develop the MiPLAN model for bedside teaching. This three-part model is designed to enable clinical teachers to simultaneously provide care to patients while assessing learners, determining high-yield teaching topics, and providing feedback to learners.The "M" refers to a preparatory meeting between teacher and learners before engaging in patient care or educational activities. During this meeting, team members should become acquainted and the teacher should set goals and clarify expectations. The "i" refers to five behaviors for the teacher to adopt during learners' bedside presentations: introduction, in the moment, inspection, interruptions, and independent thought. "PLAN" is an algorithm to establish priorities for teaching subsequent to a learner's presentation: patient care, learners' questions, attending's agenda, and next steps.The authors suggest that the MiPLAN model can help clinical teachers gain more confidence in their ability to teach at the bedside and increase the frequency and quality of bedside teaching. They propose further research to assess the generalizability of this model to other institutions, settings, and specialties and to evaluate educational and patient outcomes.

  20. My personal experiences at the BEST Medical Center: A day in the clinic-the afternoon.

    PubMed

    Cohen, Philip R; Kurzrock, Razelle

    2016-01-01

    Dr. Ida Lystic is a gastroenterologist who recently began her new faculty position at the BEST (Byron Edwards and Samuel Thompson) Medical Center. After completing her MD degree at the prestigious Harvey Medical School (recently renamed the Harvey Provider School), she did her internal medicine residency and fellowship training at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center. Her morning in gastroenterology clinic was highlighted by: (1) being reprimanded by the clinic nurse manager for a patient who not only arrived early, before clinic had opened, but also neglected to schedule the anesthesiologist for his colonoscopy; (2) the continued challenges of LEGEND (also known as Lengthy and Excessively Graded Evaluation and Nomenclature for Diagnosis by her colleagues), the new electronic medical record system after the BEST discarded the SIMPLE (Succinct Input Making Patient's Lives Electronic) system; (3) a nurse's interruption of an office visit-once the egg timer on the examination room door ran out-because she had exceeded the allocated time for the appointment; and (4) her chairman's unanticipated arrival in the clinic to visit with the clinic nurse manager. In addition to seeing her patients, Dr. Lystic's afternoon is occupied by attending a LOST (Laboratory OverSight and Testing) Committee meeting and a visit from a wayfinding and signage specialist to depersonalize the doorpost plaques of the examination rooms. Her day ends with a demeaning email from her chairman regarding the poor results of the most recent patient satisfaction survey and being personally held accountable to develop solutions to improve not only her performance but also that of the clinic. Although Dr. Ida Lystic and the gastroenterology clinic at "the BEST Medical Center" are creations of the authors' imagination, the majority of the anecdotes mentioned in this essay are based on individual patients and their physicians, clinics in medical centers and their administration

  1. Development of a Hospital-based Massage Therapy Course at an Academic Medical Center

    PubMed Central

    Dion, Liza J.; Cutshall, Susanne M.; Rodgers, Nancy J.; Hauschulz, Jennifer L.; Dreyer, Nikol E.; Thomley, Barbara S.; Bauer, Brent

    2015-01-01

    Background: Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. The present article summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center. Methods: A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course had three components in its educational experience: online learning, classroom study, and a 25-hr shadowing experience. The in-classroom study portion included an entire day in the simulation center. Results: The hospital-based massage therapy course addressed the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course indicated key learning opportunities and additional content that are needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment. Conclusions: The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This course provides an example initial step in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment. PMID

  2. Improving the Transition of Care in Patients Transferred Through the Ochsner Medical Center Transfer Center

    PubMed Central

    Amedee, Ronald G.; Maronge, Genevieve F.; Pinsky, William W.

    2012-01-01

    Background Patient transfers from other hospitals within the Ochsner Health System to the main campus are coordinated through a Transfer Center that was established in fall 2008. We analyzed the transfer process to assess distinct opportunities to enhance the overall transition of patient care. Methods We surveyed internal medicine residents and nocturnists to determine their satisfaction with transfers in terms of safety, efficiency, and usefulness of information provided at the time of transfer. After a kaizen event at which complementary goals for the institution and members of the study team were recognized and implemented, we resurveyed the group to evaluate improvement in the transfer process. Results The preintervention average satisfaction score was 1.18 (SD=0.46), while the postintervention score was 3.7 (SD=1.01). A t test showed a significant difference in the average scores between the preintervention and postintervention surveys (P<0.0001). Conclusions By including residents in the transfer calls (a result of the kaizen event), data were collected that facilitated fewer and higher quality handoffs that were performed in less time. In addition, the process resulted in increased awareness of the value of resident participation in institutional quality improvement projects. PMID:23267257

  3. A 5-year scientometric analysis of research centers affiliated to Tehran University of Medical Sciences

    PubMed Central

    Yazdani, Kamran; Rahimi-Movaghar, Afarin; Nedjat, Saharnaz; Ghalichi, Leila; Khalili, Malahat

    2015-01-01

    Background: Since Tehran University of Medical Sciences (TUMS) has the oldest and highest number of research centers among all Iranian medical universities, this study was conducted to evaluate scientific output of research centers affiliated to Tehran University of Medical Sciences (TUMS) using scientometric indices and the affecting factors. Moreover, a number of scientometric indicators were introduced. Methods: This cross-sectional study was performed to evaluate a 5-year scientific performance of research centers of TUMS. Data were collected through questionnaires, annual evaluation reports of the Ministry of Health, and also from Scopus database. We used appropriate measures of central tendency and variation for descriptive analyses. Moreover, uni-and multi-variable linear regression were used to evaluate the effect of independent factors on the scientific output of the centers. Results: The medians of the numbers of papers and books during a 5-year period were 150.5 and 2.5 respectively. The median of the "articles per researcher" was 19.1. Based on multiple linear regression, younger age centers (p=0.001), having a separate budget line (p=0.016), and number of research personnel (p<0.001) had a direct significant correlation with the number of articles while real properties had a reverse significant correlation with it (p=0.004). Conclusion: The results can help policy makers and research managers to allocate sufficient resources to improve current situation of the centers. Newly adopted and effective scientometric indices are is suggested to be used to evaluate scientific outputs and functions of these centers. PMID:26157724

  4. Implementing PDA technology in a medical library: experiences in a hospital library and an academic medical center library.

    PubMed

    Morgen, Evelyn Breck

    2003-01-01

    Personal digital assistants (PDAs) have grown from being a novelty in the late 1990s to an essential tool for healthcare professionals in the 2000s. This paper describes the experiences of a librarian who implemented PDA technology first in a hospital library, and then at an academic medical center library. It focuses on the role of the library in supporting PDA technology and resources. Included are programmatic issues such as training for library staff and clinicians, and technical issues such as Palm and Windows operating systems. This model could be used in either a hospital or academic health sciences library.

  5. Implementing PDA technology in a medical library: experiences in a hospital library and an academic medical center library.

    PubMed

    Morgen, Evelyn Breck

    2003-01-01

    Personal digital assistants (PDAs) have grown from being a novelty in the late 1990s to an essential tool for healthcare professionals in the 2000s. This paper describes the experiences of a librarian who implemented PDA technology first in a hospital library, and then at an academic medical center library. It focuses on the role of the library in supporting PDA technology and resources. Included are programmatic issues such as training for library staff and clinicians, and technical issues such as Palm and Windows operating systems. This model could be used in either a hospital or academic health sciences library. PMID:12627687

  6. A management plan for hospitals and medical centers facing radiation incidents

    PubMed Central

    Davari, Fereshteh; Zahed, Arash

    2015-01-01

    Background: Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. Materials and Methods: In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. Results: We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. Conclusion: With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary. PMID:26759575

  7. Towards Interactive Medical Content Delivery Between Simulated Body Sensor Networks and Practical Data Center.

    PubMed

    Shi, Xiaobo; Li, Wei; Song, Jeungeun; Hossain, M Shamim; Mizanur Rahman, Sk Md; Alelaiwi, Abdulhameed

    2016-10-01

    With the development of IoT (Internet of Thing), big data analysis and cloud computing, traditional medical information system integrates with these new technologies. The establishment of cloud-based smart healthcare application gets more and more attention. In this paper, semi-physical simulation technology is applied to cloud-based smart healthcare system. The Body sensor network (BSN) of system transmit has two ways of data collection and transmission. The one is using practical BSN to collect data and transmitting it to the data center. The other is transmitting real medical data to practical data center by simulating BSN. In order to transmit real medical data to practical data center by simulating BSN under semi-physical simulation environment, this paper designs an OPNET packet structure, defines a gateway node model between simulating BSN and practical data center and builds a custom protocol stack. Moreover, this paper conducts a large amount of simulation on the real data transmission through simulation network connecting with practical network. The simulation result can provides a reference for parameter settings of fully practical network and reduces the cost of devices and personnel involved. PMID:27562482

  8. Towards Interactive Medical Content Delivery Between Simulated Body Sensor Networks and Practical Data Center.

    PubMed

    Shi, Xiaobo; Li, Wei; Song, Jeungeun; Hossain, M Shamim; Mizanur Rahman, Sk Md; Alelaiwi, Abdulhameed

    2016-10-01

    With the development of IoT (Internet of Thing), big data analysis and cloud computing, traditional medical information system integrates with these new technologies. The establishment of cloud-based smart healthcare application gets more and more attention. In this paper, semi-physical simulation technology is applied to cloud-based smart healthcare system. The Body sensor network (BSN) of system transmit has two ways of data collection and transmission. The one is using practical BSN to collect data and transmitting it to the data center. The other is transmitting real medical data to practical data center by simulating BSN. In order to transmit real medical data to practical data center by simulating BSN under semi-physical simulation environment, this paper designs an OPNET packet structure, defines a gateway node model between simulating BSN and practical data center and builds a custom protocol stack. Moreover, this paper conducts a large amount of simulation on the real data transmission through simulation network connecting with practical network. The simulation result can provides a reference for parameter settings of fully practical network and reduces the cost of devices and personnel involved.

  9. Studies of New Albany shale in western Kentucky. Final report

    SciTech Connect

    Schwalb, H.R.; Norris, R.L.

    1980-02-01

    The New Albany (Upper Devonian) Shale in western Kentucky can be zoned by using correlative characteristics distinguishable on wire-line logs. Wells drilled through the shale which were logged by various methods provided a basis for zonation of the subsurface members and units of the Grassy Creek, Sweetland Creek, and Blocher. Structure and isopach maps and cross sections were prepared. The Hannibal Shale and Rockford Limestone were found in limited areas; isopach maps were not made for these members. Samples of cuttings from selected wells were studied in order to identify the contact of the shale with underlying and overlying rock units. A well-site examination of cuttings through the shale section was conducted, and the presence of natural gas was observed in the field. The New Albany Shale has the potential for additional commercially marketable natural gas production. Exploratory drilling is needed to evaluate the reservoir characteristics of the New Albany Shale.

  10. A New Concept for Medical Imaging Centered on Cellular Phone Technology

    PubMed Central

    Rubinsky, Boris

    2008-01-01

    According to World Health Organization reports, some three quarters of the world population does not have access to medical imaging. In addition, in developing countries over 50% of medical equipment that is available is not being used because it is too sophisticated or in disrepair or because the health personnel are not trained to use it. The goal of this study is to introduce and demonstrate the feasibility of a new concept in medical imaging that is centered on cellular phone technology and which may provide a solution to medical imaging in underserved areas. The new system replaces the conventional stand-alone medical imaging device with a new medical imaging system made of two independent components connected through cellular phone technology. The independent units are: a) a data acquisition device (DAD) at a remote patient site that is simple, with limited controls and no image display capability and b) an advanced image reconstruction and hardware control multiserver unit at a central site. The cellular phone technology transmits unprocessed raw data from the patient site DAD and receives and displays the processed image from the central site. (This is different from conventional telemedicine where the image reconstruction and control is at the patient site and telecommunication is used to transmit processed images from the patient site). The primary goal of this study is to demonstrate that the cellular phone technology can function in the proposed mode. The feasibility of the concept is demonstrated using a new frequency division multiplexing electrical impedance tomography system, which we have developed for dynamic medical imaging, as the medical imaging modality. The system is used to image through a cellular phone a simulation of breast cancer tumors in a medical imaging diagnostic mode and to image minimally invasive tissue ablation with irreversible electroporation in a medical imaging interventional mode. PMID:18446199

  11. Qualitative and Political Issues Impacting Academic Medical Center Strategic Planning--A Methodological Approach. AIR Forum 1982 Paper.

    ERIC Educational Resources Information Center

    Kutina, Kenneth L.; And Others

    A simulation model of an academic medical center that was developed to aid in strategic planning and policy analysis is described. The model, designated MCM for Medical Center Model, was implemented at the School of Medicine, University Hospitals of Cleveland, and the private practices of the faculty in the clinical departments at University…

  12. The Effects of Corporatization on Academic Medical Centers. How Will the Corporatization of Health Care Influence Health Professions Education?

    ERIC Educational Resources Information Center

    Dunn, Marvin R.

    Areas of agreement/conflict between academic medical centers and investor owned corporations are considered. Academic medical centers are part of the university system, which is responsible for education, research, and the related public good (e.g., nurturing of professions). Major areas for a potential confluence of interest between the academic…

  13. United States academic medical centers: priorities and challenges amid market transformation.

    PubMed

    Thompson, Irene M; Anason, Barbara

    2012-01-01

    United States academic medical centers (AMCs) have upheld their long-standing reputation for excellence by teaching and training the next generation of physicians, supporting medical research, providing world-class medical care, and offering breakthrough treatments for highly complex medical cases. In recent years, the pace and direction of change reshaping the American health care industry has created a set of new and profound challenges that AMC leaders must address in order to sustain their institutions. University HealthSystem Consortium (UHC) is an alliance of 116 leading nonprofit academic medical centers and 276 of their affiliated hospitals, all of which are focused on delivering world-class patient care. Formed in 1984, UHC fosters collaboration with and among its members through its renowned programs and services in the areas of comparative data and analytics, performance improvement, supply chain management, strategic research, and public policy. Each year, UHC surveys the executives of its member institutions to understand the issues they view as most critical to sustaining the viability and success of their organizations. The results of UHC's most recent 2011 member survey, coupled with a 2012 Strategic Health Perspectives Harris Interactive presentation, based in parton surveys of major health care industry stakeholders reveal the most important and relevant issues and opportunities that hospital leaders face today, as the United States health care delivery system undergoes a period of unprecedented transformation. PMID:23484431

  14. United States academic medical centers: priorities and challenges amid market transformation.

    PubMed

    Thompson, Irene M; Anason, Barbara

    2012-01-01

    United States academic medical centers (AMCs) have upheld their long-standing reputation for excellence by teaching and training the next generation of physicians, supporting medical research, providing world-class medical care, and offering breakthrough treatments for highly complex medical cases. In recent years, the pace and direction of change reshaping the American health care industry has created a set of new and profound challenges that AMC leaders must address in order to sustain their institutions. University HealthSystem Consortium (UHC) is an alliance of 116 leading nonprofit academic medical centers and 276 of their affiliated hospitals, all of which are focused on delivering world-class patient care. Formed in 1984, UHC fosters collaboration with and among its members through its renowned programs and services in the areas of comparative data and analytics, performance improvement, supply chain management, strategic research, and public policy. Each year, UHC surveys the executives of its member institutions to understand the issues they view as most critical to sustaining the viability and success of their organizations. The results of UHC's most recent 2011 member survey, coupled with a 2012 Strategic Health Perspectives Harris Interactive presentation, based in parton surveys of major health care industry stakeholders reveal the most important and relevant issues and opportunities that hospital leaders face today, as the United States health care delivery system undergoes a period of unprecedented transformation.

  15. Medical diplomacy and global mental health: from community and national institutions to regional centers of excellence.

    PubMed

    Aggarwal, Neil Krishan; Kohrt, Brandon A

    2013-12-01

    We explore how regional medical diplomacy can increase funding for global mental health initiatives. Interventions for infectious diseases have dominated medical diplomacy by focusing on security concerns. The global mental health movement has adopted similar strategies, but unsuccessfully since mental illnesses do not cause international epidemics. Instead, realpolitik arguments may increase funding by prioritizing economic productivity and regional diplomacy based on cultural ties to advance mental health services and research at the community level. In South Asia, initiatives to train personnel and provide refugee services offer a foundation for regional centers of excellence. This model can be expanded elsewhere. PMID:23918068

  16. A hospital as victim and responder: the Sepulveda VA Medical Center and the Northridge earthquake.

    PubMed

    Chavez, C W; Binder, B

    1996-01-01

    Many hospital emergency plans focus on the hospital as a disaster responder, with a fully operational medical facility, able to receive and treat mass casualties from a clearly defined accident scene. However, hospitals need to prepare a response for extreme casualty events such as earthquakes, tornadoes, or hurricanes. This article describes the planning, mitigation, response, and recovery of a major medical--surgical center thrust into a victim responder role following the devastating Northridge earthquake. The subsequent evacuation and care of patients, treatment of casualties, incident command, prior education and training, and recovery issues are addressed.

  17. Medical diplomacy and global mental health: from community and national institutions to regional centers of excellence.

    PubMed

    Aggarwal, Neil Krishan; Kohrt, Brandon A

    2013-12-01

    We explore how regional medical diplomacy can increase funding for global mental health initiatives. Interventions for infectious diseases have dominated medical diplomacy by focusing on security concerns. The global mental health movement has adopted similar strategies, but unsuccessfully since mental illnesses do not cause international epidemics. Instead, realpolitik arguments may increase funding by prioritizing economic productivity and regional diplomacy based on cultural ties to advance mental health services and research at the community level. In South Asia, initiatives to train personnel and provide refugee services offer a foundation for regional centers of excellence. This model can be expanded elsewhere.

  18. A model for training medical student innovators: the Harvard Medical School Center for Primary Care Abundance Agents of Change program

    PubMed Central

    Duong, David B.; Sullivan, Erin E.; Minter-Jordan, Myechia; Giesen, Lindsay; Ellner, Andrew L.

    2016-01-01

    Background In 2013, the Harvard Medical School Center for Primary Care established the Abundance Agents of Change (AoC) program to promote interprofessional learning and innovation, increase partnership between 15 academic and community health centers (CHCs) in Boston's most under-served communities, and increase medical student interest in primary care careers. Methods The AoC is modeled in the form of a ‘grants challenge’, offering $20,000 to interprofessional student teams to develop an innovative solution that addresses a healthcare delivery need identified by CHCs. The program's initial two years were characterized by a four-stage process which included working with CHCs and crafting a request for proposals, forming interprofessional 20 student teams comprising students from across and outside of Harvard University, training students using a systems-based innovation curriculum, and performing program evaluation. Results Our evaluation data from cohorts 1 and 2 of the AoC program demonstrate that we succeeded in training students as innovators and members of interprofessional teams. We also learned valuable lessons regarding creating better alignment with CHC priorities, extending the program cycle from 12 to 18 months, and changing the way funding is disbursed to 25 students, which will be incorporated in later versions of the program. Conclusions Based on our experience and evaluation data, we believe that this program is a replicable way to train students as innovators and members of interprofessional teams to address the current complex healthcare environment. PMID:27306994

  19. Patient Navigators: Agents of Creating Community-Nested Patient-Centered Medical Homes for Cancer Care

    PubMed Central

    Simon, Melissa A.; Samaras, Athena T.; Nonzee, Narissa J.; Hajjar, Nadia; Frankovich, Carmi; Bularzik, Charito; Murphy, Kara; Endress, Richard; Tom, Laura S.; Dong, XinQi

    2016-01-01

    Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients’ interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus–community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care. While the patient navigator experience has been qualitatively documented, the literature pertaining to patient navigation has largely focused on efficacy outcomes and program cost effectiveness. Here, we uniquely highlight stories of women enrolled in the DPNC, told from the perspective of patient navigators, to shed light on the myriad barriers that DPNC patients faced and document the strategies DPNC patient navigators implemented.

  20. Pathology service line: a model for accountable care organizations at an academic medical center.

    PubMed

    Sussman, Ira; Prystowsky, Michael B

    2012-05-01

    Accountable care is designed to manage the health of patients using a capitated cost model rather than fee for service. Pay for performance is an attempt to use quality and not service reduction as the way to decrease costs. Pathologists will have to demonstrate value to the system. This value will include (1) working with clinical colleagues to optimize testing protocols, (2) reducing unnecessary testing in both clinical and anatomic pathology, (3) guiding treatment by helping to personalize therapy, (4) designing laboratory information technology solutions that will promote and facilitate accurate, complete data mining, and (5) administering efficient cost-effective laboratories. The pathology service line was established to improve the efficiency of delivering pathology services and to provide more effective support of medical center programs. We have used this model effectively at the Montefiore Medical Center for the past 14 years. PMID:22333926

  1. Patient Navigators: Agents of Creating Community-Nested Patient-Centered Medical Homes for Cancer Care.

    PubMed

    Simon, Melissa A; Samaras, Athena T; Nonzee, Narissa J; Hajjar, Nadia; Frankovich, Carmi; Bularzik, Charito; Murphy, Kara; Endress, Richard; Tom, Laura S; Dong, XinQi

    2016-01-01

    Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients' interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus-community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care. While the patient navigator experience has been qualitatively documented, the literature pertaining to patient navigation has largely focused on efficacy outcomes and program cost effectiveness. Here, we uniquely highlight stories of women enrolled in the DPNC, told from the perspective of patient navigators, to shed light on the myriad barriers that DPNC patients faced and document the strategies DPNC patient navigators implemented. PMID:27594792

  2. Patient Navigators: Agents of Creating Community-Nested Patient-Centered Medical Homes for Cancer Care

    PubMed Central

    Simon, Melissa A.; Samaras, Athena T.; Nonzee, Narissa J.; Hajjar, Nadia; Frankovich, Carmi; Bularzik, Charito; Murphy, Kara; Endress, Richard; Tom, Laura S.; Dong, XinQi

    2016-01-01

    Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients’ interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus–community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care. While the patient navigator experience has been qualitatively documented, the literature pertaining to patient navigation has largely focused on efficacy outcomes and program cost effectiveness. Here, we uniquely highlight stories of women enrolled in the DPNC, told from the perspective of patient navigators, to shed light on the myriad barriers that DPNC patients faced and document the strategies DPNC patient navigators implemented. PMID:27594792

  3. Heart health: volume and revenue growth through clinically integrated medical fitness centers.

    PubMed

    Nadel, Mark A

    2003-01-01

    The number of hospital sponsored medical fitness centers has grown from fewer than 100 in the early 1980's to nearly 700 today. The reasons for this growth are: They are recognized as part of the continuum of care; They are a powerful vehicle for increasing clinical volumes, revenues, and overall market share; They can generate substantial new revenue, both clinical and retail; and, They boldly proclaim a hospital's commitment to improving the health status of the community. With proper planning and an intense focus on clinical integration, medical fitness centers can assist hospitals in achieving numerous objectives. From a cardiology standpoint, imagine being able to show the community that you have been willing to spend millions of dollars to keep people's hearts healthy. That's market differentiation.

  4. St. Luke's Medical Center Global City--Global Trigger Tool (GTT) Project.

    PubMed

    Dizon, Alejandro C; Macaraig, Victor J; Magpusao, Eulalia C

    2016-01-01

    The Global Trigger Tool (GTT) was developed by the Institute of Healthcare Improvement (IHI), to identify and measure the rate of adverse events over time in a healthcare facility. It is a sampling methodology that utilizes "triggers" in the detection of random adverse events and harms and it also measures the adverse events overtime. The Quality and Patient Safety Group of St. Luke's Medical Center--Global City initiated the implementation of the Global Trigger Tool as a proactive solution using retrospective information gathered to address the growing challenge that adverse events and harms impose in the institution with the ultimate goat of improving patient safety. St. Luke's Medical Center Global City is the first and only hospital in the Philippines to implementand utilize the Global Trigger Tool. PMID:27180470

  5. Critical limits (alert values) for physician notification: universal or medical center specific limits?

    PubMed

    Lum, G

    1998-01-01

    The concept of critical limits (alert values), defined as an imminent life threatening laboratory result requiring immediate physician notification, has been widely adopted as a standard of good laboratory practice. Although virtually all laboratories have tests with critical limits, surveys have shown that there is no universal alert value list. Recently, nine VA medical centers in the New England region, which now constitute one consolidated entity, were surveyed with the objective of summarizing critical limits. Universal (100 percent) critical limit tests for clinical chemistry were: Calcium; mean low/high, 6.5/12.4 mg/dL: Glucose 48/432 mg/dL: Potassium 2.8/6.1 mmol/L: Sodium 121/159 mmol/L. Universal hematology tests included: Hematocrit 22.2/59.7 percent: Platelet count 61K/983K: white blood count 1.9K/29K. Although there was universal agreement that abnormal coagulation tests (PT, PTT) should be included on the hematology critical limit list, there was wide variation in the reporting of coagulation tests (seconds and INR) and patient therapeutic status (anticoagulant or no-anticoagulant). Universal alert values for microbiology were: Positive blood culture: Positive cerebral spinal fluid (CSF) culture: Positive CSF Gram stain. There was no universal agreement regarding critically high (potentially toxic) therapeutic drugs, with two medical centers declining to notify physicians of any abnormally high therapeutic drug level. No other qualitative critical limits for other laboratory sections, such as physician notification of an unexpected malignancy (surgical pathology) were universal. Medical center specific critical limits, designed to meet the clinical needs of each facility, are the norm in the nine medical centers. Laboratories do need periodically to review their critical limit lists with appropriate clinical input to avoid including critical limits for laboratory tests not required for urgent physician notification and patient evaluation and treatment.

  6. New library buildings: the University of Michigan Medical Library and Learning Resource Center.

    PubMed Central

    Wulff, L Y; Calhoun, J G

    1984-01-01

    The University of Michigan opened a new medical library in July 1980. The five-story structure combines the library with a learning-resources center. Overall, the building has operated smoothly and has been well accepted. The combining of two facilities designed to support the teaching and learning objectives of the health sciences curriculum will ensure long-term cooperation between them. Images PMID:6199067

  7. Television spots win national award. Part of OSF Saint Francis Medical Center's branding effort.

    PubMed

    Rees, Tom

    2004-01-01

    "Miracles in Medicine," a series of award-winning television spots, was produced for OSF Saint Francis Medical Center, Peoria, Ill., by The Roberts Group, Inc., Waukesha, Wis. They are an integral part of a broader branding campaign, launched in May 2003, that includes newspaper, radio, and outdoor elements. The spots were deemed so successful, the branding effort was expanded to include Children's Hospital of Illinois.

  8. Information Technology Support for Clinical Genetic Testing within an Academic Medical Center

    PubMed Central

    Aronson, Samuel; Mahanta, Lisa; Ros, Lei Lei; Clark, Eugene; Babb, Lawrence; Oates, Michael; Rehm, Heidi; Lebo, Matthew

    2016-01-01

    Academic medical centers require many interconnected systems to fully support genetic testing processes. We provide an overview of the end-to-end support that has been established surrounding a genetic testing laboratory within our environment, including both laboratory and clinician facing infrastructure. We explain key functions that we have found useful in the supporting systems. We also consider ways that this infrastructure could be enhanced to enable deeper assessment of genetic test results in both the laboratory and clinic. PMID:26805890

  9. Gila Regional Medical Center doubles as art gallery. Open house marks southwestern New Mexico hospital's expansion.

    PubMed

    Rees, Tom

    2003-01-01

    Gila Regional Medical Center, Silver City, N.M., is home to a unique kind of art gallery. Though the small town boasts 30 art galleries, one more was added when the newly expanded and renovated hospital opened its doors to the public in February. More than 100 pieces of loaned art estimated to be worth more than $12,000 are on exhibit, in an effort to create a more healing atmosphere for the hospital.

  10. Television spots win national award. Part of OSF Saint Francis Medical Center's branding effort.

    PubMed

    Rees, Tom

    2004-01-01

    "Miracles in Medicine," a series of award-winning television spots, was produced for OSF Saint Francis Medical Center, Peoria, Ill., by The Roberts Group, Inc., Waukesha, Wis. They are an integral part of a broader branding campaign, launched in May 2003, that includes newspaper, radio, and outdoor elements. The spots were deemed so successful, the branding effort was expanded to include Children's Hospital of Illinois. PMID:15162576

  11. Medical Student Volunteerism Addresses Patients' Social Needs: A Novel Approach to Patient-Centered Care

    PubMed Central

    Onyekere, Chinwe; Ross, Sandra; Namba, Alexa; Ross, Justin C.; Mann, Barry D.

    2016-01-01

    Background: Healthcare providers must be equipped to recognize and address patients' psychosocial needs to improve overall health outcomes. To give future healthcare providers the tools and training necessary to identify and address psychosocial issues, Lankenau Medical Center in partnership with the Philadelphia College of Osteopathic Medicine designed the Medical Student Advocate (MSA) program. Methods: The MSA program places volunteer second-year osteopathic medical students in care coordination teams at Lankenau Medical Associates, a primary care practice serving a diverse patient population in the Philadelphia, PA, region. As active members of the team, MSAs are referred high-risk patients who have resource needs such as food, employment, child care, and transportation. MSAs work collaboratively with patients and the multidisciplinary team to address patients' nonmedical needs. Results: From August 2013 to August 2015, 31 osteopathic medical students volunteered for the MSA program and served 369 patients with 720 identified needs. Faculty and participating medical students report that the MSA program provided an enhanced understanding of the holistic nature of patient care and a comprehensive view of patient needs. Conclusion: The MSA program provides students with a unique educational opportunity that encompasses early exposure to patient interaction, social determinants of health, population health, and interdisciplinary collaboration. Students develop skills to help them build patient relationships, understand the psychosocial factors shaping health outcomes, and engage with other healthcare professionals. This work in the preclinical years provides students with the knowledge to help them perform more effectively in the changing healthcare environment. PMID:27046404

  12. My personal experiences at the BEST Medical Center: A day in the clinic-the morning.

    PubMed

    Cohen, Philip R; Kurzrock, Razelle

    2016-01-01

    Dr. Ida Lystic is a gastroenterologist who trained at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center, after having completed her MD degree at the prestigious Harvey Medical School (recently renamed the Harvey Provider School). She accepted a faculty position at the BEST (Byron Edwards and Samuel Thompson) Medical Center. Dr. Lystic shares her experiences on a typical morning in gastroenterology clinic. Although her clinic start date was delayed by 2 months after becoming sick following a mandatory flu shot and having to complete more than 70 hours of compliance training modules, she is now familiar with the BEST system. Clinic scheduling priorities include ensuring that the staff can eat lunch together and depart at 5:00 pm. It is a continual challenge to find time to complete the electronic medical record after BEST changed from the SIMPLE (Succinct Input Making Patients Lives Electronic) system to LEGEND (referred to as Lengthy and Excessively Graded Evaluation and Nomenclature for Diagnosis by her colleagues). To maintain clinic punctuality, a compliance spreadsheet is e-mailed monthly to the Wait Time Committee. Their most recent corrective action plan for tardy physicians included placing egg timers on the doors and having nurses interrupt visits that exceed the allotted time. Administrative decisions have resulted in downsizing personnel. Patients are required to schedule their own tests and procedures and follow-up appointments-causing low patient satisfaction scores; however, the money saved lead to a large year-end bonus for the vice president of BEST Efficiency, who holds "providers" accountable for the poor patient experience. Although Dr. Ida Lystic and the gastroenterology clinic at "the BEST Medical Center" are creations of the authors' imagination, the majority of the anecdotes are based on actual events.

  13. My personal experiences at the BEST Medical Center: A day in the clinic-the morning.

    PubMed

    Cohen, Philip R; Kurzrock, Razelle

    2016-01-01

    Dr. Ida Lystic is a gastroenterologist who trained at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center, after having completed her MD degree at the prestigious Harvey Medical School (recently renamed the Harvey Provider School). She accepted a faculty position at the BEST (Byron Edwards and Samuel Thompson) Medical Center. Dr. Lystic shares her experiences on a typical morning in gastroenterology clinic. Although her clinic start date was delayed by 2 months after becoming sick following a mandatory flu shot and having to complete more than 70 hours of compliance training modules, she is now familiar with the BEST system. Clinic scheduling priorities include ensuring that the staff can eat lunch together and depart at 5:00 pm. It is a continual challenge to find time to complete the electronic medical record after BEST changed from the SIMPLE (Succinct Input Making Patients Lives Electronic) system to LEGEND (referred to as Lengthy and Excessively Graded Evaluation and Nomenclature for Diagnosis by her colleagues). To maintain clinic punctuality, a compliance spreadsheet is e-mailed monthly to the Wait Time Committee. Their most recent corrective action plan for tardy physicians included placing egg timers on the doors and having nurses interrupt visits that exceed the allotted time. Administrative decisions have resulted in downsizing personnel. Patients are required to schedule their own tests and procedures and follow-up appointments-causing low patient satisfaction scores; however, the money saved lead to a large year-end bonus for the vice president of BEST Efficiency, who holds "providers" accountable for the poor patient experience. Although Dr. Ida Lystic and the gastroenterology clinic at "the BEST Medical Center" are creations of the authors' imagination, the majority of the anecdotes are based on actual events. PMID:27265082

  14. Current and future directions for hospital and physician reimbursement. Effect on the academic medical center.

    PubMed

    Petersdorf, R G

    1985-05-01

    Profound changes are occurring in the health care system, including a surfeit of physicians, cost containment, and competition. This article addresses the effects of these changes on the academic medical center. It recommends that the faculty of the future will be of two types--clinician-teachers and researcher-teachers--and outlines the qualifications of these faculties. It recommends a proper reward system for clinician-teachers, the reintroduction of part-time faculties, and careful retrenchment in medical school class size and house staff. It calls for teaching hospitals to improve their physical plants and control costs by phasing out programs that are not cost-effective. Universities should consider divesting themselves of university-owned teaching hospitals. Most importantly, local, state, and federal governments and the public must develop a more supportive attitude toward the needs of medical education.

  15. Key Elements of Clinical Physician Leadership at an Academic Medical Center

    PubMed Central

    Dine, C. Jessica; Kahn, Jeremy M; Abella, Benjamin S; Asch, David A; Shea, Judy A

    2011-01-01

    Background A considerable body of literature in the management sciences has defined leadership and how leadership skills can be attained. There is considerably less literature about leadership within medical settings. Physicians-in-training are frequently placed in leadership positions ranging from running a clinical team or overseeing a resuscitation effort. However, physicians-in-training rarely receive such training. The objective of this study was to discover characteristics associated with effective physician leadership at an academic medical center for future development of such training. Methods We conducted focus groups with medical professionals (attending physicians, residents, and nurses) at an academic medical center. The focus group discussion script was designed to elicit participants' perceptions of qualities necessary for physician leadership. The lead question asked participants to imagine a scenario in which they either acted as or observed a physician leader. Two independent reviewers reviewed transcripts to identify key domains of physician leadership. Results Although the context was not specified, the focus group participants discussed leadership in the context of a clinical team. They identified 4 important themes: management of the team, establishing a vision, communication, and personal attributes. Conclusions Physician leadership exists in clinical settings. This study highlights the elements essential to that leadership. Understanding the physician attributes and behaviors that result in effective leadership and teamwork can lay the groundwork for more formal leadership education for physicians-in-training. PMID:22379520

  16. Luxury Primary Care, Academic Medical Centers, and the Erosion of Science and Professional Ethics

    PubMed Central

    Donohoe, Martin

    2004-01-01

    Medical schools and teaching hospitals have been hit particularly hard by the financial crisis affecting health care in the United States. To compete financially, many academic medical centers have recruited wealthy foreign patients and established luxury primary care clinics. At these clinics, patients are offered tests supported by little evidence of their clinical and/or cost effectiveness, which erodes the scientific underpinnings of medical practice. Given widespread disparities in health, wealth, and access to care, as well as growing cynicism and dissatisfaction with medicine among trainees, the promotion by these institutions of an overt, two-tiered system of care, which exacerbates inequities and injustice, erodes professional ethics. Academic medical centers should divert their intellectual and financial resources away from luxury primary care and toward more equitable and just programs designed to promote individual, community, and global health. The public and its legislators should, in turn, provide adequate funds to enable this. Ways for academic medicine to facilitate this largesse are discussed. PMID:14748866

  17. Parental Perceptions of Family Centered Care in Medical Homes of Children with Neurodevelopmental Disabilities.

    PubMed

    Zajicek-Farber, Michaela L; Lotrecchiano, Gaetano R; Long, Toby M; Farber, Jon Matthew

    2015-08-01

    Life course theory sets the framework for strong inclusion of family centered care (FCC) in quality medical homes of children with neurodevelopmental disabilities (CNDD). The purpose of this study was to explore the perceptions of families with their experiences of FCC in medical homes for CNDD. Using a structured questionnaire, the Family-Centered Care Self-Assessment Tool developed by Family Voices, this study surveyed 122 parents of CNDD in a large urban area during 2010-2012. Data collected information on FCC in the provision of primary health care services for CNDD and focused on family-provider partnerships, care setting practices and policies, and community services. Frequency analysis classified participants' responses as strengths in the "most of the time" range, and weaknesses in the "never" range. Only 31 % of parents were satisfied with the primary health care their CNDD received. Based on an accepted definition of medical home services, 16 % of parents reported their CNDD had most aspects of a medical home, 64 % had some, and 20 % had none. Strengths in FCC were primarily evident in the family-provider partnership and care settings when focused on meeting the medical care needs of the child. Weaknesses in FCC were noted in meeting the needs of families, coordination, follow-up, and support with community resources. Improvements in key pediatric health care strategies for CNDD are recommended. CNDD and their families have multifaceted needs that require strong partnerships among parents, providers, and communities. Quality medical homes must include FCC and valued partnerships with diverse families and community-based providers.

  18. Neurosurgery at All India Institute of Medical Sciences, a center of excellence: A success story.

    PubMed

    Singh, Manmohan; Sawarkar, Dattaraj; Sharma, Bhawani S

    2015-01-01

    The department of neurosurgery at All India Institute of Medical Sciences (AIIMS) started its humble beginning in 1965. With the untiring and selfless hard work of Prof. P N Tandon and Prof. A K Banerji, the department progressed over time to become a center of excellence in the subcontinent. To establish a neurosciences center at AIIMS was an uphill task, which was accomplished with great efforts. The department has established itself as one of the highest centers of learning in the country with its vast infrastructure and diversity in all fields of neurosurgery. AIIMS, New Delhi was established by an act of the parliament in 1956. It was started with a grant from the Government of New Zealand under the "Colombo Plan." It was the vision of Rajkumari Amrita Kaur, the first Health Minister of India, that led to the establishment of a medical institute of international repute in India. AIIMS, New Delhi is an autonomous institute and is governed by the AIIMS Act, 1956. The department of neurosurgery at AIIMS was started in March 1965 with Prof. P.N. Tandon as the Head of the Department. Prof. A.K. Banerji joined him a few months later. The Department celebrated its golden jubilee in the year 2015, and has tremendously grown in stature from its humble beginnings to being a center of excellence with world-wide recognition. PMID:26238896

  19. Neurosurgery at All India Institute of Medical Sciences, a center of excellence: A success story.

    PubMed

    Singh, Manmohan; Sawarkar, Dattaraj; Sharma, Bhawani S

    2015-01-01

    The department of neurosurgery at All India Institute of Medical Sciences (AIIMS) started its humble beginning in 1965. With the untiring and selfless hard work of Prof. P N Tandon and Prof. A K Banerji, the department progressed over time to become a center of excellence in the subcontinent. To establish a neurosciences center at AIIMS was an uphill task, which was accomplished with great efforts. The department has established itself as one of the highest centers of learning in the country with its vast infrastructure and diversity in all fields of neurosurgery. AIIMS, New Delhi was established by an act of the parliament in 1956. It was started with a grant from the Government of New Zealand under the "Colombo Plan." It was the vision of Rajkumari Amrita Kaur, the first Health Minister of India, that led to the establishment of a medical institute of international repute in India. AIIMS, New Delhi is an autonomous institute and is governed by the AIIMS Act, 1956. The department of neurosurgery at AIIMS was started in March 1965 with Prof. P.N. Tandon as the Head of the Department. Prof. A.K. Banerji joined him a few months later. The Department celebrated its golden jubilee in the year 2015, and has tremendously grown in stature from its humble beginnings to being a center of excellence with world-wide recognition.

  20. Strom Thurmond Biomedical Research Center at the Medical Univesity for South Carolina Charleston, South Carolina

    SciTech Connect

    Not Available

    1994-02-01

    The Department of Energy (DOE) has prepared an Environmental Assessment (EA) evaluating the proposed construction and operation of the Strom Thurmond Biomedical Research Center (Center) at the Medical University of South Carolina (MUSC), Charleston, SC. The DOE is evaluating a grant proposal to authorize the MUSC to construct, equip and operate the lower two floors of the proposed nine-story Center as an expansion of on-going clinical research and out-patient diagnostic activities of the Cardiology Division of the existing Gazes Cardiac Research Institute. Based on the analysis in the EA, the DOE has determined that the proposed action does not constitute a major federal action significantly affecting the quality of the human environment within the meaning of the NEPA. Therefore, the preparation of an Environmental Impact Statement is not required.

  1. Analysis of 10-Year Training Results of Medical Students Using the Microvascular Research Center Training Program.

    PubMed

    Onoda, Satoshi; Kimata, Yoshihiro; Sugiyama, Narushi; Tokuyama, Eijiro; Matsumoto, Kumiko; Ota, Tomoyuki; Thuzar, Moe

    2016-06-01

    Background In this article, we reviewed the training results of medical students using the Microvascular Research Center Training Program (MRCP), and proposed an ideal microsurgical training program for all individuals by analyzing the training results of medical students who did not have any surgical experience. Methods As of 2015, a total of 29 medical students completed the MRCP. In the most recent 12 medical students, the number of trials performed for each training stage and the number of rats needed to complete the training were recorded. Additionally, we measured the operating time upon finishing stage 5 for the recent six medical students after it became a current program. Results The average operating time upon finishing stage 5 for the recent six medical students was 120 minutes ± 11 minutes (standard deviation [SD]). The average vascular anastomosis time (for the artery and vein) was 52 minutes ± 2 minutes (SD). For the most recent 12 medical students, there was a negative correlation between the number of trials performed in the non-rat stages (stages 1-3) and the number of rats used in the rat stages (stages 4-5). Conclusion Analysis of the training results of medical students suggests that performing microsurgery first on silicon tubes and chicken wings saves animals' lives later during the training program. We believe that any person can learn the technique of microsurgery by performing 7 to 8 hours of training per day over a period of 15 days within this program setting.

  2. Albany-Laramie Counties Health Manpower and Education Profile.

    ERIC Educational Resources Information Center

    Callen, John; And Others

    The profile is a concise description of the demographic and economic characteristics, existing health manpower employed, and health education programs for the Albany-Laramie Counties area of Wyoming, one of seven surveyed in the Mountain States region (Idaho, Montana, Wyoming, and Nevada). The first section of the profile provides general…

  3. 75 FR 66750 - Albany-Eugene Transmission Line Rebuild Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-29

    ...:30 p.m. to 7 p.m. at Harrisburg High School, 400 South 9th Street, Harrisburg, Oregon 97446. On November 17, 2010, a scoping meeting will held from 4:30 p.m. to 7 p.m. at the Albany Public Library,...

  4. Transfer Guides: University at Albany, State University of New York.

    ERIC Educational Resources Information Center

    Foti, Patrick A.

    The State University of New York (SUNY) at Albany has worked with the state's community colleges to develop guides for community college students to identify programs and patterns of study which maximize the transfer of credit from the community college courses toward specific SUNY academic programs. This collection of 11 documents provides the…

  5. Overview of Seal Development at Albany International Techniweave

    NASA Astrophysics Data System (ADS)

    Bond, Bruce

    2002-10-01

    This paper presents a general overview of seal development at Albany International Techniweave. The contents include: 1) The Ideal High Temperature Seal; 2) Reality of State of the Art Rope Seals; 3) Hybrid Rope Seal; 4) Current Applications; 5) Common Configurations; 6) Leakage Testing; 7) Test Apparatus; 8) Seal Leakage Fixture; 9) Groove Dimensions; 10) Leakage Data (SCFM/FT); and 11) New work.

  6. 77 FR 35366 - Albany-Eugene Transmission Line Rebuild Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-13

    ... Administration (BPA), Department of Energy (DOE). ACTION: Notice of Availability of Record of Decision (ROD..., based on the Albany-Eugene Transmission Line Rebuild Project (DOE/EIS-0457, March 2012). BPA has decided... will continue to operate at 115 kV. ADDRESSES: Copies of the ROD and EIS may be obtained by calling...

  7. Implementing a patient centered medical home in the Veterans health administration: Perspectives of primary care providers.

    PubMed

    Solimeo, Samantha L; Stewart, Kenda R; Stewart, Gregory L; Rosenthal, Gary

    2014-12-01

    Implementation of a patient centered medical home challenges primary care providers to change their scheduling practices to enhance patient access to care as well as to learn how to use performance metrics as part of a self-reflective practice redesign culture. As medical homes become more commonplace, health care administrators and primary care providers alike are eager to identify barriers to implementation. The objective of this study was to identify non-technological barriers to medical home implementation from the perspective of primary care providers. We conducted qualitative interviews with providers implementing the medical home model in Department of Veterans Affairs clinics-the most comprehensive rollout to date. Primary care providers reported favorable attitudes towards the model but discussed the importance of data infrastructure for practice redesign and panel management. Respondents emphasized the need for administrative leadership to support practice redesign by facilitating time for panel management and recognizing providers who utilize non-face-to-face ways of delivering clinical care. Health care systems considering adoption of the medical home model should ensure that they support both technological capacities and vertically aligned expectations for provider performance. PMID:26250631

  8. Multimedia-based courseware in the Virtual Learning Center at the Hannover Medical School.

    PubMed

    Matthies, H K; von Jan, U; Porth, A J; Tatagiba, M; Stan, A C; Walter, G F

    2000-01-01

    The commercial use of the World Wide Web causes an extensive change in information technology. Web browser are becoming the universal front-end for all kinds of client-server applications. The possibilities of telematics offer a base for multimedia applications, for instance telelearning. Learning is not limited by geography and does not cause pressure of time by the user. The development of such multimedia information and communication systems demands cooperative working teams of authors, who are able to master several areas of medical knowledge as well as the presentation of these using different multimedia facilities. A very important part of graphic design in the context of multimedia applications is the creation and interactive use of images (still, moving). The growth and the complexity of medical knowledge as well as the need for continuous, fast, and economically feasible maintenance impose requirements on the media used for medical education and training. Web-based courseware in the Virtual Learning Center at the Hannover Medical School is an innovative education resource for medical students and professionals. PMID:11187611

  9. Contingency Operations Support to NASA Johnson Space Center Medical Operations Division

    NASA Technical Reports Server (NTRS)

    Stepaniak, Philip; Patlach, Bob; Swann, Mark; Adams, Adrien

    2005-01-01

    The Wyle Laboratories Contingency Operations Group provides support to the NASA Johnson Space Center (JSC) Medical Operations Division in the event of a space flight vehicle accident or JSC mishap. Support includes development of Emergency Medical System (EMS) requirements, procedures, training briefings and real-time support of mishap investigations. The Contingency Operations Group is compliant with NASA documentation that provides guidance in these areas and maintains contact with the United States Department of Defense (DOD) to remain current on military plans to support NASA. The contingency group also participates in Space Operations Medical Support Training Courses (SOMSTC) and represents the NASA JSC Medical Operations Division at contingency exercises conducted worldwide by the DOD or NASA. The events of September 11, 2001 have changed how this country prepares and protects itself from possible terrorist attacks on high-profile targets. As a result, JSC is now considered a high-profile target and thus, must prepare for and develop a response to a Weapons of Mass Destruction (WMD) incident. The Wyle Laboratories Contingency Operations Group supports this plan, specifically the medical response, by providing expertise and manpower.

  10. A comparison of assertive community treatment fidelity measures and patient-centered medical home standards.

    PubMed

    Vanderlip, Erik R; Cerimele, Joseph M; Monroe-Devita, Maria

    2013-11-01

    OBJECTIVE This study compared program measures of assertive community treatment (ACT) with standards of accreditation for the patient-centered medical home (PCMH) to determine whether there were similarities in the infrastructure of the two methods of service delivery and whether high-fidelity ACT teams would qualify for medical home accreditation. METHODS The authors compared National Committee for Quality Assurance PCMH standards with two ACT fidelity measures (the Dartmouth Assertive Community Treatment Scale and the Tool for Measurement of Assertive Community Treatment [TMACT]) and with national ACT program standards. RESULTS PCMH standards pertaining to enhanced access and continuity, management of care, and self-care support demonstrated strong overlap across ACT measures. Standards for identification and management of populations, care coordination and follow-up, and quality improvement demonstrated less overlap. The TMACT and the program standards had sufficient overlap to score in the range of a level 1 PCMH, but no ACT measure sufficiently detailed methods of population-based screening and tracking of referrals to satisfy "must-pass" elements of the standards. CONCLUSIONS ACT measures and medical home standards had significant overlap in innate infrastructure. ACT teams following the program standards or undergoing TMACT fidelity review could have the necessary infrastructure to serve as medical homes if they were properly equipped to supervise general medical care and administer activities to improve management of chronic diseases.

  11. How Strong Is the Primary Care Safety Net? Assessing the Ability of Federally Qualified Health Centers to Serve as Patient-Centered Medical Homes.

    PubMed

    Ryan, Jamie; Riley, Pamela; Abrams, Melinda; Nocon, Robert

    2015-09-01

    By expanding access to affordable insurance coverage for millions of Americans, the Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), which provide an important source of care in low-income communities. A pair of Commonwealth Fund surveys asked health center leaders about their ability to function as medical homes. Survey findings show that between 2009 and 2013, the percentage of centers exhibiting medium or high levels of medical home capability almost doubled, from 32 percent to 62 percent. The greatest improvement was reported in patient tracking and care management. Despite this increased capability, health centers reported diminished ability to coordinate care with providers outside of the practice, particularly specialists. Ongoing federal funding and technical support for medical home transformation will be needed to ensure that FQHCs can fulfill their mission of providing high-quality, comprehensive care to low-income and minority populations. PMID:26372972

  12. 77 FR 63290 - Foreign-Trade Zone 121-Albany, NY; Notification of Proposed Production Activity; Albany Molecular...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-16

    ... Rensselaer, New York, (Board Order 698, 7/20/1994, 59 FR 18318, 7/28/1994). AMRI is now requesting to produce...; Albany Molecular Research, Inc., Subzone 121A, (Pharmaceutical Chemicals Production), Rensselaer, NY... originally approved by the Board in 1994 for the production of bulk pharmaceutical chemicals...

  13. [Bioethics in medical institutions--new custom or help? The example of clinical ethics consultation at a University Medical Center].

    PubMed

    Richter, G

    2014-08-01

    Although ethics committees are well established in the medical sciences for human clinical trials, animal research and scientific integrity, the development of clinical ethics in German hospitals started much later during the first decade of the twenty-first century. Clinical ethics consultation should be pragmatic and problem-centered and can be defined as an ethically qualified and informed conflict management within a given legal framework to deal with and resolve value-driven, normative problems in the care of patients. Clinical ethics consultations enable shared clinical decision-making of all parties (e.g. clinicians, patients, family and surrogates) involved in a particular patient's care. The clinical ethicist does not act as an ethics expert by making independent recommendations or decisions; therefore, the focus is different from other medical consultants. Ethics consultation was first established by healthcare ethics committees (HEC) or clinical ethics consultation (CEC) groups which were called in to respond to an ethically problematic situation. To avoid ethical dilemmas or crises and to act preventively with regard to ethical issues in individual patients, an ethics liaison service is an additional option to ethics case consultations which take place on a regular basis by scheduled ethics rounds during the normal ward rounds. The presence of the ethicist offers some unique advantages: it allows early recognition of even minor ethical problems and accommodates the dynamics of ethical and clinical goal-setting in the course of patient care. Most importantly, regular and non-authoritative participation of the ethicist in normal ward rounds allows continuous ethical education of the staff within the everyday clinical routine. By facilitating clinical ethical decision-making, the ethicist seeks to empower physicians and medical staff to deal appropriately with ethical problems by themselves. Because of this proactive approach, the ethics liaison service

  14. Finding Common Ground: Interprofessional Collaborative Practice Competencies in Patient-Centered Medical Homes.

    PubMed

    Swihart, Diana

    2016-01-01

    The patient-centered medical home model is predicated on interprofessional collaborative practice and team-based care. While information on the roles of various providers is increasingly woven into the literature, the competencies of those providers have been generally profession-specific. In 2011, the Interprofessional Education Collaborative comprising the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Dental Education Association, the Association of American Medical Colleges, and the Association of Schools of Public Health sponsored an expert panel of their members to identify and develop 4 domains of core competencies needed for a successful interprofessional collaborative practice: (1) Values/Ethics for Interprofessional Practice; (2) Roles/Responsibilities; (3) Interprofessional Communication; and (4) Teams and Teamwork. Their findings and recommendations were recorded in their Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. This article explores these 4 domains and how they provide common ground for team-based care within the context of the medical home model approach to patient-centered primary care. PMID:26938181

  15. Preparing an Academic Medical Center to Manage Patients Infected With Ebola: Experiences of a University Hospital.

    PubMed

    Schultz, Carl H; Koenig, Kristi L; Alassaf, Wajdan

    2015-10-01

    As Ebola has spread beyond West Africa, the challenges confronting health care systems with no experience in managing such patients are enormous. Not only is Ebola a significant threat to a population's health, it can infect the medical personnel trying to treat it. As such, it represents a major challenge to those in public health, emergency medical services (EMS), and acute care hospitals. Our academic medical center volunteered to become an Ebola Treatment Center as part of the US effort to manage the threat. We developed detailed policies and procedures for Ebola patient management at our university hospital. Both the EMS system and county public health made significant contributions during the development process. This article shares information about this process and the outcomes to inform other institutions facing similar challenges of preparing for an emerging threat with limited resources. The discussion includes information about management of (1) patients who arrive by ambulance with prior notification, (2) spontaneous walk-in patients, and (3) patients with confirmed Ebola who are interfacility transfers. Hospital management includes information about Ebola screening procedures, personal protective equipment selection and personnel training, erection of a tent outside the main facility, establishing an Ebola treatment unit inside the facility, and infectious waste and equipment management. Finally, several health policy considerations are presented. PMID:26403515

  16. The patient-centered medical home: an ethical analysis of principles and practice.

    PubMed

    Braddock, Clarence H; Snyder, Lois; Neubauer, Richard L; Fischer, Gary S

    2013-01-01

    The patient-centered medical home (PCMH), with its focus on patient-centered care, holds promise as a way to reinvigorate the primary care of patients and as a necessary component of health care reform. While its tenets have been the subject of review, the ethical dimensions of the PCMH have not been fully explored. Consideration of the ethical foundations for the core principles of the PCMH can and should be part of the debate concerning its merits. The PCMH can align with the principles of medical ethics and potentially strengthen the patient-physician relationship and aspects of health care that patients value. Patient choice and these ethical considerations are central and at least as important as the economic and practical arguments in support of the PCMH, if not more so. Further, the ethical principles that support key concepts of the PCMH have implications for the design and implementation of the PCMH. This paper explores the PCMH in light of core principles of ethics and professionalism, with an emphasis both on how the concept of the PCMH may reinforce core ethical principles of medical practice and on further implications of these principles.

  17. Preparing an Academic Medical Center to Manage Patients Infected With Ebola: Experiences of a University Hospital.

    PubMed

    Schultz, Carl H; Koenig, Kristi L; Alassaf, Wajdan

    2015-10-01

    As Ebola has spread beyond West Africa, the challenges confronting health care systems with no experience in managing such patients are enormous. Not only is Ebola a significant threat to a population's health, it can infect the medical personnel trying to treat it. As such, it represents a major challenge to those in public health, emergency medical services (EMS), and acute care hospitals. Our academic medical center volunteered to become an Ebola Treatment Center as part of the US effort to manage the threat. We developed detailed policies and procedures for Ebola patient management at our university hospital. Both the EMS system and county public health made significant contributions during the development process. This article shares information about this process and the outcomes to inform other institutions facing similar challenges of preparing for an emerging threat with limited resources. The discussion includes information about management of (1) patients who arrive by ambulance with prior notification, (2) spontaneous walk-in patients, and (3) patients with confirmed Ebola who are interfacility transfers. Hospital management includes information about Ebola screening procedures, personal protective equipment selection and personnel training, erection of a tent outside the main facility, establishing an Ebola treatment unit inside the facility, and infectious waste and equipment management. Finally, several health policy considerations are presented.

  18. Recognition as a Patient-Centered Medical Home: Fundamental or Incidental?

    PubMed Central

    Dohan, Daniel; McCuistion, Mary Honodel; Frosch, Dominick L.; Hung, Dorothy Y.; Tai-Seale, Ming

    2013-01-01

    PURPOSE Little is known about reasons why a medical group would seek recognition as a patient-centered medical home (PCMH). We examined the motivations for seeking recognition in one group and assessed why the group allowed recognition to lapse 3 years later. METHODS As part of a larger mixed methods case study, we conducted 38 key informant interviews with executives, clinicians, and front-line staff. Interviews were conducted according to a guide that evolved during the project and were audio-recorded and fully transcribed. Transcripts were analyzed and thematically coded. RESULTS PCMH principles were consistent with the organization’s culture and mission, which valued innovation and putting patients first. Motivations for implementing specific PCMH components varied; some components were seen as part of the organization’s patient-centered culture, whereas others helped the practice compete in its local market. Informants consistently reported that National Committee for Quality Assurance recognition arose incidentally because of a 1-time incentive from a local group of large employers and because the organization decided to allocate some organizational resources to respond to the complex reporting requirements for about one-half of its clinics. CONCLUSIONS Becoming patient centered and seeking recognition as such ran along separate but parallel tracks within this organization. As the Affordable Care Act continues to focus attention on primary care redesign, this apparent disconnect should be borne in mind. PMID:23690381

  19. Late diagnosis of HIV infection at two academic medical centers: 1994-2004.

    PubMed

    Jean-Jacques, M; Walensky, R P; Aaronson, W H; Chang, Y; Freedberg, K A

    2008-09-01

    Over the last decade, there has been increased attention to the role of earlier HIV testing in the United States. Our objective was to determine if this has translated into changes in the proportion of inpatients with advanced disease at the time of initial HIV diagnosis. We identified inpatients discharged with a new diagnosis of HIV infection or AIDS between 1994 and 2004 at two academic medical centers. We examined trends in initial CD4 count at diagnosis over three time periods: 1994-1996, 1997-2000 and 2001-2004. Between 1994 and 2004, 235 inpatients were newly diagnosed with HIV infection or AIDS in the two centers. For the 217 patients with available CD4 count data, the median initial CD4 count was 41/microl (interquartile range 19-138/microl). Of the 217 patients, 184(85%) had CD4 < or =200/microl and 119/217 (55%) had CD4 < or =50/microl. There were no significant differences in median CD4 count by time period. A large majority of inpatients with newly diagnosed HIV infection at two academic medical centers between 1994 and 2004 had signs of advanced immunodeficiency. Over this recent 11-year period there was no evidence that inpatients with a new HIV diagnosis were identified at earlier stages of disease.

  20. Dialysis vascular access management by interventional nephrology programs at University Medical Centers in the United States.

    PubMed

    Vachharajani, Tushar J; Moossavi, Shahriar; Salman, Loay; Wu, Steven; Dwyer, Amy C; Ross, Jamie; Dukkipati, Ramanath; Maya, Ivan D; Yevzlin, Alexander S; Agarwal, Anil; Abreo, Kenneth D; Work, Jack; Asif, Arif

    2011-01-01

    The development of interventional nephrology has undoubtedly led to an improvement in patient care at many facilities across the United States. However, these services have traditionally been offered by interventional nephrologists in the private practice arena. While interventional nephrology was born in the private practice setting, several academic medical centers across the United States have now developed interventional nephrology programs. University Medical Centers (UMCs) that offer interventional nephrology face challenges, such as smaller dialysis populations, limited financial resources, and real or perceived political "turf" issues." Despite these hurdles, several UMCs have successfully established interventional nephrology as an intricate part of a larger nephrology program. This has largely been accomplished by consolidating available resources and collaborating with other specialties irrespective of the size of the dialysis population. The collaboration with other specialties also offers an opportunity to perform advanced procedures, such as application of excimer laser and endovascular ultrasound. As more UMCs establish interventional nephrology programs, opportunities for developing standardized training centers will improve, resulting in better quality and availability of nephrology-related procedures, and providing an impetus for research activities. PMID:21999740

  1. Energy survey of Eisenhower Army Medical Center, Fort Gordon, Augusta, Georgia. Volume 2. Appendices. Final report

    SciTech Connect

    1996-12-23

    1.1 Perform a complete energy audit of the entire Army Medical Center`s (AMC) heating and cooling systems, lighting system, and other systems and areas as indicated in Annex A. 1.2 Perform a comprehensive analysis of all data collected during the audit. 1.3 Identify all Energy Conservation Opportunities (ECO`s) including low cost/no cost ECO`s and perform complete evaluations of each. Energy equipment replacement projects already underway, approved, or planned by the Medical Center staff will be factored into the evaluations. 1.4 Prepare programming documentation for all Federal Energy Management Program (FEMP) and/or Energy Conservation Improvement Program (ECIP) projects. 1.5 Prepare implementation documentation and instructions for those projects recommended for accomplishment by local forces. 1.6 List and prioritize all recommended ECO`s. 1.7 Prepare a comprehensive report which will docwnent the work accomplished, the results of the field investigation and engineering analysis, the conclusions, and recommendations.

  2. Improving pain management practice. A medical center moves beyond education to document and manage patient care.

    PubMed

    Super, A

    1996-01-01

    In 1993 nurses at Providence/ Portland Medical Center, Portland, OR, initiated a quality improvement project to assess pain levels in the facility's inpatients. A convenience sample in April 1993 showed an average pain intensity of 6.30 on a 0-10 scale (where O equals no pain and 10 is the worst pain imaginable). With the nursing administrator's support, pain management nurses presented a four-hour course in the basics of pain assessment and intervention to more than 850 nurses and 100 other professionals. In August 1993 nurses found that the intensity of patient pain had dropped to 5.70 on the 0-10 scale. Still dissatisfied with this situation, the nurses proceeded with a three-pronged approach to improve the medical center's quality of pain management: making the problem visible by better documentation and communication about pain; making an institutional commitment to pain management, including establishing pain management quality improvement as the medical center's first patient outcome institutional objective; eliciting the endorsement of influential committees. In August 1994 a random sample revealed patient pain had decreased to 3.21. The next step focused on empowering patients and families through education (e.g., revising the booklet on patient rights and responsibilities, posting signs in rooms encouraging patients to report pain) and clearing up myths and misconceptions through inservices and posters. A sampling in November 1995 showed that the average pain intensity of inpatients had been reduced to 2.32. Plans for continuous quality improvement interventions will further enhance patient comfort and recovery. PMID:10159177

  3. Putting patients first: a novel patient-centered model for medical enterprise success.

    PubMed

    Dhawan, Naveen

    2014-01-01

    This article introduces a new way of viewing patient-customers. It encourages a greater emphasis on patients' needs and the importance of considering dimensions of the patient experience to better serve them. It also draws from examples in the general business world as they can be applied to medical enterprises. The author introduces a model that directs all business activities toward the end consumer with an underlying guidance by patient needs. A business is advised to understand its customer, design a patient-directed vision, and focus on creating a unique customer experience. The article delineates key action items for physicians and administrators that will allow them to better meet their patient-customers' needs and develop loyalty. By practicing a patient-centered approach and following these guidelines, one may ensure greater success of the medical enterprise. PMID:25108980

  4. Development of a Comprehensive Surgical Information System at Madigan Army Medical Center.

    PubMed

    Westbrook, M L; Dunn, S E; Wilcox-Riggs, S

    1996-03-01

    The Operative Registry (DA Form 4108) has been the information source for surgical data supporting quality assurance and utilization review efforts at Madigan Army Medical Center. Recently, Madigan's requirements for data and reporting changed. Like other government medical facilities, Madigan began pervasive quality-improvement efforts. This resulted in new ideas to measure hospital performance. Consequently, requirements for surgical data required to support quality and resource management reporting, utilization review, residency review reporting, research and credentialing changed. This article details Madigan's approach to addressing these requirements via development of a comprehensive computing solution. It discusses Madigan's fragmented data environment before system development, and gives the reader perspective on the decision-making process that led to system development rather than purchasing a commercial product. Finally, the article describes how a strong partnership between staff and developers was key to providing a solution that exceeded established goals.

  5. 38 CFR 17.351 - Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Philippines § 17.351 Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center. Grants to assist the Republic of the Philippines in the replacement and upgrading of equipment and...

  6. 38 CFR 17.351 - Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Philippines § 17.351 Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center. Grants to assist the Republic of the Philippines in the replacement and upgrading of equipment and...

  7. 38 CFR 17.351 - Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Philippines § 17.351 Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center. Grants to assist the Republic of the Philippines in the replacement and upgrading of equipment and...

  8. 38 CFR 17.351 - Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Philippines § 17.351 Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center. Grants to assist the Republic of the Philippines in the replacement and upgrading of equipment and...

  9. 38 CFR 17.351 - Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Philippines § 17.351 Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center. Grants to assist the Republic of the Philippines in the replacement and upgrading of equipment and...

  10. The Citizen Health System (CHS): a modular medical contact center providing quality telemedicine services.

    PubMed

    Maglaveras, Nicos; Chouvarda, Ioanna; Koutkias, Vassilis G; Gogou, George; Lekka, Irini; Goulis, Dimitrios; Avramidis, Avram; Karvounis, Charalambos; Louridas, George; Balas, E Andrew

    2005-09-01

    In the context of the Citizen Health System (CHS) project, a modular Medical Contact Center (MCC) was developed, which can be used in the monitoring, treatment, and management of chronically ill patients at home, such as diabetic or congestive heart failure patients. The virtue of the CHS contact center is that, using any type of communication and telematics technology, it is able to provide timely and preventive prompting to the patients, thus, achieving better disease management. In this paper, we present the structure of the CHS system, describing the modules that enable its flexible and extensible architecture. It is shown, through specific examples, how quality of healthcare delivery can be increased by using such a system. PMID:16167689

  11. Medical Image Resource Center--making electronic teaching files from PACS.

    PubMed

    Lim, C C Tchoyoson; Yang, Guo Liang; Nowinski, Wieslaw L; Hui, Francis

    2003-12-01

    A picture archive and communications system (PACS) is a rich source of images and data suitable for creating electronic teaching files (ETF). However, the potential for PACS to support nonclinical applications has not been fully realized: at present there is no mechanism for PACS to identify and store teaching files; neither is there a standardized method for sharing such teaching images. The Medical Image Resource Center (MIRC) is a new central image repository that defines standards for data exchange among different centers. We developed an ETF server that retrieves digital imaging and communication in medicine (DICOM) images from PACS, and enables users to create teaching files that conform to the new MIRC schema. We test-populated our ETF server with illustrative images from the clinical case load of the National Neuroscience Institute, Singapore. Together, PACS and MIRC have the potential to benefit radiology teaching and research.

  12. Medical Image Resource Center--making electronic teaching files from PACS.

    PubMed

    Lim, C C Tchoyoson; Yang, Guo Liang; Nowinski, Wieslaw L; Hui, Francis

    2003-12-01

    A picture archive and communications system (PACS) is a rich source of images and data suitable for creating electronic teaching files (ETF). However, the potential for PACS to support nonclinical applications has not been fully realized: at present there is no mechanism for PACS to identify and store teaching files; neither is there a standardized method for sharing such teaching images. The Medical Image Resource Center (MIRC) is a new central image repository that defines standards for data exchange among different centers. We developed an ETF server that retrieves digital imaging and communication in medicine (DICOM) images from PACS, and enables users to create teaching files that conform to the new MIRC schema. We test-populated our ETF server with illustrative images from the clinical case load of the National Neuroscience Institute, Singapore. Together, PACS and MIRC have the potential to benefit radiology teaching and research. PMID:14747933

  13. Medical versus nonmedical mental health referral: clinical decision-making by telephone access center staff.

    PubMed

    Pulier, Myron L; Ciccone, Donald S; Castellano, Cherie; Marcus, Karen; Schleifer, Steven J

    2003-01-01

    A database review investigated decisions of clinicians staffing a university-based telephone access center in referring new adult patients to nonpsychiatrists versus psychiatrists for initial ambulatory behavioral health care appointments. Systematically collected demographic and clinical data in a computer log of calls to highly trained care managers at the access center had limited predictive value with respect to their referral decisions. Furthermore, while 28% of the 610 study patients were initially referred to psychiatrists, billing data revealed that in-person therapists soon cross-referred at least 20% more to a psychiatrist. Care managers sent 56% of callers already taking psychotropic medications to nonpsychiatrists, 51% of whom were then cross-referred to psychiatrists. Predictive algorithms showed no potential to enhance efficiency of decisions about referral to a psychiatrist versus a nonpsychiatrist. Efforts to enhance such efficiency may not be cost-effective. It may be more fiscally efficient to assign less-experienced personnel as telephone care managers.

  14. Academic Season Does Not Influence Cardiac Surgical Outcomes at United States Academic Medical Centers

    PubMed Central

    LaPar, Damien J.; Bhamidipati, Castigliano M.; Mery, Carlos M.; Stukenborg, George J.; Lau, Christine L.; Kron, Irving L.; Ailawadi, Gorav

    2011-01-01

    Objectives Previous studies have demonstrated the influence of academic season on outcomes in select surgical populations. However, the influence of academic season has not been evaluated nationwide in cardiac surgery. We hypothesized that cardiac surgical outcomes were not significantly influenced by time of year at both cardiothoracic teaching hospitals (TH) and non-cardiothoracic teaching hospitals (NTH) nationwide. Methods From 2003–2007, a weighted 1,614,394 cardiac operations were evaluated using the Nationwide Inpatient Sample (NIS) database. Patients undergoing cardiac operations at TH and NTH were identified using the Association of American Medical College’s Graduate Medical Education Tracking System. Hierarchical multivariable logistic regression analyses were utilized to estimate the effect of academic quarter on risk-adjusted outcomes. Results Mean patient age was 65.9±10.9 years. Females accounted for 32.8% of patients. Isolated coronary artery bypass grafting was the most common operation performed (64.7%) followed by isolated valve replacement (19.3%). The overall incidence of operative mortality and composite postoperative complication rate was 2.9% and 27.9%, respectively. After accounting for potentially confounding risk factors, timing of operation by academic quarter did not independently increase risk-adjusted mortality (p=0.12) or morbidity (p=0.24) at academic medical centers. Conclusions Risk-adjusted mortality and morbidity for cardiac operations are not associated with time of year in the United States at teaching and non-teaching hospitals. Patients should be reassured of the safety of performance of cardiac operations at academic medical centers throughout a given academic year. PMID:21481616

  15. Prevalence of the microbiologic flora in contact lens wearers at the Puerto Rico Medical Center.

    PubMed

    Izquierdo, N; Díaz Mendoza, S; Townsend, W; Carro, J

    1991-03-01

    The prevalence of microbioogic flora was determined in a convenience sample of contact lens wearers at the Puerto Rico Medical Center, ophthalmology clinics obtaining cultures from the conjunctival fornices. Gram positive bacterial prevalence was 100% in the control group, as well as in rigid gas permeable lens wearers. In the soft contact lens group, gram positive bacterial prevalence was 94.7%. On the other hand prevalence of Gram negative bacteria is null in the soft contact lens wearer population, being only 2.5% in control group, and 45.5% for Rigid Gas Permeable wearers. These contact lens wearers were using different disinfection systems. PMID:1854385

  16. One approach to care for patients infected with human immunodeficiency virus in an academic medical center.

    PubMed Central

    Jacobs, J. L.; Damson, L. C.; Rogers, D. E.

    1996-01-01

    The human immunodeficiency virus (HIV) epidemic poses unprecedented challenges to the health-care system. Caregivers must contend both with the complicated clinical syndromes associated with HIV infection and with issues that are central to the epidemic, such as discrimination, isolation, poverty, and substance abuse. Our HIV treatment program combines and enhances the resources of an academic medical center in a multidisciplinary care model. All patients, regardless of payor class, are offered services from 10 different disciplines. The same team of clinicians follows patients in the clinic and hospital. The program is flexible, non-hierarchical, and open to community participation. This approach may be a useful model for other institutions. PMID:8982523

  17. A "how to" guide to creating a patient-centered medical home.

    PubMed

    Valko, George; Wender, Richard C; Zawora, Michele Q

    2012-06-01

    The concept of the patient-centered medical home (PCMH) has been widely embraced as a foundation for the transformation of health care delivery. Recent evaluations of PCMH pilots validate the initial hypothesis that care provided in the PCMH has the potential to result in better health outcomes at lower cost. However, earning recognition or certification as a PCMH can be a daunting task. This article discusses the process of developing the potential to function as a PCMH, earning formal recognition, and implementing a system of continuous quality improvement to enable the establishment of a mature, sustainable PCMH.

  18. Multidisciplinary Teams and Obesity: Role of the Modern Patient-Centered Medical Home.

    PubMed

    Bernstein, Kevin M; Manning, Debra A; Julian, Regina M

    2016-03-01

    With the growing obesity epidemic, it is difficult for individual primary care providers to devote the time and effort necessary to achieve meaningful weight loss for significant numbers of patients. A variety of health care professionals provide value and evidence-based care that is effective in treating obesity and other preventable diseases. Multidisciplinary collaboration between primary care physicians and other trained health professionals within patient-centered medical homes offers an effective approach to sustainable behavioral treatment options for individuals who are obese or overweight.

  19. A decade of offering a Healing Enhancement Program at an academic medical center.

    PubMed

    Cutshall, Susanne M; Rodgers, Nancy J; Dion, Liza J; Dreyer, Nikol E; Thomley, Barbara S; Do, Alexander; Wood, Christina; Pronk, Susan C; Bauer, Brent A

    2015-11-01

    An increased focus has been given to improving the patient experience in health care. This focus has included placing value in a patient-centric, holistic approach to patient care. In the past decade, the Healing Enhancement Program was developed at 1 large medical center to address this focus through implementation of such integrative medicine services as massage, acupuncture, and music therapy to holistically address the pain, anxiety, and tension that hospitalized patients often experience. We describe the development and growth of this program over the past decade. PMID:26573445

  20. Policies of Academic Medical Centers for Disclosing Conflicts of Interest to Potential Research Participants

    PubMed Central

    Weinfurt, Kevin P.; Dinan, Michaela A.; Allsbrook, Jennifer S.; Friedman, Joëlle Y.; Hall, Mark A.; Schulman, Kevin A.; Sugarman, Jeremy

    2007-01-01

    Many professional organizations and governmental bodies recommend disclosing financial conflicts of interest to potential research participants. Three possible goals of such disclosures are to inform the decision making of potential research participants, to protect against liability, and to deter conflicts of interest. We reviewed US academic medical centers' policies regarding the disclosure of conflicts of interest in research. Forty-eight percent mentioned disclosing conflicts to potential research participants. Of those, 58% included verbatim language that could be used in informed consent documents. Considerable variability exists concerning the specific information that should be disclosed. Most of the institutions' policies are consistent with the goal of protection from legal liability. PMID:16436571

  1. Accelerating change: Fostering innovation in healthcare delivery at academic medical centers.

    PubMed

    Ostrovsky, Andrey; Barnett, Michael

    2014-03-01

    Academic medical centers (AMCs) have the potential to be leaders in the era of healthcare delivery reform, but most have yet to display a commitment to delivery innovation on par with their commitment to basic research. Several institutional factors impede delivery innovation including the paucity of adequate training in design and implementation of new delivery models and the lack of established pathways for academic career advancement outside of research. This paper proposes two initiatives to jumpstart disruptive innovation at AMCs: an institutional "innovation incubator" program and a clinician-innovator career track coupled with innovation training programs.

  2. Multidisciplinary Teams and Obesity: Role of the Modern Patient-Centered Medical Home.

    PubMed

    Bernstein, Kevin M; Manning, Debra A; Julian, Regina M

    2016-03-01

    With the growing obesity epidemic, it is difficult for individual primary care providers to devote the time and effort necessary to achieve meaningful weight loss for significant numbers of patients. A variety of health care professionals provide value and evidence-based care that is effective in treating obesity and other preventable diseases. Multidisciplinary collaboration between primary care physicians and other trained health professionals within patient-centered medical homes offers an effective approach to sustainable behavioral treatment options for individuals who are obese or overweight. PMID:26896199

  3. Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home

    PubMed Central

    O’Donnell, Alison J.; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F. de Vries; Kaye, Elise M.; Gabbay, Robert; Cronholm, Peter F.

    2016-01-01

    Introduction Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. Methods The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care. Results Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care. Conclusion Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care. PMID:26916899

  4. Clostridium difficile Infections in Medical Intensive Care Units of a Medical Center in Southern Taiwan: Variable Seasonality and Disease Severity

    PubMed Central

    Lin, Hsiao-Ju; Tsai, Pei-Jane; Ko, Wen-Chien

    2016-01-01

    Critical patients are susceptible to Clostridium difficile infections (CDIs), which cause significant morbidity and mortality in the hospital. In Taiwan, the epidemiology of CDI in intensive care units (ICUs) is not well understood. This study was aimed to describe the incidence and the characteristics of CDI in the ICUs of a medical center in southern Taiwan. Adult patients with diarrhea but without colostomy/colectomy or laxative use were enrolled. Stool samples were collected with or without 5 ml alcohol and were plated on cycloserine-cefoxitin-fructose agar. C. difficile identification was confirmed by polymerase chain reaction. There were 1,551 patients admitted to ICUs, 1,488 screened, and 145 with diarrhea. A total of 75 patients were excluded due either to laxative use, a lack of stool samples, or refusal. Overall, 70 patients were included, and 14 (20%) were diagnosed with CDI, with an incidence of 8.8 cases per 10,000 patient-days. The incidence of CDI was found to be highest in March 2013 and lowest in the last quarter of 2013. The cases were categorized as the following: 5 severe, complicated, 5 severe, and 4 mild or moderate diseases. Among the 14 cases of CDI, the median patient age was 74 (range: 47–94) years, and the median time from admission to diarrhea onset was 16.5 (4–53) days. Eight cases received antimicrobial treatment (primarily metronidazole), and the time to diarrheal resolution was 11.5 days. Though 6 cases were left untreated, no patients died of CDI. The in-hospital mortality of CDI cases was 50%, similar to that of patients without CDI (46.4%; P = 1.0). We concluded that the overall incidence of CDI in our medical ICUs was low and there were variable seasonal incidences and disease severities of CDI. PMID:27509051

  5. Health Maintenance Organizations and Academic Medical Centers. Proceedings of a National Conference (Colorado Springs, Colorado, October 1980).

    ERIC Educational Resources Information Center

    Hudson, James I., Ed.; Nevins, Madeline M., Ed.

    In October 1980 a national conference on health maintenance organizations (HMOs) and Academic Medical Centers (AMCs) was held by the Association of American Medical Colleges and supported by the Henry J. Kaiser Family Foundation, in response to inquiries about the advantages and disadvantages of AMC affiliation with or sponsorship of HMOs.…

  6. 40Ar/39Ar cooling history of the Albany Mobile Belt, Albany-Fraser Orogen, Western Australia

    NASA Astrophysics Data System (ADS)

    Scibiorski, Elisabeth; Tohver, Eric; Jourdan, Fred

    2013-04-01

    The Albany-Fraser Orogen of southwestern Australia is a Grenville-age orogenic belt that marks the suturing of the Yilgarn Craton of Western Australia to the Mawson Craton of South Australia and Antarctica. The Albany Mobile Belt is situated in the west of the orogen and consists of three geological domains: the Nornalup Zone, the Biranup Zone and the Northern Foreland. The crustal genesis and nature of boundaries between these domains is unknown. 40Ar/39Ar thermochronology of biotite and muscovite grains from a 250 km transect across all three domains in the Albany Mobile Belt is used to study the exhumation and cooling history of the amphibolite to granulite facies orogenic root. Previously published geochronological data dates peak amphibolite or granulite facies metamorphism in the Nornalup Zone, Biranup Zone and Northern Foreland at ca. 1170 Ma, ca. 1180 Ma and ca. 1210 - 1180 Ma respectively. All samples reported in this study yielded well defined plateau ages consistent with Stage II of the Albany-Fraser Orogeny (1215 - 1140 Ma). Four biotites from the Nornalup Zone give cooling ages ranging from 1144 ± 5 Ma to 1168 ± 5 Ma, one biotite from the Biranup Zone gives a cooling age of 1159 ± 5 Ma, and four muscovites from the Northern Foreland give statistically indistinguishable cooling ages ranging from 1157 ± 6 Ma to 1164 ± 5 Ma, with a weighted mean age of 1159 ± 6 Ma (P = 0.10). The new cooling ages imply that the three domains had been brought to a similar structural level (12 - 17 km depth) by ca. 1158 Ma, and have shared a common geological history since that time. This suggests that Stage II tectonic activity may have ended at ca. 1158 Ma in the Albany Mobile Belt, 20 Myr earlier than previously assumed. A cooling rate of 25°C/Myr for the Biranup Zone was calculated based on the 20 Myr interval between peak granulite-facies metamorphism and the cooling of the domain through the estimated biotite closure temperature (ca. 300°C) by ca. 1159 Ma

  7. Providing Medical Information to College Health Center Personnel: A Circuit Librarian Service at the University of Illinois

    ERIC Educational Resources Information Center

    Stumpff, Julia C.

    2003-01-01

    College health center personnel are no different from other health practitioners in their need for medical information. To help meet this need, the McKinley Health Center, University of Illinois Urbana-Champaign, developed a partnership in 1997 with the Library of the Health Sciences-Urbana, a regional site library of the University of Illinois at…

  8. Ontario pharmacists practicing in family health teams and the patient-centered medical home.

    PubMed

    Dolovich, Lisa

    2012-04-01

    The patient-centered medical home (PCMH) approach continues to gather momentum in the United States and Canada as a broad approach to reform the delivery of the complete primary care system. The family health team (FHT) model implemented in Ontario, Canada, best mirrors the PCMH approach of the United States. The integration of pharmacists as key members of the health care team providing on-site, in-office coordinated care to FHT patients was included from the start of planning the FHT model and represents a substantial opportunity for pharmacists to realize their professional vision. Several research projects in Canada and elsewhere have contributed to providing evidence to support the integration of pharmacists into primary care practice sites. Two major research programs, the Seniors Medication Assessment Research Trial (SMART) cluster randomized controlled trial and the Integrating Family Medicine and Pharmacy to Advance Primary Care Therapeutics (IMPACT) multipronged demonstration project made substantial contributions to evidence-informed policy decisions supporting the integration of pharmacists into FHTs. These projects can provide useful information to support the integration of pharmacists into the PCMH and to encourage further research to better measure the effect of the pharmacist from the holistic patient-centered perspective.

  9. Safety in the academic medical center: transforming challenges into ingredients for improvement.

    PubMed

    Blumenthal, David; Ferris, Timothy G

    2006-09-01

    Patient safety has emerged as an important challenge to the leadership of academic medical centers (i.e., teaching hospitals with significant research activity). This article describes the evidence regarding patient safety at academic medical centers (AMCs) and the special circumstances of AMCs that create challenges and opportunities for making improvements. While the research on the relative safety of patients in AMCs compared to other types of hospitals is sparse, it seems clear that AMCs in general do not stand out as models of patient safety. AMCs are unique as health care providers because of the multiple consequences of their three missions: patient care, research, and teaching. Aspects of these missions can serve to both enhance an AMC's ability to address safety issues and at the same time create unique and challenging barriers. For example, the research enterprise may distract managers' focus on safety issues but at the same time provide a wealth of highly trained talent for investigating and reducing safety problems. By addressing these challenges, AMCs have the opportunity, even the obligation, to be both the source of new knowledge on health care safety as well as the transmitter of new skills in safe patient care for the health care providers of the future.

  10. Patient-Centered Medical Home Adoption: Results From Aligning Forces For Quality.

    PubMed

    McHugh, Megan; Shi, Yunfeng; Ramsay, Patricia P; Harvey, Jillian B; Casalino, Lawrence P; Shortell, Stephen M; Alexander, Jeffrey A

    2016-01-01

    To improve health care quality within communities, increasing numbers of multistakeholder alliances-groups of payers, purchasers, providers, and consumers-have been created. We used data from two rounds (conducted in July 2007-March 2009 and January 2012-November 2013) of a large nationally representative survey of small and medium-size physician practices. We examined whether the adoption of patient-centered medical home processes spread more rapidly in fourteen Robert Wood Johnson Foundation Aligning Forces for Quality communities, where multistakeholder health care alliances promoted their use, than in other communities. We found no difference in the overall growth of adoption of the processes between the two types of communities. However, improvement on a care coordination subindex was 7.17 percentage points higher in Aligning Forces for Quality communities than in others. Despite the enthusiasm for quality improvement led by multistakeholder alliances, such alliances may not be a panacea for spreading patient-centered medical home processes across a community. PMID:26733712

  11. Needs Assessment for Research Use of High-Throughput Sequencing at a Large Academic Medical Center.

    PubMed

    Geskin, Albert; Legowski, Elizabeth; Chakka, Anish; Chandran, Uma R; Barmada, M Michael; LaFramboise, William A; Berg, Jeremy; Jacobson, Rebecca S

    2015-01-01

    Next Generation Sequencing (NGS) methods are driving profound changes in biomedical research, with a growing impact on patient care. Many academic medical centers are evaluating potential models to prepare for the rapid increase in NGS information needs. This study sought to investigate (1) how and where sequencing data is generated and analyzed, (2) research objectives and goals for NGS, (3) workforce capacity and unmet needs, (4) storage capacity and unmet needs, (5) available and anticipated funding resources, and (6) future challenges. As a precursor to informed decision making at our institution, we undertook a systematic needs assessment of investigators using survey methods. We recruited 331 investigators from over 60 departments and divisions at the University of Pittsburgh Schools of Health Sciences and had 140 respondents, or a 42% response rate. Results suggest that both sequencing and analysis bottlenecks currently exist. Significant educational needs were identified, including both investigator-focused needs, such as selection of NGS methods suitable for specific research objectives, and program-focused needs, such as support for training an analytic workforce. The absence of centralized infrastructure was identified as an important institutional gap. Key principles for organizations managing this change were formulated based on the survey responses. This needs assessment provides an in-depth case study which may be useful to other academic medical centers as they identify and plan for future needs.

  12. Information technology leadership in academic medical centers: a tale of four cultures.

    PubMed

    Friedman, C P

    1999-07-01

    Persons and groups within academic medical centers bring consistent and predictable viewpoints to planning and decision making. The varied professional and academic cultures of these individuals appear to account primarily for the diversity of their viewpoints. Understanding these professional cultures can help leaders achieve some predictability in the complex environments for which they are responsible. Leaders in information technology in particular, in order to be successful, must become part-time anthropologists, immersing themselves in the varied workplaces of their constituents to understand the work they do and the cultures that have grown up around this work. Only in this way will they be able to manage the challenges that arise continuously as the technology and the needs it can address change over time. In this article, the author briefly describes the concept of culture, portrays four specific professional cultures that typically coexist in academic medical centers, and argues that understanding these cultures is absolutely critical to effective management and use of information resources.

  13. Assessing Progress toward Becoming a Patient-Centered Medical Home: An Assessment Tool for Practice Transformation

    PubMed Central

    Daniel, Donna M; Wagner, Edward H; Coleman, Katie; Schaefer, Judith K; Austin, Brian T; Abrams, Melinda K; Phillips, Kathryn E; Sugarman, Jonathan R

    2013-01-01

    Objective. To describe the properties of the Patient-Centered Medical Home Assessment (PCMH-A) as a tool to stimulate and monitor progress among primary care practices interested in transforming to patient-centered medical homes (PCMHs). Study Setting. Sixty-five safety net practices from five states participating in a national demonstration program for PCMH transformation. Study Design. Longitudinal analyses of PCMH-A scores were performed. Scores were reviewed for agreement and sites were categorized over time into one of five categories by external facilitators. Comparisons to key activity completion rates and NCQA PCMH recognition status were completed. Data Collection/Extraction Methods. Multidisciplinary teams at each practice completed the 33-item self-assessment tool every 6 months between March 2010 and September 2012. Principal Findings. Mean overall PCMH-A scores increased (7.2, March 2010, to 9.1, September 2012; [p < .01]). Increases were statistically significant for each of the change concepts (p < .05). Facilitators agreed with scores 82% of the time. NCQA-recognized sites had higher PCMH-A scores than sites that were not yet recognized. Sites that completed more transformation activities and progressed over defined tiers reported higher PCMH-A scores. Scores improved most in areas where technical assistance was provided. Conclusions. The PCMH-A was sensitive to change over time and provided an accurate reflection of practice transformation. PMID:24138593

  14. Assessment of diabetic teleretinal imaging program at the Portland Department of Veterans Affairs Medical Center.

    PubMed

    Tsan, Grace L; Hoban, Keely L; Jun, Weon; Riedel, Kevin J; Pedersen, Amy L; Hayes, John

    2015-01-01

    We conducted a retrospective chart review of 200 diabetic patients who had teleretinal imaging performed between January 1, 2010, and January 1, 2011, at Portland Department of Veterans Affairs (VA) Medical Center outpatient clinics to assess the effectiveness of the diabetic teleretinal imaging program. Twenty patients (10%) had diabetic retinopathy. Ninety percent of the available teleretinal imaging studies were of adequate quality for interpretation. In accordance with local VA policy at that time, all teleretinal imaging patients should have been referred for a dilated retinal examination the following year. Image readers referred 97.5% of the patients to eye clinics for subsequent eye examinations, but the imagers scheduled appointments for only 80% of these patients. The redundancy rate, i.e., patients who had an eye examination within the past 6 mo, was 11%; the duplicate recall rate, i.e., patients who had a second teleretinal imaging performed within 1 yr of the eye examination, was 37%. Rates of timely diabetic eye examinations at clinics with teleretinal imaging programs, particularly when teleretinal imaging and eye clinics were colocated at the same community-based outpatient clinic, were higher than those without a teleretinal imaging program. We concluded that the Portland VA Medical Center's teleretinal imaging program was successful in increasing the screening rate for diabetic retinopathy.

  15. Program Evaluation of Remote Heart Failure Monitoring: Healthcare Utilization Analysis in a Rural Regional Medical Center

    PubMed Central

    Keberlein, Pamela; Sorenson, Gigi; Mohler, Sailor; Tye, Blake; Ramirez, A. Susana; Carroll, Mark

    2015-01-01

    Abstract Background: Remote monitoring for heart failure (HF) has had mixed and heterogeneous effects across studies, necessitating further evaluation of remote monitoring systems within specific healthcare systems and their patient populations. “Care Beyond Walls and Wires,” a wireless remote monitoring program to facilitate patient and care team co-management of HF patients, served by a rural regional medical center, provided the opportunity to evaluate the effects of this program on healthcare utilization. Materials and Methods: Fifty HF patients admitted to Flagstaff Medical Center (Flagstaff, AZ) participated in the project. Many of these patients lived in underserved and rural communities, including Native American reservations. Enrolled patients received mobile, broadband-enabled remote monitoring devices. A matched cohort was identified for comparison. Results: HF patients enrolled in this program showed substantial and statistically significant reductions in healthcare utilization during the 6 months following enrollment, and these reductions were significantly greater compared with those who declined to participate but not when compared with a matched cohort. Conclusions: The findings from this project indicate that a remote HF monitoring program can be successfully implemented in a rural, underserved area. Reductions in healthcare utilization were observed among program participants, but reductions were also observed among a matched cohort, illustrating the need for rigorous assessment of the effects of HF remote monitoring programs in healthcare systems. PMID:25025239

  16. Information technology leadership in academic medical centers: a tale of four cultures.

    PubMed

    Friedman, C P

    1999-07-01

    Persons and groups within academic medical centers bring consistent and predictable viewpoints to planning and decision making. The varied professional and academic cultures of these individuals appear to account primarily for the diversity of their viewpoints. Understanding these professional cultures can help leaders achieve some predictability in the complex environments for which they are responsible. Leaders in information technology in particular, in order to be successful, must become part-time anthropologists, immersing themselves in the varied workplaces of their constituents to understand the work they do and the cultures that have grown up around this work. Only in this way will they be able to manage the challenges that arise continuously as the technology and the needs it can address change over time. In this article, the author briefly describes the concept of culture, portrays four specific professional cultures that typically coexist in academic medical centers, and argues that understanding these cultures is absolutely critical to effective management and use of information resources. PMID:10429588

  17. Needs Assessment for Research Use of High-Throughput Sequencing at a Large Academic Medical Center

    PubMed Central

    Geskin, Albert; Legowski, Elizabeth; Chakka, Anish; Chandran, Uma R; Barmada, M. Michael; LaFramboise, William A.; Berg, Jeremy; Jacobson, Rebecca S.

    2015-01-01

    Next Generation Sequencing (NGS) methods are driving profound changes in biomedical research, with a growing impact on patient care. Many academic medical centers are evaluating potential models to prepare for the rapid increase in NGS information needs. This study sought to investigate (1) how and where sequencing data is generated and analyzed, (2) research objectives and goals for NGS, (3) workforce capacity and unmet needs, (4) storage capacity and unmet needs, (5) available and anticipated funding resources, and (6) future challenges. As a precursor to informed decision making at our institution, we undertook a systematic needs assessment of investigators using survey methods. We recruited 331 investigators from over 60 departments and divisions at the University of Pittsburgh Schools of Health Sciences and had 140 respondents, or a 42% response rate. Results suggest that both sequencing and analysis bottlenecks currently exist. Significant educational needs were identified, including both investigator-focused needs, such as selection of NGS methods suitable for specific research objectives, and program-focused needs, such as support for training an analytic workforce. The absence of centralized infrastructure was identified as an important institutional gap. Key principles for organizations managing this change were formulated based on the survey responses. This needs assessment provides an in-depth case study which may be useful to other academic medical centers as they identify and plan for future needs. PMID:26115441

  18. Validity of Agency for Healthcare Research and Quality Patient Safety Indicators at an academic medical center.

    PubMed

    Ramanathan, Rajesh; Leavell, Patricia; Stockslager, Gregory; Mays, Catherine; Harvey, Dale; Duane, Therese M

    2013-06-01

    The Agency for Healthcare Research and Quality developed Patient Safety Indicators (PSI) to screen for in-hospital complications and patient safety events through International Classification of Diseases, 9th Revision, Clinical Modification coding. The purpose of this study was to validate 10 common surgically related PSIs at our academic medical center and investigate the causes for inaccuracies. We reviewed patient records between October 2011 and September 2012 at our urban academic medical center for 10 common surgically related PSIs. The records were reviewed for incorrectly identified PSIs and a subset was further reviewed for the contributing factors. There were 93,169 charts analyzed for PSIs and 358 PSIs were identified (3.84 per 1000 cases). The overall positive predictive value (PPV) was 83 per cent (95% confidence interval 79 to -86%). The lowest PPVs were associated with catheter-related bloodstream infections (67%), postoperative respiratory failure (71%), and pressure ulcers (79%). The most common contributing factors for incorrect PSIs were coding errors (30%), documentation errors (19%), and insufficient criteria for PSI in the chart (16%). We conclude that the validity of PSIs is low and could be improved by increased education for clinicians and coders. In their current form, PSIs remain suboptimal for widespread use in public reporting and pay-for-performance evaluation. PMID:23711266

  19. Collaborating to improve the global competitiveness of US academic medical centers.

    PubMed

    Allen, Molly; Garman, Andrew; Johnson, Tricia; Hohmann, Samuel; Meurer, Steve

    2012-01-01

    President Obama announced the National Export Initiative in his 2010 State of the Union address and set the ambitious goal of doubling US exports by the end of 2014 to support millions of domestic jobs. Understanding the competitive position of US health care in the global market for international patients, University Health System Consortium (UHC), an alliance of 116 academic medical centers and 272 of their affiliated hospitals, representing 90 percent of the nation's non-profit academic medical centers partnered with Rush University, a private University in Chicago, IL and the International Trade Administration of the US Department of Commerce International Trade Administration (ITA) to participate in the Market Development Cooperator Program. The goal of this private-public partnership is to increase the global competitiveness of the US health care industry, which represents over 16 percent of the GDP, amongst foreign health care providers. This article provides an overview of the US health care market and outlines the aims of the US Cooperative for International Patient Programs, the end result of the partnership between UHC, ITA and Rush University.

  20. Health Information Security: A Case Study of Three Selected Medical Centers in Iran

    PubMed Central

    Hajrahimi, Nafiseh; Dehaghani, Sayed Mehdi Hejazi; Sheikhtaheri, Abbas

    2013-01-01

    Health Information System (HIS) is considered a unique factor in improving the quality of health care activities and cost reduction, but today with the development of information technology and use of internet and computer networks, patients’ electronic records and health information systems have become a source for hackers. Methods This study aims at checking health information security of three selected medical centers in Iran using AHP fuzzy and TOPSIS compound model. To achieve that security measures were identified, based on the research literature and decision making matrix using experts’ points of view. Results and discussion Among the 27 indicators, seven indicators were selected as effective indicators and Fuzzy AHP technique was used to determine the importance of security indicators. Based on the comparisons made between the three selected medical centers to assess the security of health information, it is concluded that Chamran hospital has the most acceptable level of security and attention in three indicators of “verification and system design, user access management, access control system”, Al Zahra Hospital in two indicators of “access management and network access control” and Amin Hospital in “equipment safety and system design”. In terms of information security, Chamran Hospital ranked first, Al-Zahra Hospital ranked second and Al- Zahra hospital has the third place. PMID:23572861

  1. A comprehensive model to build improvement capability in a pediatric academic medical center.

    PubMed

    Kaminski, Gerry M; Schoettker, Pamela J; Alessandrini, Evaline A; Luzader, Carolyn; Kotagal, Uma

    2014-01-01

    Cincinnati Children's Hospital Medical Center developed a comprehensive model to build quality improvement (QI) capability to support its goal to transform its delivery system through a series of training courses. Two online modules orient staff to basic concepts and terminology and prepare them to participate more effectively in QI teams. The basic program (Rapid Cycle Improvement Collaborative, RCIC) is focused on developing the capability to use basic QI tools and complete a narrow-scoped project in approximately 120 days. The Intermediate Improvement Science Series (I(2)S(2)) program is a leadership course focusing on improvement skills and developing a broader and deeper understanding of QI in the context of the organization and external environment. The Advanced Improvement Methods (AIM) course and Quality Scholars Program stimulate the use of more sophisticated methods and prepare Cincinnati Children's Hospital Medical Center (CCHMC) and external faculty to undertake QI research. The Advanced Improvement Leadership Systems (AILS) sessions enable interprofessional care delivery system leadership teams to effectively lead a system of care, manage a portfolio of projects, and to deliver on CCHMC's strategic plan. Implementing these programs has shown us that 1) a multilevel curricular approach to building improvement capability is pragmatic and effective, 2) an interprofessional learning environment is critical to shifting mental models, 3) repetition of project experience with coaching and feedback solidifies critical skills, knowledge and behaviors, and 4) focusing first on developing capable interprofessional improvement leaders, versus engaging in broad general QI training across the whole organization, is effective. PMID:24369867

  2. Collaborating to improve the global competitiveness of US academic medical centers.

    PubMed

    Allen, Molly; Garman, Andrew; Johnson, Tricia; Hohmann, Samuel; Meurer, Steve

    2012-01-01

    President Obama announced the National Export Initiative in his 2010 State of the Union address and set the ambitious goal of doubling US exports by the end of 2014 to support millions of domestic jobs. Understanding the competitive position of US health care in the global market for international patients, University Health System Consortium (UHC), an alliance of 116 academic medical centers and 272 of their affiliated hospitals, representing 90 percent of the nation's non-profit academic medical centers partnered with Rush University, a private University in Chicago, IL and the International Trade Administration of the US Department of Commerce International Trade Administration (ITA) to participate in the Market Development Cooperator Program. The goal of this private-public partnership is to increase the global competitiveness of the US health care industry, which represents over 16 percent of the GDP, amongst foreign health care providers. This article provides an overview of the US health care market and outlines the aims of the US Cooperative for International Patient Programs, the end result of the partnership between UHC, ITA and Rush University. PMID:22913124

  3. Population Health and the Academic Medical Center: The Time Is Right

    PubMed Central

    2014-01-01

    Optimizing the health of populations, whether defined as persons receiving care from a health care delivery system or more broadly as persons in a region, is emerging as a core focus in the era of health care reform. To achieve this goal requires an approach in which preventive care is valued and “nonmedical” determinants of patients’ health are engaged. For large, multimission systems such as academic medical centers, navigating the evolution to a population-oriented paradigm across the domains of patient care, education, and research poses real challenges but also offers tremendous opportunities, as important objectives across each mission begin to align with external trends and incentives. In clinical care, opportunities exist to improve capacity for assuming risk, optimize community benefit, and make innovative use of advances in health information technology. Education must equip the next generation of leaders to understand and address population-level goals in addition to patient-level needs. And the prospects for research to define strategies for measuring and optimizing the health of populations have never been stronger. A remarkable convergence of trends has created compelling opportunities for academic medical centers to advance their core goals by endorsing and committing to advancing the health of populations. PMID:24556766

  4. The characteristics of patients frequently admitted to academic medical centers in the United States

    PubMed Central

    Williams, Mark V.; Carrier, Danielle; Hensley, Laurie; Thomas, Stephen; Cerese, Julie

    2015-01-01

    BACKGROUND The recent intense attention to hospital readmissions and their implications for quality, safety, and reimbursement necessitates understanding specific subsets of readmitted patients. Frequently admitted patients, defined as patients who are admitted 5 or more times within 1 year, may have some distinguishing characteristics that require novel solutions. METHODS A comprehensive administrative database (University HealthSystem Consortium's Clinical Data Base/Resource Manager™) was analyzed to identify demographic, social, and clinical characteristics of frequently admitted patients in 101 US academic medical centers. RESULTS We studied 28,291 frequently admitted patients with 180,185 admissions over a 1‐year period (2011–2012). These patients comprise 1.6% of all patients, but account for 8% of all admissions and 7% of direct costs. Their admissions are driven by multiple chronic conditions; compared to other hospitalized patients, they have significantly more comorbidities (an average of 7.1 vs 2.5), and 84% of their admissions are to medical services. A minority, but significantly more than other patients, have comorbidities of psychosis or substance abuse. Moreover, although they are slightly more likely than other patients to be on Medicaid or to be uninsured (27.6% vs 21.6%), nearly three‐quarters have private or Medicare coverage. CONCLUSIONS Patients who are frequently admitted to US academic medical centers are likely to have multiple complex chronic conditions and may have behavioral comorbidities that mediate their health behaviors, resulting in acute episodes requiring hospitalization. This information can be used to identify solutions for preventing repeat hospitalization for this small group of patients who consume a highly disproportionate share of healthcare resources. Journal of Hospital Medicine 2015;10:563–568. © 2015 The Authors Journal of Hospital Medicine published by Wiley Periodicals, Inc. on behalf of Society of Hospital

  5. Integrating with users is one thing, but living with them? A case study on loss of space from the Medical Center Library, University of California, San Diego.

    PubMed

    Haynes, Craig

    2010-01-01

    The University of California, San Diego (UCSD) Medical Center is the primary hospital for the UCSD School of Medicine. The UCSD Medical Center Library (MCL), a branch of the campus's biomedical library, is located on the medical center campus. In 2007, the medical center administration made a request to MCL for space in its facility to relocate pharmacy administration from the hospital tower. The university librarian brought together a team of library managers to deliberate and develop a proposal, which ultimately accommodated the medical center's request and enhanced some of MCL's public services.

  6. Integrating with users is one thing, but living with them? a case study on loss of space from the Medical Center Library, University of California, San Diego

    PubMed Central

    Haynes, Craig

    2010-01-01

    The University of California, San Diego (UCSD) Medical Center is the primary hospital for the UCSD School of Medicine. The UCSD Medical Center Library (MCL), a branch of the campus's biomedical library, is located on the medical center campus. In 2007, the medical center administration made a request to MCL for space in its facility to relocate pharmacy administration from the hospital tower. The university librarian brought together a team of library managers to deliberate and develop a proposal, which ultimately accommodated the medical center's request and enhanced some of MCL's public services. PMID:20098651

  7. Assessment of medical waste management at a primary health-care center in Sao Paulo, Brazil

    SciTech Connect

    Moreira, A.M.M.; Guenther, W.M.R.

    2013-01-15

    Highlights: Black-Right-Pointing-Pointer Assessment of medical waste management at health-care center before/after intervention. Black-Right-Pointing-Pointer Qualitative and quantitative results of medical waste management plan are presented. Black-Right-Pointing-Pointer Adjustments to comply with regulation were adopted and reduction of waste was observed. Black-Right-Pointing-Pointer The method applied could be useful for similar establishments. - Abstract: According to the Brazilian law, implementation of a Medical Waste Management Plan (MWMP) in health-care units is mandatory, but as far as we know evaluation of such implementation has not taken place yet. The purpose of the present study is to evaluate the improvements deriving from the implementation of a MWMP in a Primary Health-care Center (PHC) located in the city of Sao Paulo, Brazil. The method proposed for evaluation compares the first situation prevailing at this PHC with the situation 1 year after implementation of the MWMP, thus allowing verification of the evolution of the PHC performance. For prior and post-diagnosis, the method was based on: (1) application of a tool (check list) which considered all legal requirements in force; (2) quantification of solid waste subdivided into three categories: infectious waste and sharp devices, recyclable materials and non-recyclable waste; and (3) identification of non-conformity practices. Lack of knowledge on the pertinent legislation by health workers has contributed to non-conformity instances. The legal requirements in force in Brazil today gave origin to a tool (check list) which was utilized in the management of medical waste at the health-care unit studied. This tool resulted into an adequate and simple instrument, required a low investment, allowed collecting data to feed indicators and also conquered the participation of the unit whole staff. Several non-conformities identified in the first diagnosis could be corrected by the instrument utilized

  8. The patient-centered medical home in oncology: from concept to reality.

    PubMed

    Page, Ray D; Newcomer, Lee N; Sprandio, John D; McAneny, Barbara L

    2015-01-01

    In recent years, the cost of providing quality cancer care has been subject to an epic escalation causing concerns on the verge of a health care crisis. Innovative patient-management models in oncology based on patient-centered medical home (PCMH) principles, coupled with alternative payments to traditional fee for service (FFS), such as bundled and episodes payment are now showing evidence of effectiveness. These efforts have the potential to bend the cost curve while also improving quality of care and patient satisfaction. However, going forward with FFS alternatives, there are several performance-based payment options with an array of financial risks and rewards. Most novel payment options convey a greater financial risk and accountability on the provider. Therefore, the oncology medical home (OMH) can be a way to mitigate some financial risks by sharing savings with the payer through better global care of the patient, proactively preventing complications, emergency department (ED) visits, and hospitalizations. However, much of the medical home infrastructure that is required to reduced total costs of cancer care comes as an added expense to the provider. As best-of-practice quality standards are being elucidated and refined, we are now at a juncture where payers, providers, policymakers, and other stakeholders should work in concert to expand and implement the OMH framework into the variety of oncology practice environments to better equip them to assimilate into the new payment reform configurations of the future. PMID:25993243

  9. Teaching Health Center Graduate Medical Education Locations Predominantly Located in Federally Designated Underserved Areas.

    PubMed

    Barclift, Songhai C; Brown, Elizabeth J; Finnegan, Sean C; Cohen, Elena R; Klink, Kathleen

    2016-05-01

    Background The Teaching Health Center Graduate Medical Education (THCGME) program is an Affordable Care Act funding initiative designed to expand primary care residency training in community-based ambulatory settings. Statute suggests, but does not require, training in underserved settings. Residents who train in underserved settings are more likely to go on to practice in similar settings, and graduates more often than not practice near where they have trained. Objective The objective of this study was to describe and quantify federally designated clinical continuity training sites of the THCGME program. Methods Geographic locations of the training sites were collected and characterized as Health Professional Shortage Area, Medically Underserved Area, Population, or rural areas, and were compared with the distribution of Centers for Medicare and Medicaid Services (CMS)-funded training positions. Results More than half of the teaching health centers (57%) are located in states that are in the 4 quintiles with the lowest CMS-funded resident-to-population ratio. Of the 109 training sites identified, more than 70% are located in federally designated high-need areas. Conclusions The THCGME program is a model that funds residency training in community-based ambulatory settings. Statute suggests, but does not explicitly require, that training take place in underserved settings. Because the majority of the 109 clinical training sites of the 60 funded programs in 2014-2015 are located in federally designated underserved locations, the THCGME program deserves further study as a model to improve primary care distribution into high-need communities.

  10. Teaching Health Center Graduate Medical Education Locations Predominantly Located in Federally Designated Underserved Areas.

    PubMed

    Barclift, Songhai C; Brown, Elizabeth J; Finnegan, Sean C; Cohen, Elena R; Klink, Kathleen

    2016-05-01

    Background The Teaching Health Center Graduate Medical Education (THCGME) program is an Affordable Care Act funding initiative designed to expand primary care residency training in community-based ambulatory settings. Statute suggests, but does not require, training in underserved settings. Residents who train in underserved settings are more likely to go on to practice in similar settings, and graduates more often than not practice near where they have trained. Objective The objective of this study was to describe and quantify federally designated clinical continuity training sites of the THCGME program. Methods Geographic locations of the training sites were collected and characterized as Health Professional Shortage Area, Medically Underserved Area, Population, or rural areas, and were compared with the distribution of Centers for Medicare and Medicaid Services (CMS)-funded training positions. Results More than half of the teaching health centers (57%) are located in states that are in the 4 quintiles with the lowest CMS-funded resident-to-population ratio. Of the 109 training sites identified, more than 70% are located in federally designated high-need areas. Conclusions The THCGME program is a model that funds residency training in community-based ambulatory settings. Statute suggests, but does not explicitly require, that training take place in underserved settings. Because the majority of the 109 clinical training sites of the 60 funded programs in 2014-2015 are located in federally designated underserved locations, the THCGME program deserves further study as a model to improve primary care distribution into high-need communities. PMID:27168895

  11. Factors that influence the choice to work in rural township health centers among 4,669 clinical medical students from five medical universities in Guangxi, China

    PubMed Central

    Qing, Yunbo; Hu, Guijie; Chen, Qingyun; Peng, Hailun; Li, Kailan; Wei, Jinling; Yi, Yanhua

    2015-01-01

    Purpose: To produce competent undergraduate-level medical doctors for rural township health centers (THCs), the Chinese government mandated that medical colleges in Central and Western China recruit rural-oriented, tuition-waived medical students (RTMSs) starting in 2010. This study aimed to identify and assess factors that influence the choice to work in rural township health centers among both RTMSs and other students from five medical universities in Guangxi, China. Methods: An internet-based self-administered questionnaire survey was conducted with medical students in Guangxi province. Multinomial logistic regression was used to identify factors related to the attitudes toward work in a rural township health center. Results: Among 4,669 medical students, 1,523 (33%) had a positive attitude and 2,574 (55%) had a neutral attitude toward working in THCs. Demographic characteristics, personal job concerns, and knowledge of THCs were associated with the choice of a career in THCs. The factors related to a positive attitude included the following: three-year program, a rural-oriented medical program, being male, an expectation of working in a county or township, a focus on medical career development, some perceived difficulty of getting a job, having family support, sufficient knowledge of THCs, optimism toward THC development, seeking lower working pressure, and a lower expected monthly salary. Conclusion: Male students in a three-year program or a rural-oriented tuition-waived medical education program were more likely to work in THCs. Selecting medical students through interviews to identify their family support and intentions to work in THCs would increase recruitment and retention. Establishing favorable policies and financial incentives to improve living conditions and the social status of rural physicians is necessary. PMID:26268830

  12. [Medical equipment companies and their ties with technology development centers in Mexico].

    PubMed

    Hernández, B; Arredondo, A; Cruz, C; Sánchez, E; Damián, T

    1993-10-01

    The purpose of this study was to determine the characteristics of the companies that produce, distribute, and service medical equipment in Mexico and the factors related to whether or not they had established ties with research and technology development centers. The data analyzed came from a survey of such companies carried out in Mexico City and environs in 1989. The information was updated in 1991. Multivariate analyses were carried out in order to identify the characteristics of companies that had established ties or wished to do so and the areas of interest of those companies. Of 208 companies surveyed, only 23% had ties with research centers. The companies that had such ties or were interested in establishing them tended to invest in research and to have made plans for expansion. The establishment of ties appeared to be a two-way process, with positive consequences for the companies involved, the research centers, and the health sector. It was concluded that it would be advantageous to design programs to promote ties with companies having the characteristics mentioned.

  13. Creating an academy of clinical excellence at Johns Hopkins Bayview Medical Center: a 3-year experience.

    PubMed

    Wright, Scott M; Kravet, Steven; Christmas, Colleen; Burkhart, Kathleen; Durso, Samuel C

    2010-12-01

    Academic health centers (AHCs) are committed to the tripartite missions of research, education, and patient care. Promotion decisions at many AHCs focus predominantly on research accomplishments, and some members of the community remain concerned about how to reward clinicians who excel in, and spend a majority of their time, caring for patients. Many clinically excellent physicians contribute substantively to all aspects of the mission by collaborating with researchers (either through intellectual discourse or enrolling participants in trials), by serving as role models for trainees with respect to ideal caring and practice, and by attracting patients to the institution. Not giving fair and appreciative recognition to these clinically excellent faculty places AHCs at risk of losing them. The Center for Innovative Medicine at Johns Hopkins set out to address this concern by defining, measuring, and rewarding clinical excellence. Prior to this initiative, little attention was directed toward the "bright spots" of excellence in patient care at Johns Hopkins Bayview. Using a scholarly approach, the authors launched a new academy; this manuscript describes the history, creation, and ongoing activities of the Miller-Coulson Academy of Clinical Excellence at Johns Hopkins University Bayview Medical Center. While membership in the academy is honorific, the members of this working academy are committed to influencing institutional culture as they collaborate on advocacy, scholarship, and educational initiatives. PMID:20978424

  14. Creating an academy of clinical excellence at Johns Hopkins Bayview Medical Center: a 3-year experience.

    PubMed

    Wright, Scott M; Kravet, Steven; Christmas, Colleen; Burkhart, Kathleen; Durso, Samuel C

    2010-12-01

    Academic health centers (AHCs) are committed to the tripartite missions of research, education, and patient care. Promotion decisions at many AHCs focus predominantly on research accomplishments, and some members of the community remain concerned about how to reward clinicians who excel in, and spend a majority of their time, caring for patients. Many clinically excellent physicians contribute substantively to all aspects of the mission by collaborating with researchers (either through intellectual discourse or enrolling participants in trials), by serving as role models for trainees with respect to ideal caring and practice, and by attracting patients to the institution. Not giving fair and appreciative recognition to these clinically excellent faculty places AHCs at risk of losing them. The Center for Innovative Medicine at Johns Hopkins set out to address this concern by defining, measuring, and rewarding clinical excellence. Prior to this initiative, little attention was directed toward the "bright spots" of excellence in patient care at Johns Hopkins Bayview. Using a scholarly approach, the authors launched a new academy; this manuscript describes the history, creation, and ongoing activities of the Miller-Coulson Academy of Clinical Excellence at Johns Hopkins University Bayview Medical Center. While membership in the academy is honorific, the members of this working academy are committed to influencing institutional culture as they collaborate on advocacy, scholarship, and educational initiatives.

  15. [The constant medical education in the Russian Scientific Center of Surgery named after academician B.V. Petrovskiĭ].

    PubMed

    Lozhkevich, I Iu

    2013-01-01

    The problem of medical education is very important in light of optimization of the medical help. The most actual is the constant postgraduate education of doctors, who need different possibilities and optimal conditions for the continued education. Scientific centers play the no lesser role in postgraduate medical education. The Russian Scientific Center of Surgery named after academician B.V. Petrovskiy pays special attention to the educational activity. Integration of the educational, research and clinical processes together with the flexibility and mobility as well as practical and individual orientation of postgraduate medical education guarantee the efficacy of it in the Center. Quality monitoring and complex scientific analysis of the results permit constant improvement and upgrading of educational process.

  16. The first private-hospital based proton therapy center in Korea; status of the Proton Therapy Center at Samsung Medical Center

    PubMed Central

    Chung, Kwangzoo; Kim, Jinsung; Ahn, Sung Hwan; Ju, Sang Gyu; Jung, Sang Hoon; Chung, Yoonsun; Cho, Sungkoo; Jo, Kwanghyun; Shin, Eun Hyuk; Hong, Chae-Seon; Shin, Jung Suk; Park, Seyjoon; Kim, Dae-Hyun; Kim, Hye Young; Lee, Boram; Shibagaki, Gantaro; Nonaka, Hideki; Sasai, Kenzo; Koyabu, Yukio; Choi, Changhoon; Huh, Seung Jae; Ahn, Yong Chan; Pyo, Hong Ryull; Lim, Do Hoon; Park, Hee Chul; Park, Won; Oh, Dong Ryul; Noh, Jae Myung; Yu, Jeong Il; Song, Sanghyuk; Lee, Ji Eun; Lee, Bomi; Choi, Doo Ho

    2015-01-01

    Purpose The purpose of this report is to describe the proton therapy system at Samsung Medical Center (SMC-PTS) including the proton beam generator, irradiation system, patient positioning system, patient position verification system, respiratory gating system, and operating and safety control system, and review the current status of the SMC-PTS. Materials and Methods The SMC-PTS has a cyclotron (230 MeV) and two treatment rooms: one treatment room is equipped with a multi-purpose nozzle and the other treatment room is equipped with a dedicated pencil beam scanning nozzle. The proton beam generator including the cyclotron and the energy selection system can lower the energy of protons down to 70 MeV from the maximum 230 MeV. Results The multi-purpose nozzle can deliver both wobbling proton beam and active scanning proton beam, and a multi-leaf collimator has been installed in the downstream of the nozzle. The dedicated scanning nozzle can deliver active scanning proton beam with a helium gas filled pipe minimizing unnecessary interactions with the air in the beam path. The equipment was provided by Sumitomo Heavy Industries Ltd., RayStation from RaySearch Laboratories AB is the selected treatment planning system, and data management will be handled by the MOSAIQ system from Elekta AB. Conclusion The SMC-PTS located in Seoul, Korea, is scheduled to begin treating cancer patients in 2015. PMID:26756034

  17. Patient-centered medical homes: standards for approval-part 2: part 2 of 3.

    PubMed

    Stack, Eric; Kier, Karen

    2014-04-01

    Part 1 of this series discussed the key aspects and health care benefits of patient-centered medical homes (PCMHs). Part 2 outlines the approval process employed by the National Committee for Quality Assurance (NCQA) to evaluate, grade, and recognize PCMHs. Primary care practice sites must develop an understanding of the various graded categories to enable them to focus attention on the critical components of a successful PCMH. Overall, the goals of NCQA's recognition standards are to enhance patient access and continuity to health care services, manage patient populations, plan care, provide each patient with support for self-care, track and coordinate patient care, and measure performance of both the clinicians and practice-site as a whole. In short, the standards provide a solid basis for primary care practice sites to evolve into a PCMH model.

  18. Searching for excellence & diversity: increasing the hiring of women faculty at one academic medical center.

    PubMed

    Sheridan, Jennifer T; Fine, Eve; Pribbenow, Christine Maidl; Handelsman, Jo; Carnes, Molly

    2010-06-01

    One opportunity to realize the diversity goals of academic health centers comes at the time of hiring new faculty. To improve the effectiveness of search committees in increasing the gender diversity of faculty hires, the authors created and implemented a training workshop for faculty search committees designed to improve the hiring process and increase the diversity of faculty hires at the University of Wisconsin-Madison. They describe the workshops, which they presented in the School of Medicine and Public Health between 2004 and 2007, and they compare the subsequent hiring of women faculty in participating and nonparticipating departments and the self-reported experience of new faculty within the hiring process. Attendance at the workshop correlates with improved hiring of women faculty and with a better hiring experience for faculty recruits, especially women. The authors articulate successful elements of workshop implementation for other medical schools seeking to increase gender diversity on their faculties.

  19. Innovative approaches to interprofessional care at the University of Pittsburgh Medical Center.

    PubMed

    Driessen, Julia; Bellon, Johanna E; Stevans, Joel; James, A Everette; Minnier, Tami; Reynolds, Benjamin R; Zhang, Yuting

    2015-01-01

    The enactment of the Affordable Care Act expands coverage to millions of uninsured Americans and creates a new workforce landscape. Interprofessional Collaborative Practice (ICP) is no longer a choice but a necessity. In this paper, we describe four innovative approaches to interprofessional practice at the University of Pittsburgh Medical Center. These models demonstrate innovative applications of ICP to inpatient and outpatient care, relying on non-physician providers, training programs, and technology to deliver more appropriate care to specific patient groups. We also discuss the ongoing evaluation plans to assess the effects of these interprofessional practices on patient health, quality of care, and healthcare costs. We conclude that successful implementation of interprofessional teams involves more than just a reassignment of tasks, but also depends on structuring the environment and workflow in a way that facilitates team-based care.

  20. Activity of daptomycin against staphylococci collected from bloodstream infections in Spanish medical centers.

    PubMed

    Picazo, Juan J; Betriu, Carmen; Culebras, Esther; Rodríguez-Avial, Iciar; Gómez, María; López, Fátima

    2009-08-01

    We used the broth microdilution method to determine the MICs of daptomycin and 13 comparator agents against 319 methicillin-susceptible Staphylococcus aureus isolates, 201 methicillin-resistant S. aureus (MRSA) isolates, and 183 coagulase-negative staphylococci (CoNS). Isolates were consecutively collected from bloodstream infections in 39 Spanish medical centers during a 3-month period (March through May 2008). Among MRSA, 1 isolate with intermediate susceptibility to vancomycin and 6 isolates resistant to linezolid were found. Nonsusceptibility to teicoplanin was detected in 3.9% of CoNS. Daptomycin was highly active against the staphylococcal blood isolates tested-all were inhibited at the daptomycin susceptibility breakpoint of < or = 1 microg/mL. Daptomycin retained its activity against the isolates that were resistant to teicoplanin or linezolid, or that had reduced susceptibility to vancomycin. These data suggest that daptomycin could be useful for the treatment of bloodstream infections caused by staphylococci. PMID:19631100

  1. Searching for Excellence & Diversity: Increasing the Hiring of Women Faculty at One Academic Medical Center

    PubMed Central

    Sheridan, Jennifer T.; Fine, Eve; Pribbenow, Christine Maidl; Handelsman, Jo; Carnes, Molly

    2014-01-01

    One opportunity to realize the diversity goals of academic health centers comes at the time of hiring new faculty. To improve the effectiveness of search committees in increasing the gender diversity of faculty hires, the authors created and implemented a training workshop for faculty search committees designed to improve the hiring process and increase the diversity of faculty hires at the University of Wisconsin–Madison. They describe the workshops, which they presented in the School of Medicine and Public Health between 2004 and 2007, and they compare the subsequent hiring of women faculty in participating and nonparticipating departments and the self-reported experience of new faculty within the hiring process. Attendance at the workshop correlates with improved hiring of women faculty and with a better hiring experience for faculty recruits, especially women. The authors articulate successful elements of workshop implementation for other medical schools seeking to increase gender diversity on their faculties. PMID:20505400

  2. The patient-centered medical home: a case study in transforming the military health system.

    PubMed

    Hudak, Ronald P; Julian, Regina; Kugler, John; Dorrance, Kevin; Lynch, Sean; Dinneen, Michael; Evans, Paula; Kosmatka, Timothy; Padden, Maureen; Reeves, Mark

    2013-02-01

    This case study describes the Military Health System's (MHS) patient-centered medical home (PCMH) initiative and how it is being delivered across the MHS by the Army, Navy, and Air Force. The MHS, an integrated delivery model that includes both military treatment facilities and civilian providers and health care institutions, is transforming its primary care platforms from the traditional acute, episodic system to the PCMH model of care to maximize patient experience, satisfaction, health care quality, and readiness and to control cost growth. Preliminary performance measures are analyzed to assess the impact of PCMH implementation on the core primary care processes of the MHS. This study also discusses lessons learned and recommendations for improving health care performance through the PCMH care model.

  3. Secure, obligated and coordinated collaboration in health care for the patient-centered medical home.

    PubMed

    Berhe, Solomon; Demurjian, Steve; Saripalle, Rishi; Agresta, Thomas; Liu, Jing; Cusano, Antonio; Fequiere, Andal; Gedarovich, Jim

    2010-11-13

    In the patient-centered medical home, PCMH, patient care is overseen by a primary care physician leading a team of health care providers, who collaborate to optimize treatment. To facilitate interactions in PCMH, secure collaboration will be needed to: control access to information; dictate who can do what when; and promote sharing and concurrent access. This contrasts approaches such as the National Institute of Standard and Technology (NIST) role-based access control (RBAC), where the emphasis is on controlling access and separating responsibilities. This paper investigates secure collaboration within an application such as PCMH, through: a futuristic scenario for patient care; proposed collaboration extensions to the NIST RBAC standard with a fine-grained obligated mechanism and workflow; and a prototype of PCMH via the Google Wave real-time collaboration platform.

  4. The Patient-Centered Medical Home: Preparation of the Workforce, More Questions than Answers.

    PubMed

    Reynolds, P Preston; Klink, Kathleen; Gilman, Stuart; Green, Larry A; Phillips, Russell S; Shipman, Scott; Keahey, David; Rugen, Kathryn; Davis, Molly

    2015-07-01

    As American medicine continues to undergo significant transformation, the patient-centered medical home (PCMH) is emerging as an interprofessional primary care model designed to deliver the right care for patients, by the right professional, at the right time, in the right setting, for the right cost. A review of local, state, regional and national initiatives to train professionals in delivering care within the PCMH model reveals some successes, but substantial challenges. Workforce policy recommendations designed to improve PCMH effectiveness and efficiency include 1) adoption of an expanded definition of primary care, 2) fundamental redesign of health professions education, 3) payment reform, 4) responsiveness to local needs assessments, and 5) systems improvement to emphasize quality, population health, and health disparities.

  5. Improving levels of service through enhanced distribution techniques at Newark Beth Israel Medical Center.

    PubMed

    Faup, S A; Felix, M J

    1994-02-01

    In an effort to reduce cost and improve service, Materiels Management Distribution Services, in cooperation with a prime vendor, created a distribution method unique to the needs of Newark Beth Israel Medical Center. The project combined the vendor's expertise and ability to "deliver direct" to an internal hospital location by product group with the distribution staff's ability to complete the process and deliver the merchandise to the final destination in an expedited manner. This article provides a contract template that can be adapted for other collaborative efforts and highlights the components of a successful program: electronic data interchange, verification of usage and par, reconfiguration of space, direct pallet delivery, and some basic indicators of success. PMID:10131692

  6. [Significance of Multi-center Obstetrics Perioperative Team Training Including Various Medical Staffs].

    PubMed

    Komasawa, Nobuyasu; Fujita, Daisuke; Nakayama, Mai; Fujiwara, Shunsuke; Mihara, Ryosuke; Okada, Daisuke; Omoto, Haruka; Tanaka, Motoshige; Nishihara, Isao; Minami, Toshiaki

    2016-02-01

    We report the development of a multi-center/multispecialist obstetrics perioperative team training program. Participants were members of the team, including anesthesiologists, obstetricians, and operation nurses. A questionnaire survey was conducted prior to course participation to clarify any questions team members had. The courses included a lecture and simulation training with scenario-based discussions or the use of a simulator. Scenarios included massive bleeding during cesarean section, massive bleeding after vaginal delivery, and emergency cesarean section for premature placental abruption. After each course, participants discussed problems associated with obstetrics medical safety in the context of each theme. Simulation-based perioperative team training with anesthesiologists, obstetricians, and operation nurses may serve as a vehicle to promote perioperative obstetrics patient safety.

  7. Perspectives on the role of patient-centered medical homes in HIV Care.

    PubMed

    Pappas, Gregory; Yujiang, Jia; Seiler, Naomi; Malcarney, Mary-Beth; Horton, Katherine; Shaikh, Irshad; Freehill, Gunther; Alexander, Carla; Akhter, Mohammad N; Hidalgo, Julia

    2014-07-01

    To strengthen the quality of HIV care and achieve improved clinical outcomes, payers, providers, and policymakers should encourage the use of patient-centered medical homes (PCMHs), building on the Ryan White CARE Act Program established in the 1990s. The rationale for a PCMH with HIV-specific expertise is rooted in clinical complexity, HIV's social context, and ongoing gaps in HIV care. Existing Ryan White HIV/AIDS Program clinicians are prime candidates to serve HIV PCMHs, and HIV-experienced community-based organizations can play an important role. Increasingly, state Medicaid programs are adopting a PCMH care model to improve access and quality to care. Stakeholders should consider several important areas for future action and research with regard to development of the HIV PCMH.

  8. The Houston Academy of Medicine--Texas Medical Center Library management information system.

    PubMed Central

    Camille, D; Chadha, S; Lyders, R A

    1993-01-01

    A management information system (MIS) provides a means for collecting, reporting, and analyzing data from all segments of an organization. Such systems are common in business but rare in libraries. The Houston Academy of Medicine-Texas Medical Center Library developed an MIS that operates on a system of networked IBM PCs and Paradox, a commercial database software package. The data collected in the system include monthly reports, client profile information, and data collected at the time of service requests. The MIS assists with enforcement of library policies, ensures that correct information is recorded, and provides reports for library managers. It also can be used to help answer a variety of ad hoc questions. Future plans call for the development of an MIS that could be adapted to other libraries' needs, and a decision-support interface that would facilitate access to the data contained in the MIS databases. PMID:8251972

  9. Perspectives on the Role of Patient-Centered Medical Homes in HIV Care

    PubMed Central

    Yujiang, Jia; Seiler, Naomi; Malcarney, Mary-Beth; Horton, Katherine; Shaikh, Irshad; Freehill, Gunther; Alexander, Carla; Akhter, Mohammad N.; Hidalgo, Julia

    2014-01-01

    To strengthen the quality of HIV care and achieve improved clinical outcomes, payers, providers, and policymakers should encourage the use of patient-centered medical homes (PCMHs), building on the Ryan White CARE Act Program established in the 1990s. The rationale for a PCMH with HIV-specific expertise is rooted in clinical complexity, HIV’s social context, and ongoing gaps in HIV care. Existing Ryan White HIV/AIDS Program clinicians are prime candidates to serve HIV PCMHs, and HIV-experienced community-based organizations can play an important role. Increasingly, state Medicaid programs are adopting a PCMH care model to improve access and quality to care. Stakeholders should consider several important areas for future action and research with regard to development of the HIV PCMH. PMID:24832431

  10. Informatics in radiology (infoRAD): multimedia extension of medical imaging resource center teaching files.

    PubMed

    Yang, Guo Liang; Aziz, Aamer; Narayanaswami, Banukumar; Anand, Ananthasubramaniam; Lim, C C Tchoyoson; Nowinski, Wieslaw Lucjan

    2005-01-01

    A new method has been developed for multimedia enhancement of electronic teaching files created by using the standard protocols and formats offered by the Medical Imaging Resource Center (MIRC) project of the Radiological Society of North America. The typical MIRC electronic teaching file consists of static pages only; with the new method, audio and visual content may be added to the MIRC electronic teaching file so that the entire image interpretation process can be recorded for teaching purposes. With an efficient system for encoding the audiovisual record of on-screen manipulation of radiologic images, the multimedia teaching files generated are small enough to be transmitted via the Internet with acceptable resolution. Students may respond with the addition of new audio and visual content and thereby participate in a discussion about a particular case. MIRC electronic teaching files with multimedia enhancement have the potential to augment the effectiveness of diagnostic radiology teaching.

  11. Implementing the Patient-Centered Medical Home: Observation and Description of the National Demonstration Project

    PubMed Central

    Stewart, Elizabeth E.; Nutting, Paul A.; Crabtree, Benjamin F.; Stange, Kurt C.; Miller, William L.; Jaén, Carlos Roberto

    2010-01-01

    PURPOSE We provide an overall description of the National Demonstration Project (NDP) intervention to transform family practices into patient-centered medical homes. METHODS An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and project meetings, site visits to practices, depth interviews with practice members and implementation team members, access to practice communications (eg, telephone calls, e-mails), and public domain materials (eg, the NDP Web site). RESULTS The American Academy of Family Physicians created a new division called TransforMED, which launched the 24-month NDP in June 2006. From 337 family medicine practices completing an extensive online application, 36 were selected and randomized to a facilitated group, which received tailored, intensive assistance and services from TransforMED, or a self-directed group, which received very limited assistance. Three facilitators from diverse backgrounds in finance, practice management, and organizational psychology used multiple practice change strategies including site visits, e-mails, metrics, and learning sessions. The self-directed practices worked primarily on their own, but self-organized a retreat midway through the project. The intervention model for the project evolved to be consistent with the emerging national consensus principles of the patient-centered medical home. The independent evaluation team studied the NDP and provided ongoing feedback to inform the implementation process. CONCLUSIONS The NDP illustrates that complex practice change interventions must combine flexibility in the intervention model, implementation strategy, and the evaluation, in order to maximize ongoing learning. PMID:20530392

  12. Establishment of a new robotic prostatectomy program at a tertiary Veteran's Affairs medical center.

    PubMed

    Moore, Blake W; Dolat, Mary Ellen T; McPartlin, Daniel; Mayer Grob, B; Guruli, Georgi; Hampton, Lance J

    2013-06-01

    The objective of this study is to report the initial results of a newly established robotic prostatectomy (DVP) program at a Veteran's Affairs (VA) medical center. All patients who underwent a radical prostatectomy during the first 18 months of our robotic surgical program were included in this study. These patients were compared to a control group that included all patients who underwent an open prostatectomy 18 months prior to starting our robotic program. Preoperative, intraoperative and postoperative data was compared between open and robotic prostatectomies. 38 men underwent radical retropubic prostatectomy (RRP) between September 2007 and February 2009. With the introduction of robotic prostatectomy, the total number of prostatectomies increased by 84 % to 70 (9 RRP, 61 DVP). Prostate-specific antigen (PSA), Gleason score and clinical stage were similar for both groups. Average estimated blood loss (EBL) was 1205 mL for RRP and 126 mL for DVP. Mean operative times in minutes were 259 and 254 for RRP and DVP, respectively. Complications included two rectal perforations, a cerebrovascular accident, one death after RRP and one open conversion for failure to progress. Average length of stay was 5.1 for RRP and 1.8 days for DVP. Total positive margins were 24 % for RRP and 15 % for DVP. For T2-specific disease, 16.7 % had positive margins after RRP compared to 4.3 % after DVP. The establishment of a robotic prostatectomy program at a tertiary VA medical center was achieved in a safe and efficient manner with improvement in EBL and length of stay when compared to our open prostatectomies. Oncologic outcomes were equivalent when compared to other initial DVP programs.

  13. Implementation of Epic Beaker Clinical Pathology at an academic medical center

    PubMed Central

    Krasowski, Matthew D.; Wilford, Joseph D.; Howard, Wanita; Dane, Susan K.; Davis, Scott R.; Karandikar, Nitin J.; Blau, John L.; Ford, Bradley A.

    2016-01-01

    Background: Epic Beaker Clinical Pathology (CP) is a relatively new laboratory information system (LIS) operating within the Epic suite of software applications. To date, there have not been any publications describing implementation of Beaker CP. In this report, we describe our experience in implementing Beaker CP version 2012 at a state academic medical center with a go-live of August 2014 and a subsequent upgrade to Beaker version 2014 in May 2015. The implementation of Beaker CP was concurrent with implementations of Epic modules for revenue cycle, patient scheduling, and patient registration. Methods: Our analysis covers approximately 3 years of time (2 years preimplementation of Beaker CP and roughly 1 year after) using data summarized from pre- and post-implementation meetings, debriefings, and the closure document for the project. Results: We summarize positive aspects of, and key factors leading to, a successful implementation of Beaker CP. The early inclusion of subject matter experts in the design and validation of Beaker workflows was very helpful. Since Beaker CP does not directly interface with laboratory instrumentation, the clinical laboratories spent extensive preimplementation effort establishing middleware interfaces. Immediate challenges postimplementation included bar code scanning and nursing adaptation to Beaker CP specimen collection. The most substantial changes in laboratory workflow occurred with microbiology orders. This posed a considerable challenge with microbiology orders from the operating rooms and required intensive interventions in the weeks following go-live. In postimplementation surveys, pathology staff, informatics staff, and end-users expressed satisfaction with the new LIS. Conclusions: Beaker CP can serve as an effective LIS for an academic medical center. Careful planning and preparation aid the transition to this LIS. PMID:26955505

  14. Advances in the care of head and neck cancer patients at Baylor University Medical Center.

    PubMed

    O'Brien, John C

    2008-01-01

    Editor's note: The Society of Baylor Surgeons held a meeting on August 10 to 11, 2007: "Advances in Surgery and Surgical Education: The Past 20 Years," in honor of Dr. Ronald C. Jones' 20th year as chairman of the Department of Surgery at Baylor University Medical Center. This society was founded in 1981 by Dr. Robert Sparkman, past chief of the department, as a way to reunite former Baylor surgery residents and provide continuing surgical education for residents and members of the medical staff.Under the direction of program director John Preskitt, MD, the 2007 CME-accredited meeting included presentations from four prominent guest speakers: Edward M. Copeland, MD, president of the American College of Surgeons; R. Scott Jones, MD, professor and chairman of surgery emeritus for the University of Virginia Health System; Kirby I. Bland, MD, chairman of the Department of Surgery at the University of Alabama; and Stanley Dudrick, MD, chairman of the Department of Surgery at St. Mary's Hospital, Waterbury, Connecticut. In addition, 12 physicians from Baylor made presentations at this meeting, and some provided summaries, which are reproduced in this issue of Proceedings.

  15. Virtual microscopy in medical research: Open European Nephrology Science Center (OpEN.SC)

    NASA Astrophysics Data System (ADS)

    Schrader, Thomas; Beil, Michael; Schmidt, Danilo; Dietel, Manfred; Lindemann, Gabriela

    2007-03-01

    The amount and heterogeneity of data in biomedical research, notably in transnational research, requires new methods for the collection, presentation and analysis of information. Important data from laboratory experiments as well as patient trials are available as images. Thus, the integration and processing of image data represent a crucial component of information systems in biomedical research. The Charité Medical School in Berlin has established a new information service center for kidney diseases and transplantation (Open European Nephrology Science Centre - OpEN.SC) together with the German Research Agency (DFG). The aims of this project are (i) to improve the availability of raw data, (ii) to establish an infrastructure for clinical trials, (iii) to monitor the occurrence of rare disease patterns and (iv) to establish a quality assurance system. Major diagnostic procedures in medicine are based on the processing and analysis of image data. In diagnostic pathology, the availability of automated slide scanners provide the opportunity to digitize entire microscopic slides. The processing, presentation and analysis of these image data are called virtual microscopy. The integration of this new technology into the OpEN.SC system and the link to other heterogeneous data of individual patients represent a major technological challenge. Thus, new ways in communication between clinical and scientific partners have to be established and will be promoted by the project. The technological basis of the repository are web services for a scalable and adaptable system. HL7 and DICOM are considered the main medical standards of communication.

  16. Advancing educational continuity in primary care residencies: an opportunity for patient-centered medical homes.

    PubMed

    Bowen, Judith L; Hirsh, David; Aagaard, Eva; Kaminetzky, Catherine P; Smith, Marie; Hardman, Joseph; Chheda, Shobhina G

    2015-05-01

    Continuity of care is a core value of patients and primary care physicians, yet in graduate medical education (GME), creating effective clinical teaching environments that emphasize continuity poses challenges. In this Perspective, the authors review three dimensions of continuity for patient care-informational, longitudinal, and interpersonal-and propose analogous dimensions describing continuity for learning that address both residents learning from patient care and supervisors and interprofessional team members supporting residents' competency development. The authors review primary care GME reform efforts through the lens of continuity, including the growing body of evidence that highlights the importance of longitudinal continuity between learners and supervisors for making competency judgments. The authors consider the challenges that primary care residency programs face in the wake of practice transformation to patient-centered medical home models and make recommendations to maximize the opportunity that these practice models provide. First, educators, researchers, and policy makers must be more precise with terms describing various dimensions of continuity. Second, research should prioritize developing assessments that enable the study of the impact of interpersonal continuity on clinical outcomes for patients and learning outcomes for residents. Third, residency programs should establish program structures that provide informational and longitudinal continuity to enable the development of interpersonal continuity for care and learning. Fourth, these educational models and continuity assessments should extend to the level of the interprofessional team. Fifth, policy leaders should develop a meaningful recognition process that rewards academic practices for training the primary care workforce. PMID:25470307

  17. Nurses and Psychologists Advancing the Patient-Centered Medical Home Model.

    PubMed

    Corso, Kent A; Gage, Donna

    2016-01-01

    As America experiences the largest health care revolution of the past 50 years, clinicians and administrators are refocusing their attention on the goals of the Quadruple Aim. Motivation and capabilities among stakeholders vary as practical tools and an adequate workforce remain elusive. At the same time, the patient-centered medical home (PCMH) model is spreading rapidly but demonstrating variable results. Positive PCMH outcomes seem to reflect high-quality teamwork. A primary care physician shortage is looming, and increasing numbers of health professionals are being pushed into the PCMH, mandated to provide "integrated" care. Even now, the majority of our Graduate Medical Education programs do not train clinicians in team-based workflow models and interaction skills. Consequently, PCMH teams will only optimize and realize the model's true potential if they learn to coordinate, communicate, and collaborate effectively. This means all PCMH staff members achieve solid teamwork skills and work at the top of their license. The authors discuss resources for improving coordination, communication, and collaboration among members of PCMH teams, and strategies for including other professionals.

  18. Early Clinical Experiences for Second-Year Student Pharmacists at an Academic Medical Center

    PubMed Central

    Amerine, Lindsey B.; Chen, Sheh-Li; Luter, David N.; Arnall, Justin; Smith, Shayna; Roth, Mary T.; Rodgers, Philip T.; Williams, Dennis M.; Pinelli, Nicole R.

    2015-01-01

    Objective. To examine student outcomes associated with the Student Medication and Reconciliation Team (SMART) program, which was designed to provide second-year student pharmacists at the University of North Carolina (UNC) Eshelman School of Pharmacy direct patient care experience at UNC Medical Center. Design. Twenty-two second-year student pharmacists were randomly selected from volunteers, given program training, and scheduled for three 5-hour evening shifts in 2013-2014. Pre/post surveys and reflection statements were collected from 19 students. Data were analyzed with a mixed methods approach. Assessment. Survey results revealed an increase in student self-efficacy (p<0.05) and positive perceptions of SMART. Qualitative findings suggest the program provided opportunities for students to develop strategies for practice, promoted an appreciation for the various roles pharmacists play in health care, and fostered an appreciation for the complexity of real-world practice. Conclusion. Early clinical experiences can enhance student learning and development while fostering an appreciation for pharmacy practice. PMID:26839428

  19. Bridging the gap: creating faculty development opportunities at a large medical center.

    PubMed

    James, Kia M G

    2004-01-01

    Faculty development often focuses on developing practicing professionals into teaching experts within a classroom setting. As such, the topic of nursing faculty development is often written about from the standpoint of an employing traditional academic institution. Nursing faculty also have development needs related to practice within a clinical education institution. How do faculty members maintain a current perspective on endless changes in the clinical setting? This becomes particularly challenging if faculty are not actively engaged in nursing practice at the bedside and utilize a clinical facility for education sporadically throughout an academic year. This article describes the method one large academic medical center used to partner collaboratively with schools of nursing to create opportunities for faculty development. A need for clinical faculty development was recognized and a clinical facility faculty day was created and implemented. Information shared during this faculty development day included institutional practice changes, the implementation of a computerized medical record documentation system, general orientation policies, and procedures related to the conducting of business within the institution. A networking opportunity was also provided for faculty and the institutional healthcare leadership staff. Anecdotal evaluation information is also shared.

  20. Value-based financially sustainable behavioral health components in patient-centered medical homes.

    PubMed

    Kathol, Roger G; Degruy, Frank; Rollman, Bruce L

    2014-01-01

    Because a high percentage of primary care patients have behavioral problems, patient-centered medical homes (PCMHs) that wish to attain true comprehensive whole-person care will find ways to integrate behavioral health services into their structure. Yet in today's health care environment, the incorporation of behavioral services into primary care is exceptional rather than usual practice. In this article, we discuss the components considered necessary to provide sustainable, value-added integrated behavioral health care in the PCMH. These components are to: (1) combine medical and behavioral benefits into one payment pool; (2) target complex patients for priority behavioral health care; (3) use proactive onsite behavioral "teams;" (4) match behavioral professional expertise to the need for treatment escalation inherent in stepped care; (5) define, measure, and systematically pursue desired outcomes; (6) apply evidence-based behavioral treatments; and (7) use cross-disciplinary care managers in assisting the most complicated and vulnerable. By adopting these 7 components, PCHMs will augment their ability to achieve improved health in their patients at lower cost in a setting that enhances ease of access to commonly needed services.

  1. Summary of the National Demonstration Project and recommendations for the patient-centered medical home.

    PubMed

    Crabtree, Benjamin F; Nutting, Paul A; Miller, William L; Stange, Kurt C; Stewart, Elizabeth E; Jaén, Carlos Roberto

    2010-01-01

    This article summarizes findings from the National Demonstration Project (NDP) and makes recommendations for policy makers and those implementing patient-centered medical homes (PCMHs) based on these findings and an understanding of diverse efforts to transform primary care. The NDP was launched in June 2006 as the first national test of a particular PCMH model in a diverse sample of 36 family practices, randomized to facilitated or self-directed groups. An independent evaluation team used a multimethod evaluation strategy, analyzing data from direct observation, depth interviews, e-mail streams, medical record audits, and patient and clinical staff surveys. Peer-reviewed manuscripts from the NDP provide answers to 4 key questions: (1) Can the NDP model be built? (2) What does it take to build the NDP model? (3) Does the NDP model make a difference in quality of care? and (4) Can the NDP model be widely disseminated? We find that although it is feasible to transform independent practices into the NDP conceptualization of a PCMH, this transformation requires tremendous effort and motivation, and benefits from external support. Most practices will need additional resources for this magnitude of transformation. Recommendations focus on the need for the PCMH model to continue to evolve, for delivery system reform, and for sufficient resources for implementing personal and practice development plans. In the meantime, we find that much can be done before larger health system reform. PMID:20530397

  2. Nutritional management of enterocutaneous fistula: a retrospective study at a Malaysian university medical center.

    PubMed

    Badrasawi, Manal Mh; Shahar, Suzana; Sagap, Ismail

    2014-01-01

    Enterocutaneous fistula is a challenging clinical condition with serious complications and considerable morbidity and mortality. Early nutritional support has been found to decrease these complications and to improve the clinical outcome. Location of the fistula and physiological status affect the nutrition management plan in terms of feeding route, calories, and protein requirements. This study investigated the nutritional management procedures at the Universiti Kebangsaan Malaysia Medical Center, and attempted to determine factors that affect the clinical outcome. Nutritional management was evaluated retrospectively in 22 patients with enterocutaneous fistula seen over a 5-year period. Medical records were reviewed to obtain data on nutritional status, biochemical indices, and route and tolerance of feeding. Calories and protein requirements are reported and categorized. The results show that surgery was the predominant etiology and low output fistula was the major physiological category; anatomically, the majority were ileocutaneous. The spontaneous healing rate was 14%, the total healing rate was 45%, and the mortality rate was 22%, with 14% due to fistula-associated complications. There was a significant relationship between body mass index/serum albumin levels and fistula healing; these parameters also had a significant relationship with mortality. Glutamine was used in 50% of cases; however, there was no significant relationship with fistula healing or mortality rate. The nutritional status of the patient has an important impact on the clinical outcome. Conservative management that includes nutrition support is very important in order to improve nutritional status before surgical repair of the fistula.

  3. Drug reps and the academic medical center: a case for management rather than prohibition.

    PubMed

    Huddle, Thomas S

    2008-01-01

    Abstract:Academic physicians and bioethicists are increasingly voicing objections to "drug rep" detailing. Leaders in academic medical centers are considering proposals to ban the small gifts of detailing within their walls. Such bans would be a mistake, as the small gifts are unlikely to act as bribes and do not create unacceptable conflicts of interest for physicians. Drug rep detailing does influence physician behavior, but this influence has not been shown to be harmful. Calls for a ban are premised on empirical evidence for harm that is inconclusive at best, and emerging literature in economics suggests that detailing may well be socially beneficial. A preponderance of harm over benefit is not, however, the primary source of the animus against detailing, which stems from moral considerations that are independent of its social consequences. However, pharmaceutical advertising, including detailing, is a morally legitimate aspect of the world of medical practice that we in academic medicine ought to be preparing our trainees to encounter and properly sift. PMID:18453729

  4. Nutritional management of enterocutaneous fistula: a retrospective study at a Malaysian university medical center

    PubMed Central

    Badrasawi, Manal MH; Shahar, Suzana; Sagap, Ismail

    2014-01-01

    Enterocutaneous fistula is a challenging clinical condition with serious complications and considerable morbidity and mortality. Early nutritional support has been found to decrease these complications and to improve the clinical outcome. Location of the fistula and physiological status affect the nutrition management plan in terms of feeding route, calories, and protein requirements. This study investigated the nutritional management procedures at the Universiti Kebangsaan Malaysia Medical Center, and attempted to determine factors that affect the clinical outcome. Nutritional management was evaluated retrospectively in 22 patients with enterocutaneous fistula seen over a 5-year period. Medical records were reviewed to obtain data on nutritional status, biochemical indices, and route and tolerance of feeding. Calories and protein requirements are reported and categorized. The results show that surgery was the predominant etiology and low output fistula was the major physiological category; anatomically, the majority were ileocutaneous. The spontaneous healing rate was 14%, the total healing rate was 45%, and the mortality rate was 22%, with 14% due to fistula-associated complications. There was a significant relationship between body mass index/serum albumin levels and fistula healing; these parameters also had a significant relationship with mortality. Glutamine was used in 50% of cases; however, there was no significant relationship with fistula healing or mortality rate. The nutritional status of the patient has an important impact on the clinical outcome. Conservative management that includes nutrition support is very important in order to improve nutritional status before surgical repair of the fistula. PMID:25187726

  5. Transforming physician practices to patient-centered medical homes: lessons from the national demonstration project.

    PubMed

    Nutting, Paul A; Crabtree, Benjamin F; Miller, William L; Stange, Kurt C; Stewart, Elizabeth; Jaén, Carlos

    2011-03-01

    Many commentators view the conversion of small, independent primary care practices into patient-centered medical homes as a vital step in creating a better-performing health care system. The country's first national medical home demonstration, which ran from June 1, 2006, to May 31, 2008, and involved thirty-six practices, showed that this transformation can be lengthy and complex. Among other features, the transformation process requires an internal capability for organizational learning and development; changes in the way primary care clinicians think about themselves and their relationships with patients as well as other clinicians on the care team; and awareness on the part of primary care clinicians that they will need to make long-term commitments to change that may require three to five years of external assistance. Additionally, transforming primary care requires synchronizing practice redesign with development of the health care "neighborhood," which is made up of a broad range of health and health care resources available to patients. It also requires payment reform that supports practice development and a policy environment that sets reasonable expectations and time frames for the adoption of appropriate innovations. PMID:21383361

  6. Nurses and Psychologists Advancing the Patient-Centered Medical Home Model.

    PubMed

    Corso, Kent A; Gage, Donna

    2016-01-01

    As America experiences the largest health care revolution of the past 50 years, clinicians and administrators are refocusing their attention on the goals of the Quadruple Aim. Motivation and capabilities among stakeholders vary as practical tools and an adequate workforce remain elusive. At the same time, the patient-centered medical home (PCMH) model is spreading rapidly but demonstrating variable results. Positive PCMH outcomes seem to reflect high-quality teamwork. A primary care physician shortage is looming, and increasing numbers of health professionals are being pushed into the PCMH, mandated to provide "integrated" care. Even now, the majority of our Graduate Medical Education programs do not train clinicians in team-based workflow models and interaction skills. Consequently, PCMH teams will only optimize and realize the model's true potential if they learn to coordinate, communicate, and collaborate effectively. This means all PCMH staff members achieve solid teamwork skills and work at the top of their license. The authors discuss resources for improving coordination, communication, and collaboration among members of PCMH teams, and strategies for including other professionals. PMID:27259123

  7. Medicine at the medical center then and now: one hundred years of progress.

    PubMed

    Cooper, M Robert; Stewart, David C; Kahl, Frederic R; Brown, W Mark; Cordell, A Robert

    2002-10-01

    The health and life expectancy of persons residing in the United States has improved dramatically during the 20th century. The average life span in the US has increased by more than 30 years since 1900. This significant gain is attributable to improvements in both public health and medical care. Tempering this notable achievement is the observation that the mortality rate per 1,000 population, although showing a significant decline in the era from 1920 to 1940, has now plateaued, and may be showing a slight increase. Our scientists and physicians have appropriately exploited the scientific discoveries of the 20th century and are poised as a medical tour de force for the 21st century. The decline in deaths from coronary artery disease and stroke has resulted from risk-factor modification and the innovations of surgeons and physicians who have dedicated themselves to early detection and better treatment of these cases. During the 1960s, patients admitted to our medical center with advanced Hodgkin's disease, hairy cell leukemia, and the acute leukemias had a life expectancy of < 1 year. Today, even advanced Hodgkin's disease and hairy cell leukemia are curable, and many patients with other acute leukemias respond to therapy and have very durable remissions. The rate of maternal mortality has shown a dramatic decline, and many childhood diseases have been eradicated or reduced to infrequent occurrences. Our public health scientists and physicians are joining forces to further diminish the morbidity and mortality rates for many of our common diseases. The achievements of our past afford us the vision for what we can become. PMID:12425493

  8. The Cost of Sustaining a Patient-Centered Medical Home: Experience From 2 States

    PubMed Central

    Magill, Michael K.; Ehrenberger, David; Scammon, Debra L.; Day, Julie; Allen, Tatiana; Reall, Andreu J.; Sides, Rhonda W.; Kim, Jaewhan

    2015-01-01

    PURPOSE As medical practices transform to patient-centered medical homes (PCMHs), it is important to identify the ongoing costs of maintaining these “advanced primary care” functions. A key required input is personnel effort. This study’s objective was to assess direct personnel costs to practices associated with the staffing necessary to deliver PCMH functions as outlined in the National Committee for Quality Assurance Standards. METHODS We developed a PCMH cost dimensions tool to assess costs associated with activities uniquely required to maintain PCMH functions. We interviewed practice managers, nurse supervisors, and medical directors in 20 varied primary care practices in 2 states, guided by the tool. Outcome measures included categories of staff used to perform various PCMH functions, time and personnel costs, and whether practices were delivering PCMH functions. RESULTS Costs per full-time equivalent primary care clinician associated with PCMH functions varied across practices with an average of $7,691 per month in Utah practices and $9,658 in Colorado practices. PCMH incremental costs per encounter were $32.71 in Utah and $36.68 in Colorado. The average estimated cost per member per month for an assumed panel of 2,000 patients was $3.85 in Utah and $4.83 in Colorado. CONCLUSIONS Identifying costs of maintaining PCMH functions will contribute to effective payment reform and to sustainability of transformation. Maintenance and ongoing support of PCMH functions require additional time and new skills, which may be provided by existing staff, additional staff, or both. Adequate compensation for ongoing and substantial incremental costs is critical for practices to sustain PCMH functions. PMID:26371263

  9. Clinical skills training in undergraduate medical education using a student-centered approach.

    PubMed

    Tolsgaard, Martin Grønnebæk

    2013-08-01

    This thesis focuses on how to engage students in self-directed learning and in peer-learning activities to improve clinical skills training in undergraduate medical education. The first study examined the clinical skills teaching provided by student teachers compared to that provided by associate professors. This study showed that student teachers performed as good as or even better than associate professors when teaching simple clinical skills. The second study of this thesis examined how complex clinical skills--such as patient management skills--develop with increasing levels of competence. The Reporter-Interpreter-Manager-Educator framework was used to reflect this change and construct validity was explored for RIME-based evaluations of single-patient encounters. In the third study the effects of training in pairs--also known as dyad practice--examined. This study showed that the students practicing in pairs significantly out-performed those training alone using RIME-based assessments and that dyad training significantly improved students' confidence in managing future patient encounters. The final study examined students' use of self-directed clinical encounter cards (CECs) based on the RIME framework. Results from this study showed that self-directed CECs can have positive effects on participatory practice and clinical reasoning when implemented in a supporting environment but the chance of success depends on the context of use. Self-directed CECs can be successful but major faculty development initiatives are required before implementation in large and dispersed settings. In conclusion, this thesis demonstrated different aspects of student-centered approaches to clinical skills learning. Whereas self-directed learning is difficult in clinical clerkship, the experimental studies demonstrated remarkable advantages to peer-learning in skills-lab. Thus, peer-learning activities could be essential to providing high-quality medical training in the face of limited

  10. Clinical skills training in undergraduate medical education using a student-centered approach.

    PubMed

    Tolsgaard, Martin Grønnebæk

    2013-08-01

    This thesis focuses on how to engage students in self-directed learning and in peer-learning activities to improve clinical skills training in undergraduate medical education. The first study examined the clinical skills teaching provided by student teachers compared to that provided by associate professors. This study showed that student teachers performed as good as or even better than associate professors when teaching simple clinical skills. The second study of this thesis examined how complex clinical skills--such as patient management skills--develop with increasing levels of competence. The Reporter-Interpreter-Manager-Educator framework was used to reflect this change and construct validity was explored for RIME-based evaluations of single-patient encounters. In the third study the effects of training in pairs--also known as dyad practice--examined. This study showed that the students practicing in pairs significantly out-performed those training alone using RIME-based assessments and that dyad training significantly improved students' confidence in managing future patient encounters. The final study examined students' use of self-directed clinical encounter cards (CECs) based on the RIME framework. Results from this study showed that self-directed CECs can have positive effects on participatory practice and clinical reasoning when implemented in a supporting environment but the chance of success depends on the context of use. Self-directed CECs can be successful but major faculty development initiatives are required before implementation in large and dispersed settings. In conclusion, this thesis demonstrated different aspects of student-centered approaches to clinical skills learning. Whereas self-directed learning is difficult in clinical clerkship, the experimental studies demonstrated remarkable advantages to peer-learning in skills-lab. Thus, peer-learning activities could be essential to providing high-quality medical training in the face of limited

  11. The proton therapy nozzles at Samsung Medical Center: A Monte Carlo simulation study using TOPAS

    NASA Astrophysics Data System (ADS)

    Chung, Kwangzoo; Kim, Jinsung; Kim, Dae-Hyun; Ahn, Sunghwan; Han, Youngyih

    2015-07-01

    To expedite the commissioning process of the proton therapy system at Samsung Medical Center (SMC), we have developed a Monte Carlo simulation model of the proton therapy nozzles by using TOol for PArticle Simulation (TOPAS). At SMC proton therapy center, we have two gantry rooms with different types of nozzles: a multi-purpose nozzle and a dedicated scanning nozzle. Each nozzle has been modeled in detail following the geometry information provided by the manufacturer, Sumitomo Heavy Industries, Ltd. For this purpose, the novel features of TOPAS, such as the time feature or the ridge filter class, have been used, and the appropriate physics models for proton nozzle simulation have been defined. Dosimetric properties, like percent depth dose curve, spreadout Bragg peak (SOBP), and beam spot size, have been simulated and verified against measured beam data. Beyond the Monte Carlo nozzle modeling, we have developed an interface between TOPAS and the treatment planning system (TPS), RayStation. An exported radiotherapy (RT) plan from the TPS is interpreted by using an interface and is then translated into the TOPAS input text. The developed Monte Carlo nozzle model can be used to estimate the non-beam performance, such as the neutron background, of the nozzles. Furthermore, the nozzle model can be used to study the mechanical optimization of the design of the nozzle.

  12. Improving the Safety of Oral Chemotherapy at an Academic Medical Center

    PubMed Central

    Casella, Erica; Capozzi, Donna; McGettigan, Suzanne; Gangadhar, Tara C.; Schuchter, Lynn; Myers, Jennifer S.

    2016-01-01

    Purpose: Over the last decade, the use of oral chemotherapy (OC) for the treatment of cancer has dramatically increased. Despite their route of administration, OCs pose many of the same risks as intravenous agents. In this quality improvement project, we sought to examine our current process for the prescription of OC at the Abramson Cancer Center of the University of Pennsylvania and to improve on its safety. Methods: A multidisciplinary team that included oncologists, advanced-practice providers, and pharmacists was formed to analyze the current state of our OC practice. Using Lean Six Sigma quality improvement tools, we identified a lack of pharmacist review of the OC prescription as an area for improvement. To address these deficiencies, we used our electronic medical system to route OC orders placed by treating providers to an oncology-specific outpatient pharmacist at the Abramson Cancer Center for review. Results: Over 7 months, 63 orders for OC were placed for 45 individual patients. Of the 63 orders, all were reviewed by pharmacists, and, as a result, 22 interventions were made (35%). Types of interventions included dosage adjustment (one of 22), identification of an interacting drug (nine of 22), and recommendations for additional drug monitoring (12 of 22). Conclusion: OC poses many of the same risks as intravenous chemotherapy and should be prescribed and reviewed with the same oversight. At our institution, involvement of an oncology-trained pharmacist in the review of OC led to meaningful interventions in one third of the orders. PMID:26733627

  13. Changing clinicians' behaviors in an academic medical center: does institutional commitment to total quality management matter?

    PubMed

    Wyszewianski, L; Kratochwill, E W

    1997-01-01

    The purpose of this project was to determine whether changing clinicians' behaviors to reduce costs in a large academic medical center is facilitated by the prior existence of a total quality management program. Ten teams, made up primarily of clinicians, were charged with devising strategies for altering specific clinical behaviors to reduce costs without detriment to quality of care. Half the teams followed the center's total quality management approach. Team success was assessed by how well three key tasks were completed: problem definition, design of plan of action, and plan implementation. Two teams achieved outright successes, three had outright failures, and five were in between. Adherence to a total quality management approach was not found to be associated with team success. A much better predictor of success was the level of involvement and support by clinicians and managers; because that factor is largely controlled by institutional incentives, those incentives may need to be realigned before the effectiveness of a total quality management approach can be properly evaluated. PMID:9116529

  14. Disruptive innovation in academic medical centers: balancing accountable and academic care.

    PubMed

    Stein, Daniel; Chen, Christopher; Ackerly, D Clay

    2015-05-01

    Numerous academic medicine leaders have argued that academic referral centers must prepare for the growing importance of accountability-driven payment models by adopting population health initiatives. Although this shift has merit, execution of this strategy will prove significantly more problematic than most observers have appreciated. The authors describe how successful implementation of an accountable care health strategy within a referral academic medical center (AMC) requires navigating a critical tension: The academic referral business model, driven by tertiary-level care, is fundamentally in conflict with population health. Referral AMCs that create successful value-driven population health systems within their organizations will in effect disrupt their own existing tertiary care businesses. The theory of disruptive innovation suggests that balancing the push and pull of academic and accountable care within a single organization is achievable. However, it will require significant shifts in resource allocation and changes in management structure to enable AMCs to make the inherent difficult choices and trade-offs that will ensue. On the basis of the theories of disruptive innovation, the authors present recommendations for how academic health systems can successfully navigate these issues as they transition toward accountability-driven care. PMID:25517702

  15. Disruptive innovation in academic medical centers: balancing accountable and academic care.

    PubMed

    Stein, Daniel; Chen, Christopher; Ackerly, D Clay

    2015-05-01

    Numerous academic medicine leaders have argued that academic referral centers must prepare for the growing importance of accountability-driven payment models by adopting population health initiatives. Although this shift has merit, execution of this strategy will prove significantly more problematic than most observers have appreciated. The authors describe how successful implementation of an accountable care health strategy within a referral academic medical center (AMC) requires navigating a critical tension: The academic referral business model, driven by tertiary-level care, is fundamentally in conflict with population health. Referral AMCs that create successful value-driven population health systems within their organizations will in effect disrupt their own existing tertiary care businesses. The theory of disruptive innovation suggests that balancing the push and pull of academic and accountable care within a single organization is achievable. However, it will require significant shifts in resource allocation and changes in management structure to enable AMCs to make the inherent difficult choices and trade-offs that will ensue. On the basis of the theories of disruptive innovation, the authors present recommendations for how academic health systems can successfully navigate these issues as they transition toward accountability-driven care.

  16. The Honolulu Liver Disease Cluster at the Medical Center: Its Mysteries and Challenges

    PubMed Central

    Teschke, Rolf; Eickhoff, Axel

    2016-01-01

    In 2013, physicians at the Honolulu Queen’s Medical Center (QMC) noticed that seven liver disease patients reported the use of OxyELITE Pro (OEP), a widely consumed dietary supplement (DS). Assuming a temporal association between OEP use and disease, they argued that OEP was the cause of this mysterious cluster. Subsequent reexamination, however, has revealed that this QMC cohort is heterogeneous and not a cluster with a single agent causing a single disease. It is heterogeneous because patients used multiple DS’s and drugs and because patients appeared to have suffered from multiple liver diseases: liver cirrhosis, liver failure by acetaminophen, hepatotoxicity by non-steroidal antiinflammatory drugs (NSAIDs), resolving acute viral hepatitis by hepatitis B virus (HBV), herpes simplex virus (HSV), and varicella zoster virus (VZV), and suspected hepatitis E virus (HEV). Failing to exclude these confounders and to consider more viable diagnoses, the QMC physicians may have missed specific treatment options in some of their patients. The QMC physicians unjustifiably upgraded their Roussel Uclaf Causality Assessment Method (RUCAM) causality scores so that all patients would appear to be “probable” for OEP. However, subsequent RUCAM reassessments by our group demonstrated a lack of causality for OEP in the evaluated QMC cases. The QMC’s questionable approaches explain the extraordinary accumulation of suspected OEP cases at the QMC in Hawaii as single place, whereas similar cohorts were not published by any larger US liver center, substantiating that the problem is with the QMC. In this review article, we present and discuss new case data and critically evaluate upcoming developments of problematic regulatory assessments by the US Centers for Disease Control and Prevention (CDC), the Hawaii Department of Health (HDOH), and the Food and Drug Administration (FDA), as based on invalid QMC conclusions, clarifying now also basic facts and facilitating constructive

  17. Assessment of Unconscious Decision Aids Applied to Complex Patient-Centered Medical Decisions

    PubMed Central

    Manigault, Andrew Wilhelm; Whillock, Summer Rain

    2015-01-01

    reporting judgments. Cognitive load was manipulated by having participants memorize semi-random (high), line structured (low), or no dot patterns and recall these intermittently with their decision reports. Overall then, participants were randomly assigned to the conditions of a 3 (thought condition) by 3 (cognitive-load level) between-subjects design. Results A logistic regression analysis indicated that the odds of participants choosing the best treatment were 2.25 times higher in the unconscious-thought condition compared to the immediate-decision condition (b=.81, Wald=4.32, P=.04, 95% CI 1.048-4.836), and 2.39 times greater compared to the conscious-thought condition (b=.87, Wald=4.87, P=.027, 95% CI 1.103-5.186). No difference was observed between the conscious-thought condition compared to the immediate-decision condition, and cognitive load manipulations did not affect choices or alter the above finding. Conclusions This research demonstrates a plausible benefit of unconscious thinking as a decision aid for complex medical decisions, and represents the first use of unconscious thought processes as a patient-centered medical decision aid. Further, the quality of decisions reached unconsciously does not appear to be affected by the amount of cognitive load participants experienced. PMID:25677337

  18. Clinical trials of boron neutron capture therapy [in humans] [at Beth Israel Deaconess Medical Center][at Brookhaven National Laboratory

    SciTech Connect

    Wallace, Christine

    2001-05-29

    Assessment of research records of Boron Neutron Capture Therapy was conducted at Brookhaven National Laboratory and Beth Israel Deaconess Medical Center using the Code of Federal Regulations, FDA Regulations and Good Clinical Practice Guidelines. Clinical data were collected from subjects' research charts, and differences in conduct of studies at both centers were examined. Records maintained at Brookhaven National Laboratory were not in compliance with regulatory standards. Beth Israel's records followed federal regulations. Deficiencies discovered at both sites are discussed in the reports.

  19. Fostering Interprofessional Teamwork in an Academic Medical Center: Near-Peer Education for Students during Gross Medical Anatomy

    ERIC Educational Resources Information Center

    Shields, Richard K.; Pizzimenti, Marc A.; Dudley-Javoroski, Shauna; Schwinn, Debra A.

    2015-01-01

    The purpose of this report is to describe student satisfaction with a near-peer interprofessional education (IPE) session for physical therapy and medical students. Ten senior physical therapy students worked in peer-groups to develop a musculoskeletal anatomy demonstration for first-semester medical students. Together with their classmates, they…

  20. The HIV Epidemic and Medical Education. A Report of the AAMC Committee on AIDS and the Academic Medical Center.

    ERIC Educational Resources Information Center

    Association of American Medical Colleges, Washington, DC.

    This report examines the implications of the HIV (human immunodeficiency virus) epidemic for general professional education in medicine with a focus on the period of medical student education and the early years of residency training. Five sections are as follows: impact of the HIV epidemic on medical practice; issues for general professional…

  1. Two Reports of the AAMC Committee on AIDS and the Academic Medical Center.

    ERIC Educational Resources Information Center

    Academic Medicine, 1989

    1989-01-01

    Association of American Medical Colleges' reports concerning Acquired Immune Deficiency Syndrome include "Policy Guidelines for Addressing HIV [human immunodeficiency virus] Infection in the Academic Medical Community" and "The HIV Epidemic and Medical Education." (MSE)

  2. Characteristics of youth in the U.S. receiving services from a Patient-Centered Medical Home (PCMH).

    PubMed

    McCarter, Susan; Jones, King; Rager, Kristin M

    2011-01-01

    Using data from the 2007 National Survey of Children's Health, this study identifies the characteristics of those youth served and not served by a medical home. Although Patient-Centered Medical Homes (PCMHs) are being piloted with Medicaid clients, these national data indicate that adolescents are least likely to receive services from a medical home as are youth of color, those with family income levels between 0-99% of the Federal poverty level, and those currently uninsured. These populations, as well as children with special health care needs and youth in the child welfare system, however, may be those most likely to benefit from a PCMH. PMID:21919639

  3. SU-E-P-01: An Informative Review On the Role of Diagnostic Medical Physicist in the Academic and Private Medical Centers

    SciTech Connect

    Weir, V; Zhang, J

    2014-06-01

    Purpose: The role of physicist in the academic and private hospital environment continues to evolve and expand. This becomes more obvious with the newly revised requirements of the Joint Commission (JC) on imaging modalities and the continued updated requirements of ACR accreditation for medical physics (i.e., starting in June 2014, a physicists test will be needed before US accreditation). We provide an informative review on the role of diagnostic medical physicist and hope that our experience will expedite junior physicists in understanding their role in medical centers, and be ready to more opportunities. Methods: Based on our experience, diagnostic medical physicists in both academic and private medical centers perform several clinical functions. These include providing clinical service and physics support, ensuring that all ionizing radiation devices are tested and operated in compliance with the State and Federal laws, regulations and guidelines. We also discuss the training and education required to ensure that the radiation exposure to patients and staff is as low as reasonably achievable. We review the overlapping roles of medical and health physicist in some institutions. Results: A detailed scheme on the new requirements (effective 7/1/2014) of the JC is provided. In 2015, new standards for fluoroscopy, cone beam CT and the qualifications of staff will be phased in. A summary of new ACR requirements for different modalities is presented. Medical physicist have other duties such as sitting on CT and fluoroscopy committees for protocols design, training of non-radiologists to meet the new fluoroscopy rules, as well as helping with special therapies such as Yittrium 90 cases. Conclusion: Medical physicists in both academic and private hospitals are positioned to be more involved and prominent. Diagnostic physicists need to be more proactive to involve themselves in the day to day activities of the radiology department.

  4. Performance evaluation of Al-Zahra academic medical center based on Iran balanced scorecard model

    PubMed Central

    Raeisi, Ahmad Reza; Yarmohammadian, Mohammad Hossein; Bakhsh, Roghayeh Mohammadi; Gangi, Hamid

    2012-01-01

    Background: Growth and development in any country's national health system, without an efficient evaluation system, lacks the basic concepts and tools necessary for fulfilling the system's goals. The balanced scorecard (BSC) is a technique widely used to measure the performance of an organization. The basic core of the BSC is guided by the organization's vision and strategies, which are the bases for the formation of four perspectives of BSC. The goal of this research is the performance evaluation of Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences, based on Iran BSC model. Materials and Methods: This is a combination (quantitative–qualitative) research which was done at Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences in 2011. The research populations were hospital managers at different levels. Sampling method was purposive sampling in which the key informed personnel participated in determining the performance indicators of hospital as the BSC team members in focused discussion groups. After determining the conceptual elements in focused discussion groups, the performance objectives (targets) and indicators of hospital were determined and sorted in perspectives by the group discussion participants. Following that, the performance indicators were calculated by the experts according to the predetermined objectives; then, the score of each indicator and the mean score of each perspective were calculated. Results: Research findings included development of the organizational mission, vision, values, objectives, and strategies. The strategies agreed upon by the participants in the focus discussion group included five strategies, which were customer satisfaction, continuous quality improvement, development of human resources, supporting innovation, expansion of services and improving the productivity. Research participants also agreed upon four perspectives for the Al-Zahra hospital BSC. In the patients and community

  5. Human-centered risk management for medical devices - new methods and tools.

    PubMed

    Janß, Armin; Plogmann, Simon; Radermacher, Klaus

    2016-04-01

    Studies regarding adverse events with technical devices in the medical context showed, that in most of the cases non-usable interfaces are the cause for use deficiencies and therefore a potential harm for the patient and third parties. This is partially due to the lack of suitable methods for interlinking usability engineering and human-centered risk management. Especially regarding the early identification of human-induced errors and the systematic control of these failures, medical device manufacturers and in particular the developers have to be supported in order to guarantee reliable design and error-tolerant human-machine interfaces (HMI). In this context, we developed the HiFEM methodology and a corresponding software tool (mAIXuse) for model-based human risk analysis. Based on a two-fold approach, HiFEM provides a task-type-sensitive modeling structure with integrated temporal relations in order to represent and analyze the use process in a detailed way. The approach can be used from early developmental stages up to the validation process. Results of a comparative study with the HiFEM method and a classical process-failure mode and effect analysis (FMEA) depict, that the new modeling and analysis technique clearly outperforms the FMEA. Besides, we implemented a new method for systematic human risk control (mAIXcontrol). Accessing information from the method's knowledge base enables the operator to detect the most suitable countermeasures for a respective risk. Forty-one approved generic countermeasure principles have been indexed as a resulting combination of root causes and failures in a matrix. The methodology has been tested in comparison to a conventional approach as well. Evaluation of the matrix and the reassessment of the risk priority numbers by a blind expert demonstrate a substantial benefit of the new mAIXcontrol method.

  6. Process and Outcomes of Patient-Centered Medical Care With Alaska Native People at Southcentral Foundation

    PubMed Central

    Driscoll, David L.; Hiratsuka, Vanessa; Johnston, Janet M.; Norman, Sara; Reilly, Katie M.; Shaw, Jennifer; Smith, Julia; Szafran, Quenna N.; Dillard, Denise

    2013-01-01

    PURPOSE This study describes key elements of the transition to a patient-centered medical home (PCMH) model at Southcentral Foundation (SCF), a tribally owned and managed primary care system, and evaluates changes in emergency care use for any reason, for asthma, and for unintentional injuries, during and after the transition. METHODS We conducted a time series analyses of emergency care use from medical record data. We also conducted 45 individual, in-depth interviews with PCMH patients (customer-owners), primary care clinicians, health system employees, and tribal leaders. RESULTS Emergency care use for all causes was increasing before the PCMH implementation, dropped during and immediately after the implementation, and subsequently leveled off. Emergency care use for adult asthma dropped before, during, and immediately after implementation, subsequently leveling off approximately 5 years after implementation. Emergency care use for unintentional injuries, a comparison variable, showed an increasing trend before and during implementation and decreasing trends after implementation. Interview participants observed improved access to primary care services after the transition to the PCMH tempered by increased staff fatigue. Additional themes of PCMH transformation included the building of relationships for coordinated, team-based care, and the important role of leadership in PCMH implementation. CONCLUSIONS All reported measures of emergency care use show a decreasing trend after the PCMH implementation. Before the implementation, overall use and use for unintentional injuries had been increasing. The combined quantitative and qualitative results are consistent with decreased emergency care use resulting from a decreased need for emergency care services due to increased availability of primary care services and same-day appointments. PMID:23690385

  7. Teaching while learning while practicing: reframing faculty development for the patient-centered medical home.

    PubMed

    Clay, Michael A; Sikon, Andrea L; Lypson, Monica L; Gomez, Arthur; Kennedy-Malone, Laurie; Bussey-Jones, Jada; Bowen, Judith L

    2013-09-01

    Soaring costs of health care, patients living longer with chronic illnesses, and continued attrition of interest in primary care contribute to the urgency of developing an improved model of health care delivery. Out of this need, the concept of the team-based, patient-centered medical home (PCMH) has developed. Amidst implementation in academic settings, clinical teachers face complex challenges not previously encountered: teaching while simultaneously learning about the PCMH model, redesigning clinical delivery systems while simultaneously delivering care within them, and working more closely in expanded interprofessional teams.To address these challenges, the authors reviewed three existing faculty development models and recommended four important adaptations for preparing clinical teachers for their roles as system change agents and facilitators of learning in these new settings. First, many faculty find themselves in the awkward position of teaching concepts they have yet to master themselves. Professional development programs must recognize that, at least initially, health professions learners and faculty will be learning system redesign content and skills together while practicing in the evolving workplace. Second, all care delivery team members influence learning in the workplace. Thus, the definition of faculty must expand to include nurses, pharmacists, social workers, medical assistants, patients, and others. These team members will need to accept their roles as educators. Third, learning to deliver health care in teams will require support of both interprofessional collaboration and intraprofessional identity development. Fourth, learning to manage change and uncertainty should be part of the core content of any faculty development program within the PCMH. PMID:23887006

  8. Rejecting conventional wisdom: how academic medical centers can regain their leadership positions.

    PubMed

    Krauss, K; Smith, J

    1997-07-01

    Academic medical centers (i.e., medical schools and their principal hospitals) are following very similar strategies in attempts to secure their futures. It is likely that these undifferentiated strategies will fail, since most of them have been copied from the lower-cost, geographically better-positioned hospitals and health systems. Despite a wealth of innovative, entrepreneurial talent and the potential to reshape the world that AMCs live in, most AMCs are in reactive modes. Future directions and strategies are almost always shaped, forced, and justified by external pressures. The major problem with the strategic plans of most AMCs is that they are based on conventional industry wisdom. Strategic plans tend not to be analytically driven. The insight and understanding of those factors that drive the demand for AMCs' services and determine the performances of AMCs are lacking. The authors note some questions that are critical to the formulation of strategies for AMCs. For example, how can the research mission be changed from a cost-based to a value-based endeavor? Most AMCs cannot answer these questions, and if they do address them in the planning process, they do so superficially. Several examples of the factors that need to be understood are also given, such as patients' purposes and needs in seeking specialty care. Alternative strategies are listed, such as maintaining and exploiting the economic irrationality of the market rather than acting as if it were economically rational or forcing it to become so. Last, the authors outline the scope of the changes that are required and urge AMCs to reject conventional wisdom, determine their own unique situations, and work from there. PMID:9236466

  9. Holistic Health Care for the Medically Uninsured: The Church Health Center of Memphis.

    PubMed

    Morris, G Scott

    2015-01-01

    The Church Health Center (CHC) in Memphis was founded in 1987 to provide quality, affordable health care for working, uninsured people and their families. With numerous, dedicated financial supporters and health care volunteers, CHC has become the largest faith-based health care organization of its type nationally, serving >61,000 patients. CHC embraces a holistic approach to health by promoting wellness in every dimension of life. It offers on-site services including medical care, dentistry, optometry, counseling, social work, and nutrition and fitness education, to promote wellness in every dimension of life. A 2012 economic analysis estimated that a $1 contribution to the CHC provided roughly $8 in health services. The CHC has trained >1200 Congregational Health Promoters to be health leaders and is conducting research on the effectiveness of faith community nurses partnering with congregations to assist in home care for patients recently discharged from Memphis hospitals. The MEMPHIS Plan, CHC's employer-sponsored health care plan for small business and the self-employed, offers uninsured people in lower-wage jobs access to quality, affordable health care. The CHC also conducts replications workshops several times a year to share their model with leaders in other communities. The Institute for Healthcare Improvement (IHI) recently completed a case study that concluded: "The CHC is one of a very few organizations successfully embodying all three components of the IHI Triple Aim by improving population health outcomes, enhancing the individual's health care experience, and controlling costs. All three have been part of the Center's DNA since its inception, and as a transforming force in the community, the model is well worth national attention."

  10. Take-Wait-Stop: A Patient-Centered Strategy for Writing PRN Medication Instructions

    PubMed Central

    McCarthy, Danielle M.; Davis, Terry C.; King, Jennifer P.; Mullen, Rebecca J.; Bailey, Stacy C.; Serper, Marina; Jacobson, Kara L.; Parker, Ruth M.; Wolf, Michael S.

    2013-01-01

    Recent studies have linked patient misunderstanding of label instructions for as needed (PRN) medications to dosing errors. This study conducted a preliminary field test of patient-centered PRN label instructions. Patients participated in a hypothetical dosing experiment and were randomized to a patient-centered label (referred to as “Take-Wait-Stop”) or standard label. Participants were asked to demonstrate dosing the medicine over 24 hours. Three types of independent dosing errors were measured: (a) taking more than two pills at one time, (b) exceeding the maximum daily dose, and (c) waiting fewer than 4 hours between doses. Generalized linear models were used to assess the association between label type, health literacy, and sociodemographic characteristics. Participants' mean age was 39.8 years, 62.1% were female, 43.7% were White, and 72.4% had adequate literacy. Of participants, 31.8% who were shown the standard label demonstrated taking in excess of 6 pills in 24 hours compared with only 14.0% of participants who were shown the Take-Wait-Stop label (p = .05). Overall, only 1 person demonstrated he would take more than 2 pills in a single dose. Of the standard label group, 20.5% demonstrated dosing intervals of fewer than 4 hours compared with 23.3% of the Take-Wait-Stop label group (p = .75). In a multivariate model, participants who were exposed to the standard label were 2.5 times more likely to exceed the recommended maximum daily dose (95% CI [1.05, 7.70], p = .03). The Take-Wait-Stop label was beneficial in preventing participants from exceeding the maximum dose in 24 hours, although it did not significantly reduce other dosing errors. PMID:24093344

  11. Take-Wait-Stop: a patient-centered strategy for writing PRN medication instructions.

    PubMed

    McCarthy, Danielle M; Davis, Terry C; King, Jennifer P; Mullen, Rebecca J; Bailey, Stacy C; Serper, Marina; Jacobson, Kara L; Parker, Ruth M; Wolf, Michael S

    2013-01-01

    Recent studies have linked patient misunderstanding of label instructions for as needed (PRN) medications to dosing errors. This study conducted a preliminary field test of patient-centered PRN label instructions. Patients participated in a hypothetical dosing experiment and were randomized to a patient-centered label (referred to as "Take-Wait-Stop") or standard label. Participants were asked to demonstrate dosing the medicine over 24 hours. Three types of independent dosing errors were measured: (a) taking more than two pills at one time, (b) exceeding the maximum daily dose, and (c) waiting fewer than 4 hours between doses. Generalized linear models were used to assess the association between label type, health literacy, and sociodemographic characteristics. Participants' mean age was 39.8 years, 62.1% were female, 43.7% were White, and 72.4% had adequate literacy. Of participants, 31.8% who were shown the standard label demonstrated taking in excess of 6 pills in 24 hours compared with only 14.0% of participants who were shown the Take-Wait-Stop label (p = .05). Overall, only 1 person demonstrated he would take more than 2 pills in a single dose. Of the standard label group, 20.5% demonstrated dosing intervals of fewer than 4 hours compared with 23.3% of the Take-Wait-Stop label group (p=.75). In a multivariate model, participants who were exposed to the standard label were 2.5 times more likely to exceed the recommended maximum daily dose (95% CI [1.05, 7.70], p=.03). The Take-Wait-Stop label was beneficial in preventing participants from exceeding the maximum dose in 24 hours, although it did not significantly reduce other dosing errors. PMID:24093344

  12. [Teen-Age Medical Center and Walk-In Counseling Center (Model Cities). End of Contract Report.

    ERIC Educational Resources Information Center

    Galt, Lester

    This paper presents the objectives and results of an experimental program, the Teen Age Medical Service, in Minneapolis, Minnesota. The first objective of this program was to experiment with new ways of delivering additional, more extensive, and continuous personal services while maintaining the emergency and episodic services that have…

  13. Technology Transfer: Learning from Lost Opportunities and Sharing Best Practices--Experiences at Cedars-Sinai Medical Center, USA

    ERIC Educational Resources Information Center

    Vari, Sandor G.; Laur, James D.

    2006-01-01

    One significant aspect of Cedars-Sinai Medical Center's charitable mission is to ensure that its research results benefit society at large. This is accomplished through researcher education, securing appropriate intellectual property protection and licensing so that inventions are developed into useful products. The Swan-Ganz and Barath balloon…

  14. Reduced acute inpatient care was largest savings component of Geisinger Health System's patient-centered medical home.

    PubMed

    Maeng, Daniel D; Khan, Nazmul; Tomcavage, Janet; Graf, Thomas R; Davis, Duane E; Steele, Glenn D

    2015-04-01

    Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health System's patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care.

  15. Geospatial Modeling and Disease Insect Vector Management at the USDA-ARS Center for Medical, Agricultural, and Veterinary Entomology

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Geospatial modeling at the Center for Medical, Agricultural and Veterinary Entomology (CMAVE) is used assist in the surveillance of insect vectors and in the management of insect transmitted diseases. The most recent Geospatial Modeling/Technology Transfer success involves the prediction of Rift Val...

  16. 76 FR 36955 - West Los Angeles VA Medical Center Veterans Programs Enhancement Act of 1998; Master Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-23

    ... homeless veterans, especially those coping with mental health problems such as PTSD. The WLA campus is a... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS West Los Angeles VA Medical Center Veterans Programs Enhancement Act of 1998; Master Plan...

  17. New Tools for Learning: A Case of Organizational Problem Analysis Derived from Debriefing Records in a Medical Center

    ERIC Educational Resources Information Center

    Holzmann, Vered; Mischari, Shoshana; Goldberg, Shoshana; Ziv, Amitai

    2012-01-01

    Purpose: This article aims to present a unique systematic and validated method for creating a linkage between past experiences and management of future occurrences in an organization. Design/methodology/approach: The study is based on actual data accumulated in a series of projects performed in a major medical center. Qualitative and quantitative…

  18. Reduced acute inpatient care was largest savings component of Geisinger Health System's patient-centered medical home.

    PubMed

    Maeng, Daniel D; Khan, Nazmul; Tomcavage, Janet; Graf, Thomas R; Davis, Duane E; Steele, Glenn D

    2015-04-01

    Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health System's patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care. PMID:25847647

  19. Colorectal Cancer Screening Rates Increased after Exposure to the Patient-Centered Medical Home (PCMH)

    PubMed Central

    Green, Beverly B.; Anderson, Melissa L.; Chubak, Jessica; Baldwin, Laura Mae; Tuzzio, Leah; Catz, Sheryl; Cole, Alison; Vernon, Sally W.

    2016-01-01

    Objective The patient-centered medical home (PCMH) includes comprehensive chronic illness and preventive services, including identifying patients who are overdue for colorectal cancer screening (CRCS). The association between PCMH implementation and CRCS during the Systems of Support to Increase Colorectal Cancer Screening Trial (SOS) is described. Methods The SOS enrolled 4664 patients from 21 clinics from August 2008 to November 2009. Patients were randomized to usual care, mailed fecal kits, kits plus brief assistance, or kits plus assistance and navigation. A PCMH model that included a workflow for facilitating CRCS was implemented at all study clinics in late 2009. Patients enrolled early had little exposure to the PCMH, whereas patients enrolled later were exposed during most of their first year in the trial. Logistic regression models were used to assess the association between PCMH exposure and CRCS. Results Usual care patients with ≥8 months in the PCMH had higher CRCS rates than those with ≤4 months in the PCMH (adjusted difference, 10.1%; 95% confidence interval, 5.7–14.6). SOS interventions led to significant increases in CRCS, but the magnitude of effect was attenuated by exposure to the PCMH (P for interaction = .01). Conclusion Exposure to a PCMH was associated with higher CRCS rates. Automated mailed and centrally delivered stepped interventions increased CRCS rates, even in the presence of a PCMH. (J Am Board Fam Med 2016;29:191–200.) PMID:26957375

  20. Thoracic outlet syndrome: a 50-year experience at Baylor University Medical Center

    PubMed Central

    Kourlis, Harry

    2007-01-01

    During the past 5 decades, the recognition and management of thoracic outlet syndrome (TOS) have evolved. This article elucidates these changes and improvements in the diagnosis and management of TOS at Baylor University Medical Center. The most remarkable change over the past 50 years is the use of nerve conduction velocity to diagnose and monitor patients with nerve compression. Recognition that procedures such as breast implantation and median sternotomy may produce TOS has been revealing. Prompt thrombolysis followed by surgical venous decompression for Paget-Schroetter syndrome has markedly improved results compared with the conservative anticoagulation approach; thrombolysis and prompt first rib resection is the optimal treatment for most patients with Paget-Schroetter syndrome. Complete first rib extirpation at the initial procedure markedly reduces the incidence of recurrent neurologic symptoms or the need for a second procedure. Chest pain or pseudoangina can be caused by TOS. Dorsal sympathectomy is helpful for patients with sympathetic maintained pain syndrome or causalgia and patients with recurrent TOS symptoms who need a second procedure. PMID:17431445

  1. Factitious disease: clinical lessons from case studies at Baylor University Medical Center

    PubMed Central

    Savino, Adria C.; Fordtran, John S.

    2006-01-01

    Factitious disease is defined as the intentional production (or feigning) of disease in oneself to relieve emotional distress by assuming the role of a sick person. Although the self-induction of disease is a conscious act, the underlying motivation is usually unconscious. It has been estimated that 3% to 5% of physician-patient encounters involve factitious disease. This article presents 6 case studies from Baylor University Medical Center that highlight various clinical aspects of factitious disease. Patients with factitious diseases are extremely difficult to recognize because they do not appear different from patients with authentic causes of similar symptoms, because their psychiatric abnormalities are not appreciated, and because doctors and nurses have alowindex of suspicion. Since patients with factitious disease present a false medicalhistory, their physicians prescribe unnecessary procedures and therapies that may result in iatrogenic disease. In many cases, damage to these patients from doctors' actions exceeds the harm resulting from the patients' self-induced illness. The clues that should suggest factitious disease, the diagnostic roles of the clinician and a consulting psychiatrist, and the ethical conflicts that confront doctors taking care of such patients are discussed. To help keep factitious disease in clinical perspective, one of the case studies involves the antithesis of factitious disease, where a patient was mistakenly diagnosed as having psychogenic pain when in fact the symptoms were caused by an overlooked physical disease. Better knowledge of the clinical features of factitious disease might have prevented the disastrous outcome. PMID:17252033

  2. Pharmaceutical speakers' bureaus, academic freedom, and the management of promotional speaking at academic medical centers.

    PubMed

    Boumil, Marcia M; Cutrell, Emily S; Lowney, Kathleen E; Berman, Harris A

    2012-01-01

    Pharmaceutical companies routinely engage physicians, particularly those with prestigious academic credentials, to deliver "educational" talks to groups of physicians in the community to help market the company's brand-name drugs. Although presented as educational, and even though they provide educational content, these events are intended to influence decisions about drug selection in ways that are not based on the suitability and effectiveness of the product, but on the prestige and persuasiveness of the speaker. A number of state legislatures and most academic medical centers have attempted to restrict physician participation in pharmaceutical marketing activities, though most restrictions are not absolute and have proven difficult to enforce. This article reviews the literature on why Speakers' Bureaus have become a lightning rod for academic/industry conflicts of interest and examines the arguments of those who defend physician participation. It considers whether the restrictions on Speakers' Bureaus are consistent with principles of academic freedom and concludes with the legal and institutional efforts to manage industry speaking. PMID:22789048

  3. New England Medical Center Posterior Circulation Stroke Registry II. Vascular Lesions

    PubMed Central

    Wityk, RJ; Pazdera, L; Chang, H-M; Pessin, MS; DeWitt, LD

    2005-01-01

    Among 407 New England Medical Center Posterior Circulation Registry (NEMC-PCR) patients, the extracranial (ECVA) and intracranial vertebral arteries (ICVA) were the commonest sites of severe occlusive disease followed by the basilar artery (BA). Severe occlusive lesions were found in >1 large artery in 148 patients; 134 had unilateral or bilateral severe disease at one arterial location. Single arterial site occlusive disease occurred most often in the ECVA (52 patients, 15 bilateral) followed by the ICVA (40 patients, 12 bilateral) and the BA (46 patients). Involvement of the ICVAs and the BA was very common and some patients also had ECVA lesions. Hypertension, smoking, and coronary and peripheral vascular disease were most prevalent in patients with extracranial disease while diabetes and hyperlipidemia were more common when occlusive lesions were only intracranial. Intra-arterial embolism was the most common mechanism of brain infarction in patients with ECVA and ICVA occlusive disease. ICVA occlusive lesions infrequently caused infarction limited to the proximal territory (medulla and posterior inferior cerebellum). BA lesions most often caused infarcts limited to the middle posterior circulation territory (pons and anterior inferior cerebellum). Posterior cerebral artery occlusive lesions were predominantly embolic. Penetrating artery disease caused mostly pontine and thalamic infarcts. Prognosis was poorest in patients with BA disease. The best prognosis surprisingly was in patients who had multiple arterial occlusive lesions; they often had position-sensitive transient ischemic attacks during months or years. PMID:20396470

  4. Good Neighbors: Shared Challenges and Solutions Toward Increasing Value at Academic Medical Centers and Universities.

    PubMed

    Clancy, Gerard P

    2015-12-01

    Academic medical centers (AMCs) and universities are experiencing increasing pressure to enhance the value they offer at the same time that they are facing challenges related to outcomes, controlling costs, new competition, and government mandates. Yet, rarely do the leaders of these academic neighbors work cooperatively to enhance value. In this Perspective the author, a former university regional campus president with duties in an AMC as an academic physician, shares his insights into the shared challenges these academic neighbors face in improving the value of their services in complex environments. He describes the successes some AMCs have had in generating revenues from new clinical programs that reduce the overall cost of care for larger populations. He also describes how several universities have taken a comprehensive approach to reduce overhead and administrative costs. The author identifies six themes related to successful value improvement efforts and provides examples of successful strategies used by AMCs and their university neighbors to improve the overall value of their programs. He concludes by encouraging leaders of AMCs and universities to share information about their successes in value improvements with each other, to seek additional joint value enhancement efforts, and to market their value improvements to the public.

  5. [Using SWOT to analyze breastfeeding education results in a medical center].

    PubMed

    Lee, Pei-Shan; Huang, Chiu-Mieh

    2005-08-01

    The breastfeeding rate within the first month after postpartum dropped from 95% in 1962 to 25% in 1989. As a result, the Department of Health, Executive Yuan, has made a lot of effort to promote a baby-friendly hospital policy since 2001, with the aim of increasing the breastfeeding rate. However, many studies have pointed out that the Department of Health is encountering difficulties when implementing this policy. This study is designed to use the Strengths, Weakness, Opportunities, and Threats (SWOT) Analysis to evaluate the development of breastfeeding education in a certain medical center. We divide those factors that influence the effect of this policy into extrinsic environmental factors and intrinsic environmental factors. The intrinsic environmental factors are the strengths and weaknesses of the baby-friendly hospital policy. The extrinsic environmental factors are the opportunities and threats. The SWOT Matrix is also applied to develop appropriate strategies to take the greatest possible advantage of opportunities available. With the SWOT approach, managers can not only readily extinguish intrinsic advantages from intrinsic disadvantages, but also recognize external opportunities and threats. Furthermore, it assists managers in resolving problems and turning adversity into opportunity. In providing the SWOT analysis, we hope clinical nursing staff will gain a better understanding of the baby-friendly hospital policy and deliver higher quality of health care for postpartum mothers, thus increasing the breastfeeding rate. PMID:16088785

  6. New Intervention Model of Regional Transfer Network System to Alleviate Crowding of Regional Emergency Medical Center

    PubMed Central

    2016-01-01

    Emergency department (ED) crowding is a serious problem in most tertiary hospitals in Korea. Although several intervention models have been established to alleviate ED crowding, they are limited to a single hospital-based approach. This study was conducted to determine whether the new regional intervention model could alleviate ED crowding in a regional emergency medical center. This study was designed as a “before and after study” and included patients who visited the tertiary hospital ED from November 2011 to October 2013. One tertiary hospital and 32 secondary hospitals were included in the study. A transfer coordinator conducted inter-hospital transfers from a tertiary hospital to a secondary hospital for suitable patients. A total of 1,607 and 2,591 patients transferred from a tertiary hospital before and after the study, respectively (P < 0.001). We found that the median ED length of stay (LOS) decreased significantly from 3.68 hours (interquartile range [IQR], 1.85 to 9.73) to 3.20 hours (IQR, 1.62 to 8.33) in the patient group after implementation of the Regional Transfer Network System (RTNS) (P < 0.001). The results of multivariate analysis showed a negative association between implementation of the RTNS and ED LOS (beta coefficient -0.743; 95% confidence interval -0.914 to -0.572; P < 0.001). In conclusion, the ED LOS in the tertiary hospital decreased after implementation of the RTNS. PMID:27134506

  7. Frequency of enteric protozoan parasites among patients with gastrointestinal complaints in medical centers of Zahedan, Iran.

    PubMed

    Haghighi, Ali; Khorashad, Alireza Salimi; Nazemalhosseini Mojarad, Ehsan; Kazemi, Bahram; Rostami Nejad, Mohammad; Rasti, Sima

    2009-05-01

    We investigated the prevalence of intestinal protozoan parasites in patients with gastrointestinal complaints in medical centers in Zahedan, Iran. A total of 1562 stool samples was examined from July 2004 to January 2006 using microscopy (direct smear, formalin-ether concentration), xenic culture and PCR techniques. Four hundred and twenty-seven (27.3%) of the patients were infected with one or more intestinal parasites. Giardia lamblia (10.1%), Entamoeba coli (10%), E. hartmanni (1.7%), Blastocystis hominis (2.2%), Chilomastix mesnili (1.7%), Trichomonas hominis (0.7%), E. histolytica/E. dispar (0.51%) and Iodamoeba butschlii (0.45%) were the most prevalent protozoa detected with microscopy. Of the eight microscopy-positive E. histolytica/E. dispar samples, six were identified as E. dispar by PCR/gel electrophoresis, whereas E. histolytica was not detected at all. Although Zahedan is an area with poor hygiene located in a tropical area near the border of Pakistan and Afghanistan, the prevalence of E. histolytica and E. dispar here compared with other parasites and infectious diseases is unexpectedly low. PMID:19084249

  8. The impact of interhospital transfers on surgical quality metrics for academic medical centers.

    PubMed

    Crippen, Cristina J; Hughes, Steven J; Chen, Sugong; Behrns, Kevin E

    2014-07-01

    The emergence of pay-for-performance systems pose a risk to an academic medical center's (AMC) mission to provide care for interhospital surgical transfer patients. This study examines quality metrics and resource consumption for a sample of these patients from the University Health System Consortium (UHC) and our Department of Surgery (DOS). Standard benchmarks, including mortality rate, length of stay (LOS), and cost, were used to evaluate the impact of interhospital surgical transfers versus direct admission (DA) patients from January 2010 to December 2012. For 1,423,893 patients, the case mix index for transfer patients was 38 per cent (UHC) and 21 per cent (DOS) greater than DA patients. Mortality rates were 5.70 per cent (UHC) and 6.93 per cent (DOS) in transferred patients compared with 1.79 per cent (UHC) and 2.93 per cent (DOS) for DA patients. Mean LOS for DA patients was 4 days shorter. Mean total costs for transferred patients were greater $13,613 (UHC) and $13,356 (DOS). Transfer patients have poorer outcomes and consume more resources than DA patients. Early recognition and transfer of complex surgical patients may improve patient rescue and decrease resource consumption. Surgeons at AMCs and in the community should develop collaborative programs that permit collective assessment and decision-making for complicated surgical patients.

  9. Carbon Ion Radiotherapy at the Gunma University Heavy Ion Medical Center: New Facility Set-up

    PubMed Central

    Ohno, Tatsuya; Kanai, Tatsuaki; Yamada, Satoru; Yusa, Ken; Tashiro, Mutsumi; Shimada, Hirofumi; Torikai, Kota; Yoshida, Yukari; Kitada, Yoko; Katoh, Hiroyuki; Ishii, Takayoshi; Nakano, Takashi

    2011-01-01

    Carbon ion radiotherapy (C-ion RT) offers superior dose conformity in the treatment of deep-seated tumors compared with conventional X-ray therapy. In addition, carbon ion beams have a higher relative biological effectiveness compared with protons or X-ray beams. C-ion RT for the first patient at Gunma University Heavy Ion Medical Center (GHMC) was initiated in March of 2010. The major specifications of the facility were determined based on the experience of clinical treatments at the National Institute of Radiological Sciences (NIRS), with the size and cost being reduced to one-third of those at NIRS. The currently indicated sites of cancer treatment at GHMC are lung, prostate, head and neck, liver, rectum, bone and soft tissue. Between March 2010 and July 2011, a total of 177 patients were treated at GHMC although a total of 100 patients was the design specification during the period in considering the optimal machine performance. In the present article, we introduce the facility set-up of GHMC, including the facility design, treatment planning systems, and clinical preparations. PMID:24213124

  10. Political strategy, business strategy, and the academic medical center: linking theory and practice.

    PubMed

    Souba, W W; Weitekamp, M R; Mahon, J F

    2001-09-01

    The purpose of this paper is to link external political strategy theory to a specific health care setting-that of the academic medical center (AMC). Political strategy encompasses those activities undertaken by AMCs to acquire, develop, and use power (clout, influence, and credibility) to gain an advantage in situations of conflict. It should be differentiated from internal politics, a topic that will not be dealt with in this review. Political strategy should also be distinguished from but not divorced from competitive strategy. As political and social action can change the competitive landscape and the rules of competition, AMCs must become adept in issues management and stakeholder management. The focus on political strategy is a reflection of the enormous changes in the external environment that have impacted AMCs in recent years. These changes have often emerged out of political and social action and they impact significantly on the organization's more traditional business strategies. We suggest that a tighter alignment between political and business strategies in the future will help ensure organizational survival and success. This article reviews the literature and theory in corporate political strategy and illustrates the application of political strategy with examples of issues and problems faced by AMCs. Models of political strategy are well crafted, and this article concludes with succinct observations on the use of political strategies to enhance the business-based strategies of AMCs. Although the focus is on AMCs, the use of political strategies is applicable to any health care institution.

  11. Facilitators and Barriers to Care Coordination in Patient-centered Medical Homes (PCMHs) from Coordinators’ Perspectives

    PubMed Central

    Friedman, Asia; Howard, Jenna; Shaw, Eric K.; Cohen, Deborah J.; Shahidi, Laleh; Ferrante, Jeanne M.

    2016-01-01

    Background Care coordinators are increasingly featured in patient-centered medical home (PCMH) projects, yet little research examines how coordinators themselves define and experience their role. This is the first study describing experiences of care coordinators across the US from their own perspectives. Methods This qualitative study used a 5-month private, online discussion forum to gather data from 25 care coordinators from PCMH practices representing diversity in practice size, setting, and type. Participants answered questions and interacted with one another, creating an online social learning collaborative while allowing for data collection for research. Results Coordinators identified barriers and facilitators in their work at the organization/system level, the interpersonal level, and the individual level. Some factors emerged as both barriers and facilitators, including the functionality of clinical information technology; the availability of community resources; interactions with clinicians and other health care facilities; interactions with patients; and self-care practices for mental health and wellness. Colocation and full integration into practices were other key facilitators, whereas excessive case loads and data management responsibilities were felt to be important barriers. Conclusions While all the barriers and facilitators were important to performing coordinators’ roles, relationship building materialized as key to effective care coordination, whether with clinicians, patients, or outside organizations. We discuss implications for practice and provide suggestions for further research. PMID:26769881

  12. The impact of interhospital transfers on surgical quality metrics for academic medical centers.

    PubMed

    Crippen, Cristina J; Hughes, Steven J; Chen, Sugong; Behrns, Kevin E

    2014-07-01

    The emergence of pay-for-performance systems pose a risk to an academic medical center's (AMC) mission to provide care for interhospital surgical transfer patients. This study examines quality metrics and resource consumption for a sample of these patients from the University Health System Consortium (UHC) and our Department of Surgery (DOS). Standard benchmarks, including mortality rate, length of stay (LOS), and cost, were used to evaluate the impact of interhospital surgical transfers versus direct admission (DA) patients from January 2010 to December 2012. For 1,423,893 patients, the case mix index for transfer patients was 38 per cent (UHC) and 21 per cent (DOS) greater than DA patients. Mortality rates were 5.70 per cent (UHC) and 6.93 per cent (DOS) in transferred patients compared with 1.79 per cent (UHC) and 2.93 per cent (DOS) for DA patients. Mean LOS for DA patients was 4 days shorter. Mean total costs for transferred patients were greater $13,613 (UHC) and $13,356 (DOS). Transfer patients have poorer outcomes and consume more resources than DA patients. Early recognition and transfer of complex surgical patients may improve patient rescue and decrease resource consumption. Surgeons at AMCs and in the community should develop collaborative programs that permit collective assessment and decision-making for complicated surgical patients. PMID:24987902

  13. Terms used for isolation practices by nurses at an academic medical center

    PubMed Central

    Landers, Timothy; McWalters, Jessica; Behta, Maryam; Bufe, Gina; Ross, Barbara; Vawdrey, David K.; Larson, Elaine

    2010-01-01

    Aim This paper is a report of a study to determine if the terms used by nurses to describe isolation precautions are associated with correct identification of required personal protective equipment. Background Isolation measures are important in the prevention of health care-associated infections. The terms used to describe categories of isolation have changed in response to new pathogens and with advances in infection prevention. Methods For three months in2009, nurses from an academic medical center on the East Coast of the United States of America completed a survey consisting of ten clinical scenarios which asked about recommended personal protective equipment and for the name of the recommended isolation type. Correct identification of required personal protective equipment was compared to use of an approved isolation category term, controlling for infection knowledge and demographic variables. Results Three hundred and seventeen nurses gave responses to2, 215 clinical scenarios. Use of non-approved category terms was associated with statistically significantly lower rates of correct personal protective equipment identification compared to use of an approved term (62.2% vs. 77.8%; p<.001). Specific PPE was also selected for use when not indicated--including gowns (42%), N-95 respirators (13%), fluid shield masks(13%) and sterile gloves (6%). Conclusion Inconsistent terminology for isolation precautions may contribute to variations in practice. Adoption of internationally-accepted and standardized category terms may improve adherence to these precautions. PMID:20722801

  14. Impact of 5 years of lean six sigma in a University Medical Center.

    PubMed

    Niemeijer, Gerard C; Trip, Albert; de Jong, Laura J; Wendt, Klaus W; Does, Ronald J M M

    2012-01-01

    Lean Six Sigma (LSS) is an originally industry-based methodology for cost reduction and quality improvement. In more recent years, LSS was introduced in health care as well. This article describes the experiences of the University Medical Center Groningen, the second largest hospital in the Netherlands, with LSS. It was introduced in 2007 to create the financial possibility to develop innovations. In this article, we describe how LSS was introduced, and how it developed in the following years. We zoom in at the traumatology department, where all main processes have been analyzed and improved. An evaluation after 5 years shows that LSS helped indeed reducing cost and improving quality. Moreover, it aided the transition of the organization from purely problem oriented to more process oriented, which in turn is helpful in eliminating waste and finding solutions for difficult problems. A major benefit of the program is that own employees are trained to become project leaders for improvement. Several people from the primary process were thus stimulated and equipped to become role models for continuous improvement.

  15. Reducing intraoperative red blood cell unit wastage in a large academic medical center

    PubMed Central

    Whitney, Gina M.; Woods, Marcella C.; France, Daniel J.; Austin, Thomas M.; Deegan, Robert J.; Paroskie, Allison; Booth, Garrett S.; Young, Pampee P.; Dmochowski, Roger R.; Sandberg, Warren S.; Pilla, Michael A.

    2015-01-01

    BACKGROUND The wastage of red blood cell (RBC) units within the operative setting results in significant direct costs to health care organizations. Previous education-based efforts to reduce wastage were unsuccessful at our institution. We hypothesized that a quality and process improvement approach would result in sustained reductions in intraoperative RBC wastage in a large academic medical center. STUDY DESIGN AND METHODS Utilizing a failure mode and effects analysis supplemented with time and temperature data, key drivers of perioperative RBC wastage were identified and targeted for process improvement. RESULTS Multiple contributing factors, including improper storage and transport and lack of accurate, locally relevant RBC wastage event data were identified as significant contributors to ongoing intraoperative RBC unit wastage. Testing and implementation of improvements to the process of transport and storage of RBC units occurred in liver transplant and adult cardiac surgical areas due to their history of disproportionately high RBC wastage rates. Process interventions targeting local drivers of RBC wastage resulted in a significant reduction in RBC wastage (p <0.0001; adjusted odds ratio, 0.24; 95% confidence interval, 0.15–0.39), despite an increase in operative case volume over the period of the study. Studied process interventions were then introduced incrementally in the remainder of the perioperative areas. CONCLUSIONS These results show that a multidisciplinary team focused on the process of blood product ordering, transport, and storage was able to significantly reduce operative RBC wastage and its associated costs using quality and process improvement methods. PMID:26202213

  16. MODELING CHRONIC DISEASE PATIENT FLOWS DIVERTED FROM EMERGENCY DEPARTMENTS TO PATIENT-CENTERED MEDICAL HOMES

    PubMed Central

    Diaz, Rafael; Behr, Joshua; Kumar, Sameer; Britton, Bruce

    2016-01-01

    Chronic Disease is defined as a long lasting health condition, which can develop and/or worsen over an extended time, but which can also be controlled. The monetary and budgetary toll due to its persistent nature has become unsustainable and requires pressing actions to limit their incidence and burden. This paper demonstrates the utility of the System Dynamics approach to simulate the behavior of key factors involved in the implementation of chronic disease management. We model the patient flow diversion from emergency departments (ED) to patient-centered medical homes (PCMH), with emphasis on the visit rates, as well as the effect of insurance coverage, in an effort to assure continuity of quality care for Asthma patients at lower costs. The model is used as an evaluative method to identify conditions of a maintained health status through adequate policy planning, in terms of resources and capacity. This approach gives decision makers the ability to track the level of implementation of the intervention and generate knowledge about dynamics between population demands and the intervention effectiveness. The functionality of the model is demonstrated through the consideration of hypothetical scenarios executed using sensitivity analysis. PMID:26770663

  17. Military inpatient residential treatment of substance abuse disorders: the Eisenhower Army Medical Center experience.

    PubMed

    Mooney, Scott R; Horton, Philip A; Trakowski, John H; Lenard, Janet H; Barron, Mark R; Nave, Peggy V; Gautreaux, Melissa S; Lott, Heather D

    2014-06-01

    Opened in 2009, the Dwight D. Eisenhower Army Medical Center Inpatient Residential Treatment Facility (RTF) is the largest and most well-established inpatient substance use disorder treatment facility in the Department of Defense. The RTF is a 28-day inpatient treatment program that employs evidence-based practices and is based on Alcoholics/Narcotics Anonymous principles that are incorporated with a hybrid of military daily structure regime including early morning physical training. Family involvement is encouraged. The RTF is staffed by a multidisciplinary team specializing in addictions and admits Active/Activated Service Members (SMs) from all Service branches, typically those who have failed other military/civilian substance use disorder programs. Eighty-seven percent of SMs referred to the program successfully commenced, with continuous sobriety observed in over half of SMs 6 months later, and 1 year relapse rates comparable to other alcohol treatment programs. Limitations of our program evaluation efforts, lessons learned, and recommendations for the way ahead are shared.

  18. [Using SWOT to analyze breastfeeding education results in a medical center].

    PubMed

    Lee, Pei-Shan; Huang, Chiu-Mieh

    2005-08-01

    The breastfeeding rate within the first month after postpartum dropped from 95% in 1962 to 25% in 1989. As a result, the Department of Health, Executive Yuan, has made a lot of effort to promote a baby-friendly hospital policy since 2001, with the aim of increasing the breastfeeding rate. However, many studies have pointed out that the Department of Health is encountering difficulties when implementing this policy. This study is designed to use the Strengths, Weakness, Opportunities, and Threats (SWOT) Analysis to evaluate the development of breastfeeding education in a certain medical center. We divide those factors that influence the effect of this policy into extrinsic environmental factors and intrinsic environmental factors. The intrinsic environmental factors are the strengths and weaknesses of the baby-friendly hospital policy. The extrinsic environmental factors are the opportunities and threats. The SWOT Matrix is also applied to develop appropriate strategies to take the greatest possible advantage of opportunities available. With the SWOT approach, managers can not only readily extinguish intrinsic advantages from intrinsic disadvantages, but also recognize external opportunities and threats. Furthermore, it assists managers in resolving problems and turning adversity into opportunity. In providing the SWOT analysis, we hope clinical nursing staff will gain a better understanding of the baby-friendly hospital policy and deliver higher quality of health care for postpartum mothers, thus increasing the breastfeeding rate.

  19. Beam Optics for a Scanned Proton Beam at Loma Linda University Medical Center

    NASA Astrophysics Data System (ADS)

    Coutrakon, George; Hubbard, Jeff; Koss, Peter; Sanders, Ed; Panchal, Mona

    2003-08-01

    Beam scanning in proton therapy is a medical technique to lower the dose to healthy tissue while irradiating a tumor volume. Scanned proton beams for proton radiation therapy require small beam sizes at the tumor location. In beam scanning, a small beam usually less than 1 cm diameter is swept across the tumor volume with two magnets located several meters upstream of the patient. In general, all proton beams in a therapy facility must be transported from the accelerator to the treatment rooms where the scanning systems are located. This paper addresses the problem of transporting the beam without losses to the patient and achieving a small beam at the tumor location in the patient. The strengths of the beam line quadrupoles were allowed to vary to produce the desired beam sizes along the beam lines. Quadrupole strengths were obtained using the beam simulation program TRANSPORT originally from Stanford Linear Accelerator Center in Palo Alto, CA. An enhanced version of the original program by Accel Soft Inc. in San Diego, CA has been used for these studies. Beam size measurements were used for comparison with TRANSPORT to verify the predictions of TRANSPORT calculations.

  20. The Changing Landscape of Molecular Diagnostic Testing: Implications for Academic Medical Centers

    PubMed Central

    Rehm, Heidi L.; Hynes, Elizabeth; Funke, Birgit H.

    2016-01-01

    Over the last decade, the field of molecular diagnostics has undergone tremendous transformation, catalyzed by the clinical implementation of next generation sequencing (NGS). As technical capabilities are enhanced and current limitations are addressed, NGS is increasingly capable of detecting most variant types and will therefore continue to consolidate and simplify diagnostic testing. It is likely that genome sequencing will eventually serve as a universal first line test for disorders with a suspected genetic origin. Academic Medical Centers (AMCs), which have been at the forefront of this paradigm shift are now presented with challenges to keep up with increasing technical, bioinformatic and interpretive complexity of NGS-based tests in a highly competitive market. Additional complexity may arise from altered regulatory oversight, also triggered by the unprecedented scope of NGS-based testing, which requires new approaches. However, these challenges are balanced by unique opportunities, particularly at the interface between clinical and research operations, where AMCs can capitalize on access to cutting edge research environments and establish collaborations to facilitate rapid diagnostic innovation. This article reviews present and future challenges and opportunities for AMC associated molecular diagnostic laboratories from the perspective of the Partners HealthCare Laboratory for Molecular Medicine (LMM). PMID:26828522

  1. Good Neighbors: Shared Challenges and Solutions Toward Increasing Value at Academic Medical Centers and Universities.

    PubMed

    Clancy, Gerard P

    2015-12-01

    Academic medical centers (AMCs) and universities are experiencing increasing pressure to enhance the value they offer at the same time that they are facing challenges related to outcomes, controlling costs, new competition, and government mandates. Yet, rarely do the leaders of these academic neighbors work cooperatively to enhance value. In this Perspective the author, a former university regional campus president with duties in an AMC as an academic physician, shares his insights into the shared challenges these academic neighbors face in improving the value of their services in complex environments. He describes the successes some AMCs have had in generating revenues from new clinical programs that reduce the overall cost of care for larger populations. He also describes how several universities have taken a comprehensive approach to reduce overhead and administrative costs. The author identifies six themes related to successful value improvement efforts and provides examples of successful strategies used by AMCs and their university neighbors to improve the overall value of their programs. He concludes by encouraging leaders of AMCs and universities to share information about their successes in value improvements with each other, to seek additional joint value enhancement efforts, and to market their value improvements to the public. PMID:26266460

  2. Current state of information technologies for the clinical research enterprise across academic medical centers.

    PubMed

    Murphy, Shawn N; Dubey, Anil; Embi, Peter J; Harris, Paul A; Richter, Brent G; Turisco, Fran; Weber, Griffin M; Tcheng, James E; Keogh, Diane

    2012-06-01

    Information technology (IT) to support clinical research has steadily grown over the past 10 years. Many new applications at the enterprise level are available to assist with the numerous tasks necessary in performing clinical research. However, it is not clear how rapidly this technology is being adopted or whether it is making an impact upon how clinical research is being performed. The Clinical Research Forum's IT Roundtable performed a survey of 17 representative academic medical centers (AMCs) to understand the adoption rate and implementation strategies within this field. The results were compared with similar surveys from 4 and 6 years ago. We found the adoption rate for four prominent areas of IT-supported clinical research had increased remarkably, specifically regulatory compliance, electronic data capture for clinical trials, data repositories for secondary use of clinical data, and infrastructure for supporting collaboration. Adoption of other areas of clinical research IT was more irregular with wider differences between AMCs. These differences appeared to be partially due to a set of openly available applications that have emerged to occupy an important place in the landscape of clinical research enterprise-level support at AMC's. PMID:22686207

  3. Holmium:YAG laser coronary angioplasty: quantitative angiography and clinical results in a large experience of a single medical center

    NASA Astrophysics Data System (ADS)

    Topaz, On; Luxenberg, Michael; Schumacher, Audrey

    1994-07-01

    Clinical experience with the mid IR holmium:YAG laser in a single medical center (St. Paul Ramsey Medical Center, University of Minnesota Medical School, St. Paul, MN) includes 112 patients who underwent holmium laser coronary angioplasty. Utilizing a unique lasing technique; `pulse and retreat,' we applied this laser to thrombotic and nonthrombotic lesions in patients presenting with unstable angina, stable angina, and acute myocardial infarction. A very high clinical success and very low complication rates were achieved. Holmium:YAG laser is effective and safe therapy for patients with symptomatic coronary artery disease. Unlike excimer lasers, the clinical success, efficacy and safety of holmium laser angioplasty is not compromised when thrombus is present.

  4. Creating a Longitudinal Integrated Clerkship with Mutual Benefits for an Academic Medical Center and a Community Health System

    PubMed Central

    Poncelet, Ann Noelle; Mazotti, Lindsay A; Blumberg, Bruce; Wamsley, Maria A; Grennan, Tim; Shore, William B

    2014-01-01

    The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills. Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment. Success factors include continued support and investment from both organizations’ leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers. PMID:24867551

  5. Creating a longitudinal integrated clerkship with mutual benefits for an academic medical center and a community health system.

    PubMed

    Poncelet, Ann Noelle; Mazotti, Lindsay A; Blumberg, Bruce; Wamsley, Maria A; Grennan, Tim; Shore, William B

    2014-01-01

    The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills.Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment.Success factors include continued support and investment from both organizations' leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers.

  6. Should We Offer Medication to Reduce Breast Cancer Risk?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

    PubMed

    Burns, Risa B; Schonberg, Mara A; Tung, Nadine M; Libman, Howard

    2016-08-01

    In November 2013, the U.S. Preventive Services Task Force issued a guideline on medications for risk reduction of primary breast cancer in women. Although mammography can detect early cases, it cannot prevent development of breast cancer. Tamoxifen and raloxifene are selective estrogen receptor modulators that have been shown to reduce the risk for estrogen receptor-positive breast cancer and are approved by the U.S. Food and Drug Administration (FDA) for this indication. However, neither medication reduces the risk for estrogen receptor-negative breast cancer or all-cause mortality. The Task Force concluded that postmenopausal women with an estimated 5-year risk for breast cancer of 3% or greater will probably have more net benefit than harm and recommends that clinicians engage in shared, informed decision making about these medications. The American Society of Clinical Oncology issued a practice guideline on use of pharmacologic interventions for breast cancer in 2013. It recommends that women aged 35 years or older at increased risk, defined as a 5-year absolute risk for breast cancer of 1.66% or greater, discuss breast cancer prevention medications with their primary care practitioner. The Society includes the aromatase inhibitor exemestane in addition to tamoxifen and raloxifene as a breast cancer prevention medication, although exemestane is not FDA approved for this indication. Here, an oncologist and an internist discuss how they would balance these recommendations and what they would suggest for an individual patient. PMID:27479221

  7. [Medical care for asylum seekers and refugees at the University Medical Center Hamburg-Eppendorf--A case series].

    PubMed

    Sothmann, Peter; Schmedt auf der Günne, Nina; Addo, Marylyn; Lohse, Ansgar; Schmiedel, Stefan

    2016-01-01

    As the number of refugees rises, medical care for refugees, asylum seekers and people with unclear residence status becomes a priority task for our health system. While access to health care is restricted for these groups of people in many German states, Hamburg provides unrestricted access to healthcare for refugees by handing out health insurance cards on arrival. Daily practice shows, however, that adequate medical care is still not always easy to achieve. In this case series we demonstrate that barriers to health care still exist on many levels. We discuss these barriers and further propose strategies to improve and to secure access to adequate health care. PMID:26710201

  8. [Medical care for asylum seekers and refugees at the University Medical Center Hamburg-Eppendorf--A case series].

    PubMed

    Sothmann, Peter; Schmedt auf der Günne, Nina; Addo, Marylyn; Lohse, Ansgar; Schmiedel, Stefan

    2016-01-01

    As the number of refugees rises, medical care for refugees, asylum seekers and people with unclear residence status becomes a priority task for our health system. While access to health care is restricted for these groups of people in many German states, Hamburg provides unrestricted access to healthcare for refugees by handing out health insurance cards on arrival. Daily practice shows, however, that adequate medical care is still not always easy to achieve. In this case series we demonstrate that barriers to health care still exist on many levels. We discuss these barriers and further propose strategies to improve and to secure access to adequate health care.

  9. Racial comparisons of diabetes care and intermediate outcomes in a patient-centered medical home.

    PubMed

    Simonetti, Joseph A; Fine, Michael J; Chen, Yi-Fan; Simak, Deborah; Hess, Rachel

    2014-04-01

    OBJECTIVE To assess racial differences in diabetes processes and intermediate outcomes of care in an internal medicine, patient-centered medical home (PCMH) group practice. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of 1,457 adults with diabetes receiving care from 89 medical providers within a PCMH-designated academic practice between 1 July 2009 and 31 July 2010. We used mixed models to assess independent associations between patient race (non-Hispanic white or black) and 1) receipt of processes of care (A1C and LDL testing, foot and retinal examination, and influenza and pneumococcal vaccination) and 2) achievement of intermediate outcomes (LDL <100 mg/dL, blood pressure [BP] <140/90 mmHg, A1C <7.0% [<53 mmol/mol], and A1C >9.0% [>75 mmol/mol]), controlling for sociodemographic factors, health status, treatment intensity, and clinical continuity. RESULTS Compared with non-Hispanic white patients, black patients were younger, were more often single, had lower educational attainment, and were less likely to have commercial insurance. In unadjusted analyses, fewer black patients received a retinal examination and influenza vaccination during the study period or any lifetime pneumococcal vaccination (P < 0.05 [all comparisons]). Fewer black patients achieved an LDL <100 mg/dL, BP <140/90 mmHg, or A1C <7.0% (<53 mmol/mol), while more black patients had an A1C >9.0% (>75 mmol/mol) (P < 0.05 [all comparisons]). In multivariable models, black patients were less likely to receive A1C testing (odds ratio [OR] 0.57 [95% CI 0.34-0.95]) or influenza vaccination (OR 0.75 [95% CI 0.57-0.99]) or to achieve an LDL <100 mg/dL (OR 0.74 [95% CI 0.55-0.99]) or BP <140/90 mmHg (OR 0.64 [95% CI 0.49-0.84]). CONCLUSIONS Racial differences in processes and intermediate outcomes of diabetes care were present within this PCMH-designated practice, controlling for differences in sociodemographic, clinical, and treatment factors.

  10. Evaluation of Patients' Compliance with Medical Practitioners' Prescriptions: University Health Center Experience.

    ERIC Educational Resources Information Center

    Parsons, Robert J.; And Others

    1980-01-01

    This research report examines the characteristics of patients and their compliance with drug prescriptions and suggests that there is a need for education among patients receiving medication so that they do not prematurely terminate the medication process. (JN)

  11. 75 FR 14170 - Medical Device Epidemiology Network: Developing Partnership Between the Center for Devices and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-24

    ... HUMAN SERVICES Food and Drug Administration Medical Device Epidemiology Network: Developing Partnership... public workshop entitled ``Medical Device Epidemiology Network (MDEpiNet): Developing Partnership Between... to facilitate discussion among FDA and academic researchers with expertise in epidemiology and...

  12. Quality of discharge practices and patient understanding at an academic medical center

    PubMed Central

    Horwitz, Leora I.; Moriarty, John P.; Chen, Christine; Fogerty, Robert L.; Brewster, Ursula C.; Kanade, Sandhya; Ziaeian, Boback; Jenq, Grace Y.; Krumholz, Harlan M.

    2013-01-01

    Importance With growing national focus on reducing readmissions, there is a need to comprehensively assess the quality of transitional care, including discharge practices, patient perspectives, and patient understanding. Objective To conduct a multifaceted evaluation of transitional care from a patient-centered perspective. Design Prospective observational cohort study, May 2009-April, 2010 Setting Urban, academic medical center Participants Patients 65 and older discharged home after hospitalization for acute coronary syndrome, heart failure or pneumonia. Main outcome measures Discharge practices, including presence of follow-up appointment and patient-friendly discharge instructions; patient understanding of diagnosis and follow-up appointment; and patient perceptions of and satisfaction with discharge care. Results The 395 enrolled patients (66.7% of eligible) had a mean age of 77.2 years. Although 349 (95.6%) patients reported understanding the reason they had been in the hospital, only 218 (59.6%) patients were able to accurately describe their diagnosis in post-discharge interviews. Discharge instructions routinely included symptoms to watch out for (98.4%), activity instructions (97.3%) and diet advice (89.7%) in lay language; however, 99 (26.3%) written reasons for hospitalization did not use language likely to be intelligible to patients. Of the 123 (32.6%) patients discharged with a scheduled primary care or cardiology appointment, 54 (43.9%) accurately recalled details of either appointment. During post-discharge interviews, 118 (30.0%) of patients reported receiving less than one day’s advance notice of discharge, and 246 (66.1%) reported that staff asked if they would have the support they needed at home before discharge. Conclusions Patient perceptions of discharge care quality and self-rated understanding were high and written discharge instructions were generally comprehensive though not consistently clear. However, follow-up appointments and

  13. Physicians for Rural America: The Role of Institutional Commitment within Academic Medical Centers

    ERIC Educational Resources Information Center

    Wheat, John R.; Higginbotham, John C.; Yu, Jing; Leeper, James D.

    2005-01-01

    Context: Prior study suggests that contextual characteristics of medical schools (e.g., state demographics, public vs private, NIH research effort) predict output of rural physicians without also considering the effects of the medical schools' own policies and programs. Purpose: This study examines medical school commitment to rural policies and…

  14. Physicians for Rural America: The Role of Institutional Commitment Within Academic Medical Centers

    ERIC Educational Resources Information Center

    Wheat, John R.; Higginbotham, John C.; Yu, Jing; Leeper, James D.

    2005-01-01

    Context: Prior study suggests that contextual characteristics of medical schools (eg, state demographics, public vs private, NIH research effort) predict output of rural physicians without also considering the effects of the medical schools? own policies and programs. Purpose: This study examines medical school commitment to rural policies and…

  15. The drug thief at Georgetown University Medical Center: anatomy of a $2 billion class-action lawsuit.

    PubMed

    2000-08-01

    Separate lawsuits filed on behalf of plaintiff patients at Georgetown University Medical Center, Washington, DC, have been consolidated under a District of Columbia judge who is scheduled to rule soon on whether to certify them as a class-action suit against the medical center. The case involves a drug-abusing worker in the interventional radiology unit at Georgetown University Hospital who may have exposed up to 500 patients to HIV, hepatitis, and other viruses during his period of employment from September 8, 1999 to February 2, 2000. The lawsuits allege that the med center failed to protect patients by not adopting American Hospital Association guidelines that call for universal pre-employment drug screening. The hospital currently is in the final stages of being sold to Medstar Health, Columbia, MD, which may eventually change the drug-screening policy. The episode not only has been embarrassing for the prestigious medical center, but also has focused attention on the potential consequences for hospitals that do not screen employees for drug use.

  16. The "for-benefit" academic medical center: a solution for survival.

    PubMed

    Sabeti, Heerad; Kahn, Marc J; Sachs, Benjamin P

    2015-05-01

    Academic medical centers (AMCs) are the backbone of the U.S. health care system. They provide a disproportionate share of charity care and serve as a training ground for future physicians. Yet, AMCs face profound economic challenges, from changes in funding to changes in the health care market. To survive, many AMCs will need to form integrated health systems, a process expected to cost tens, if not hundreds, of millions of dollars. Nearly all AMCs are structured as not-for- profit entities, which places restrictions on their ability to forge partnerships, pursue joint ventures, and access private capital, often essential elements for forming such integrated systems. An alternative model known as the "for-benefit" corporation can allow AMCs to retain their important social mission and the other advantages of their not-for-profit status while allowing them flexibility and access to both investment and philanthropic capital. To pursue the for-benefit pathway, AMCs have two options-either they could work within the constraints of existing laws to restructure themselves as for-benefit entities, or they could create, under federal law, a new for-benefit AMC model, allowing for the orderly conversion of not-for-profit AMCs. Essential components of a for-benefit AMC include a social purpose, access to multiple forms of capital, the use of earnings to support its purpose, transparency, aligned compensation, and tax exemptions. Restructuring an AMC as a for-benefit entity enables it to both advance shareholder value and further the public good. PMID:25426740

  17. Implementation of a Research Participant Satisfaction Survey at an Academic Medical Center

    PubMed Central

    Smailes, Paula; Reider, Carson; Hallarn, Rose Kegler; Hafer, Lisa; Wallace, Lorraine; Miser, William F.

    2016-01-01

    This descriptive case study covers the development of a survey to assess research subject satisfaction among those participating in clinical research studies at an academic medical center (AMC). The purpose was twofold: to gauge the effectiveness of the survey, as well as to determine the level of satisfaction of the research participants. The authors developed and implemented an electronic research participant satisfaction survey. It was created to provide research teams at the authors’ AMC with a common instrument to capture research participant experiences in order to improve upon the quality of research operations. The instrument captured participant responses in a standardized format. Ultimately, the results are to serve as a means to improve the research experience of participants for single studies, studies conducted within a division or department of the AMC, or across the entire research enterprise at the institution. For ease of use, the survey was created within an electronic data capture system known as REDCap, which is used by a consortium of more than 1,800 institutional partners as a tool from the Clinical and Translational Science Awards (CTSA) program of the National Institutes of Health (NIH). Participants in the survey described in this article were more than 18 years of age and participating in an institutional review board (IRB)-approved study. Results showed that the vast majority of participants surveyed had a positive experience engaging in research at the authors’ AMC. Further, the tool was found to be effective in making that determination. The authors hope to expand the use of the survey as a means to increase research satisfaction and quality at their university. PMID:27390769

  18. Successful Resident Engagement in Quality Improvement: The Detroit Medical Center Story.

    PubMed

    Hussain, Syed Ahmed; Arsene, Camelia; Hamstra, Corinne; Woehrlen, Tess H; Wiese-Rometsch, Wilhelmine; White, Suzanne R

    2016-05-01

    Background In 2014, the Detroit Medical Center launched a new program to engage residents and fellows in a strategy to deliver optimal care within 1 year, focusing on quality at an earlier stage of their careers and preparing them for working posttraining. Methods Residents from clinically relevant residency and fellowships programs were selected to be Resident Quality Directors. The project involved development of an interactive electronic health record (EHR) checklist to visually depict real time gaps in 40 process measures, while focusing on 14 areas related to stroke and venous thromboembolism (VTE) prophylaxis. We also implemented an incentive approach, using a pay-for-performance (P4P) model. Results The project included 800 residents led by 14 resident quality directors. We were able to achieve 100% resident participation. Prior compliance with VTE quality measures 6 months was 88.5%, with performance increasing to 94.2% (P < .006) at 6 months and 100% at 12 months (P < .005) after the intervention. The VTE prophylaxis score improved from the 89.7% to 92.9% range at inception to 100% by 12 months. A similar steady improvement of stroke process measures was observed, with a 100% compliance within 12 months. The institution made 4 incentive payments to trainees (ranging from $300 to $4,000 per year). The remaining 26 process measures remained at goal with above 95% compliance. Conclusions This quality improvement initiative was associated with system-wide quality performance on VTE prevention and stroke care process measures, which was facilitated by a interactive EHR-based checklist and linkage to P4P incentive payments.

  19. The Uses of the Smartphone for Doctors: An Empirical Study from Samsung Medical Center

    PubMed Central

    Choi, Jong Soo; Yi, Byoungkee; Park, Jong Hwan; Choi, Kyesook; Jung, Jaegon; Park, Seung Woo

    2011-01-01

    Objectives In healthcare, mobile computing made possible by smartphones is becoming an important tool among healthcare professionals. However, currently there is very little research into the effectiveness of such applications of technology. This study aims to present a framework for a smartphone application to give doctors mobile access to patient information, then review the consequences of its use and discuss its future direction. Methods Since 2003 when Samsung Medical Center introduced its first mobile application, a need to develop a new application targeting the latest smartphone technology was identified. To that end, an application named Dr. SMART S was officially launched on December 22nd, 2010. Results We analyzed the usage data of the application for a month until April 25th, 2011. On average, 170 doctors (13% of the entire body of doctors) logged on 2.4 times per day and that number keeps growing. The number was uniformly distributed across all working hours, with exceptions of heavy accesses around 6-8 AM and 4-6 PM when doctors do their regular rounds to see the patients. The most commonly accessed content was inpatient information, this constituted 78.6% of all accesses, within this 50% was to accesses lab results. Conclusions Looking at the usage data, we can see the use of Dr. SMART S by doctors is growing in sync with the popularity of smartphones. Since u-Health seem an inevitable future trend, a more rigorous study needs to be conducted on how such mobile applications as Dr. SMART S affect the quality of care and patient safety to derive directions for further improvements. PMID:21886874

  20. Therapeutic drug monitoring of mexiletine at a large academic medical center

    PubMed Central

    Nei, Scott D; Danelich, Ilya M; Lose, Jennifer M; Leung, Lydia Yuk Ting; Asirvatham, Samuel J; McLeod, Christopher J

    2016-01-01

    Introduction: The therapeutic trough range for mexiletine (0.8–2 mcg/mL) was largely established in the setting of arrhythmia prophylaxis following myocardial infarction. Objective: Describe the usage patterns of serum mexiletine concentrations and the impact of these concentrations on mexiletine dosing in modern practice for ventricular arrhythmia treatment. Methods: A single-center, retrospective analysis was conducted using the electronic medical record to identify serum mexiletine concentrations drawn between December 2004 and December 2014. The primary endpoint was the incidence of mexiletine concentrations drawn as troughs. Secondary outcomes included the incidence of mexiletine concentrations that prompted a dose change, association between adverse events and elevated concentrations, and association between baseline characteristics and mexiletine concentrations. Results: A total of 237 individual concentrations were included for analysis with 109 (46.0%) drawn appropriately as trough concentrations. Only 31 (13.1%) of the 237 concentrations drawn prompted a dose change. Mexiletine was primarily used for the treatment of ventricular arrhythmias (96.2%), and 108 (45.6%) concentrations were drawn in an effort to assess efficacy. The median concentration was statistically different between patients with and without an adverse event (0.8 vs 0.7 mcg/mL, respectively; p = 0.017), but may not represent a clinical significance. Patients with hepatic dysfunction had higher median concentrations compared to those without hepatic dysfunction (1.30 vs 1.07 mcg/mL; p = 0.01). Conclusion: Mexiletine concentrations are often drawn at inappropriate times and seldom influence a dose change. This study suggests that routine monitoring of mexiletine concentrations may not be necessary; however, therapeutic drug monitoring may be considered in patients with hepatic dysfunction or to confirm mexiletine absorption in patients where this represents a concern. PMID

  1. Successful Resident Engagement in Quality Improvement: The Detroit Medical Center Story.

    PubMed

    Hussain, Syed Ahmed; Arsene, Camelia; Hamstra, Corinne; Woehrlen, Tess H; Wiese-Rometsch, Wilhelmine; White, Suzanne R

    2016-05-01

    Background In 2014, the Detroit Medical Center launched a new program to engage residents and fellows in a strategy to deliver optimal care within 1 year, focusing on quality at an earlier stage of their careers and preparing them for working posttraining. Methods Residents from clinically relevant residency and fellowships programs were selected to be Resident Quality Directors. The project involved development of an interactive electronic health record (EHR) checklist to visually depict real time gaps in 40 process measures, while focusing on 14 areas related to stroke and venous thromboembolism (VTE) prophylaxis. We also implemented an incentive approach, using a pay-for-performance (P4P) model. Results The project included 800 residents led by 14 resident quality directors. We were able to achieve 100% resident participation. Prior compliance with VTE quality measures 6 months was 88.5%, with performance increasing to 94.2% (P < .006) at 6 months and 100% at 12 months (P < .005) after the intervention. The VTE prophylaxis score improved from the 89.7% to 92.9% range at inception to 100% by 12 months. A similar steady improvement of stroke process measures was observed, with a 100% compliance within 12 months. The institution made 4 incentive payments to trainees (ranging from $300 to $4,000 per year). The remaining 26 process measures remained at goal with above 95% compliance. Conclusions This quality improvement initiative was associated with system-wide quality performance on VTE prevention and stroke care process measures, which was facilitated by a interactive EHR-based checklist and linkage to P4P incentive payments. PMID:27168890

  2. Daily cardiac catheterization procedural volume and complications at an academic medical center

    PubMed Central

    Slicker, Kipp; Lane, Wesley G.; Oyetayo, Ola O.; Copeland, Laurel A.; Stock, Eileen M.; Erwin, John P.

    2016-01-01

    Background Over 1,000,000 cardiac catheterizations (CC) are performed annually in the United States. There is a small risk of complication that has persisted despite advances in technology. It is unknown whether daily CC procedural volume can influence this risk. In an effort to improve outcomes at our academic medical center, we investigated the relationship between daily CC volume and complication rates. Methods We obtained data from both the National Cardiovascular Data Registry (NCDR) Cath-PCI and Lumedx© databases reviewing the records of patients undergoing scheduled, non-emergent CC at our facility between January 2005 to June 2013. Daily CC volume was analyzed as were complications including death, post-procedure MI, cardiogenic shock, heart failure, stroke, tamponade, bleeding, hematoma and acute kidney injury (AKI). Results 12,773 patients were identified who underwent 16,612 CCs on 2,118 days. The average age was 63 years (SD 12.4; range, 18–95). 61% were men. A total of 326 complications occurred in 243 patients on 233 separate days (2.0% CC complication rate). The average volume per day was 7.8 CCs. We found a low correlation between daily complications and CC volume (Spearman’s rho =0.11; P<0.01) though complication rates were lowest on days with 6–11 procedures; higher rates were found on slower and busier days. Conclusions We observed a U-shaped association between CC volume and rates of CC complications. The lowest complication rates were found on days with 6–11 procedures a day. The highest complication rate was seen with >11 procedures a day. PMID:27747168

  3. What can we learn from patient dissatisfaction? Analysis of dissatisfying events at an academic medical center

    PubMed Central

    Lee, Alicia V.; Moriarty, John P.; Borgstrom, Christopher; Horwitz, Leora I.

    2010-01-01

    Background Patient satisfaction is typically measured by quantitative surveys using predetermined domains. However, dissatisfaction may be a distinct entity from satisfaction, may have different determinants, and may better reflect problems in healthcare delivery. Objective To describe domains of dissatisfaction experienced by patients during hospitalization. Setting United States urban, academic medical center Patients Adults discharged between July 1, 2007 and June 30, 2008 Intervention Post-discharge telephone interview: “If there was one thing we could have done to improve your experience in the hospital what would it have been?” Measurements Standard qualitative analysis of suggestions for improvement. Results We randomly selected 976 of 9764 interviews. A total of 439/976 (45.0%) included at least one suggestion for improvement. We identified six major domains of dissatisfaction: ineptitude (7.68%), disrespect (6.05%), waits (15.78%), ineffective communication (7.38%), lack of environmental control (15.57%) and substandard amenities (6.87%). These domains corresponded to six implicit expectations for quality hospital care: safety, treatment with respect and dignity, minimized wait times, effective communication, control over physical surroundings and high quality amenities. Some of these expectations, such as for safe care, effective communication between providers, and lack of disrespect, may not be adequately captured in existing patient satisfaction assessments. Conclusions The results represent patient-generated priorities for quality improvement in health care. These priorities are not all consistently represented in standard patient satisfaction surveys and quality improvement initiatives. Patient input is critical to assessing the quality of hospital care and to identifying areas for improvement. PMID:21162153

  4. Adult seafood allergy in the Texas Medical Center: A 13-year experience.

    PubMed

    Khan, Faria; Orson, Frank; Ogawa, Yoshiko; Parker, Crystal; Davis, Carla McGuire

    2011-04-01

    There is a paucity of data regarding prevalence and characteristics of adult seafood allergy in United States cohorts. This study was designed to determine the characteristics of patient-reported seafood allergy in a large allergy referral adult population. Retrospective analysis was performed of laboratory and clinical characteristics of seafood-allergic patients in three allergy clinics in the Texas Medical Center between January 1, 1997 and January 30, 2010. Of 5162 patients seen in this adult allergy referral population, 159 had physician-diagnosed seafood allergy with an average age of diagnosis of 50.2 (18-81 years) years. Shellfish allergy (59.1%) was more frequent than fish allergy (13.8%). Crustacean allergy (82.6%) was more frequent than mollusk allergy (7.2%). Shrimp (72.5%), crab (34.8%), and lobster (17.4%) were the most common shellfish allergies and tuna (28.6%), catfish (23.8%), and salmon (23.8%) were the most common fish allergies. One-third of seafood-allergic patients reported reactions to more than one seafood. Shellfish-allergic adults were more likely to experience respiratory symptoms than fish-allergic adults (p < 0.05). The likelihood of having anaphylaxis (32%) was not statistically different between shellfish- and fish-allergic subjects. Severe reactions were 12.9 times more likely to occur within the 1st hour of ingestion compared with nonsevere reactions (p < 0.005). The percentage of seafood allergy in this adult allergy referral population was 3.08%.

  5. Bringing Together Community Health Centers, Information Technology and Data to Support a Patient-Centered Medical Village from the OCHIN community of solutions

    PubMed Central

    DeVoe, Jennifer E.; Sears, Abigail

    2013-01-01

    Creating integrated, comprehensive care practices requires access to data and informatics expertise. Information technology (IT) resources are not readily available to individual practices. One model of shared IT resources and learning is a “patient-centered medical village.” We describe the OCHIN Community Health Information Network as an example of this model where community practices have come together collectively to form an organization which leverages shared IT expertise, resources, and data, providing members with the means to fully capitalize on new technologies that support improved care. This collaborative facilitates the identification of “problem-sheds” through surveillance of network-wide data, enables shared learning regarding best practices, and provides a “community laboratory” for practice-based research. As an example of a Community of Solution, OCHIN utilizes health IT and data-sharing innovations to enhance partnerships between public health leaders, community health center clinicians, informatics experts, and policy makers. OCHIN community partners benefit from the shared IT resource (e.g. a linked electronic health record (EHR), centralized data warehouse, informatics and improvement expertise). This patient-centered medical village provides (1) the collective mechanism to build community tailored IT solutions, (2) “neighbors” to share data and improvement strategies, and (3) infrastructure to support EHR-based innovations across communities, using experimental approaches. PMID:23657695

  6. The OCHIN community information network: bringing together community health centers, information technology, and data to support a patient-centered medical village.

    PubMed

    Devoe, Jennifer E; Sears, Abigail

    2013-01-01

    Creating integrated, comprehensive care practices requires access to data and informatics expertise. Information technology (IT) resources are not readily available to individual practices. One model of shared IT resources and learning is a "patient-centered medical village." We describe the OCHIN Community Health Information Network as an example of this model; community practices have come together collectively to form an organization that leverages shared IT expertise, resources, and data, providing members with the means to fully capitalize on new technologies that support improved care. This collaborative facilitates the identification of "problem sheds" through surveillance of network-wide data, enables shared learning regarding best practices, and provides a "community laboratory" for practice-based research. As an example of a community of solution, OCHIN uses health IT and data-sharing innovations to enhance partnerships between public health leaders, clinicians in community health centers, informatics experts, and policy makers. OCHIN community partners benefit from the shared IT resource (eg, a linked electronic health record, centralized data warehouse, informatics, and improvement expertise). This patient-centered medical village provides (1) the collective mechanism to build community-tailored IT solutions, (2) "neighbors" to share data and improvement strategies, and (3) infrastructure to support innovations based on electronic health records across communities, using experimental approaches.

  7. Model for a merger: New York-Presbyterian's use of service lines to bring two academic medical centers together.

    PubMed

    Corwin, Steven J; Cooper, Mary Reich; Leiman, Joan M; Stein, Dina E; Pardes, Herbert; Berman, Michael A

    2003-11-01

    NewYork-Presbyterian Hospital is the result of the 1998 merger of two large New York City academic medical centers, the former New York and Presbyterian Hospitals, and is affiliated with two independent medical schools, the Columbia University College of Physicians and Surgeons and the Joan and Sanford J. Weill Medical College of Cornell University. At the time of the merger, the hospital faced a number of significant challenges, chief among them the clinical integration of the two medical centers. Size, separate medical schools, geography, and different histories and cultures all presented barriers to collaboration. To bring about the needed clinical alignment, the hospital turned to service lines as a way to realize the benefits of clinical integration without forcing the consolidation of departments. In this article, members of the hospital's senior management review the thinking behind the hospital's use of the service lines, their development and operation, and the significant, positive effects they have had on volume, clinical quality, clinical efficiency, best practices, and revenue management. They discuss how the service lines were used to bring together the two clinical cultures, the impact they have had on the way the hospital is operated and managed, and why service lines have worked at NewYork-Presbyterian in contrast to other hospitals that tried and abandoned them. Service lines play an increasingly central role in the hospital's clinical and business strategies, and are being extended into the NewYork-Presbyterian health care system.

  8. Effects of internal marketing on nurse job satisfaction and organizational commitment: example of medical centers in Southern Taiwan.

    PubMed

    Chang, Ching-Sheng; Chang, Hsin-Hsin

    2007-12-01

    As nurses typically represent the largest percentage of employees at medical centers, their role in medical care is exceptionally important and becoming more so over time. The quality and functions of nurses impact greatly on medical care quality. The concept of internal marketing, with origins in the field of market research, argues that enterprises should value and respect their employees by treating them as internal customers. Such a marketing concept challenges traditional marketing methods, which focus on serving external customers only. The main objective of internal marketing is to help internal customers (employees) gain greater job satisfaction, which should promote job performance and facilitate the organization accomplishing its ultimate business objectives. A question in the medical service industry is whether internal marketing can similarly increase the job satisfaction of nurses and enhance their commitment to the organization. This study aimed to explore the relational model of nurse perceptions related to internal marketing, job satisfaction, and organizational commitment by choosing nurses from two medical centers in Southern Taiwan as research subjects. Of 450 questionnaire distributed, 300 valid questionnaires were returned, giving a response rate of 66.7%. After conducting statistical analysis and estimation using structural equation modeling, findings included: (1) job satisfaction has positive effects on organizational commitment; (2) nurse perceptions of internal marketing have positive effects on job satisfaction; and (3) nurse perceptions of internal marketing have positive effects on organizational commitment. PMID:18080971

  9. China's new cooperative medical scheme improved finances of township health centers but not the number of patients served.

    PubMed

    Babiarz, Kimberly S; Miller, Grant; Yi, Hongmei; Zhang, Linxiu; Rozelle, Scott

    2012-05-01

    China's New Cooperative Medical Scheme, launched in 2003, was designed to protect rural households from the financial risk posed by health care costs and to increase the use of health care services. This article reports on findings from a longitudinal study of how the program affected the use of health care services, out-of-pocket spending on medical care, and the operations and financial viability of China's township health centers, which constitute a middle tier of care in between village clinics and county hospitals. We found that between 2005 and 2008 the program provided some risk protection and increased the intensity of inpatient care at township health centers. Importantly, the program appears to have improved the centers' financial status. At the same time, the program did not increase the overall number of patients served or the likelihood that a sick person would seek care at a township center. These findings serve as a benchmark of the program's early impact. The results also suggest that the composition of health care use in China has changed, with people increasingly seeking outpatient care at village clinics and inpatient care at township health centers.

  10. An Analysis of Information Technology Adoption by IRBs of Large Academic Medical Centers in the United States.

    PubMed

    He, Shan; Botkin, Jeffrey R; Hurdle, John F

    2015-02-01

    The clinical research landscape has changed dramatically in recent years in terms of both volume and complexity. This poses new challenges for Institutional Review Boards' (IRBs) review efficiency and quality, especially at large academic medical centers. This article discusses the technical facets of IRB modernization. We analyzed the information technology used by IRBs in large academic institutions across the United States. We found that large academic medical centers have a high electronic IRB adoption rate; however, the capabilities of electronic IRB systems vary greatly. We discuss potential use-cases of a fully exploited electronic IRB system that promise to streamline the clinical research work flow. The key to that approach utilizes a structured and standardized information model for the IRB application.

  11. Continuity in a VA Patient-Centered Medical Home Reduces Emergency Department Visits

    PubMed Central

    Chaiyachati, Krisda H.; Gordon, Kirsha; Long, Theodore; Levin, Woody; Khan, Ali; Meyer, Emily; Justice, Amy; Brienza, Rebecca

    2014-01-01

    Background One major goal of the Patient-Centered Medical Home (PCMH) is to improve continuity of care between patients and providers and reduce the utilization of non-primary care services like the emergency department (ED). Objective To characterize continuity under the Veterans Health Administration’s PCMH model – the Patient Aligned Care Team (PACT), at one large Veterans Affair’s (VA’s) primary care clinic, determine the characteristics associated with high levels of continuity, and assess the association between continuity and ED visits. Design Retrospective, observational cohort study of patients at the West Haven VA (WHVA) Primary Care Clinic from March 2011 to February 2012. Patients The 13,495 patients with established care at the Clinic, having at least one visit, one year before March 2011. Main Measures Our exposure variable was continuity of care –a patient seeing their assigned primary care provider (PCP) at each clinic visit. The outcome of interest was having an ED visit. Results The patients encompassed 42,969 total clinic visits, and 3185 (24%) of them had 15,458 ED visits. In a multivariable logistic regression analysis, patients with continuity of care – at least one visit with their assigned PCP – had lower ED utilization compared to individuals without continuity (adjusted odds ratio [AOR] 0.54; 95% CI: 0.41, 0.71), controlling for frequency of primary care visits, comorbidities, insurance, distance from the ED, and having a trainee PCP assigned. Likewise, the adjusted rate of ED visits was 544/1000 person-year (PY) for patients with continuity vs. 784/1000 PY for patients without continuity (p = 0.001). Compared to patients with low continuity (<33% of visits), individuals with medium (33–50%) and high (>50%) continuity were less likely to utilize the ED. Conclusions Strong continuity of care is associated with decreased ED utilization in a PCMH model and improving continuity may help reduce the utilization of non

  12. David Grant Medical Center energy use baseline and integrated resource assessment

    SciTech Connect

    Richman, E.E.; Hoshide, R.K.; Dittmer, A.L.

    1993-04-01

    The US Air Mobility Command (AMC) has tasked Pacific Northwest Laboratory (PNL) with supporting the US Department of Energy (DOE) Federal Energy Management Program's (FEMP) mission to identify, evaluate, and assist in acquiring all cost-effective energy resource opportunities (EROs) at the David Grant Medical Center (DGMC). This report describes the methodology used to identify and evaluate the EROs at DGMC, provides a life-cycle cost (LCC) analysis for each ERO, and prioritizes any life-cycle cost-effective EROs based on their net present value (NPV), value index (VI), and savings to investment ratio (SIR or ROI). Analysis results are presented for 17 EROs that involve energy use in the areas of lighting, fan and pump motors, boiler operation, infiltration, electric load peak reduction and cogeneration, electric rate structures, and natural gas supply. Typical current energy consumption is approximately 22,900 MWh of electricity (78,300 MBtu), 87,600 kcf of natural gas (90,300 MBtu), and 8,300 gal of fuel oil (1,200 MBtu). A summary of the savings potential by energy-use category of all independent cost-effective EROs is shown in a table. This table includes the first cost, yearly energy consumption savings, and NPV for each energy-use category. The net dollar savings and NPV values as derived by the life-cycle cost analysis are based on the 1992 federal discount rate of 4.6%. The implementation of all EROs could result in a yearly electricity savings of more than 6,000 MWh or 26% of current yearly electricity consumption. More than 15 MW of billable load (total billed by the utility for a 12-month period) or more than 34% of current billed demand could also be saved. Corresponding natural gas savings would be 1,050 kcf (just over 1% of current consumption). Total yearly net energy cost savings for all options would be greater than $343,340. This value does not include any operations and maintenance (O M) savings.

  13. David Grant Medical Center energy use baseline and integrated resource assessment

    SciTech Connect

    Richman, E.E.; Hoshide, R.K.; Dittmer, A.L.

    1993-04-01

    The US Air Mobility Command (AMC) has tasked Pacific Northwest Laboratory (PNL) with supporting the US Department of Energy (DOE) Federal Energy Management Program`s (FEMP) mission to identify, evaluate, and assist in acquiring all cost-effective energy resource opportunities (EROs) at the David Grant Medical Center (DGMC). This report describes the methodology used to identify and evaluate the EROs at DGMC, provides a life-cycle cost (LCC) analysis for each ERO, and prioritizes any life-cycle cost-effective EROs based on their net present value (NPV), value index (VI), and savings to investment ratio (SIR or ROI). Analysis results are presented for 17 EROs that involve energy use in the areas of lighting, fan and pump motors, boiler operation, infiltration, electric load peak reduction and cogeneration, electric rate structures, and natural gas supply. Typical current energy consumption is approximately 22,900 MWh of electricity (78,300 MBtu), 87,600 kcf of natural gas (90,300 MBtu), and 8,300 gal of fuel oil (1,200 MBtu). A summary of the savings potential by energy-use category of all independent cost-effective EROs is shown in a table. This table includes the first cost, yearly energy consumption savings, and NPV for each energy-use category. The net dollar savings and NPV values as derived by the life-cycle cost analysis are based on the 1992 federal discount rate of 4.6%. The implementation of all EROs could result in a yearly electricity savings of more than 6,000 MWh or 26% of current yearly electricity consumption. More than 15 MW of billable load (total billed by the utility for a 12-month period) or more than 34% of current billed demand could also be saved. Corresponding natural gas savings would be 1,050 kcf (just over 1% of current consumption). Total yearly net energy cost savings for all options would be greater than $343,340. This value does not include any operations and maintenance (O&M) savings.

  14. Final Report for The University of Texas at Arlington Optical Medical Imaging Section of Advanced Imaging Research Center

    SciTech Connect

    Khosrow Behbehani

    2013-02-26

    The goal of this project was to create state-of-the-art optical medical imaging laboratories for the Biomedical Engineering faculty and student researchers of the University of Texas at Arlington (UTA) on the campus of the University of Texas Southwestern Medical Center (UTSW). This has been successfully achieved. These laboratories provide an unprecedented opportunity for the bioengineers (from UTA) to bring about new breakthroughs in medical imaging using optics. Specifically, three major laboratories have been successfully established and state-of-the-art scientific instruments have been placed in the labs. As a result of this grant, numerous journal and conference publications have been generated, patents for new inventions have been filed and received, and many additional grants for the continuation of the research has been received.

  15. The evolution of integrative medical education: the influence of the University of Arizona Center for Integrative Medicine.

    PubMed

    Maizes, Victoria; Horwitz, Randy; Lebensohn, Patricia; McClafferty, Hilary; Dalen, James; Weil, Andrew

    2015-11-01

    The University of Arizona Center for Integrative Medicine (AzCIM) was founded in 1994 with a primary focus of educating physicians in integrative medicine (IM). Twenty years later, IM has become an internationally recognized movement in medicine. With 40% of United States' medical schools having membership in the Academic Consortium for Integrative Medicine and Health it is foreseeable that all medical students and residents will soon receive training in the principles and practices of IM. The AzCIM has the broadest range and depth of IM educational programs and has had a major influence on integrative medical education in the United States. This review describes the fellowship, residency and medical student programs at AzCIM as well as other significant national drivers of IM education; it also points out the challenges faced in developing IM initiatives. The field of IM has matured with new national board certification in IM requiring fellowship training. Allied health professional IM educational courses, as well as integrative health coaching, assure that all members of the health care team can receive training. This review describes the evolution of IM education and will be helpful to academic centers, health care institutions, and countries seeking to introduce IM initiatives.

  16. The new albany shale in Illinois: Emerging play or prolific source

    USGS Publications Warehouse

    Crockett, J.; Morse, D.

    2010-01-01

    The New Albany shale (Upper Devonian) in the Illinois basin is the primary hydrocarbon source rock for the basins nearly 4 billion bbl of oil production to date. The gas play is well-established in Indiana and Western Kentucky. One in-situ oil producing well was reported in a multiply competed well in the New Albany at Johnsonville field in Wayne County, Illinois. The Illinois gas and oil wells at Russellville, in Lawrence County are closely associated with the 0.6% reflectance contour, which suggests a higher level of thermal maturity in this area. Today, only one field, Russellville in eastern Lawrence County has established commercial production in the Ness Albany in Illinois. Two wildcat wells with gas shows were drilled in recent years in southern Saline County, where the New Albany is relatively deeply buried and close to faults associated with the Fluorspar District.

  17. Impact of a Cost Visibility Tool in the Electronic Medical Record on Antibiotic Prescribing in an Academic Medical Center

    PubMed Central

    Fargo, Kelly L.; Johnston, Jessica; Stevenson, Kurt B.; Deutscher, Meredith

    2015-01-01

    Background: Studies evaluating the impact of passive cost visibility tools on antibiotic prescribing are lacking. Objective: The objective of this study was to evaluate whether the implementation of a passive antibiotic cost visibility tool would impact antibiotic prescribing and decrease antibiotic spending. Methods: An efficiency and effectiveness initiative (EEI) was implemented in October 2012. To support the EEI, an antibiotic cost visibility tool was created in June 2013 displaying the relative cost of antibiotics. Using an observational study of interrupted time series design, 3 time frames were studied: pre EEI, post EEI, and post cost visibility tool implementation. The primary outcome was antibiotic cost per 1,000 patient days. Secondary outcomes included case mix index (CMI)–adjusted antibiotic cost per 1,000 patient days and utilization of the cost visibility tool. Results: Initiation of the EEI was associated with a $4,675 decrease in antibiotic cost per 1,000 patient days (P = .003), and costs continued to decrease in the months following EEI (P = .009). After implementation of the cost visibility tool, costs remained stable (P = .844). Despite CMI increasing over time, adjustment for CMI had no impact on the directionality or statistical significance of the results. Conclusion: Our study demonstrated a significant and sustained decrease in antibiotic cost per 1,000 patient days when focused medication cost reduction efforts were implemented, but passive cost visibility tool implementation was not associated with additional cost reduction. Antibiotic cost visibility tools may be of most benefit when prior medication cost reduction efforts are lacking or when an active intervention is incorporated. PMID:26405341

  18. 3 CFR - Medicare Demonstration To Test Medical Homes in Federally Qualified Health Centers

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Memorandum for the Secretary of Health and Human Services My Administration is committed to building a high-quality, efficient health care system and improving access to health care for all Americans. Health centers are a vital part of the health care delivery system. For more than 40 years, health centers...

  19. Implementing Behavioral Activation and Life-Steps for Depression and HIV Medication Adherence in a Community Health Center

    PubMed Central

    Magidson, Jessica F.; Seitz-Brown, C. J.; Safren, Steven A.; Daughters, Stacey B.

    2014-01-01

    Antiretroviral therapy to treat HIV/AIDS has substantially improved clinical outcomes among patients living with HIV/AIDS, but only in the presence of very consistent adherence. One of the most prevalent and impactful individual-level predictors of poor adherence is depressive symptoms, even at subthreshold levels. Evidence-based cognitive behavioral interventions exist to address improvements in depressive symptoms and adherence in this population, yet these techniques have largely been designed and tested as individual treatments for delivery in mental health settings. This presents a significant challenge when transporting these techniques to medical settings where other formats for delivery may be more appropriate (i.e., groups, less frequent visits) and few hands-on resources exist to guide this process. As such, primary aims of this study were to adapt and implement evidence-based cognitive behavioral techniques for depression (behavioral activation; BA) and HIV medication adherence (Life-Steps) that have potential for dissemination in an outpatient community health center. The intervention incorporated feedback from health center staff and utilized a modular, group format that did not rely on sequential session attendance. Feasibility was examined over 8 weeks (n = 13). Preliminary effects on depression, health-related quality of life, and medication adherence were examined and exit interviews were conducted with a subset of participants (n = 4) to inform future modifications. Treatment descriptions and recommendations for effective clinical implementation based on patient and clinician feedback are provided along with case material of two individual patients and an example group session. Current efforts are an important next step for disseminating evidence-based techniques for depression and HIV medication adherence to community health center or AIDS service organization settings. PMID:25419102

  20. Family-centered rounds and medical student performance on the NBME pediatrics subject (shelf) examination: a retrospective cohort study

    PubMed Central

    Kimbrough, Tiffany N.; Heh, Victor; Wijesooriya, N. Romesh; Ryan, Michael S.

    2016-01-01

    Objective To determine the association between family-centered rounds (FCR) and medical student knowledge acquisition as assessed by the National Board of Medical Examiners (NBME) pediatric subject (shelf) exam. Methods A retrospective cohort study was conducted of third-year medical students who graduated from Virginia Commonwealth University School of Medicine between 2009 and 2014. This timeframe represented the transition from ‘traditional’ rounds to FCR on the pediatric inpatient unit. Data collected included demographics, United States Medical Licensing Examination (USMLE) Step 1 and 2 scores, and NBME subject examinations in pediatrics (PSE), medicine (MSE), and surgery (SSE). Results Eight hundred and sixteen participants were included in the analysis. Student performance on the PSE could not be statistically differentiated from performance on the MSE for any year except 2011 (z-score=−0.17, p=0.02). Average scores on PSE for years 2009, 2010, 2013, and 2014 were significantly higher than for SSE, but not significantly different for all other years. The PSE was highly correlated with USMLE Step 1 and Step 2 examinations (correlation range 0.56–0.77) for all years. Conclusions Our results showed no difference in PSE performance during a time in which our institution transitioned to FCR. These findings should be reassuring for students, attending physicians, and medical educators. PMID:27087016

  1. The effect of organizational climate on patient-centered medical home implementation.

    PubMed

    Reddy, Ashok; Shea, Judy A; Canamucio, Anne; Werner, Rachel M

    2015-01-01

    Organizational climate is a key determinant of successful adoption of innovations; however, its relation to medical home implementation is unknown. This study examined the association between primary care providers' (PCPs') perception of organization climate and medical home implementation in the Veterans Health Administration. Multivariate regression was used to test the hypothesis that organizational climate predicts medical home implementation. This analysis of 191 PCPs found that higher scores in 2 domains of organizational climate (communication and cooperation, and orientation to quality improvement) were associated with a statistically significantly higher percentage (from 7 to 10 percentage points) of PCPs implementing structural changes to support the medical home model. In addition, some aspects of a better organizational climate were associated with improved organizational processes of care, including a higher percentage of patients contacted within 2 days of hospital discharge (by 2 to 3 percentage points) and appointments made within 3 days of a patient request (by 2 percentage points). PMID:24788252

  2. The effect of organizational climate on patient-centered medical home implementation.

    PubMed

    Reddy, Ashok; Shea, Judy A; Canamucio, Anne; Werner, Rachel M

    2015-01-01

    Organizational climate is a key determinant of successful adoption of innovations; however, its relation to medical home implementation is unknown. This study examined the association between primary care providers' (PCPs') perception of organization climate and medical home implementation in the Veterans Health Administration. Multivariate regression was used to test the hypothesis that organizational climate predicts medical home implementation. This analysis of 191 PCPs found that higher scores in 2 domains of organizational climate (communication and cooperation, and orientation to quality improvement) were associated with a statistically significantly higher percentage (from 7 to 10 percentage points) of PCPs implementing structural changes to support the medical home model. In addition, some aspects of a better organizational climate were associated with improved organizational processes of care, including a higher percentage of patients contacted within 2 days of hospital discharge (by 2 to 3 percentage points) and appointments made within 3 days of a patient request (by 2 percentage points).

  3. Comparison of Information Available in the Medication Profile of an Electronic Health Record and the Inpatient Best Possible Medication History in a Mother and Child Teaching Hospital Center.

    PubMed

    Daupin, J; Rosseaux, G; Lebel, D; Atkinson, S; Bedard, P; Bussieres, J-F

    2016-01-01

    BackgroundMedication reconciliation (MedRec) can improve patient safety. In Canada, most provinces are implementing electronic health records (EHR). The Quebec Health Record (QHR) can theoretically be used for medication reconciliation. However, the quantity and the quality of information available in this EHR have not been studied. ObjectivesThe main objective was to compare the quantity and quality of the information collected between the inpatient best possible medication history (BPMH) and the QHR.   MethodsThis is a descriptive prospective study conducted at CHU Sainte-Justine, a 500-bed tertiary mother-and-child university hospital center. All inpatients from May 19-26, 2015 were considered for inclusion. Every prescription line in the BPMH and QHR were compared. ResultsThe study included 344 patients and 1,039 prescription lines were analyzed. The medications' name and dosing were more often available in the QHR (95%) than in the BPMH (61%). Concordance between the medication names between QHR and BPMH was found in 48% of the prescription lines; this rate fell to 29% when also factoring daily dosage.  ConclusionsThis study suggests that the QHR can provide high-quality information to support the MedRec hospital process. However, it should be used as a second source to optimize the BPMH obtained from a thorough interview with the patient and/or his or her family. More studies are required to confirm the most optimal way to integrate the QHR to the MedRec process in hospitals. PMID:27462999

  4. Enhanced Performance of Community Health Service Centers during Medical Reforms in Pudong New District of Shanghai, China: A Longitudinal Survey

    PubMed Central

    Sun, Xiaoming; Li, Yanting; Liu, Shanshan; Lou, Jiquan; Ding, Ye; Liang, Hong; Gu, Jianjun; Jing, Yuan; Fu, Hua; Zhang, Yimin

    2015-01-01

    Background The performance of community health service centers (CHSCs) has not been well monitored and analysed since China’s latest community health reforms in 2009. The aim of the current investigation was to evaluate the performing trends of the CHSCs and to analyze the main factors that could affect the performance in Pudong new district of Shanghai, China. Methods A regional performance assessment indicator system was applied to the evaluation of Pudong CHSCs’ performance from 2011 to 2013. All of the data were sorted out by a panel, and analyzed using descriptive statistics and a generalized estimating equation model. Results We found that the overall performance increased annually, with a growing number of CHSCs achieving high scores. Significant differences were observed in institutional management, public health services, basic medical services and comprehensive satisfaction during the period of three years. However, we found no differences in the service scores of Chinese traditional medicine (CTM). The investigation also demonstrated that the key factors affecting performance were the location, information system level, family GP program and medical association program rather than the size of the center. However, the medical association participation appeared to have a significant negative effect on performance. Conclusions It can be concluded from the three-year investigation that the overall performance was improved, but that it could have been further enhanced, especially in institutional management and basic medical service; therefore, it is imperative that CHSCs undertake approaches such as optimizing the resource allocation and utilization, reinforcing the establishment of the information system level, extending the family GP program to more local communities, and promoting the medical association initiative. PMID:25950172

  5. A psychometric reanalysis of the Albany Panic and Phobia Questionnaire.

    PubMed

    Brown, Timothy A; White, Kamila S; Barlow, David H

    2005-03-01

    The psychometric properties of the 27-item Albany Panic and Phobia Questionnaire (APPQ) were evaluated in 1930 outpatients with DSM-IV anxiety and mood disorders. Although prior findings of a 3-factor latent structure were upheld in several replications (Social Phobia, Agoraphobia, Interoceptive), three items failed to load on their predicted factor (Interoceptive). Multiple-groups CFAs indicated that the measurement properties of the APPQ were invariant in male and female patients, with the exception of an intercept of one item from the Agoraphobia scale which evidenced bias against females. The three APPQ dimensions were consistently associated with high levels of scale reliability and factor determinacy. Strong evidence of concurrent validity of the Social Phobia and Agoraphobia factors was obtained in relation to interview and questionnaire measures. Although the Interoceptive factor was more strongly related to criterion measures of anxiety sensitivity and fear of panic than Social Phobia, the Agoraphobia factor had the strongest relationships with these validity indices. The results are discussed in regard to psychometric implications for the APPQ and conceptual issues pertaining to the discriminant validity of fear of agoraphobic situations and fear of sensation-producing activities.

  6. A third world international health elective for U.S. medical students: the 25-year experience of the State University of New York, Downstate Medical Center.

    PubMed

    Imperato, Pascal James

    2004-10-01

    The Department of Preventive Medicine and Community Health at the State University of New York, Downstate Medical Center instituted a 6-8 weeks third world international health elective for fourth year medical students in 1980. Since that time, some 217 students have participated in a score of third world countries. However, the most popular sites have been India, Kenya and Thailand. The purposes of this elective are to provide fourth year medical students with an opportunity to observe and study the structure and functions of a health care delivery system in a third world country, to provide medical service, and to have a cross-cultural experience. The emphasis in this elective is on public health, preventive medicine and primary care. There are high levels of student competition for this elective. However, interest in it has been affected by world events such as the terrorist attacks of September 11, 2001 and the recent outbreak of Severe Acute Respiratory Syndrome (SARS) in Asia. Recent annual applications for this elective have been twenty-five and more out of a class of two hundred students. Annual acceptance rates vary considerably, ranging from as low as 27.2% in 1995-1996 to a high of 81.8% in 1987-1988. Careful screening, including an examination of academic records and personal interviews, has resulted in the selection of highly mature, adaptable, and dedicated students who overall have performed well at overseas sites. Student rated satisfaction levels with this elective are extremely high, with most rating it the best experience of their medical school years. Students undergo extensive preparation prior to going overseas. This includes individual health and safety issues, travel and lodging, and the nature of the host country culture, health care system, and assignment site. Our students are especially experienced in cross-cultural understanding because of the unusual diversity of the patients they treat in Brooklyn, and the ethnic diversity of local

  7. The U.S. health care system is in crisis: implications for academic medical centers and their missions.

    PubMed

    Lofgren, Richard; Karpf, Michael; Perman, Jay; Higdon, Courtney M

    2006-08-01

    The medical care system in the United States is in crisis. Health care costs are escalating and threatening coverage for millions of people. Concerns about the quality of care and patient safety are heightening; patients and payers now publicly share these concerns and want to make providers more accountable. Traditionally, the response to rising health care costs has been to modify reimbursement models and incentives. Currently there is a movement to shift the responsibility of cost containment to the patients. The authors express doubts about the overall effectiveness of this strategy and propose reengineering the health care system to improve quality and efficiency. Leaders of academic medical centers must understand the forces and dynamics of change, and the potential institutional response to improve the quality and efficiency of their delivery systems and to preserve their missions: clinical care, education, research, and community service. As they suggest the operational changes needed to respond to this evolving health care environment, the authors discuss the implications for the various missions. The graduates of training programs must be prepared to function within multidisciplinary teams and constantly seek ways to improve quality and efficiency to ensure that care is accessible, affordable, and safe. Academic medical centers need to expand their research agenda to develop more expertise in quality and process improvement research. Additionally, they must provide the leadership to foster the transition from an era of "managed care" to an era of "organized systems of care."

  8. New Paradigms for Patient-Centered Outcomes Research in Electronic Medical Records: An Example of Detecting Urinary Incontinence Following Prostatectomy

    PubMed Central

    Hernandez-Boussard, Tina; Tamang, Suzanne; Blayney, Douglas; Brooks, Jim; Shah, Nigam

    2016-01-01

    Introduction: National initiatives to develop quality metrics emphasize the need to include patient-centered outcomes. Patient-centered outcomes are complex, require documentation of patient communications, and have not been routinely collected by healthcare providers. The widespread implementation of electronic medical records (EHR) offers opportunities to assess patient-centered outcomes within the routine healthcare delivery system. The objective of this study was to test the feasibility and accuracy of identifying patient centered outcomes within the EHR. Methods: Data from patients with localized prostate cancer undergoing prostatectomy were used to develop and test algorithms to accurately identify patient-centered outcomes in post-operative EHRs – we used urinary incontinence as the use case. Standard data mining techniques were used to extract and annotate free text and structured data to assess urinary incontinence recorded within the EHRs. Results A total 5,349 prostate cancer patients were identified in our EHR-system between 1998–2013. Among these EHRs, 30.3% had a text mention of urinary incontinence within 90 days post-operative compared to less than 1.0% with a structured data field for urinary incontinence (i.e. ICD-9 code). Our workflow had good precision and recall for urinary incontinence (positive predictive value: 0.73 and sensitivity: 0.84). Discussion. Our data indicate that important patient-centered outcomes, such as urinary incontinence, are being captured in EHRs as free text and highlight the long-standing importance of accurate clinician documentation. Standard data mining algorithms can accurately and efficiently identify these outcomes in existing EHRs; the complete assessment of these outcomes is essential to move practice into the patient-centered realm of healthcare. PMID:27347492

  9. Prevalence and Predictors of Self-Medication with Antibiotics in Al Wazarat Health Center, Riyadh City, KSA

    PubMed Central

    Al Rasheed, Abdulrahman; Yagoub, Umar; Alkhashan, Hesham; Abdelhay, Osama; Alawwad, Ahmad; Al Aboud, Aboud; Al Battal, Saad

    2016-01-01

    Background. Antibiotics are responsible for most dramatic improvement in medical therapy in history. These medications contributed significantly to the decreasing mortality and morbidity when prescribed based on evidence of microbial infection. Objective. The aim of this study was to determine the prevalence and predictors of self-prescription with antibiotics in Al Wazarat Health Center, Riyadh City, Kingdom of Saudi Arabia. Material and Methods. Cross-sectional study was conducted in Al Wazarat Health Center between February 2014 and November 2014. Respondents were randomly selected using a multistage clustered random sampling technique. Data was entered into SPSS version 21 and analyzed. Descriptive statistics and multiple logistic regression models were applied. Results. A total of 681 patients have participated in this study with a response rate of 92%. The prevalence of self-prescription with antibiotics in Al Wazarat Health Center was 78.7%. Amoxicillin was the most used self-prescribed antibiotic with prevalence of (22.3%). Friend advice on self-prescription of antibiotics use (p = 0.000) and pharmacy near to the participants (p = 0.002) were the most common predictors for self-prescription with antibiotics. Conclusion. The level of self-prescribing antibiotics is relatively high among participants. Health education on the appropriate use of antibiotics is highly recommended. The proper use of treatment guidelines for antibiotic therapy will significantly reduce self-prescription with antibiotics. PMID:26881218

  10. Laboratory test utilization program: structure and impact in a large academic medical center.

    PubMed

    Warren, Jeffrey S

    2013-03-01

    In 2008, the University of Michigan Health System (UMHS) created a Laboratory Test Utilization Program that included the establishment of a Laboratory Formulary Committee under the imprimatur of the Faculty Group Practice, the Office of Clinical Affairs, the Department of Pathology, and UMHS hospital administration. A critical component of the program is UM-CareLink, an order entry system for inpatients and inpatient-like venues. UM-CareLink allows very basic decision support comment prompts. Through the application of peer-reviewed medical evidence, input by medical content experts, excellent cooperation by medical staff, and close oversight by Pathology of the Sendout Laboratory, this program has led to a robust process of test utilization oversight, excellent communication with clinical services, and significant UMHS activity-adjusted reductions in laboratory expense.

  11. Client-Centered Advocacy: Every Occupational Therapy Practitioner's Responsibility to Understand Medical Necessity.

    PubMed

    Stover, Alyson D

    2016-01-01

    Occupational therapy practitioners must advocate for clients in multiple ways. The Occupational Therapy Practice Framework: Domain and Process as well as the Occupational Therapy Code of Ethics lend support to advocacy. Recognizing one's responsibility to provide advocacy for clients is different from knowing how to provide that advocacy. One aspect of health care affected by the Patient Protection and Affordable Care Act (ACA) is the definition and implementation of medical necessity. This article outlines some major concepts around medical necessity, particularly in relation to the passage of the ACA, and outlines guidance on how to advocate effectively to meet both individual and community needs.

  12. Client-Centered Advocacy: Every Occupational Therapy Practitioner's Responsibility to Understand Medical Necessity.

    PubMed

    Stover, Alyson D

    2016-01-01

    Occupational therapy practitioners must advocate for clients in multiple ways. The Occupational Therapy Practice Framework: Domain and Process as well as the Occupational Therapy Code of Ethics lend support to advocacy. Recognizing one's responsibility to provide advocacy for clients is different from knowing how to provide that advocacy. One aspect of health care affected by the Patient Protection and Affordable Care Act (ACA) is the definition and implementation of medical necessity. This article outlines some major concepts around medical necessity, particularly in relation to the passage of the ACA, and outlines guidance on how to advocate effectively to meet both individual and community needs. PMID:27548855

  13. [The role of the medical director as manager of health centers].

    PubMed

    Cuervo Argudín, J I

    1991-01-01

    In this review the role of physicians in management position of health services in Spain is analyzed. Araising from the high rotation rate in these positions, the experience and reports of foreing countries are reviewed. Finally, the functions of a medical director in a management team are defined. Also, the need of their influence on the profile of services an professional curricula in order to ensure continuity are discussed. Training is the key element for continuity and stability of medical directors in health services management teams. PMID:1783497

  14. New Dimensions in Patient–Physician Interaction: Values, Autonomy, and Medical Information in the Patient-Centered Clinical Encounter

    PubMed Central

    Agarwal, Aakash Kumar; Murinson, Beth Brianna

    2012-01-01

    Patient–physician interactions are increasingly influenced by the extraordinary diversification of populations and rapid expansion of medical knowledge that characterize our modern era. By contrast, the patient–physician interaction models currently used to teach medical trainees have little capacity to address these twin challenges. We developed a new model of patient–physician interaction to explicitly address these problems. Historically, models of patient–physician interaction viewed patient autonomy and the manifestation of clearly defined health care-related values as tightly linked, and it was assumed that patients’ medical knowledge was low. Unfortunately, this does not adequately represent patients such as 1) the highly educated non-medical specialist who possesses little familiarity with health-related values but is highly autonomous, and 2) the patient from a non-Western background who may have well-established health care-related values but a low sense of personal independence. In addition, it is evident to us that the assumption that all patients possess little medical knowledge can create alienation between patient and physician, e.g. the well-informed patient with a rare disease. We propose a paradigm that models autonomy, health care-related values formation, and medical knowledge as varying from patient to patient. Four examples of patient types are described within the context of the model based on clinical experience. We believe that adopting this model will have implications for optimizing patient–physician interactions and teaching about patient-centered care. Further research is needed to identify relevant patient types within this framework and to assess the impact on health care outcomes. PMID:23908841

  15. Collaborative Family Healthcare Association commentary on the "joint principles: Integrating behavioral health care into the patient-centered medical home".

    PubMed

    Runyan, Christine; Khatri, Parinda

    2014-06-01

    The Collaborative Family Healthcare Association (CFHA) welcomes the opportunity to comment on the complementary set of Joint Principles underscoring the Integration of Behavioral Health Care Into the Patient-Centered Medical Home (The Working Party Group on Integrated Behavioral Healthcare et al., 2014). CFHA is an organization that promotes comprehensive and cost-effective models of health care delivery that integrate mind and body, individual and family, patients, providers, and communities. CFHA appreciates that the Joint Principles do not explicitly endorse any single model of collaboration between behavioral health and medical practice. Rather, they broadly emphasize integration, affirming the only way to have a whole person orientation is to adopt a biopsychosocial-spiritual perspective. This commentary will highlight areas of notable strength within the Joint Principles, as well as challenge the language, if not perspective, on a few critical elements. PMID:24955686

  16. International Center for Medical Technologies acknowledges Artificial Organ Pioneers at the ASAIO-ISAO Joint Congress in 2003.

    PubMed

    Nosé, Yukihiko; Phillips, Steven; Harmison, Lowell; DeBakey, Michael E

    2004-01-01

    The International Center for Medical Technologies (ICMT), a museum for artificial organs in Houston, Texas, officially opened in November 2002, as previously published in Artificial Organs 2003;27(9):821-32. The museum expanded its original activities to formulate the International Academy for Artificial Organ Pioneers (Academy) and the International Faculty for Health and Medical Technologies (Faculty). At the joint American Society for Artificial Internal Organs (ASAIO) and International Society for Artificial Organs (ISAO) Congress in Washington, DC on June 18, 2003, Yukihiko Nosé introduced the ICMT and its formulation. The activities and future perspectives were presented by the ICMT Museum Director, Steven Phillips; the Academy Dean, Lowell Harmison; and the Faculty Dean, Michael E. DeBakey.

  17. Ocular diseases and nonbattle injuries seen at a tertiary care medical center during the Global War on Terrorism.

    PubMed

    Psolka, Maximilian; Bower, Kraig S; Brooks, Dain B; Donnelly, Steven J; Iglesias, Melissa; Rimm, William R; Ward, Thomas P

    2007-05-01

    We retrospectively reviewed the records of 107 U.S. military personnel referred to the Walter Reed Army Medical Center ophthalmology service with eye diseases and nonbattle injuries diagnosed during Operation Enduring Freedom and Operation Iraqi Freedom. Ocular diseases and nonbattle injuries ranged from minor to vision-threatening, represented a broad variety of conditions, and required the expertise of a number of ophthalmic subspecialists. The most common diagnoses were uveitis (13.1%), retinal detachment (11.2%), infectious keratitis (4.7%), and choroidal neovascularization (4.7%). Eighty-four patients (78.5%) met Army retention standards and were returned to duty. Twenty patients (18.7%) were referred to a medical evaluation board, seven (6.5%) of whom failed to meet retention standards for eye and vision; the retention status of three patients (2.8%) remains to be determined.

  18. HEALTH LITERACY, MEDICATION ADHERENCE, AND BLOOD PRESSURE LEVEL AMONG HYPERTENSIVE OLDER ADULTS TREATED AT PRIMARY HEALTH CARE CENTERS.

    PubMed

    Wannasirikul, Phitchayaphat; Termsirikulchai, Lakkhana; Sujirarat, Dusit; Benjakul, Sarunya; Tanasugarn, Chanuantong

    2016-01-01

    We conducted this study to explore the causal relationships between health literacy, individual characteristics, literacy, culture and society, cognitive ability, medication adherence, and the blood pressure levels of hypertensive older adults receiving health care services at Primary Health Care Centers in Sa Kaeo Province, Thailand. Six hundred hypertensive older adults had their blood pressure level recorded and were interviewed using questionnaires. Structural Equation Modeling (SEM) was used to determine the effect size, both direct and indirect, among factors. Almost half (48.7%) of studied subjects had inadequate health literacy, 98.3% had good medication adherence, and 80% had good blood pressure levels. The highest effect size on health literacy was literacy, followed by cognitive ability, and culture and society. Medication adherence was affected directly and indirectly by cognitive ability, literacy, and culture and society. Health literacy had not only a direct effect on medication adherence but was also the mediator. Finally, the highest effect size on blood pressure level was critical and communicative health literacy. These findings suggest that health literacy should be considered in the Health Literacy Program of the National Public Health Policy and Plan, Ministry of Public Health. PMID:27086432

  19. HEALTH LITERACY, MEDICATION ADHERENCE, AND BLOOD PRESSURE LEVEL AMONG HYPERTENSIVE OLDER ADULTS TREATED AT PRIMARY HEALTH CARE CENTERS.

    PubMed

    Wannasirikul, Phitchayaphat; Termsirikulchai, Lakkhana; Sujirarat, Dusit; Benjakul, Sarunya; Tanasugarn, Chanuantong

    2016-01-01

    We conducted this study to explore the causal relationships between health literacy, individual characteristics, literacy, culture and society, cognitive ability, medication adherence, and the blood pressure levels of hypertensive older adults receiving health care services at Primary Health Care Centers in Sa Kaeo Province, Thailand. Six hundred hypertensive older adults had their blood pressure level recorded and were interviewed using questionnaires. Structural Equation Modeling (SEM) was used to determine the effect size, both direct and indirect, among factors. Almost half (48.7%) of studied subjects had inadequate health literacy, 98.3% had good medication adherence, and 80% had good blood pressure levels. The highest effect size on health literacy was literacy, followed by cognitive ability, and culture and society. Medication adherence was affected directly and indirectly by cognitive ability, literacy, and culture and society. Health literacy had not only a direct effect on medication adherence but was also the mediator. Finally, the highest effect size on blood pressure level was critical and communicative health literacy. These findings suggest that health literacy should be considered in the Health Literacy Program of the National Public Health Policy and Plan, Ministry of Public Health.

  20. Patient-centered medical home initiative produced modest economic results for Veterans Health Administration, 2010-12.

    PubMed

    Hebert, Paul L; Liu, Chuan-Fen; Wong, Edwin S; Hernandez, Susan E; Batten, Adam; Lo, Sophie; Lemon, Jaclyn M; Conrad, Douglas A; Grembowski, David; Nelson, Karin; Fihn, Stephan D

    2014-06-01

    In 2010 the Veterans Health Administration (VHA) began a nationwide initiative called Patient Aligned Care Teams (PACT) that reorganized care at all VHA primary care clinics in accordance with the patient-centered medical home model. We analyzed data for fiscal years 2003-12 to assess how trends in health care use and costs changed after the implementation of PACT. We found that PACT was associated with modest increases in primary care visits and with modest decreases in both hospitalizations for ambulatory care-sensitive conditions and outpatient visits with mental health specialists. We estimated that these changes avoided $596 million in costs, compared to the investment in PACT of $774 million, for a potential net loss of $178 million in the study period. Although PACT has not generated a positive return, it is still maturing, and trends in costs and use are favorable. Adopting patient-centered care does not appear to have been a major financial risk for the VHA.