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Sample records for portland medical center

  1. 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.

  2. Demonstration Assessment of Light Emitting Diode (LED) Commercial Garage Lights In the Providence Portland Medical Center, Portland, Oregon

    SciTech Connect

    Ton, My K.; Richman, Eric E.; Gilbride, Theresa L.

    2008-11-11

    This U.S. Department of Energy GATEWAY Demonstration project studied the applicability of light-emitting diode (LED) luminaires for commercial parking garage applications. High-pressure sodium (HPS) area luminaires were replaced with new LED area luminaires. The project was supported under the U.S. Department of Energy (DOE) Solid State Lighting Program. Other participants in the demonstration project included Providence Portland Medical Center in Portland, Oregon, the Energy Trust of Oregon, and Lighting Sciences Group (LSG) Inc. Pacific Northwest National Laboratory (PNNL) conducted the measurements and analysis of the results. PNNL manages GATEWAY demonstrations for DOE and represents their perspective in the conduct of the work. Quantitative and qualitative measurements of light and electrical power were taken at the site for both HPS and LED light sources. Economic costs were estimated and garage users’ responses to the new light sources were gauged with a survey. Six LED luminaires were installed in the below-ground parking level A, replacing six existing 150W HPS lamps spread out over two rows of parking spaces. Illuminance measurements were taken at floor level approximately every 4 ft on a 60-ft x 40-ft grid to measure light output of these LED luminaires which were termed the “Version 1” luminaires. PNNL conducted power measurements of the circuit in the garage to which the 6 luminaires were connected and determined that they drew an average of 82 W per lamp. An improved LED luminaire, Version 2, was installed in Level B of the parking garage. Illuminance measurements were not made of this second luminaire on site due to higher traffic conditions, but photometric measurements of this lamp and Version 1 were made in an independent testing laboratory and power usage for Version 2 was also measured. Version 1 was found to produce 3600 lumens and Version 2 was found to produce 4700 lumens of light and to consume 78 Watts. Maximum and minimum light

  3. Law and Order: Legal Research Center, Portland, Or.

    ERIC Educational Resources Information Center

    Progressive Architecture, 1979

    1979-01-01

    The Legal Research Center for Lewis and Clark Law School in Portland, Oregon, was designed to allow existing facilities to dominate, to continue a linear development of a steep nonlinear site, and to connect gracefully to adjacent buildings. (Author/MLF)

  4. Whitney M. Young Learning Center in the Portland Public Schools. 1986-87 Evaluation Report.

    ERIC Educational Resources Information Center

    Mitchell, Stephanie

    The Whitney Young Learning Center (WYLC) is an after-school homework assistance and tutoring program for students in grades 6-12 in north and northeast Portland, Oregon. The program strives to help students achieve academic success and become self-directed learners with enhanced racial pride and self-esteem. During 1986-87, the WYLC program…

  5. 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.

  6. 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.

  7. The academic medical center today.

    PubMed

    Rogers, D E; Blendon, R J

    1984-05-01

    Some recent circumstances, including the nation's economic difficulties, a probable physician surplus, a declining need for acute-care medical beds, and an overwhelming public perception that medical care is too expensive, are creating serious problems for academic medical centers today. To survive, many academic medical centers probably will make certain short-term adaptations that will be viewed as undesirable by many. We suggest four initiatives that may help academic centers maintain their vital national role. These initiatives include becoming major public advocates for the medical care needs of the least fortunate; a sharp reduction in the training of subspecialists; the commitment of more of their faculty practice income to academic research, teaching, and support of low-income students; and refocusing attention on the training of young persons to be the physicians of tomorrow.

  8. Advertising by academic medical centers.

    PubMed

    Larson, Robin J; Schwartz, Lisa M; Woloshin, Steven; Welch, H Gilbert

    2005-03-28

    Many academic medical centers have increased their use of advertising to attract patients. While the content of direct-to-consumer pharmaceutical advertisements (ads) has been studied, to our knowledge, advertising by academic medical centers has not. We aimed to characterize advertising by the nation's top academic medical centers. We contacted all 17 medical centers named to the US News & World Report 2002 honor roll of "America's Best Hospitals" for a semistructured interview regarding their advertising practices. In addition, we obtained and systematically analyzed all non-research-related print ads placed by these institutions in their 5 most widely circulating local newspapers during 2002. Of the 17 institutions, 16 reported advertising to attract patients; 1 stated, "We're just word of mouth." While all 17 centers confirmed the presence of an institutional review board process for approving advertising to attract research subjects, none reported a comparable process for advertising to attract patients. We identified 127 unique non-research-related print ads for the 17 institutions during 2002 (mean, 7.5; range, 0-39). Three ads promoted community events with institution sponsorship, 2 announced genuine public services, and 122 were aimed at attracting patients. Of the latter group, 36 ads (29.5%) promoted the medical center as a whole, while 65 (53.3%) promoted specific clinical departments and 21 (17.2%) promoted single therapeutic interventions or diagnostic tests. The most commonly used marketing strategies included appealing to emotions (61.5%), highlighting institution prestige (60.7%), mentioning a symptom or disease (53.3%), and promoting introductory lectures or special offers likely to lead to further business (47.5%). Of the 21 ads for single interventions, most were for unproved (38.1%) or cosmetic (28.6%) procedures. While more than half of these ads presented benefits, none quantified their positive claims and just 1 mentioned potential harms

  9. 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.

  10. 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.

  11. Establishing cost centers within libraries of medical centers.

    PubMed Central

    Schultz, C K

    1983-01-01

    Medical centers that educate students, treat patients, and perform medical research usually adopt accounting methods for separating those functions financially--designating each function as a cost center. Faculty members who participate in more than one of the separately charged activities have their salaries apportioned accordingly. Cost-shared services, such as a computer facility or a power plant, may also be apportioned among the cost centers. Given this approach to accounting, the shared services of the medical center's library should be included in such an apportionment. Whether such is the case, why the matter is of concern, and how such accounting can be performed were recently studied. PMID:6860398

  12. Medical Service Plans in Academic Medical Centers

    ERIC Educational Resources Information Center

    Siegel, Bernard

    1978-01-01

    The control of clinical practice and the disposition of income from this practice have complicated the governance of medical schools for many years. The problem has been magnified recently by a decrease in income from other sources, reduction in the number of service patients, expansion of private services, and federal legislation. Implications…

  13. Malpractice Issues in the Academic Medical Center.

    ERIC Educational Resources Information Center

    Rich, Ben A.

    1986-01-01

    A discussion of legal issues in the academic medical center focuses on standards of care applicable to practitioners, special problems of patient care delivery, and the special status of public academic medical centers. Informed consent to care, relations with affiliated institutions, and private/non-private patient status are also considered.…

  14. Medical center staff attitudes about spanking.

    PubMed

    Gershoff, Elizabeth T; Font, Sarah A; Taylor, Catherine A; Foster, Rebecca H; Garza, Ann Budzak; Olson-Dorff, Denyse; Terreros, Amy; Nielsen-Parker, Monica; Spector, Lisa

    2016-11-01

    Several medical professional organizations, including the American Academy of Pediatrics, recommend that parents avoid hitting children for disciplinary purposes (e.g., spanking) and that medical professionals advise parents to use alternative methods. The extent to which medical professionals continue to endorse spanking is unknown. This study is the first to examine attitudes about spanking among staff throughout medical settings, including non-direct care staff. A total of 2580 staff at a large general medical center and 733 staff at a children's hospital completed an online survey; respondents were roughly divided between staff who provide direct care to patients (e.g., physicians, nurses) and staff who do not (e.g., receptionists, lab technicians). Less than half (44% and 46%) of staff at each medical center agreed that spanking is harmful to children, although almost all (85% and 88%) acknowledged that spanking can lead to injury. Men, staff who report being religious, and staff who held non-direct care positions at the medical center reported stronger endorsement of spanking and perceived their co-workers to be more strongly in favor of spanking. Non-direct care staff were more supportive of spanking compared with direct care staff on every item assessed. All staff underestimated the extent to which their co-workers held negative views of spanking. If medical centers and other medical settings are to lead the charge in informing the community about the harms of spanking, comprehensive staff education about spanking is indicated.

  15. Characterizing customers at medical center farmers' markets.

    PubMed

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

    2014-08-01

    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 and 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 180-2,000 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.

  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. Medical center farmers markets: a strategic partner in the patient-centered medical home.

    PubMed

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

    2013-08-01

    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. 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. 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. 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. 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.

  18. 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.

  19. Academic Medical Centers as digital health catalysts.

    PubMed

    DePasse, Jacqueline W; Chen, Connie E; Sawyer, Aenor; Jethwani, Kamal; Sim, Ida

    2014-09-01

    Emerging digital technologies offer enormous potential to improve quality, reduce cost, and increase patient-centeredness in healthcare. Academic Medical Centers (AMCs) play a key role in advancing medical care through cutting-edge medical research, yet traditional models for invention, validation and commercialization at AMCs have been designed around biomedical initiatives, and are less well suited for new digital health technologies. Recently, two large bi-coastal Academic Medical Centers, the University of California, San Francisco (UCSF) through the Center for Digital Health Innovation (CDHI) and Partners Healthcare through the Center for Connected Health (CCH) have launched centers focused on digital health innovation. These centers show great promise but are also subject to significant financial, organizational, and visionary challenges. We explore these AMC initiatives, which share the following characteristics: a focus on academic research methodology; integration of digital technology in educational programming; evolving models to support "clinician innovators"; strategic academic-industry collaboration and emergence of novel revenue models. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Developing physician leaders in academic medical centers.

    PubMed

    Bachrach, D J

    1997-01-01

    While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management; intramurally conducted courses in leadership skill development, management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. While part one of this series, which appeared in Volume 43, No. 6 of Medical Group Management Journal addressed, "The changing role of physician leaders at academic medical centers," part 2 will examine as a case study the faculty leadership development program at the University of Texas M.D. Anderson Cancer Center. These two articles were prepared by the author from his research into, and the presentation of a thesis entitled. "The importance of leadership training and development for physicians in academic medical centers in an increasingly complex health care environment," prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in this College.*

  1. 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.

  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. 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…

  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.

  5. Research imaging in an academic medical center.

    PubMed

    Armato, Samuel G; Gruszauskas, Nicholas P; Macmahon, Heber; Torno, Michael D; Li, Feng; Engelmann, Roger M; Starkey, Adam; Pudela, Caileigh L; Marino, Jonathan S; Santiago, Faustino; Chang, Paul J; Giger, Maryellen L

    2012-06-01

    Managing and supervising the complex imaging examinations performed for clinical research in an academic medical center can be a daunting task. Coordinating with both radiology and research staff to ensure that the necessary imaging is performed, analyzed, and delivered in accordance with the research protocol is nontrivial. The purpose of this communication is to report on the establishment of a new Human Imaging Research Office (HIRO) at our institution that provides a dedicated infrastructure to assist with these issues and improve collaborations between radiology and research staff. The HIRO was created with three primary responsibilities: 1) coordinate the acquisition of images for clinical research per the study protocol, 2) facilitate reliable and consistent assessment of disease response for clinical research, and 3) manage and distribute clinical research images in a compliant manner. The HIRO currently provides assistance for 191 clinical research studies from 14 sections and departments within our medical center and performs quality assessment of image-based measurements for six clinical research studies. The HIRO has fulfilled 1806 requests for medical images, delivering 81,712 imaging examinations (more than 44.1 million images) and related reports to investigators for research purposes. The ultimate goal of the HIRO is to increase the level of satisfaction and interaction among investigators, research subjects, radiologists, and other imaging professionals. Clinical research studies that use the HIRO benefit from a more efficient and accurate imaging process. The HIRO model could be adopted by other academic medical centers to support their clinical research activities; the details of implementation may differ among institutions, but the need to support imaging in clinical research through a dedicated, centralized initiative should apply to most academic medical centers. Copyright © 2012 AUR. Published by Elsevier Inc. All rights reserved.

  6. 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

  7. [Medical education centers: strategies and purpose].

    PubMed

    Binetti, P

    1999-01-01

    The introduction of new didactic guidelines, for the graduate degrees in medicine and allied disciplines, is secondary to the new needs of the National Health Care System, and in part to the significant developments of science. It is not easy to meet this challenge. It is likewise not easy to channel coherently the required changes, with respect to the scientific, clinical and didactic goals. Paradoxically the same institutions that are in such great need of transformation, are also a significant part of the existing problem. In many countries, schools of medicine have developed centers for medical education that are geared toward the development and growth of students, teachers-tutors, and patients alike. Medical education has become more global, in an attempt to meet much needed communication needs, from both ends, teachers and students, as well as the recipients of care, patients. One major goal of such centers is the introduction of innovative didactic activities. There is indeed a new tendency toward the development of methodological tracks aiming at the acquisition and consolidation of a deeper and broader cultural knowledge. Amongst these initiatives there is the introduction of an evaluation of the teaching delivered, as well as the development of a multidisciplinary approach to didactics. The latter, is a prerequisite of an effective training directed toward the development of the concept of "team approach", whose ultimate goal is patient care. In Italy, at the Università Campus Biomedico, in Rome, one of the first of such centers of medical education has been developed. Its goal is to be both a learning organization, as well as a center for both research and clinical services.

  8. 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.

  9. Collaborative practice model: Madigan Army Medical Center.

    PubMed

    Nielsen, Peter E; Munroe, Michelle; Foglia, Lisa; Piecek, Roxanne I; Backman, Mary Paul; Cypher, Rebecca; Smith, Denise C

    2012-09-01

    In 2007, Madigan Army Medical Center implemented a new maternity care delivery model, integrating obstetricians and certified nurse-midwives (CNMs) in a collaborative practice. The change was driven by multiple factors, including patient preference, changes in the resident workweek, and low provider satisfaction. This article describes the elements of successful collaboration, including the structure, effective teamwork principles, role of the CNM in resident education, and preliminary data on mode of delivery, the number of CNM-supervised resident births, and procedures, such as episiotomy and epidural use.

  10. ENTRANCE TO CEMETERY FROM VA MEDICAL CENTER CAMPUS, WITH ADMINISTRATION ...

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

    ENTRANCE TO CEMETERY FROM VA MEDICAL CENTER CAMPUS, WITH ADMINISTRATION BUILDING IN BACKGROUND. VIEW TO NORTH. - Bath National Cemetery, Department of Veterans Affairs Medical Center, San Juan Avenue, Bath, Steuben County, NY

  11. 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

  12. 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

  13. 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

  14. An Experiment in Change (Girls Residential Youth Center, Portland, Maine--Phase II. Final Report and Evaluation)

    ERIC Educational Resources Information Center

    Hussey, Frederick A.; And Others

    The project was a residential youth center designed to address the needs of hard-core, high risk, girls between the ages of 14 and 18, with a history of poverty, unemployability, and school failure. The report describes the history and goals of the project, the nature of the population under study, the use of volunteers and nonprofessionals in…

  15. Cast Study: National Naval Medical Center, A Graduate Management Project

    DTIC Science & Technology

    2002-06-10

    of Health Sciences), the Naval Medical Research Institute (now the Naval Medical Research Center), and the Naval Dental School (now the National...Naval Dental Center) (History, 2000). The NNMC mission became regional on January 1, 1973 with the establishment of the National Naval Medical Center...General Surgery Material Management Inpatient Surgery Postal Operations Ophthalmology Oerations Service Oral & Maxillo- Bahelor Housing facial/ Dental

  16. School Desegregation: Portland Style.

    ERIC Educational Resources Information Center

    Heflin, John F.; Douglas, Marcia

    In this paper, the Policy Process Model developed by Charles O. Jones is adopted in order to analyze school desegregation policy in Portland, Oregon. A major focus of this case study is the interaction between the Portland Public School Board and two community groups (the Community Coalition for School Integration and the Black United Front) as…

  17. 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.

  18. 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

  19. The University of Tennessee Medical Center at Knoxville.

    PubMed

    Goldman, Mitchell H

    2012-09-01

    The University of Tennessee Medical Center at Knoxville hosts the University Health Services and the University of Tennessee Graduate School of Medicine. Founded in 1956, the center along with the Department of Surgery has grown in size and in academic stature to become an outstanding tertiary clinical, medical education, and research center.

  20. [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.

  1. Deaths in an academic medical center.

    PubMed

    Lagman, Ruth L; Walsh, Declan; Kunkle, Chad; LeGrand, Susan B; Davis, Mellar P

    2006-12-01

    The number of inpatient deaths in a calendar year in an academic medical center was reviewed from a computerized database. The total number was 1222. The median length of hospital stay for those who died was 7 days (range, 1-190); 404 (33%) were 75 years or older. There were 678 (55%) males and 544 (45%) females. The pulmonary medicine service had the most deaths with 290 (24%) followed by hematology/oncology 230 (18%). The most common primary diagnoses in the decedents were subendocardial infarction 58 (5%), congestive heart failure 57 (5%), and pneumonia 45 (4%). The most common diagnostic-related groups (DRGs) were respiratory system disorders (475), 98 (8%); tracheostomy (483), 75 (6%); and heart surgery (110), 65 (5%). Frequent procedures done prior to death were mechanical ventilation (<96 hours) 101 (8%), and mechanical ventilation (>96 hours) 55 (5%), and tracheostomy 54 (4%). Invasive procedures were common. Forty-five percent of the predeath patient days were spent in intensive care units. Palliative medicine was involved in the care of 20% of all the decedents.

  2. 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.

  3. 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.

  4. Poet Portland Approval

    EPA Pesticide Factsheets

    This update August 9, 2016 letter from EPA approves the petition, with modifications, from Poet Biorefining-Portland, LLC, regarding non-grandfathered ethanol produced through a dry mill process, qualifying under the Clean Air Act for renewable fuel

  5. 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

  6. Implementation of a pharmacy technician-centered medication reconciliation program at an urban teaching medical center.

    PubMed

    Sen, Sanchita; Siemianowski, Laura; Murphy, Michelle; McAllister, Susan Coutinho

    2014-01-01

    An inpatient medication reconciliation (MR) program emphasizing pharmacy technicians' role in the MR process is described. As part of quality-improvement (QI) efforts focused on MR-related adverse drug events, an urban academic medical center in New Jersey implemented a pharmacy technician-centered MR (PTMR) program targeting patients on its internal medicine, oncology, and clinical decision units. The program is staffed by five full- or part-time technicians who are trained in MR methods and work under direct pharmacist supervision, interviewing newly admitted patients and using other information sources (e.g., community pharmacies, physician offices, nursing facilities) to compile an accurate and complete medication list. About 30% of all patients admitted to the hospital are served by the PTMR program, which averages more than 500 cases each month. During one three-month period, 1748 discrepancies on preadmission medication lists were identified, most of which involved the omission of drugs (65.7% of cases) and incorrect information on dose and frequency of use (14.4%). Efforts to overcome resource constraints and other program challenges (e.g., privacy concerns, delays in community pharmacy transmittal of prescription refill lists) are ongoing. To date, most research on PTMR has been conducted in emergency departments or perioperative settings; experience with the PTMR program suggests that this approach can be applied in other hospital areas to improve MR processes and, ultimately, enhance pharmacotherapy safety and effectiveness across transitions of care. Based on experience, providers' perspectives, and QI data, the PTMR program is an effective method to obtain, document, and communicate accurate MR data for patients at this institution.

  7. 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…

  8. 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)

  9. 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…

  10. 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)

  11. Delinquent Medical Service Accounts at Landstuhl Regional Medical Center Need Additional Management Oversight

    DTIC Science & Technology

    2016-04-28

    L 2 8 , 2 0 1 6 Report No. DODIG-2016-079 Delinquent Medical Service Accounts at Landstuhl Regional Medical Center Need Additional Management...Service Accounts at Landstuhl Regional Medical Center Need Additional Management Oversight Visit us at www.dodig.mil April 28, 2016 Objective Our...objective was to determine whether Landstuhl Regional Medical Center (LRMC) effectively managed accounts delinquent over 120 days by properly

  12. Research support in an academic medical center.

    PubMed

    Cheek, Fern M

    2010-01-01

    In 2003, the Prior Health Sciences Library (Prior Library) at The Ohio State University (OSU) explored the possibility of providing specialized support to biomedical, nursing, and allied health researchers by adding a research librarian position. The decision came about after the Medical Library Association (MLA) investigated how libraries could provide enhanced support to medical researchers. This article describes how the research librarian position was developed and how it continues to evolve.

  13. Lessons learned: mobile device encryption in the academic medical center.

    PubMed

    Kusche, Kristopher P

    2009-01-01

    The academic medical center is faced with the unique challenge of meeting the multi-faceted needs of both a modern healthcare organization and an academic institution, The need for security to protect patient information must be balanced by the academic freedoms expected in the college setting. The Albany Medical Center, consisting of the Albany Medical College and the Albany Medical Center Hospital, was challenged with implementing a solution that would preserve the availability, integrity and confidentiality of business, patient and research data stored on mobile devices. To solve this problem, Albany Medical Center implemented a mobile encryption suite across the enterprise. Such an implementation comes with complexities, from performance across multiple generations of computers and operating systems, to diversity of application use mode and end user adoption, all of which requires thoughtful policy and standards creation, understanding of regulations, and a willingness and ability to work through such diverse needs.

  14. 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.

  15. 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…

  16. 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…

  17. [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.

  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), looking east. - Fitzsimons General Hospital, Tennis Courts, Northeast Corner of East McCloskey Avenue & North Hickey Street, 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). - Fitzsimons General Hospital, Artesian Well, East McCloskey Avenue, East of Building No. 231, Aurora, Adams County, CO

  20. 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

  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, Greenhouse, West Pennington Avenue, East of Building No. 139, 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). - Fitzsimons General Hospital, Semi-Infirmary Turbercular Ward, Northwest Corner of Charlie Kelly Boulevard & South Hickey 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), showing southwest corner of building 732. - Fitzsimons General Hospital, Storehouses, Northwest Corner of East Harlow Avenue & North Thirteenth Street, Aurora, Adams County, CO

  4. 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

  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, Post Exchange Garage, Northwest Corner of West Pennington Avenue & North Eighth 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). - Fitzsimons General Hospital, Storehouse, East Harlow Avenue, immediately South of Building 201, 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). - Fitzsimons General Hospital, Ambulent Tubercular Ward, Southeast Corner of East Bushnell Avenue & South Hickey 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). - Fitzsimons General Hospital, Semi-Infirmary Tubercular Ward, Southeast Corner of East Harlow Avenue & South Page 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), showing south and east sides. - Fitzsimons General Hospital, Ice Plant, Southwest Corner of East I Avenue & North Thirteenth Street, 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), east and south sides. - Fitzsimons General Hospital, Pharmacy & Prophylactic Station, Northwest Corner of West McAfee Avenue & South Eighth Street, Aurora, Adams County, CO

  11. 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

  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), 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

  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 cover), south and east sides. - Fitzsimons General Hospital, Post Exchange Garage, North Eighth Street, North of Building No. 143, Aurora, Adams County, CO

  14. 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

  15. 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

  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), east and south sides. - Fitzsimons General Hospital, Workshop Building, East Harlow Avenue, immediately East of Building No. 529, Aurora, Adams County, CO

  17. 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

  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 side. - Fitzsimons General Hospital, Tubercular Ward, Southwest Corner of East Bushnell Avenue & South Page Street, 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), south and east sides. - Fitzsimons General Hospital, Nurses Quarters No. 3, Northwest Corner of West Harlow Avenue & North Seventh Street, Aurora, Adams County, CO

  20. 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

  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), south and east sides. - Fitzsimons General Hospital, Storage Sheds, Northeast 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), east and north sides. - Fitzsimons General Hospital, Wagon Shed with Office, Southeast Corner of East J Avenue & North Tenth Street, Aurora, Adams County, CO

  3. 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

  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 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

  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), probably south and west sides. - Fitzsimons General Hospital, Nurses' Quarters, Southeast Corner of West McAfee Avenue & South Hickey 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), probably south and west sides. - Fitzsimons General Hospital, Utilities Storeroom, West Pennington Avenue, East of Building No. 145, 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) south and east sides. - Fitzsimons General Hospital, Nurses' Garage, East of Building No. 121, 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), south side. - Fitzsimons General Hospital, Office Building, Northwest Corner of West McCloskey Avenue & North Tenth Street, Aurora, Adams County, CO

  10. 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

  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), probably south side. - Fitzsimons General Hospital, Officers' Garage, West Pennington Avenue, West of Building 129, 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 side. - Fitzsimons General Hospital, Laboratory Annex, Northwest Corner of East McCloskey Avenue & North Twelfth 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 south and west sides. - Fitzsimons General Hospital, Power House, Northwest Corner of East Harlow Avenue & North Page 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 clover), west side. - Fitzsimons General Hospital, Motor Transport Dispatcher's Office, Northeast Corner of East Harlow Avenue & North Tenth Street, Aurora, Adams County, CO

  15. 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

  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 side. - Fitzsimons General Hospital, Shops Building, Northwest Corner of West Pennington 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), south and east sides. - Fitzsimons General Hospital, Nurses' Quarters, Southwest Corner of West Harlow Avenue, & South Eighth Street, Aurora, Adams County, CO

  18. Krauel v. Iowa Methodist Medical Center.

    PubMed

    1996-09-11

    The U.S. Court of Appeals for the Eighth Circuit held that an employer-provided health insurance plan policy of denying coverage for infertility treatments does not violate the Americans with Disabilities Act (ADA), the Pregnancy Discrimination Act (PDA), or Title VII of the Civil Rights Act of 1964. Krauel underwent artificial insemination and GIFT (gamete intrafallopian tube transfer) prior to pregnancy and birth. She unsuccessfully sought reimbursement for those costs from her medical insurer. The court held that infertility does not substantially affect what are "major life activities" within the meaning of the ADA. The infertility exclusion applies equally to all insured employees, male of female, disabled or not, and thus does not thwart the purpose of the ADA, nor does it constitute a discriminatory sex-based classification under Title VII. Furthermore, infertility is not a medical condition related to pregnancy or childbirth, and so falls outside the scope of the PDA.

  19. 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.

  20. Research Plan for the National Center for Medical Rehabilitation Research.

    ERIC Educational Resources Information Center

    National Inst. of Child Health and Human Development (NIH), Bethesda, MD.

    This research plan describes a framework for defining and developing the field of rehabilitation sciences and research opportunities for the National Center for Medical Rehabilitation Research (NCMRR) and other agencies funding medical rehabilitation research. The plan addresses the needs of both persons who are involved in habilitation and in…

  1. Connecticut Children's Medical Center multi-year branding campaign.

    PubMed

    Botvin, J

    2000-01-01

    As the only children's hospital in the state, Connecticut Children's Medical Center was challenged by the inherent complacency of parents. It met the challenge through a multi-level marketing effort which included television and radio, community outreach and strong media relations. By emphasizing the unique nature of children, the campaign affirms the need for a specialized children's health center.

  2. The Center for Healthy Weight: an academic medical center response to childhood obesity

    PubMed Central

    Robinson, T N; Kemby, K M

    2012-01-01

    Childhood obesity represents a worldwide medical and public health challenge. Academic medical centers cannot avoid the effects of the obesity epidemic, and must adopt strategies for their academic, clinical and public policy responses to childhood obesity. The Center for Healthy Weight at Stanford University and Lucile Packard Children's Hospital at Stanford provides an example and model of one such strategy. The design provides both breadth and depth through six cores: Research, Patient Care, Community Programs, Advocating for Public Policy Change, Training and Professional Education, and the Healthy Hospital Initiative. The Center and its cores are designed to facilitate interdisciplinary collaboration across the university, medical school, children's hospital and surrounding community. The foci of these cores are likely to be relevant to almost any academic medical center's mission and functions. PMID:25089192

  3. Benefits of Student-Centered Tandem Teaching in Medical English.

    PubMed

    Antić, Zorica

    2015-01-01

    This paper addresses some of the key notions about English for special purposes with special regard to English for medical purposes. The content was determined by observations and based on authors' professional experience. The starting point of a medical English course is a thorough analysis of students' needs, which is then used in course design and definition of appropriate learning goals. The student is at the center of learning and it is necessary to establish a positive cooperation between students and teachers. As medical English course is highly context-based, the inclusion of medical teachers can offer many opportunities for a successful learning process.

  4. Can academic medical centers compete in a managed care system?

    PubMed

    Kralewski, J E; Hart, G; Perlmutter, C; Chou, S N

    1995-10-01

    The authors review characteristics of successful group practices, health maintenance organizations, and integrated service networks and then identify the critical actions that academic medical centers must take in order to compete with such service-oriented community providers. Centers must (1) form the clinical faculty into a competitive medical group that offers more price-competitive and user-friendly services; (2) restructure clinical training to be more relevant to the emerging practice situation; and (3) clearly delineate funding streams and identify the cross-subsidies taking place in the teaching, research, and patient care enterprises. These changes have the potential to strengthen clinical training and improve the financial positions of both the faculty and the university hospitals. The authors maintain that centers can make these and other necessary changes while still providing high-quality care and maintaining their educational and research functions; they cite organizations that have succeeded in these ways. However, as with all complex, large-scale organizations, public and private alike, the major factor limiting centers' ability to make the organizational changes required to successfully compete in the new health care environment is the lack of political will. It will be very difficult for academic medical centers to unite their powerful internal interest groups and take action without first experiencing a rather severe external jolt. The challenge for the leaders of academic medical centers is to prepare for the managed care jolt so that they can then guide their institutions to a new, more competitive position.

  5. Association Between Patient-Centered Medical Homes and Adherence to Chronic Disease Medications: A Cohort Study.

    PubMed

    Lauffenburger, Julie C; Shrank, William H; Bitton, Asaf; Franklin, Jessica M; Glynn, Robert J; Krumme, Alexis A; Matlin, Olga S; Pezalla, Edmund J; Spettell, Claire M; Brill, Gregory; Choudhry, Niteesh K

    2017-01-17

    Despite the widespread adoption of patient-centered medical homes into primary care practice, the evidence supporting their effect on health care outcomes has come primarily from geographically localized and well-integrated health systems. To assess the association between medication adherence and medical homes in a national patient and provider population, given the strong ties between adherence to chronic disease medications and health care quality and spending. Retrospective cohort study. Claims from a large national health insurer. Patients initiating therapy with common medications for chronic diseases (diabetes, hypertension, and hyperlipidemia) between 2011 and 2013. Medication adherence in the 12 months after treatment initiation was compared among patients cared for by providers practicing in National Committee for Quality Assurance-recognized patient-centered medical homes and propensity score-matched control practices in the same Primary Care Service Areas. Linear mixed models were used to examine the association between medical homes and adherence. Of 313 765 patients meeting study criteria, 18 611 (5.9%) received care in patient-centered medical homes. Mean rates of adherence were 64% among medical home patients and 59% among control patients. Among 4660 matched control and medical home practices, medication adherence was significantly higher in medical homes (2.2% [95% CI, 1.5% to 2.9%]). The association between medical homes and better adherence did not differ significantly by disease state (diabetes, 3.0% [CI, 1.5% to 4.6%]; hypertension, 3.2% [CI, 2.2% to 4.2%]; hyperlipidemia, 1.5% [CI, 0.6% to 2.5%]). Clinical outcomes related to medication adherence were not assessed. Receipt of care in a patient-centered medical home is associated with better adherence, a vital measure of health care quality, among patients initiating treatment with medications for common high-cost chronic diseases. CVS Health.

  6. 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.

  7. [Promoting research in a medical center--the management narrative].

    PubMed

    Halevy, Jonathan; Turner, Dan

    2014-12-01

    Promoting research within a medical institute is a delicate balance between the importance of facilitating academia and maximizing resources towards the primary goal of a hospital--healing sick people. Shaare Zedek Medical Center have successfully adopted a "niche" approach to research in which the hospital invests in selected talented clinicians-scientists rather than futile expectation that all clinicians would be engaged in high impact research. Moreover, these research excellence centers are developing into a driving force to also foster research endeavors of other clinicians and residents in the hospital. In this special issue of Harefuah honoring Shaare Zedek investigators, 18 manuscripts included reflect the diversity of research projects performed in the medical center. We believe that this project will assist and encourage clinicians to be engaged in research, at all levels and disciplines.

  8. Delinquent Medical Service Accounts at Naval Medical Center Portsmouth Need Additional Management Oversight

    DTIC Science & Technology

    2015-03-04

    and Surgery CAC Common Access Card CRS Centralized Receivables Service DoD FMR DoD Financial Management Regulation MSA Medical Service Account MTF...H 4 , 2 0 1 5 Delinquent Medical Service Accounts at Naval Medical Center Portsmouth Need Additional Management Oversight Report No. DODIG-2015...04 MAR 2015 2. REPORT TYPE 3. DATES COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Delinquent Medical Service Accounts at Naval

  9. Developing a user-centered voluntary medical incident reporting system.

    PubMed

    Hua, Lei; Gong, Yang

    2010-01-01

    Medical errors are one of leading causes of death among adults in the United States. According to the Institute of Medicine, reporting of medical incidents could be a cornerstone to learn from errors and to improve patient safety, if incident data are collected in a properly structured format which is useful for the detection of patterns, discovery of underlying factors, and generation of solutions. Globally, a number of medical incident reporting systems were deployed for collecting observable incident data in care delivery organizations (CDO) over the past several years. However, few researches delved into design of user-centered reporting system for improving completeness and accuracy of medical incident collection, let alone design models created for other institutes to follow. In this paper, we introduce the problems identified in a current using voluntary reporting system and our effort is being made towards complete, accurate and useful user-centered new reporting system through a usability engineering process.

  10. Student perceptions of a patient- centered medical training curriculum

    PubMed Central

    Gallentine, Ashley; Salinas-Miranda, Abraham A.; Shaffer-Hudkins, Emily; Hinojosa, Sara; Monroe, Alicia

    2014-01-01

    Objectives To evaluate a patient-centered medical training curriculum, the SELECT program, through perceptions of the inaugural student cohort. Methods Data were collected from two focus groups conducted in the university setting, comprised of fifteen first-year medical students who participated in the SELECT program during its inaugural year. A questioning protocol was used to guide the focus group discussion, which was transcribed and hand-coded through thematic analyses. Results Various themes related to patient-centered care were identified. Students noted changes in their attitudes towards interacting with patients in an empowering and educative manner as a result of communication and motivational interviewing exercises. Additionally, they recognized certain external, structural barriers as well as internal conflict between pragmatism and emotional intelligence that could potentially hinder patient-centered care. The impact of family dynamics and social support on quality of life and health outcomes was acknowledged. Students also emphasized the value of collaborating with multiple health professionals. Lastly, students provided suggestions for program improvement, namely additional simulations, more education regarding other healthcare professionals’ roles, more standardized experiences, and application of principles to acute and primary care. Conclusions Upon completion of the first year of the SELECT program, students gained an appreciation for patient-centered care and various factors and skills that facilitate such care. Additionally, they experienced a dissonance between didactic concepts from the curriculum and observed medical practices. This study highlights the educational benefits of a patient-centered medical curriculum and provides suggestions for future improvement. PMID:25341218

  11. Responding to disasters: academic medical centers' responsibilities and opportunities.

    PubMed

    Sklar, David P; Richards, Michael; Shah, Mark; Roth, Paul

    2007-08-01

    Disaster preparedness and disaster response should be a capability of all academic health centers. The authors explore the potential role and impact of academic medical centers (AMC)s in disaster response. The National Disaster Medical System and the evolution of disaster medical assistance teams (DMAT) are described, and the experience at one AMC with DMAT is reviewed. The recent deployment of a DMAT sponsored by an AMC to the Hurricane Katrina disaster is described, and the experience is used to illustrate the opportunities and challenges of future disaster medical training, research, and practice at AMCs. AMCs are encouraged to identify an appropriate academic unit to house and nurture disaster-preparedness activities, participate in education programs for health professionals and the public, and perform research on disaster epidemiology and response. Networks of AMCs offer the potential of acting as a critical resource for those AMCs stricken by a disaster and for communities needing the infusion of highly trained and motivated health care providers. The Association of American Medical Colleges can play a critical role in assisting and coordinating AMC networks through its relationship with all AMCs and the federal government and by increasing the awareness of medical educators and researchers about this important, emerging area of medical knowledge.

  12. Resuscitation center designation: recommendations for emergency medical services practices.

    PubMed

    Mechem, C Crawford; Goodloe, Jeffrey M; Richmond, Neal J; Kaufman, Bradley J; Pepe, Paul E

    2010-01-01

    Regionalization of medical resources by designating specialty receiving centers, such as trauma and stroke centers, within emergency medical services (EMS) systems is intended to ensure the highest-quality patient care in the most efficient and fiscally responsible fashion. Significant advances in the past decade such as induction of therapeutic hypothermia following resuscitation from cardiac arrest and a time-driven, algorithmic approach to management of septic patients have created compelling arguments for similar designation for specialized resuscitative interventions. Resuscitation of critically ill patients is both labor- and resource-intensive. It can significantly interrupt emergency department (ED) patient throughput. In addition, clinical progress in developing resuscitation techniques is often dependent on the presence of a strong research infrastructure to generate and validate new therapies. It is not feasible for many hospitals to make the commitment to care for large numbers of critically ill patients and the accompanying investigational activities, whether in the prehospital, ED, or inpatient arena. Because of this, the question of whether EMS systems should designate specific hospitals as "resuscitation centers" has now come center stage. Just as EMS systems currently delineate criteria and monitor compliance for trauma, ST-elevation myocardial infarction (STEMI), and stroke centers, strong logic now exists to develop similar standards for resuscitation facilities. Accordingly, this discussion reviews the current applicable trends in resuscitation science and presents a rationale for resuscitation center designation within EMS systems. Potential barriers to the establishment of such centers are discussed and strategies to overcome them are proposed.

  13. Patient Workload Profile: National Naval Medical Center (NNMC), Bethesda, MD.

    DTIC Science & Technology

    1980-06-01

    HLBLOOD Commander Technical Director ADMINISTRATIVE INFORMATION This Technical Document reports on work performed under NOSC Work Unit TA37 between 1...823- TA37 San Diego, CA 92152 1I. CONTROLLING OFFICE NAME AND ADDRESS - Naval Medical Data Services Center, I JunJ’j0 Code 04 is 1

  14. 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

  15. 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.

  16. Vocational Rehabilitation within a V.A. Medical Center.

    ERIC Educational Resources Information Center

    Quick, Matthew; And Others

    Many military veterans struggle with substance abuse, homelessness, physical and emotional disabilities, disappointing work histories, and low income. A vocational rehabilitation program at a Veterans' Administration medical center, designed to help veterans with some of these struggles, is described here. Personnel work within the context of each…

  17. Marketing physician services in an academic medical center.

    PubMed

    Eudes, J A; Divis, K L; Vaughan, D G; Fottler, M D

    1987-01-01

    As a result of recent environmental changes in the health care industry, marketing has become a vital necessity for the survival of most hospitals. Kotler's conceptual framework is used to study and evaluate an innovative program for marketing physician services in a large urban medical center. This program was quite successful in increasing admissions and referrals and won a national award in 1984.

  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 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

  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). 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

  20. 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

  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). 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

  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 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

  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, Red Cross Building, South Eighth Street Bounded by West McAfee Avenue on South & West Harlow Avenue on North, Aurora, Adams County, CO

  4. 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

  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), 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

  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). 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

  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). 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

  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 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

  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), 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

  10. 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…

  11. Teaching health centers: a new paradigm in graduate medical education.

    PubMed

    Chen, Candice; Chen, Frederick; Mullan, Fitzhugh

    2012-12-01

    The Patient Protection and Affordable Care Act of 2010 created the Teaching Health Center Graduate Medical Education (THCGME) program to provide graduate medical education (GME) funding directly to community-based health centers that expand or establish new primary care residency programs. The THCGME program was the legislation's only new investment in GME, and it represents a significant departure from the Medicare GME funding system. It provides payments to ambulatory care centers for both direct and indirect GME expenses, and mandates a level of reporting from recipients that is not required for Medicare GME support. This initial look at the 11 inaugural teaching health centers (THCs) shows that they are training primary care residents in relevant delivery models (e.g., interprofessional teams, patient-centered medical homes), developing educational initiatives that address primary care practice in underserved areas, and transforming organizational and funding structures to support community-based training. The THCs plan to evaluate and report resident performance, patient quality of care, and graduate outcomes. The work of the first THCs has implications for primary care training, the GME system, and future policies and legislation aimed at strengthening the health care workforce.

  12. Managing information technology in academic medical centers: a "multicultural" experience.

    PubMed

    Friedman, C P; Corn, M; Krumrey, A J; Perry, D R; Stevens, R H

    1998-09-01

    Based on a session at the 1997 conference on Information Resources and Academic Medicine sponsored by the Association of American Medical Colleges, this article illustrates how the beliefs and concerns of academic medicine's diverse professional cultures affect the management of information technology. Two scenarios--one dealing with the standardization of desktop PCs, the other with publication of syllabi on an institutional intranet--form the basis of this exercise. Four prototypical members of a hypothetical medical center community--the chairman of surgery, a senior basic scientist, the chief information officer of an affiliated hospital, and the chief administrative officer--offer their perspectives on each scenario. Their statements illustrate many of the challenges of planning, deploying, and maintaining effective information technology in the "multicultural" environment of academic medical centers.

  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. Project HOPE—The People-to-People Health Foundation, Inc.

  14. Pioneers in trauma care at Harborview Medical Center.

    PubMed

    Whalen, Eileen; Hecker, Cynthia J; Butler, Steven

    2012-01-01

    Harborview Medical Center in Seattle has been home to the pioneering work of University of Washington (UW) Medicine physicians and staff who have led innovations to improve trauma care for more than 40 years. As the only level I adult and pediatric trauma center and regional burn center for Washington, Alaska, Montana, and Idaho, Harborview provides cares for more than 6500 critically injured trauma and burn patients per year. Our physicians, researchers and staff are recognized as national experts and as collaborative partners with nursing in the delivery of outstanding clinical care, research, and education. Beginning with the establishment of Seattle Medic One in the late 1960s, a groundbreaking program to train firefighters as paramedics, Harborview and the work of UW Medicine has been recognized locally and globally as a leader in every component of the ideal trauma system, as defined by the American College of Surgeons: prevention, access, acute hospital care, rehabilitation, education, and research activities.

  15. 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. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Supply chain optimization at an academic medical center.

    PubMed

    Labuhn, Jonathan; Almeter, Philip; McLaughlin, Christopher; Fields, Philip; Turner, Benjamin

    2017-08-01

    A successful supply chain optimization project that leveraged technology, engineering principles, and a technician workflow redesign in the setting of a growing health system is described. With continued rises in medication costs, medication inventory management is increasingly important. Proper management of central pharmacy inventory and floor-stock inventory in automated dispensing cabinets (ADCs) can be challenging. In an effort to improve control of inventory costs in the central pharmacy of a large academic medical center, the pharmacy department implemented a supply chain optimization project in collaboration with the medical center's inhouse team of experts on process improvement and industrial engineering. The project had 2 main components: (1) upgrading and reconfiguring carousel technology within an expanded central pharmacy footprint to generate accurate floor-stock inventory replenishment reports, which resulted in efficiencies within the medication-use system, and (2) implementing a technician workflow redesign and algorithm to right-size the ADC inventory, which decreased inventory stockouts (i.e., incidents of depletion of medication stock) and improved ADC user satisfaction. Through a multifaceted approach to inventory management, the number of stockouts per month was decreased and ADC inventory was optimized, resulting in a one-time inventory cost savings of $220,500. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  17. 78 FR 10608 - David Grant United States Air Force Medical Center Specialty Care Travel Reimbursement...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-14

    ... of the Secretary David Grant United States Air Force Medical Center Specialty Care Travel... States Air Force Medical Center Specialty Care Travel Reimbursement Demonstration Project. This... MTF, and sustain readiness-related medical skills activities for the military providers....

  18. Educational assessment center techniques for entrance selection in medical school.

    PubMed

    ten Cate, Olle; Smal, Ko

    2002-07-01

    Dutch higher education is freely accessible for those who have proper high school qualifications. However, admission to medical schools has been limited by government to regulate manpower planning. Selection has been carried out by a national lottery approach since 1972, but in 2000, the Dutch government asked medical schools to experiment with qualitative selection procedures at their own institutions. The University Medical Center Utrecht School of Medical Sciences has used a technique derived from assessment-center approaches to assist in the medical school admission process. Dutch assessment centers use observation procedures in which candidates act in simulated activities that are characteristic of the vacant position. In April 2001, 61 candidates for 23 places were invited for selection days. After a selection interview, candidates were asked to perform activities that are characteristic of course requirements: (1) studying a three-to-five page text about diagnostic and therapeutic procedures of disease A during one hour; (2) explaining the studied procedures to another candidate and receiving information about disease B, studied by this other candidate, during one hour; (3) answering the questions of a standardized patient about disease A in 15 minutes; and (4) answering the questions of a standardized patient about disease B in 15 minutes. A three-person selection committee behind a one-way screen observed the two 15-minute interviews with the standardized patients. The selection committee independently scored content quality of the information that was given to the standardized patients as well as the quality of attitude towards and communication with both patients. The average scores for these three criteria were weighted equally to arrive at a total score. In addition, each candidate received a score resulting from the interview with the other candidate who explained disease B. This score was combined with the other three to a final score. The Utrecht

  19. 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.

  20. The impact of the IRB on medical centers.

    PubMed

    Lee, A S; Thompson, J H

    1981-01-01

    The role of the IRB in a Medical Center is presented with respect to investigations of medical device safety and effectiveness involving human subjects. The prime points presented and discussed are: the reasons (governmental, social, economic, legal-liability, scientific and moral) for the existence of an IRB; the analytical and descriptive documentation which should always precede experimentation; the concepts governing an application to a "typical" IRB; a practical, detailed outline of some special facts and circumstances typically most important to an IRB; and, the question of confidentiality of trade secrets.

  1. Physician assistant and nurse practitioner utilization in academic medical centers.

    PubMed

    Moote, Marc; Krsek, Cathleen; Kleinpell, Ruth; Todd, Barbara

    2011-01-01

    The purpose of this study was to collect information on the utilization of physician assistants (PAs) and nurse practitioners (NPs) in academic health centers. Data were gathered from a national sample of University HealthSystem Consortium member academic medical centers (AMCs). PAs and NPs have been integrated into most services of respondent AMCs, where they are positively rated for the value they bring to these organizations. The primary reason cited by most AMCs for employing PAs and NPs was Accreditation Council for Graduate Medical Education resident duty hour restrictions (26.9%). Secondary reasons for employing PAs and NPs include increasing patient throughput (88%), increasing patient access (77%), improving patient safety/quality (77%), reducing length of stay (73%), and improving continuity of care (73%). However, 69% of AMCs report they have not successfully documented the financial impact of PA/NP practice or outcomes associated with individual PA or NP care.

  2. Academic Medical Centers and Community Hospitals Integration: Trends and Strategies.

    PubMed

    Fleishon, Howard B; Itri, Jason N; Boland, Giles W; Duszak, Richard

    2017-01-01

    Academic medical centers are widely recognized as vital components of the American health care system, generally differentiated from their community hospital peers by their tripartite mission of clinical care, education, and research. Community hospitals fill a critical and complementary role, serving as the primary sites for health care in most communities. Health care reform initiatives and economic pressures have created incentives for hospitals and health systems to integrate, resulting in a nationwide trend toward consolidation with academic medical centers leveraging their substantial assets to merge, acquire, or establish partnerships with their community peers. As these alliances accelerate, they have and will continue to affect the radiology groups providing services at these institutions. A deeper understanding of these new marketplace dynamics, changing relationships and potential strategies will help both academic and private practice radiologists adapt to this ongoing change. Copyright © 2016. Published by Elsevier Inc.

  3. "On the scene": Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

    PubMed

    Hoying, Cheryl; Lecher, William T; Mosko, Dee Dee; Roberto, Nancy; Mason, Char; Murphy, Susan Wade; Taylor, Janalee; Cortina, Sandra; Mathison, Elizabeth; Dick, Leaann; Schoettker, Pamela J; Britto, Maria T

    2014-01-01

    Cincinnati Children's Hospital Medical Center is transforming the way it cares for its patients by building a sophisticated model that focuses on accountable care across the continuum. As nurses from different parts of the organization, we act as change agents to develop an integrated structure built around the patient's needs, from prevention to self-management. We demonstrate how organizational structure, fluid staffing, professional practice, and healthy behaviors operationally catalyze the continuum of care, and how we utilize self-management, community-based programs, and care integration to change the outcome for our patients and families. While care coordination is taking on many forms in medical centers around the world, Cincinnati Children's is proud and passionate about sharing its best practices along the way.

  4. Extending Medical Center Computer Application to Rural Health Clinics

    PubMed Central

    Gottfredson, Douglas K.

    1983-01-01

    A paper entitled “A COMPUTER DATA BASE FOR CLINICIANS, MANAGERS AND RESEARCHERS,” presented during the 1981 SCAMC, described the Salt Lake VA Medical Center computer system. Since that time, two Rural Health Clinics each about 150 miles from Salt Lake City were established by the SL VAMC to reduce traveling distances and improve services for Veterans. Although many existing computer applications were available with no modifications, additional software was needed to support unique needs of the clinics. The Rural Health package of software was designed to gather and store demographic and clinical information on each Veteran, determine the types of services provided, track services over time, monitor services provided by local hospitals and clinical laboratories which are paid for by the VA, determine total clinic costs, etc. These computer applications may be of interest to Medical Centers with separate clinics or outreach programs and individuals or groups in private practice with programs similar to the VA Rural Health Clinics.

  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. [NEURO-ONCOLOGY A NEW FIELD IN DAVIDOFF CANCER CENTER AT RABIN MEDICAL CENTER].

    PubMed

    Yust-Katz, Shlomit; Limon, Dror; Abu-Shkara, Ramez; Siegal, Tali

    2017-08-01

    Neuro-oncology is a subspecialty attracting physicians from medical disciplines such as neurology, neurosurgery, pediatrics, oncology, and radiotherapy. It deals with diagnosis and management of primary brain tumors, as well as metastatic and non-metastatic neurological manifestations that frequently affect cancer patients including brain metastases, paraneoplastic syndromes and neurological complications of cancer treatment. A neuro-oncology unit was established in Davidoff Cancer Center at Rabin Medical Center. It provides a multidisciplinary team approach for management of brain tumors and services, such as expert outpatient clinics and inpatient consultations for the departments of oncology, hematology, bone marrow transplantation and other departments in the Rabin Medical Center. In addition, expert consultation is frequently provided to other hospitals that treat cancer patients with neurological manifestations. The medical disciplines that closely collaborate for the daily management of neuro-oncology patients include radiotherapy, hematology, oncology, neuro-surgery, neuro-radiology and neuro-pathology. The neuro-oncology center is also involved in clinical and laboratory research conducted in collaboration with researchers in Israel and abroad. The new service contributes substantially to the improved care of cancer patients and to the advance of research topics in the field of neuro-oncology.

  7. 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.

  8. 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.

  9. The patient-centered medical home and health information technology.

    PubMed

    Leventhal, Teri; Taliaferro, J Peyton; Wong, Kenneth; Hughes, Cortney; Mun, Seong

    2012-03-01

    To demonstrate that concepts of patient-centeredness and technology-centeredness must work together within the context of the transformation to the patient-centered medical home (PCMH), a primary care model that emphasizes coordinated, comprehensive, accessible, and cost-effective care. Information in this article was gathered from a workshop on the Medical Home in Alexandria, VA in June 2010 that brought together civilian and military medical providers, researchers, and other stakeholders in PCMH to discuss their experiences in transitioning from traditional primary care to PCMH in addition to a literature review of articles from medical journals. Patient-centeredness is often only vaguely defined as being in opposition to provider-centered or technology-centered. Our analysis shows that focusing on either technological improvements or enhancing patient-centered care will not improve the fragmented healthcare system in the United States. We argue that these two concepts are not incompatible as sometimes believed, but rather it is critical that we recognize they must work together in routine practices in order to truly improve the state of healthcare. Health information technology (HIT) supports many of the core principles of PCMH, but there are still several challenges as not all technologies have functionalities yet that facilitate the model. We suggest patient-centeredness be one of the main concepts that drives the redesign and implementation of new health technologies in primary care. It is no longer about just implementing new technologies; these technologies must enhance patient-provider relationships, communication, access, and patients' engagement in their own care.

  10. 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

  11. A New Methodology to Design Distributed Medical Diagnostic Centers

    DTIC Science & Technology

    2001-10-25

    METHODOLOGY TO DESIGN DISTRIBUTED MEDICAL DIAGNOSTIC CENTERS P. A. Baziana,. E. I. Karavatselou, D. K. Lymberopoulos, D. N. Serpanos Department of...Electrical and Computer Engineering, University of Patras, Patras, Hellas This paper introduces a new methodology for DDC design by controlling the above...TSPs) to design and support cooperative schemes among RUs and DUs in form of DDCs [2]. This paper introduces a global methodology for such a DDC’s

  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), 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

  13. 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.

  14. The value of a writing center at a medical university.

    PubMed

    Ariail, Jennie; Thomas, Suzanne; Smith, Tom; Kerr, Lisa; Richards-Slaughter, Shannon; Shaw, Darlene

    2013-01-01

    Students often enter graduate healthcare/biomedical schools with insufficient undergraduate instruction in effective writing, yet the ability to write well affects their career opportunities in health care and in scientific research. The present study was conducted to determine the value and effectiveness of instruction by faculty with expertise in teaching writing at a writing center at an academic health science center. Two separate sources of data were collected and analyzed. First, an anonymous campus-wide survey assessed students' satisfaction and utilization of the university's Writing Center. Second, a nonexperimental objective study was conducted comparing a subsample of students who used versus those who did not receive instruction at the Writing Center on quality of writing, as determined by an evaluator who was blind to students' utilization status. From the campus-wide survey, more than 90% of respondents who used the center (which was 26% of the student body) agreed that it was a valuable and effective resource. From the objective study of writing quality, students who used the Writing Center were twice as likely as students who did not to receive an A grade on the written assignment, and the blinded evaluator accurately estimated which students used the Writing Center based on the clarity of writing. The instruction at the Writing Center at our university is highly valued by students, and its value is further supported by objective evidence of efficacy. Such a center offers the opportunity to provide instruction that medical and other healthcare students increasingly need without requiring additions to existing curricula. By developing competency in writing, students prepare for scholarly pursuits, and through the process of writing, they engage critical thinking skills that can make them more attuned to narrative and more reflective and empathetic in the clinical setting.

  15. 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.

  16. Medication wrong route administration: a poisons center-based study.

    PubMed

    Bloch-Teitelbaum, Alexandra; Lüde, Saskia; Rauber-Lüthy, Christine; Kupferschmidt, Hugo; Russmann, Stefan; Kullak-Ublick, Gerd A; Ceschi, Alessandro

    2013-03-01

    To describe clinical effects, circumstances of occurrence, management and outcomes of cases of inadvertent administration of medications by an incorrect parenteral route. Retrospective single-center consecutive review of parenteral route errors of medications, reported to our center between January 2006 and June 2010. We collected demographic data and information on medications, route and time of administration, severity of symptoms/signs, treatment, and outcome. Seventy-eight cases (68 adults, 10 children) were available for analysis. The following wrong administration routes were recorded: paravenous (51%), intravenous (33%), subcutaneous (8%), and others (8%). Medications most frequently involved were iodinated x-ray contrast media (11%) and iron infusions (9%). Twenty-eight percent of the patients were asymptomatic and 54% showed mild symptoms; moderate and severe symptoms were observed in 9% and 7.7%, respectively, and were mostly due to intravenous administration errors. There was no fatal outcome. In most symptomatic cases local nonspecific treatment was performed. Enquiries concerning administration of medicines by an incorrect parenteral route were rare, and mainly involved iodinated x-ray contrast media and iron infusions. Most events occurred in adults and showed a benign clinical course. Although the majority of exposures concerned the paravenous route, the occasional severe cases were observed mainly after inadvertent intravenous administration.

  17. Interpersonal Communications Curriculum. Claretian Medical Center for the Worker Education Program of Northeastern Illinois University, Chicago Teacher's Center.

    ERIC Educational Resources Information Center

    Estes, Florence S.

    This teaching guide contains the materials required to teach a 6-week course in interpersonal communications that was developed for the workers of a Chicago medical center through a partnership involving the medical center, its employees, their union, and Northeastern Illinois University. Based on the student-centered philosophy of teaching, the…

  18. Medical waste management in Jordan: A study at the King Hussein Medical Center

    SciTech Connect

    Oweis, Rami . E-mail: oweis@just.edu.jo; Al-Widyan, Mohamad . E-mail: widyan@just.edu.jo; Al-Limoon, Ohood . E-mail: oweis@just.edu.jo

    2005-07-01

    As in many other developing countries, the generation of regulated medical waste (RMW) in Jordan has increased significantly over the last few decades. Despite the serious impacts of RMW on humans and the environment, only minor attention has been directed to its proper handling and disposal. This study was conducted in the form of a case study at one of Jordan's leading medical centers, namely, the King Hussein Medical Center (KHMC). Its purpose was to report on the current status of medical waste management at KHMC and propose possible measures to improve it. In general, it was found that the center's administration was reasonably aware of the importance of medical waste management and practiced some of the measures to adequately handle waste generated at the center. However, it was also found that significant voids were present that need to be addressed in the future including efficient segregation, the use of coded and colored bags, better handling and transfer means, and better monitoring and tracking techniques, as well as the need for training and awareness programs for the personnel.

  19. Delinquent Medical Service Accounts at Brooke Army Medical Center Need Additional Management Oversight

    DTIC Science & Technology

    2014-08-13

    collection. This is the first in a series of reports concerning medical service accounts ( MSAs ). This report provides the results of our review...performed at U.S. Army Brooke Army Medical Center (BAMC). We reviewed the 25 highest dollar delinquent MSAs valued at $11.0 million. Finding BAMC...Uniform Business Office (UBO) management did not effectively manage delinquent MSAs . As of May 29, 2013, BAMC UBO management had 15,106 outstanding

  20. 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.

  1. The Absent Interpreter in Administrative Detention Center Medical Units.

    PubMed

    Rondeau-Lutz, Murielle; Weber, Jean-Christophe

    2017-03-01

    The particular situation of the French administrative detention center (ADC) medical units appears to be an exemplary case to study the difficulties facing medical practice. Indeed, the starting point of our inquiry was an amazing observation that needed to be addressed and understood: why are professional interpreters so seldom requested in ADC medical units, where one would expect that they would be "naturally" present? Aiming to fully explore the meanings of the "absent interpreter", this article takes into account the possible meanings of this situation: the recourse to professional interpreters in France is far from expected given cumulative evidence of its benefits; perceptions of illegal immigrants and medical habitus itself may both hamper the use of a third party; the ADCs are a very stressful place for healthcare professionals, with conflicting missions, political issues enmeshed with medical goals, and heavy affective burden that may lead to self-protection. Silencing voices of suffering others might be seen as the hidden indecent truth of the "absent interpreter". These reflections open a window to a larger issue with regard to the full range of medicine: what are the place, the role and the function of patient's words and narratives in contemporary medicine? The highly invested somatic perspective and its political corollary giving primacy to bare life harbor potential risks of obscuring speeches and undervaluing narratives.

  2. An academic medical center under prolonged rocket attack--organizational, medical, and financial considerations.

    PubMed

    Bar-El, Yaron; Michaelson, Moshe; Hyames, Gila; Skorecki, Karl; Reisner, Shimon A; Beyar, Rafael

    2009-09-01

    The Rambam Medical Center, the major academic health center in northern Israel, serving a population of two million and providing specialized tertiary care, was exposed to an unprecedented experience during the Second Lebanon War in the summer of 2006. For more than one month, it was subjected to continuous rocket attacks, but it continued to provide emergency and routine medical services to the civilian population and also served the military personnel who were evacuated from the battlefront. To accomplish the goals of serving the population while itself being under fire, the Rambam Medical Center had to undertake major organizational decisions, which included maximizing safety within the hospital by shifting patients and departments, ensuring that the hospital was properly fortified, managing the health professional teams' work schedules, and providing needed services for the families of employees. The Rambam Medical Center's Level I trauma center expertise included multidisciplinary teams and extensive collaborations; modern imaging modalities usually reserved for peacetime medical practice were frequently used. The function of the hospital teams during the war was efficient and smooth, based on the long-term actions taken to prepare for disasters and wartime conditions. Routine hospital services continued, although at 60% of normal occupancy. Financial losses incurred were primarily due to the decrease in revenue-generating activity. The two most important components of managing the hospital under these conditions are (1) the ability to arrive at prompt and meaningful decisions with respect to the organizational and medical hospital operations and (2) the leadership and management of the professional staff and teams.

  3. Patient-Centered Tools for Medication Information Search

    PubMed Central

    Wilcox, Lauren; Feiner, Steven; Elhadad, Noémie; Vawdrey, David; Tran, Tran H.

    2016-01-01

    Recent research focused on online health information seeking highlights a heavy reliance on general-purpose search engines. However, current general-purpose search interfaces do not necessarily provide adequate support for non-experts in identifying suitable sources of health information. Popular search engines have recently introduced search tools in their user interfaces for a range of topics. In this work, we explore how such tools can support non-expert, patient-centered health information search. Scoping the current work to medication-related search, we report on findings from a formative study focused on the design of patient-centered, medication-information search tools. Our study included qualitative interviews with patients, family members, and domain experts, as well as observations of their use of Remedy, a technology probe embodying a set of search tools. Post-operative cardiothoracic surgery patients and their visiting family members used the tools to find information about their hospital medications and were interviewed before and after their use. Domain experts conducted similar search tasks and provided qualitative feedback on their preferences and recommendations for designing these tools. Findings from our study suggest the importance of four valuation principles underlying our tools: credibility, readability, consumer perspective, and topical relevance. PMID:28163972

  4. Patient-Centered Tools for Medication Information Search.

    PubMed

    Wilcox, Lauren; Feiner, Steven; Elhadad, Noémie; Vawdrey, David; Tran, Tran H

    2014-05-20

    Recent research focused on online health information seeking highlights a heavy reliance on general-purpose search engines. However, current general-purpose search interfaces do not necessarily provide adequate support for non-experts in identifying suitable sources of health information. Popular search engines have recently introduced search tools in their user interfaces for a range of topics. In this work, we explore how such tools can support non-expert, patient-centered health information search. Scoping the current work to medication-related search, we report on findings from a formative study focused on the design of patient-centered, medication-information search tools. Our study included qualitative interviews with patients, family members, and domain experts, as well as observations of their use of Remedy, a technology probe embodying a set of search tools. Post-operative cardiothoracic surgery patients and their visiting family members used the tools to find information about their hospital medications and were interviewed before and after their use. Domain experts conducted similar search tasks and provided qualitative feedback on their preferences and recommendations for designing these tools. Findings from our study suggest the importance of four valuation principles underlying our tools: credibility, readability, consumer perspective, and topical relevance.

  5. Toward a human-centered voluntary medical incident reporting system.

    PubMed

    Gong, Yang

    2010-01-01

    Voluntary medical incident reports are a valuable source for studying adverse events and near misses. Underreporting and low quality of reports in local organizations, however, have become the impediments in identifying trends and patterns relating at the local, regional and national level. Human factors on usefulness and ease of use have shown their important role in acceptance of voluntary reporting systems. To understand and identify the obstacles of quality reporting, we employed a set of human-centered analysis methods to examine one-year voluntary medical incident reports of a University Hospital. We found about 30% of the reports labeled as "miscellaneous" and "other", and their real incident types or error descriptions were identified through an in-depth recoding. Human-centered analyses show that the pre-defined reporting categories could serve well for the voluntary reporting need if reporters' tasks were better represented on user-friendly interfaces. We suggest that a human-centered, ontology based system design for voluntary reporting is feasible which could help improve completeness, accuracy, and interoperability among national and international standards.

  6. Evaluating Community Engagement in an Academic Medical Center

    PubMed Central

    Shone, Laura P.; Dozier, Ann M.; Newton, Gail L.; Green, Theresa; Bennett, Nancy M.

    2014-01-01

    From the perspective of academic medical centers (AMCs), community engagement is a collaborative process of working toward mutually defined goals to improve the community’s health, and involves partnerships between AMCs, individuals, and entities representing the surrounding community. AMCs increasingly recognize the importance of community engagement, and recent programs such as Prevention Research Centers and Clinical and Translational Science Awards have highlighted community engagement activities. However, there is no standard or accepted metric for evaluating AMCs’ performance and impact of community engagement activities. In this article, the authors present a framework for evaluating AMCs’ community engagement activities. The framework includes broad goals and specific activities within each goal, wherein goals and activities are evaluated using a health services research framework consisting of structure, process, and outcome criteria. To illustrate how to use this community engagement evaluation framework, the authors present specific community engagement goals and activities of the University of Rochester Medical Center to (1) improve the health of the community served by the AMC; (2) increase the AMC’s capacity for community engagement; and (3) increase generalizable knowledge and practices in community engagement and public health. Using a structure-process-outcomes framework, a multidisciplinary team should regularly evaluate an AMC’s community engagement program with the purpose of measurably improving the performance of the AMC and the health of its surrounding community. PMID:24556768

  7. Hospitalizations of adults with intellectual disability in academic medical centers.

    PubMed

    Ailey, Sarah H; Johnson, Tricia; Fogg, Louis; Friese, Tanya R

    2014-06-01

    Individuals with intellectual disability (ID) represent a small but important group of hospitalized patients who often have complex health care needs. Individuals with ID experience high rates of hospitalization for ambulatory-sensitive conditions and high rates of hospitalizations in general, even when in formal community care systems; however, no research was found on the common reasons for which this population is hospitalized. Academic medical centers often treat the most complex patients, and data from these centers can provide insight into the needs of patient populations with complex needs. The purpose of this study was to analyze descriptive data from the UHC (formerly known as the University Healthsystem Consortium; an alliance of 115 U.S. academic medical centers and 300 of their affiliated hospitals) regarding common reasons for hospitalization, need for intensive care, and common hospitalization outcome measures of length of stay and complications for adult (age ≥ 18) patients with ID. Findings indicate the need for specific attention to the needs of hospitalized patients with ID.

  8. 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…

  9. 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…

  10. 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…

  11. Medical economics of PM&R. V. Surviving the complexities of academic medical centers.

    PubMed

    Melvin, J L; Pate, C M

    1993-02-01

    The mission statements of academic medical centers call on them to accomplish many goals. This often leads to conflicting choices when selecting activities and establishing policies. When individual faculty members are expected to divide work time to meet research, teaching and clinical needs, careful planning and disciplined decisions of action are necessary to avoid a sense of ambiguity and frustration.

  12. A Study to Determine a Methodology for Establishing a Center of Excellence Program at Fitzsimons Army Medical Center.

    DTIC Science & Technology

    1992-01-10

    69 D. SPECIAL REQUIREMENTS FOR GRADUATE MEDICAL EDUCATION PROGRAM IN CARDIOLOGY ............................ 74 E...FITZSIMONS ARMY MEDICAL CENTER GRADUATE MEDICAL EDUCATION PROGRAM IN CARDIOLOGY ................... 76 1 A Study to Determine a Methodology for...prioritized according to average government cost for 27 different diagnostic medical specialties to include adverse reaction, allergy, cardiology

  13. 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…

  14. 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

  15. Implementing the patient-centered medical home in residency education.

    PubMed

    Doolittle, Benjamin R; Tobin, Daniel; Genao, Inginia; Ellman, Matthew; Ruser, Christopher; Brienza, Rebecca

    2015-01-01

    In recent years, physician groups, government agencies and third party payers in the United States of America have promoted a Patient-centered Medical Home (PCMH) model that fosters a team-based approach to primary care. Advocates highlight the model's collaborative approach where physicians, mid-level providers, nurses and other health care personnel coordinate their efforts with an aim for high-quality, efficient care. Early studies show improvement in quality measures, reduction in emergency room visits and cost savings. However, implementing the PCMH presents particular challenges to physician training programs, including institutional commitment, infrastructure expenditures and faculty training. Teaching programs must consider how the objectives of the PCMH model align with recent innovations in resident evaluation now required by the Accreditation Council of Graduate Medical Education (ACGME) in the US. This article addresses these challenges, assesses the preliminary success of a pilot project, and proposes a viable, realistic model for implementation at other institutions.

  16. 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.

  17. 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. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. 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.

  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). 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

  20. Civilian primary care prescribing psychologist in an army medical center.

    PubMed

    Shearer, David S

    2012-12-01

    The present article discusses the integration of a civilian prescribing psychologist into a primary care clinic at Madigan Army Medical Center. A description of the role of the prescribing psychologist in this setting is provided. The author asserts that integrating prescribing psychology into primary care can improve patient access to skilled behavioral health services including psychotherapeutic and psychopharmacologic treatment. Potential benefits to the primary care providers (PCPs) working in primary care clinics are discussed. The importance of collaboration between the prescribing psychologist and PCP is emphasized. Initial feedback indicates that integration of a prescribing psychologist into primary care has been well received in this setting.

  1. 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.

  2. 78 FR 74163 - Harrison Medical Center, a Subsidiary of Franciscan Health System Bremerton, Washington; Notice...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-10

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF LABOR Employment and Training Administration Harrison Medical Center, a Subsidiary of Franciscan Health System... Adjustment Assistance (TAA), applicable to workers and former workers of Harrison Medical Center,...

  3. Evaluation of pegfilgrastim use at an academic medical center.

    PubMed

    Tang, Kathy; Duffy, Alison; Gilmore, Steven

    2017-01-01

    Purpose Pegfilgrastim is indicated to reduce the risk of febrile neutropenia. As a cost-savings initiative, Pegfilgrastim Process Guidelines were developed and implemented at a large, academic teaching institution to improve appropriate use of pegfilgrastim and to decrease costs of outpatient infusion center administration by deferring doses to home self-administration for eligible patients. Methods A retrospective medical record review was conducted post-implementation of the Pegfilgrastim Process Guideline to evaluate the use of pegfilgrastim and to assess the safety and efficacy of transferring pegfilgrastim orders from outpatient infusion center to home administration for eligible patients. Results Fifty-nine patients were included in the study, with 35 patients receiving pegfilgrastim in the outpatient infusion center, 13 patients self-injecting at home, and 11 patients receiving doses in both settings. The total wholesale cost avoidance for pegfilgrastim orders transferred to self-administration at home during this time period totaled $205,163. The revenue from outpatient prescriptions of pegfilgrastim totaled $291,111.93. The percentage of febrile neutropenia admissions was 11.4%, 0%, and 9.1% in the outpatient infusion, home, and outpatient/home group, respectively. Conclusion Implementation of the Pegfilgrastim Process Guidelines demonstrated decreased total pegfilgrastim orders to be dispensed by the infusion center and a cost avoidance of $205,163 in four months without any perceivable changes in patient outcomes. This represents a significant cost-savings opportunity.

  4. Promoting cancer screening within the patient centered medical home.

    PubMed

    Sarfaty, Mona; Wender, Richard; Smith, Robert

    2011-01-01

    While consensus has grown that primary care is the essential access point in a high-performing health care system, the current model of primary care underperforms in both chronic disease management and prevention. The Patient Centered Medical Home model (PCMH) is at the center of efforts to reinvent primary care practice, and is regarded as the most promising approach to addressing the burden of chronic disease, improving health outcomes, and reducing health spending. However, the potential for the medical home to improve the delivery of cancer screening (and preventive services in general) has received limited attention in both conceptualization and practice. Medical home demonstrations to date have included few evidence-based preventive services in their outcome measures, and few have evaluated the effect of different payment models. Decreasing use of hospitals and emergency rooms and an emphasis on improving chronic care represent improvements in effective delivery of healthcare, but leave opportunities for reducing the burden of cancer untouched. Data confirm that what does or does not happen in the primary care setting has a substantial impact on cancer outcomes. Insofar as cancer is the leading cause of death before age 80, the PCMH model must prioritize adherence to cancer screening according to recommended guidelines, and systems, financial incentives, and reimbursements must be aligned to achieve that goal. This article explores capacities that are needed in the medical home model to facilitate the integration of cancer screening and other preventive services. These capacities include improved patient access and communication, health risk assessments, periodic preventive health exams, use of registries that store cancer risk information and screening history, ability to track and follow up on tests and referrals, feedback on performance, and payment models that reward cancer screening.

  5. Association Between Patient-Centered Medical Home Rating and Operating Cost at Federally Funded Health Centers

    PubMed Central

    Nocon, Robert S.; Sharma, Ravi; Birnberg, Jonathan M.; Ngo-Metzger, Quyen; Lee, Sang Mee; Chin, Marshall H.

    2013-01-01

    Context Little is known about the cost associated with a health center’s rating as a patient-centered medical home (PCMH). Objective To determine whether PCMH rating is associated with operating cost among health centers funded by the US Health Resources and Services Administration. Design, Setting, and Participants Cross-sectional study of PCMH rating and operating cost in 2009. PCMH rating was assessed through surveys of health center administrators conducted by Harris Interactive of all 1009 Health Resources and Services Administration–funded community health centers. The survey provided scores from 0 (worst) to 100 (best) for total PCMH score and 6 subscales: access/communication, care management, external coordination, patient tracking, test/referral tracking, and quality improvement. Costs were obtained from the Uniform Data System reports submitted to the Health Resources and Services Administration. We used generalized linear models to determine the relationship between PCMH rating and operating cost. Main Outcome Measures Operating cost per physician full-time equivalent, operating cost per patient per month, and medical cost per visit. Results Six hundred sixty-nine health centers (66%) were included in the study sample, with 340 excluded because of nonresponse or incomplete data. Mean total PCMH score was 60 (SD,12; range, 21–90). For the average health center, a 10-point higher total PCMH score was associated with a $2.26 (4.6%) higher operating cost per patient per month (95% CI, $0.86–$4.12). Among PCMH subscales, a 10-point higher score for patient tracking was associated with higher operating cost per physician full-time equivalent ($27 300; 95% CI,$3047–$57 804) and higher operating cost per patient per month ($1.06;95%CI,$0.29–$1.98). A 10-point higher score for quality improvement was also associated with higher operating cost per physician full-time equivalent ($32 731; 95% CI, $1571–$73 670) and higher operating cost per patient

  6. 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.

  7. Patient opinion regarding patient-centered medical home fundamentals.

    PubMed

    Wexler, Randell K; King, Dana E; Andrews, Mark

    2012-04-01

    Although conceptually there is agreement on how the Patient-Centered Medical Home (PCMH) should be organized, there is little information regarding which PCMH components are the most important to patients. An anonymous, voluntary survey was administered to patients at three US academic medical centers. Questions sought opinions regarding the National Committee for Quality Assurance's key components and essential elements of the PCMH. Analysis of the survey responses was conducted using SAS version 9.1. A total of 780 surveys were returned. Patients expressed believing strongly that the ability to coordinate care, help patients to manage their own disease, and track laboratory results were the most important aspects of a PCMH office. There were no differences in response to the survey according to age, sex, race, or site. Patients listed care coordination, patient self-management, and improved access to care as the top priority attributes of a PCMH. Patients were consistent in their opinions that care coordination, access, and patient self-management were the most important elements of a PCMH.

  8. 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

  9. First things first: foundational requirements for a medical home in an academic medical center.

    PubMed

    Forman, Jane; Harrod, Molly; Robinson, Claire; Annis-Emeott, Ann; Ott, Jessica; Saffar, Darcy; Krein, Sarah L; Greenstone, Clinton L

    2014-07-01

    In 2010, the Veterans Health Administration (VHA) began implementation of its medical home, Patient Aligned Care Teams (PACT), in 900 primary care clinics nationwide, with 120 located in academically affiliated medical centers. The literature on Patient-Centered Medical Home (PCMH) implementation has focused mainly on small, nonacademic practices. To understand the experiences of primary care leadership, physicians and staff during early PACT implementation in a VHA academically affiliated primary care clinic and provide insights to guide future PCMH implementation. We conducted a qualitative case study during early PACT implementation. Primary care clinical leadership, primary care providers, residents, and staff. Between February 2011 and March 2012, we conducted 22 semi-structured interviews, purposively sampling participants by clinic role, and convenience sampling within role. We also conducted observations of 30 nurse case manager staff meetings, and collected data on growth in the number of patients, staff, and physicians. We used a template organizing approach to data analysis, using select constructs from the Consolidated Framework for Implementation Research (CFIR). Establishing foundational requirements was an essential first step in implementing the PACT model, with teamlets able to do practice redesign work. Short-staffing undermined development of teamlet working relationships. Lack of co-location of teamlet members in clinic and difficulty communicating with residents when they were off-site hampered communication. Opportunities to educate and reinforce PACT principles were constrained by the limited clinic hours of part-time primary care providers and residents, and delays in teamlet formation. Large academic medical centers face special challenges in implementing the medical home model. In an era of increasing emphasis on patient-centered care, our findings will inform efforts to both improve patient care and train clinicians to move from physician

  10. 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.

  11. Evaluation of Patient Centered Medical Home Practice Transformation Initiatives

    PubMed Central

    Crabtree, Benjamin F.; Chase, Sabrina M.; Wise, Christopher G.; Schiff, Gordon D.; Schmidt, Laura A.; Goyzueta, Jeanette R.; Malouin, Rebecca A.; Payne, Susan M. C.; Quinn, Michael T.; Nutting, Paul A.; Miller, William L.; Jaén, Carlos Roberto

    2011-01-01

    Background The patient-centered medical home (PCMH) has become a widely cited solution to the deficiencies in primary care delivery in the United States. To achieve the magnitude of change being called for in primary care, quality improvement interventions must focus on whole-system redesign, and not just isolated parts of medical practices. Methods Investigators participating in 9 different evaluations of Patient Centered Medical Home implementation shared experiences, methodological strategies, and evaluation challenges for evaluating primary care practice redesign. Results A year-long iterative process of sharing and reflecting on experiences produced consensus on 7 recommendations for future PCMH evaluations: (1) look critically at models being implemented and identify aspects requiring modification; (2) include embedded qualitative and quantitative data collection to detail the implementation process; (3) capture details concerning how different PCMH components interact with one another over time; (4) understand and describe how and why physician and staff roles do, or do not evolve; (5) identify the effectiveness of individual PCMH components and how they are used; (6) capture how primary care practices interface with other entities such as specialists, hospitals, and referral services; and (7) measure resources required for initiating and sustaining innovations. Conclusions Broad-based longitudinal, mixed-methods designs that provide for shared learning among practice participants, program implementers, and evaluators are necessary to evaluate the novelty and promise of the PCMH model. All PCMH evaluations should as comprehensive as possible, and at a minimum should include a combination of brief observations and targeted qualitative interviews along with quantitative measures. PMID:21079525

  12. Measuring physicians' productivity in a Veterans' Affairs Medical Center.

    PubMed

    Coleman, David L; Moran, Eileen; Serfilippi, Delchi; Mulinski, Paul; Rosenthal, Ronnie; Gordon, Bruce; Mogielnicki, R Peter

    2003-07-01

    The mission of the Department of Veterans Affairs includes patient care, education, research, and backup to the Department of Defense. Because the measurement of physicians' productivity must reflect both institutional goals and market forces, the authors designed a productivity model that uses measures of clinical workload and academic activities commensurate with the VA's investments in these activities. The productivity model evaluates four domains of physicians' activity: clinical work, education, research, and administration. Examples of the application of the productivity model in the evaluation of VA-paid physician-staff and in the composition of contracts for clinical services are provided. The proposed model is a relatively simple strategy for measuring a broad range of the work of academic physicians in VA medical centers. The model provides incentives for documentation of resident supervision and participation in administrative activities required for effective and efficient clinical care. In addition, the model can aid in determining resource distribution among clinical services and permits comparison with non-VA health care systems. A strategy for modifying the model to incorporate measures of quality of clinical care, research, education, and administration is proposed. The model has been a useful part of the process to ensure the optimum use of resources and to meet clinical and academic institutional goals. The activities and accomplishments used to define physician productivity will have a substantial influence on the character of the medical profession, the vitality of medical education and research, and the cost and quality of health care.

  13. 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.

  14. 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.

  15. 77 FR 15263 - Security Zone; Portland Rose Festival on Willamette River; Portland, OR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-15

    ... SECURITY Coast Guard 33 CFR Part 165 Security Zone; Portland Rose Festival on Willamette River; Portland... will enforce the Portland Rose Festival Security Zone in 33 CFR 165.1312 from 11 a.m. on June 6, 2012..., including the public vessels present on the Willamette River during the Portland Rose festival. During...

  16. Medical humanities as tools for the teaching of patient-centered care.

    PubMed

    Nazario, Rubén J

    2009-10-01

    The Institute of Medicine, in its 2001 report Crossing the Quality Chasm: A New Health System for the 21st Century, highlighted patient-centered care as an area for the development of quality measures. Since then, medical centers across the country have incorporated patient-centered modalities in their healthcare delivery systems. In academic medical centers, interest in patient-centered care has raised the awareness of the interactions between the humanities and medicine. This work aims to define the roles of patient-centered medicine and the medical humanities in the academic medical environment, to establish the shared values between the medical humanities and patient-centered care, and to demonstrate how the medical humanities can be a tool for the teaching of patient-centered care. Copyright 2009 Society of Hospital Medicine

  17. 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.

  18. 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.

  19. The Logistics Of Installing Pacs In An Existing Medical Center

    NASA Astrophysics Data System (ADS)

    Saarinen, Allan O.; Goodsitt, Mitchell M.; Loop, John W.

    1989-05-01

    A largely overlooked issue in the Picture Archiving and Communication Systems (PACS) area is the tremendous amount of site planning activity required to install such a system in an existing medical center. Present PACS equipment requires significant hospital real estate, specialized electrical power, cabling, and environmental controls to operate properly. Marshaling the hospital resources necessary to install PACS equipment requires many different players. The site preparation costs are nontrivial and usually include a number of hidden expenses. This paper summarizes the experience of the University of Washington Department of Radiology in installing an extensive digital imaging network (DIN) and PACS throughout the Department and several clinics in the hospital. The major logistical problems encountered at the University are discussed, a few recommendations are made, and the installation costs are documented. Overall, the University's site preparation costs equalled about seven percent (7%) of the total PACS equipment expenditure at the site.

  20. 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.

  1. Medical practice in the peripheral health centers in Nepal.

    PubMed

    Sitaula, S; Magar, A

    2011-10-01

    The Ministry of Health and Population has implemented a compulsory two year service contract in government health facilities for all the scholarship holders of the Ministry of Education. Doctors are now being deployed to all hospitals and primary health centers of the country. Prior to 2005 it was very difficult to send doctors to the peripheral part, and now they wish to go more remote area due to the privilege given to the National Academy of Medical Sciences Post Graduate Entrance Examination, which help them get MD/MS seat. However, there are more challenges due to weak health system and failure to implement established rule and regulation. This paper highlights the outcry of a doctor working in the remote part of the country.

  2. Medical decision support: experience with implementing the Arden Syntax at the Columbia-Presbyterian Medical Center.

    PubMed Central

    Jenders, R. A.; Hripcsak, G.; Sideli, R. V.; DuMouchel, W.; Zhang, H.; Cimino, J. J.; Johnson, S. B.; Sherman, E. H.; Clayton, P. D.

    1995-01-01

    We began implementation of a medical decision support system (MDSS) at the Columbia-Presbyterian Medical Center (CPMC) using the Arden Syntax in 1992. The Clinical Event Monitor which executes the Medical Logic Modules (MLMs) runs on a mainframe computer. Data are stored in a relational database and accessed via PL/I programs known as Data Access Modules (DAMs). Currently we have 18 clinical, 12 research and 10 administrative MLMs. On average, the clinical MLMs generate 50357 simple interpretations of laboratory data and 1080 alerts each month. The number of alerts actually read varies by subject of the MLM from 32.4% to 73.5%. Most simple interpretations are not read at all. A significant problem of MLMs is maintenance, and changes in laboratory testing and message output can impair MLM execution significantly. We are now using relational database technology and coded MLM output to study the process outcome of our MDSS. PMID:8563259

  3. Defining and Measuring the Patient-Centered Medical Home

    PubMed Central

    Nutting, Paul A.; Miller, William L.; Jaén, Carlos R.; Crabtree, Benjamin F.; Flocke, Susan A.; Gill, James M.

    2010-01-01

    The patient-centered medical home (PCMH) is four things: 1) the fundamental tenets of primary care: first contact access, comprehensiveness, integration/coordination, and relationships involving sustained partnership; 2) new ways of organizing practice; 3) development of practices’ internal capabilities, and 4) related health care system and reimbursement changes. All of these are focused on improving the health of whole people, families, communities and populations, and on increasing the value of healthcare. The value of the fundamental tenets of primary care is well established. This value includes higher health care quality, better whole-person and population health, lower cost and reduced inequalities compared to healthcare systems not based on primary care. The needed practice organizational and health care system change aspects of the PCMH are still evolving in highly related ways. The PCMH will continue to evolve as evidence comes in from hundreds of demonstrations and experiments ongoing around the country, and as the local and larger healthcare systems change. Measuring the PCMH involves the following:Giving primacy to the core tenets of primary careAssessing practice and system changes that are hypothesized to provide added valueAssessing development of practices’ core processes and adaptive reserveAssessing integration with more functional healthcare system and community resourcesEvaluating the potential for unintended negative consequences from valuing the more easily measured instrumental features of the PCMH over the fundamental relationship and whole system aspectsRecognizing that since a fundamental benefit of primary care is its adaptability to diverse people, populations and systems, functional PCMHs will look different in different settings.Efforts to transform practice to patient-centered medical homes must recognize, assess and value the fundamental features of primary care that provide personalized, equitable health care and foster

  4. Defining and measuring the patient-centered medical home.

    PubMed

    Stange, Kurt C; Nutting, Paul A; Miller, William L; Jaén, Carlos R; Crabtree, Benjamin F; Flocke, Susan A; Gill, James M

    2010-06-01

    The patient-centered medical home (PCMH) is four things: 1) the fundamental tenets of primary care: first contact access, comprehensiveness, integration/coordination, and relationships involving sustained partnership; 2) new ways of organizing practice; 3) development of practices' internal capabilities, and 4) related health care system and reimbursement changes. All of these are focused on improving the health of whole people, families, communities and populations, and on increasing the value of healthcare. The value of the fundamental tenets of primary care is well established. This value includes higher health care quality, better whole-person and population health, lower cost and reduced inequalities compared to healthcare systems not based on primary care. The needed practice organizational and health care system change aspects of the PCMH are still evolving in highly related ways. The PCMH will continue to evolve as evidence comes in from hundreds of demonstrations and experiments ongoing around the country, and as the local and larger healthcare systems change. Measuring the PCMH involves the following: Giving primacy to the core tenets of primary care. Assessing practice and system changes that are hypothesized to provide added value Assessing development of practices' core processes and adaptive reserve. Assessing integration with more functional healthcare system and community resources. Evaluating the potential for unintended negative consequences from valuing the more easily measured instrumental features of the PCMH over the fundamental relationship and whole system aspects. Recognizing that since a fundamental benefit of primary care is its adaptability to diverse people, populations and systems, functional PCMHs will look different in different settings. Efforts to transform practice to patient-centered medical homes must recognize, assess and value the fundamental features of primary care that provide personalized, equitable health care and foster

  5. Decision making in acquiring medical technologies in Israeli medical centers: a preliminary study.

    PubMed

    Greenberg, Dan; Pliskin, Joseph S; Peterburg, Yitzhak

    2003-01-01

    This preliminary study had two objectives: a) charting the considerations relevant to decisions about acquisition of new medical technology at the hospital level; and b) creating a basis for the development of a research tool that will examine the function of the Israeli health system in assessment of new medical technologies. A comprehensive literature review and in-depth interviews with decision makers at different levels allowed formulation of criteria considered by decision makers when they decide to purchase and use (or disallow the use) of new medical technology. The resulting questionnaire was sent to medical center directors, along with a letter explaining the goals of the study. The questionnaire included 31 possible considerations for decision making concerning the acquisition of new medical technology by medical centers. The interviewees were asked to indicate the relevance of each consideration in the decision-making process. The most relevant criteria for the adoption of new technologies related to the need for a large capital investment, clinical efficacy of the technology as well as its influence on side effects and complication rates, and a formal approval by the Ministry of Health. Most interviewees stated that pressures exerted by the industry, by patients, or by senior physicians in the hospital are less relevant to decision making. Very small and usually not statistically significant differences in the ranking of hospital directors were found according to the hospitals' ownership, size, or location. The present study is a basis for a future study that will map and describe the function of hospital decision makers within the area of new technology assessment and the decision-making process in the adoption of new healthcare technologies.

  6. 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

  7. 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

  8. Establishing a Geriatric Psychiatric Consultation in a VA Medical Center.

    PubMed

    Baker, F M; Chrismer, Brady

    1995-01-01

    The authors describe the establishment of a Geriatric Psychiatry Consultation-Liaison Team (GPCLT) at a Veterans Administration Medical Center (VAMC) that previously had no organized geriatric psychiatric service. Geriatric psychiatric consultation was required by three intermediate-care units treating older, chronically medically ill veterans with psychiatric symptoms or disorders. The GPCLT comprised a black, female geriatric psychiatrist and a white, male social worker. This combination of disciplines maximized skills, and the ethnic-gender differences of team members addressed questions of racial tension and gender issues between patients and VAMC staff members. The compliance with recommendations of the GPCLT, ranging from 89% to 98% across the three units, its selection as a clinical site for a university-affiliated Geriatric Psychiatry Fellowship Program, and the increase in the total hours of social work time assigned to the GPCLT documented the positive perception of the team by both the VAMC and the affiliated university. Specific recommendations are presented for consideration by other, similar settings. Copyright © 1995 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  9. 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.

  10. Patient-centered communication in digital medical encounters.

    PubMed

    Alpert, Jordan M; Dyer, Karen E; Lafata, Jennifer Elston

    2017-10-01

    Patients are increasingly using the secure messaging function available through online patient portals to communicate with their health care providers, yet little is known about the characteristics of conversations that occur. The goal of this study is to describe the types of messages initiated by patients communicating via patient portals and to assess whether providers employ patient-centered strategies in their electronic responses. A total of 193 messages from 58 message threads between patients and providers were collected during a one-week period in a large health care system. Content analysis of patient messages was conducted and deductive analysis of provider responses was employed for two types of patient-centered communication, provider use of supportive talk and partnership building. Patients sent nearly double the number of messages compared to providers (65% versus 35%). Patient messages expressed concern, sought medical solutions and requested assistance with administrative tasks. Over half (53.4%) of provider replies did not contain language reflective of either partnership building or supportive talk. Partnership building language and supportive talk occurred at lower rates than documented in the literature on in-person encounters. This may represent a lost opportunity to strengthen the patient-provider relationship. As secure messaging is increasingly utilized as a form of patient-provider communication, it is important to understand how aspects of this communication channel, including the patient-centeredness of the language used by providers, impact patient-provider relationships and patient outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. 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.

  12. Patient-Centered Medical Home Recognition and Clinical Performance in U.S. Community Health Centers.

    PubMed

    Shi, Leiyu; Lee, De-Chih; Chung, Michelle; Liang, Hailun; Lock, Diana; Sripipatana, Alek

    2017-06-01

    America's community health centers (HCs) are uniquely poised to implement the patient-centered medical home (PCMH) model, as they are effective in providing comprehensive, accessible, and continuous primary care. This study aims to evaluate the relationship between PCMH recognition in HCs and clinical performance. Data for this study came from the 2012 Uniform Data System (UDS) as well as a survey of HCs' PCMH recognition achievement. The dependent variables included all 16 measures of clinical performance collected through UDS. Control measures included HC patient, provider, and practice characteristics. Bivariate analyses and multiple logistic regressions were conducted to compare clinical performance between HCs with and without PCMH recognition. Health centers that receive PCMH recognition generally performed better on clinical measures than HCs without PCMH recognition. After controlling for HC patient, provider, and practice characteristics, HCs with PCMH recognition reported significantly better performance on asthma-related pharmacologic therapy, diabetes control, pap testing, prenatal care, and tobacco cessation intervention. This study establishes a positive association between PCMH recognition and clinical performance in HCs. If borne out in future longitudinal studies, policy makers and practices should advance the PCMH model as a strategy to further enhance the quality of primary care. © Health Research and Educational Trust.

  13. Patient-centered Medical Home Capability and Clinical Performance in HRSA-supported Health Centers

    PubMed Central

    Shi, Leiyu; Lock, Diana C.; Lee, De-Chih; Lebrun-Harris, Lydie A.; Chin, Marshall H.; Chidambaran, Preeta; Nocon, Robert S.; Zhu, Jinsheng; Sripipatana, Alek

    2015-01-01

    Objectives To evaluate the relationship between Patient-centered Medical Home (PCMH) model adoption in health centers (HCs) and clinical performance measures and to determine if adoption of PCMH characteristics is associated with better clinical performance. Research Design Data came from the Health Resources and Services Administration’s 2009 Uniform Data System and the 2009 Commonwealth Fund National Survey of Federally Qualified Health Centers. Clinical performance measures included 2 process measures (childhood immunization and cervical cancer screening) and 2 outcome measures (hypertension control and diabetes control). Total and subscale PCMH scores were regressed on the clinical performance measures, adjusting for patient, provider, financial, and institutional characteristics. Results The findings showed different directional relationships, with some PCMH domains (care management, test/referral tracking, quality improvement, and external coordination) showing little or no effect on outcome measures of interest, 1 domain (access/communication) associated with improved outcomes, and 1 domain (patient tracking/registry) associated with worse outcomes. Conclusions This study is among the first to examine the association between PCMH transformation and clinical performance in HCs, providing an understanding of the impact of PCMH adoption within safety-net settings. The mixed results highlight the importance of examining relationships between specific PCMH domains and specific clinical quality measures, in addition to analyzing overall PCMH scores which could yield distorted findings. PMID:25793267

  14. 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: Notice...

  15. 78 FR 16679 - Center for Drug Evaluation and Research Medical Policy Council; Request for Comments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-18

    ... HUMAN SERVICES Food and Drug Administration Center for Drug Evaluation and Research Medical Policy... interested organizations, on medical policy issues that may be considered by the CDER Medical Policy Council (Council) in FDA's Center for Drug Evaluation and Research (CDER). These comments will help the...

  16. Design strategy and implementation of the medical diagnostic image support system at two large military medical centers

    NASA Astrophysics Data System (ADS)

    Smith, Donald V.; Smith, Stan M.; Sauls, F.; Cawthon, Michael A.; Telepak, Robert J.

    1992-07-01

    The Medical Diagnostic Imaging Support (MDIS) system contract for federal medical treatment facilities was awarded to Loral/Siemens in the Fall of 1991. This contract places ''filmless'' imaging in a variety of situations from small clients to large medical centers. The MDIS system approach is a ''turn-key'', performance based specification driven by clinical requirements.

  17. Coordination within medical neighborhoods: Insights from the early experiences of Colorado patient-centered medical homes.

    PubMed

    Alidina, Shehnaz; Rosenthal, Meredith; Schneider, Eric; Singer, Sara

    2016-01-01

    The term "medical neighborhood" refers to relationships that patient-centered medical homes (PCMHs) seek to establish with other providers to facilitate coordinated patient care. Yet, how PCMHs can accomplish this coordination is not well understood. Drawing upon organizational theory (; ; ), we explored how PCMHs use coordination mechanisms to build and optimize their medical neighborhoods. We used mixed methods, blending data collected via interviews and surveys with practice leaders and care coordinators at 30 months after a PCMH collaborative intervention in Colorado as well as surveys from all providers from 13 PCMHs before and 30 months after the intervention. We used thematic analysis to understand the role and use of coordination mechanisms by PCMHs and changes in the ability to coordinate and deliver care continuity. PCMHs drew on four coordination mechanisms to build relationships with their medical neighbors: interorganizational routines to improve reliability of information flow; information connectivity to facilitate continuity and safe care; boundary spanners to integrate care across silos; and communication, negotiation, and decision mechanisms to introduce shared accountability. When providers were fairly confident of the patient's diagnosis and management required sequential interactions (such as tests or procedures), PCMHs tended to coordinate care through interorganizational routines and information connectivity. When a diagnosis was less certain and required reciprocal interaction (i.e., consultation), PCMHs employed boundary spanners and communication, negotiation, and decision mechanisms. Use of coordination mechanisms by PCMHs can help to improve care coordination in medical neighborhoods. All four mechanisms appear to be useful. The optimal mix of coordination mechanisms requires attention to patient context. Successfully building medical neighborhoods also requires meta-leaders, collaboration competencies, and high-quality relationships

  18. Medication therapy management clinic: perception of healthcare professionals in a University medical center setting.

    PubMed

    Shah, Mansi; Markel Vaysman, Anna; Wilken, Lori

    2013-07-01

    To determine the overall perception and utilization of the pharmacist managed medication therapy management (MTM) clinic services, by healthcare professionals in a large, urban, university medical care setting. This was a cross-sectional, anonymous survey sent to 195 healthcare professionals, including physicians, nurses, and pharmacists at The University of Illinois Outpatient Care Center to determine their perception and utilization of the MTM clinic. The survey consisted of 12 questions and was delivered through a secure online application. Sixty-two healthcare professionals (32%) completed the survey. 82% were familiar with the MTM clinic, and 63% had referred patients to the clinic. Medication adherence and disease state management was the most common reason for referral. Lack of knowledge on the appropriate referral procedure was the prominent reason for not referring patients to the MTM clinic. Of the providers that were aware of MTM services, 44% rated care as 'excellent', 44% as 'good', 5% as 'fair', and 0% stated 'poor'. Strengths of MTM clinic identified by healthcare providers included in-depth education to patients, close follow-up, and detailed medication reconciliation provided by MTM clinic pharmacists. Of those familiar with MTM clinic, recommendations included; increase marketing efforts to raise awareness of the MTM clinic service, create collaborative practice agreements between MTM pharmacists and physicians, and ensure that progress notes are more concise. In a large, urban, academic institution MTM clinic is perceived as a valuable resource to optimize patient care by providing patients with in-depth education as it relates to their prescribed medications and disease states. These identified benefits of MTM clinic lead to frequent patient referrals specifically for aid with medication adherence and disease state management.

  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. Examining Invasive Bedside Procedure Performance at an Academic Medical Center.

    PubMed

    Kay, Cynthia; Wozniak, Erica M; Szabo, Aniko; Jackson, Jeffrey L

    2016-07-01

    Explore the performance patterns of invasive bedside procedures at an academic medical center, evaluate whether patient characteristics predict referral, and examine procedure outcomes. This was a prospective, observational, and retrospective chart review of adults admitted to a general medicine service who had a paracentesis, thoracentesis, or lumbar puncture between February 22, 2013 and February 21, 2014. Of a total of 399 procedures, 335 (84%) were referred to a service other than the primary team for completion. Patient characteristics did not predict referral status. Complication rates were low overall and did not differ, either by referral status or location of procedure. Model-based results showed a 41% increase in the average length of time until procedure completion for those referred to the hospital procedure service or radiology (7.9 vs 5.8 hours; P < 0.05) or done in radiology instead of at the bedside (9.0 vs 5.8 hours; P < 0.001). The average procedure cost increased 38% ($1489.70 vs $1023.30; P < 0.001) for referred procedures and 56% ($1625.77 vs $1150.98; P < 0.001) for radiology-performed procedures. Although referral often is the easier option, our study shows its shortcomings, specifically pertaining to cost and time until completion. Procedure performance remains an important skill for residents and hospitalists to learn and use as a part of patient care.

  1. Ten-year experience of phototherapy in Yonsei Medical Center.

    PubMed

    Park, S H; Hann, S K; Park, Y K

    1996-12-01

    Phototherapy with PUVA or UVB has been used to treat a wide variety of diseases such as psoriasis, vitiligo, atopic dermatitis and mycosis fungoides, etc. The present study was performed to investigate the pattern of phototherapy in the phototherapy clinic of Yonsei Medical Center. One thousand six hundred ninety two patients who received PUVA or UVB phototherapy were included in this study. We analyzed the protocols for phototherapy between 1985 and 1994. The number of phototherapy per year increased sharply until 1991 and thereafter it has remained relatively constant. The most common age group at the start of phototherapy was the third decade. The most common indications for PUVA and UVB phototherapy were vitiligo and psoriasis, respectively. Most patients had received less than 50 treatments of PUVA and less than 200 J/cm2 of cumulative UVA. Most patients had received less than 50 treatments with UVB and cumulative UVB doses were variable. We had not found any malignancy in the skin. Since the maximum safe cumulative doses of UVA or UVB have not yet been established, it is difficult to decide when phototherapy should be discontinued. The data presented in this study needs to be further analyzed in correlation with photoaging and cancer development for the safe usage of phototherapy.

  2. Cultural Awareness Among Nursing Staff at an Academic Medical Center.

    PubMed

    McElroy, Jennifer; Smith-Miller, Cheryl A; Madigan, Catherine K; Li, Yin

    2016-03-01

    The goal is to identify areas for targeted improvement in regard to cultural awareness and competence among nursing staff and in the work environment. Many facilities have initiated programs to facilitate cultural competence development among nursing staff; however, there has been little examination of the effect of these initiatives, assessment of experienced nurses' cultural awareness, or investigation of nurse leader's role in promoting cultural competence in the literature. In this cross-sectional descriptive study, a cultural awareness survey was modified and electronically distributed to all registered nurses and assistive personnel at an academic medical center. The modified survey instrument showed good reliability and validity among the study population. Most nursing staff exhibited a moderate to high level of cultural awareness and held positive opinions about nursing leadership and the work environment with regard to cultural issues. In increasingly diverse work environments, assessing the cultural awareness of nursing staff enables nurse leaders to evaluate efforts in promoting cultural competence and to identify specific areas in which to target staff development efforts and leadership training.

  3. Mental Health Recovery in the Patient-Centered Medical Home

    PubMed Central

    Aarons, Gregory A.; O’Connell, Maria; Davidson, Larry; Groessl, Erik J.

    2015-01-01

    Objectives. We examined the impact of transitioning clients from a mental health clinic to a patient-centered medical home (PCMH) on mental health recovery. Methods. We drew data from a large US County Behavioral Health Services administrative data set. We used propensity score analysis and multilevel modeling to assess the impact of the PCMH on mental health recovery by comparing PCMH participants (n = 215) to clients receiving service as usual (SAU; n = 22 394) from 2011 to 2013 in San Diego County, California. We repeatedly assessed mental health recovery over time (days since baseline assessment range = 0–1639; mean = 186) with the Illness Management and Recovery (IMR) scale and Recovery Markers Questionnaire. Results. For total IMR (log-likelihood ratio χ2[1] = 4696.97; P < .001) and IMR Factor 2 Management scores (log-likelihood ratio χ2[1] = 7.9; P = .005), increases in mental health recovery over time were greater for PCMH than SAU participants. Increases on all other measures over time were similar for PCMH and SAU participants. Conclusions. Greater increases in mental health recovery over time can be expected when patients with severe mental illness are provided treatment through the PCMH. Evaluative efforts should be taken to inform more widespread adoption of the PCMH. PMID:26180945

  4. Mental Health Recovery in the Patient-Centered Medical Home.

    PubMed

    Sklar, Marisa; Aarons, Gregory A; O'Connell, Maria; Davidson, Larry; Groessl, Erik J

    2015-09-01

    We examined the impact of transitioning clients from a mental health clinic to a patient-centered medical home (PCMH) on mental health recovery. We drew data from a large US County Behavioral Health Services administrative data set. We used propensity score analysis and multilevel modeling to assess the impact of the PCMH on mental health recovery by comparing PCMH participants (n = 215) to clients receiving service as usual (SAU; n = 22,394) from 2011 to 2013 in San Diego County, California. We repeatedly assessed mental health recovery over time (days since baseline assessment range = 0-1639; mean = 186) with the Illness Management and Recovery (IMR) scale and Recovery Markers Questionnaire. For total IMR (log-likelihood ratio χ(2)[1] = 4696.97; P < .001) and IMR Factor 2 Management scores (log-likelihood ratio χ(2)[1] = 7.9; P = .005), increases in mental health recovery over time were greater for PCMH than SAU participants. Increases on all other measures over time were similar for PCMH and SAU participants. Greater increases in mental health recovery over time can be expected when patients with severe mental illness are provided treatment through the PCMH. Evaluative efforts should be taken to inform more widespread adoption of the PCMH.

  5. The Patient-Centered Medical Home and Patient Experience

    PubMed Central

    Martsolf, Grant R; Alexander, Jeffrey A; Shi, Yunfeng; Casalino, Lawrence P; Rittenhouse, Diane R; Scanlon, Dennis P; Shortell, Stephen M

    2012-01-01

    Objective To examine the relationship between practices' reported use of patient-centered medical home (PCMH) processes and patients' perceptions of their care experience. Data Source Primary survey data from 393 physician practices and 1,304 patients receiving care in those practices. Study Design This is an observational, cross-sectional study. Using standard ordinary least-squares and a sample selection model, we estimated the association between patients' care experience and the use of PCMH processes in the practices where they receive care. Data Collection We linked data from a nationally representative survey of individuals with chronic disease and two nationally representative surveys of physician practices. Principal Findings We found that practices' use of PCMH processes was not associated with patient experience after controlling for sample selection as well as practice and patient characteristics. Conclusions In our study, which was large, but somewhat limited in its measures of the PCMH and of patient experience, we found no association between PCMH processes and patient experience. The continued accumulation of evidence related to the possibilities of the PCMH, how PCMH is measured, and how the impact of PCMH is gauged provides important information for health care decision makers. PMID:22670806

  6. [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.

  7. [Bronchial carcinoma at the Zadar Medical Center 1982-1986].

    PubMed

    Mazzi, A; Mazzi, M

    1989-01-01

    In the period between 1982-1986, 2132 neoplasms were registered in the Zadar Medical Center, out of them 164 (7.7%) were primary bronchial carcinomas of which 138 (84.1%) were morphologically verified. The difference between the number of the registered and verified bronchial carcinomas is due to the difference in the registration criteria. The annual average incidence rate of the verified carcinomas was about 30 which is lower than in the Zagreb area and Croatia as a whole. The average number of cases diagnosed in other institutions was about 20 percent. An analysis by sex revealed a prevalence among males aged 55-75. Morphologically, the most common type of carcinoma was planocellular, followed by anaplastic, small cell carcinoma and adenocarcinoma. The greatest majority of the positive findings was obtained by bronchoscopy and sputum examination. The average number of sputa obtained per patient was 3.5; 63 percent of these were adequate and 40 percent of them were positive. In 86% of cases the diagnosis was established from the first three sputa. The most frequently used bronchoscopic method of material obtained was aspiration and the best diagnostic results were obtained by puncture biopsy and excision. The high percentage of positive results obtained by transtracheal biopsy justifies its use.

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. 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.

  13. Trends in the Use of Medical Imaging to Diagnose Appendicitis at an Academic Medical Center.

    PubMed

    Repplinger, Michael D; Weber, Andrew C; Pickhardt, Perry J; Rajamanickam, Victoria P; Svenson, James E; Ehlenbach, William J; Westergaard, Ryan P; Reeder, Scott B; Jacobs, Elizabeth A

    2016-09-01

    To quantify the trends in imaging use for the diagnosis of appendicitis. A retrospective study covering a 22-year period was conducted at an academic medical center. Patients were identified by International Classification of Diseases-9 diagnosis code for appendicitis. Medical record data extraction of these patients included imaging test used (ultrasound, CT, or MRI), gender, age, and body mass index (BMI). The proportion of patients undergoing each scan was calculated by year. Regression analysis was performed to determine whether age, gender, or BMI affected imaging choice. The study included a total of 2,108 patients, including 967 (43.5%) females and 599 (27%) children (<18 years old). CT use increased over time for the entire cohort (2.9% to 82.4%, P < .0001), and each subgroup (males, females, adults, children; P < .0001 for each). CT use increased more in females and adults than in males and children, but differences in trends were not statistically significant (male versus female, P = .8; adult versus child, P = .1). The percentage of patients who had no imaging used for the diagnosis of appendicitis decreased over time (P < .0001 overall and for each subgroup), and no difference was found in trends between complementary subgroups (male versus female, P = .53; adult versus child, P = .66). No statistically significant changes were found in use of ultrasound or MRI over the study period. With increasing BMI, CT was more frequently used. Of those diagnosed with appendicitis at an academic medical center, CT use increased more than 20-fold. However, no statistically significant trend was found for increased use of ultrasound or MRI. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  14. Enriching Patient-Centered Medical Homes Through Peer Support.

    PubMed

    Daaleman, Timothy P; Fisher, Edwin B

    2015-08-01

    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.

  15. 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.

  16. Factors influencing teamwork and collaboration within a tertiary medical center

    PubMed Central

    Chien, Shu Feng; Wan, Thomas TH; Chen, Yu-Chih

    2012-01-01

    AIM: To understand how work climate and related factors influence teamwork and collaboration in a large medical center. METHODS: A survey of 3462 employees was conducted to generate responses to Sexton’s Safety Attitudes Questionnaire (SAQ) to assess perceptions of work environment via a series of five-point, Likert-scaled questions. Path analysis was performed, using teamwork (TW) and collaboration (CO) as endogenous variables. The exogenous variables are effective communication (EC), safety culture (SC), job satisfaction (JS), work pressure (PR), and work climate (WC). The measurement instruments for the variables or summated subscales are presented. Reliability of each sub-scale are calculated. Alpha Cronbach coefficients are relatively strong: TW (0.81), CO (0.76), EC (0.70), SC (0.83), JS (0.91), WP (0.85), and WC (0.78). Confirmatory factor analysis was performed for each of these constructs. RESULTS: Path analysis enables to identify statistically significant predictors of two endogenous variables, teamwork and intra-organizational collaboration. Significant amounts of variance in perceived teamwork (R2 = 0.59) and in collaboration (R2 = 0.75) are accounted for by the predictor variables. In the initial model, safety culture is the most important predictor of perceived teamwork, with a β weight of 0.51, and work climate is the most significant predictor of collaboration, with a β weight of 0.84. After eliminating statistically insignificant causal paths and allowing correlated predictors1, the revised model shows that work climate is the only predictor positively influencing both teamwork (β = 0.26) and collaboration (β = 0.88). A relatively weak positive (β = 0.14) but statistically significant relationship exists between teamwork and collaboration when the effects of other predictors are simultaneously controlled. CONCLUSION: Hospital executives who are interested in improving collaboration should assess the work climate to ensure that employees are

  17. Factors influencing teamwork and collaboration within a tertiary medical center.

    PubMed

    Chien, Shu Feng; Wan, Thomas Th; Chen, Yu-Chih

    2012-04-26

    To understand how work climate and related factors influence teamwork and collaboration in a large medical center. A survey of 3462 employees was conducted to generate responses to Sexton's Safety Attitudes Questionnaire (SAQ) to assess perceptions of work environment via a series of five-point, Likert-scaled questions. Path analysis was performed, using teamwork (TW) and collaboration (CO) as endogenous variables. The exogenous variables are effective communication (EC), safety culture (SC), job satisfaction (JS), work pressure (PR), and work climate (WC). The measurement instruments for the variables or summated subscales are presented. Reliability of each sub-scale are calculated. Alpha Cronbach coefficients are relatively strong: TW (0.81), CO (0.76), EC (0.70), SC (0.83), JS (0.91), WP (0.85), and WC (0.78). Confirmatory factor analysis was performed for each of these constructs. Path analysis enables to identify statistically significant predictors of two endogenous variables, teamwork and intra-organizational collaboration. Significant amounts of variance in perceived teamwork (R(2) = 0.59) and in collaboration (R(2) = 0.75) are accounted for by the predictor variables. In the initial model, safety culture is the most important predictor of perceived teamwork, with a β weight of 0.51, and work climate is the most significant predictor of collaboration, with a β weight of 0.84. After eliminating statistically insignificant causal paths and allowing correlated predictors1, the revised model shows that work climate is the only predictor positively influencing both teamwork (β = 0.26) and collaboration (β = 0.88). A relatively weak positive (β = 0.14) but statistically significant relationship exists between teamwork and collaboration when the effects of other predictors are simultaneously controlled. Hospital executives who are interested in improving collaboration should assess the work climate to ensure that employees are operating in a setting conducive

  18. Deficits in allergy knowledge among physicians at academic medical centers.

    PubMed

    Stukus, David R; Green, Todd; Montandon, Shari V; Wada, Kara J

    2015-07-01

    Allergic conditions have high prevalence in the general population. Misconceptions regarding the diagnosis and management of allergic disease among physicians can lead to suboptimal clinical care. To determine the extent of allergy-related knowledge deficits among physicians. Pediatric and internal medicine resident and attending physicians from 2 separate academic medical centers were asked to answer an anonymous electronic survey. Survey questions addressed 7 different allergy content areas. Four hundred eight physicians completed surveys (23.9% response rate). Respondents had few correct answers (mean ± SD 1.91 ± 1.43). Pediatric respondents had a larger number of correct answers compared with medicine-trained physicians (P < .001). No individual answered every survey question correctly, and 50 respondents (12.3%) had no correct answer. Three hundred seventy-eight respondents (92.6%) were unable to provide correct answers for at least 50% of survey questions. Level of residency training and prior rotation through an allergy and immunology elective correlated with a larger number of correct responses (P < .01). Only 1 survey question had an overall correct response rate higher than 50% (n = 261, 64%). Correct response rate was lower than 30% for 7 of the 9 possible questions. There are significant knowledge deficits in many areas of allergy-related content among pediatric and internal medicine physicians and across all levels of training and specialty. Given the prevalence of allergic conditions, the potential implications of a negative impact on clinical care are staggering. Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  19. 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.

  20. [Patient-centered care. Improvement of communication between university medical centers and general practitioners for patients in neuro-oncology].

    PubMed

    Renovanz, M; Keric, N; Richter, C; Gutenberg, A; Giese, A

    2015-12-01

    Communication between university medical centers and general practitioners (GP) is becoming increasingly more important in supportive patient care. A survey among GPs was performed with the primary objective to assess their opinion on current workflow and communication between GPs and the university medical center. The GPs were asked to score (grades 1-6) their opinion on the current interdisciplinary workflow in the care of patients with brain tumors, thereby rating communication between a university medical center in general and the neuro-oncology outpatient center in particular. Questionnaires were sent to1000 GPs and the response rate was 15 %. The mean scored evaluation of the university medical center in general was 2.62 and of the neuro-oncological outpatient clinic 2.28 (range 1-6). The most often mentioned issues to be improved were easier/early telephone information (44 %) and a constantly available contact person (49 %). Interestingly, > 60 % of the GPs indicated they would support web-based tumor boards for interdisciplinary and palliative neuro-oncological care. As interdisciplinary care for neuro-oncology patients is an essential part of therapy, improvement of communication between GPs and university medical centers is indispensable. Integrating currently available electronic platforms under data protection aspects into neuro-oncological palliative care could be an interesting tool in order to establish healthcare networks and could find acceptance with GPs.

  1. Impact of Mobile Dose-Tracking Technology on Medication Distribution at an Academic Medical Center.

    PubMed

    Kelm, Matthew; Campbell, Udobi

    2016-05-01

    Medication dose-tracking technologies have the potential to improve efficiency and reduce costs associated with re-dispensing doses reported as missing. Data describing this technology and its impact on the medication use process are limited. The purpose of this study is to assess the impact of dose-tracking technology on pharmacy workload and drug expense at an academic, acute care medical center. Dose-tracking technology was implemented in June 2014. Pre-implementation data were collected from February to April 2014. Post-implementation data were collected from July to September 2014. The primary endpoint was the percent of re-dispensed oral syringe and compounded sterile product (CSP) doses within the pre- and post-implementation periods per 1,000 discharges. Secondary endpoints included pharmaceutical expense generated from re-dispensing doses, labor costs, and staff satisfaction with the medication distribution process. We observed an average 6% decrease in re-dispensing of oral syringe and CSP doses from pre- to post-implementation (15,440 vs 14,547 doses; p = .047). However, when values were adjusted per 1,000 discharges, this trend did not reach statistical significance (p = .074). Pharmaceutical expense generated from re-dispensing doses was significantly reduced from pre- to post-implementation ($834,830 vs $746,466 [savings of $88,364]; p = .047). We estimated that $2,563 worth of technician labor was avoided in re-dispensing missing doses. We also saw significant improvement in staff perception of technology assisting in reducing missing doses (p = .0003), as well as improvement in effectiveness of resolving or minimizing missing doses (p = .01). The use of mobile dose-tracking technology demonstrated meaningful reductions in both the number of doses re-dispensed and cost of pharmaceuticals dispensed.

  2. 75 FR 20523 - Regulated Navigation Areas; Port of Portland Terminal 4, Willamette River, Portland, OR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-20

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA11 Regulated Navigation Areas; Port of Portland Terminal 4... establishing two Regulated Navigation Areas (RNA) at the Port of Portland Terminal 4 on the Willamette River in... rulemaking (NPRM) entitled ``Regulated Navigation Areas; Port of Portland Terminal 4, Willamette...

  3. 75 FR 20778 - Security Zone; Portland Rose Festival Fleet Week, Willamette River, Portland, OR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-21

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA87 Security Zone; Portland Rose Festival Fleet Week... Hawthorne and Steel Bridges in Portland, Oregon during the Portland Rose Festival Fleet Week from June 2... Rose Festival Fleet Week, and there is insufficient time to publish a notice of proposed...

  4. The Role of a Medical Education Center in Location Decisions of Practicing Physicians.

    ERIC Educational Resources Information Center

    Buesching, Don; Glasser, Michael

    1983-01-01

    The factors involved in the decisions of physicians to locate in Rockford, IL were examined. Questions were asked concerning faculty status, factors influencing practice location decisions, and perceived advantages of association with a medical education center. The medical education center was an important secondary factor. (Author/MLW)

  5. 76 FR 55917 - Medicare Program; Notification of Closure of St. Vincent's Medical Center; Extension of the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-09

    ... Medicare & Medicaid Services (CMS), HHS. ACTION: Notice of extension of the Deadline for Submission of... & Medicaid Services (CMS) to receive St. Vincent's Medical Center's full time equivalent (FTE) resident cap... apply to the Centers for Medicare & Medicaid Services (CMS) to receive St. Vincent's Medical...

  6. 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

    ... ``Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and Information... HUMAN SERVICES Food and Drug Administration Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and Information on Non-Standardized Allergenic Extracts in the...

  7. 13. VIEW OF PORTLAND RESERVOIR NO. 2, LOOKING EAST FROM ...

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

    13. VIEW OF PORTLAND RESERVOIR NO. 2, LOOKING EAST FROM NORTHWEST CORNER OF RESERVOIR. POST OF ORIGINAL FENCE IS IN FOREGROUND - Portland Reservoir No. 2, 6007 Southeast Division Street, Portland, Multnomah County, OR

  8. 9. VIEW OF PORTLAND RESERVOIR NO. 2, LOOKING SOUTHWEST, SHOWING ...

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

    9. VIEW OF PORTLAND RESERVOIR NO. 2, LOOKING SOUTHWEST, SHOWING CHAIN-LINK FENCE IN FOREGROUND AND FOUNDATION STRUCTURE IN THE MIDDLE OF RESERVOIR BASIN - Portland Reservoir No. 2, 6007 Southeast Division Street, Portland, Multnomah County, OR

  9. 19. Photocopy of photograph (from Station 'L' office files, Portland, ...

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

    19. Photocopy of photograph (from Station 'L' office files, Portland, Oregon) Photographer unknown, 1930 LAYING THE BASEMENT FLOOR FOR THE POWERHOUSE EXTENSION, 1930 - Portland General Electric Company, Station "L", 1841 Southeast Water Street, Portland, Multnomah County, OR

  10. 14. Photocopy of photograph (from Station 'L' office files, Portland, ...

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

    14. Photocopy of photograph (from Station 'L' office files, Portland, Oregon) Photographer unknown, c.1930 HISTORIC VIEW OF STEPHENS SUBSTATION - Portland General Electric Company, Station "L", 1841 Southeast Water Street, Portland, Multnomah County, OR

  11. 20. Photocopy of photograph (from Station 'L' office files, Portland, ...

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

    20. Photocopy of photograph (from Station 'L' office files, Portland, Oregon) Photographer unknown, c.1930 TURBINE WHEEL, NOTE WORN BUCKETS - Portland General Electric Company, Station "L", 1841 Southeast Water Street, Portland, Multnomah County, OR

  12. 17. Photocopy of photograph (from Station 'L' office files, Portland, ...

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

    17. Photocopy of photograph (from Station 'L' office files, Portland, Oregon) Photographer unknown, 1936-37 INSTALLATION OF BOILER #16, 1936-37 - Portland General Electric Company, Station "L", 1841 Southeast Water Street, Portland, Multnomah County, OR

  13. 16. Photocopy of photograph (from Station 'L' office files, Portland, ...

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

    16. Photocopy of photograph (from Station 'L' office files, Portland, Oregon) Photographer unknown, 1936-37 INSTALLING THE FURNACE OF BOILER #16, 1936-37 - Portland General Electric Company, Station "L", 1841 Southeast Water Street, Portland, Multnomah County, OR

  14. 18. Photocopy of photograph (from Station 'L' office files, Portland, ...

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

    18. Photocopy of photograph (from Station 'L' office files, Portland, Oregon) Photographer unknown, 1930 CONSTRUCTION OF THE POWERHOUSE EXTENSION, 1930 - Portland General Electric Company, Station "L", 1841 Southeast Water Street, Portland, Multnomah County, OR

  15. 15. Photocopy of photograph (from Station 'L' office files, Portland, ...

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

    15. Photocopy of photograph (from Station 'L' office files, Portland, Oregon) Photographer unknown, 1936-37 CONSTRUCTION OF BOILER #16 - Portland General Electric Company, Station "L", 1841 Southeast Water Street, Portland, Multnomah County, OR

  16. Teaching in Medical Education | Center for Cancer Research

    Cancer.gov

    Many postdoctoral fellows are considering an academic career at a medical school. In addition to conducting research, new faculty members must learn effective teaching methodologies. This course will focus on good teaching practices, including basic strategies for developing and organizing a course. The purpose of the "Teaching in Medical Education (TIME)" course is to increase the scientist's ability to teach in medical education. The course will provide basic knowledge in teaching methods, course planning, writing a syllabus and developing examinations.

  17. Portland Public School Children Move with Propane

    SciTech Connect

    Not Available

    2004-04-01

    This 2-page Clean Cities fact sheet describes the use of propane as a fuel source for Portland Public Schools' fleet of buses. It includes information on the history of the program, along with contact information for the local Clean Cities Coordinator and Portland Public Schools.

  18. 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.

  19. Tumor Registry Follow-Up at Army Medical Centers.

    DTIC Science & Technology

    1983-06-03

    GROUP SUB-GROUP Hospitals ; healthcare; medical information systems; tumor registry7 c 1 ,’ 19. ABSTRACT (Continue on reverse if necessary and... hospitals , the Army Medical Department has supported the accreditation of its tumor registries by the American College of Surgeons. While accreditati is...TELEPHONE (Include Area Code) 22c OFFICE SYMBOL Lawrence M. Leahy, MAJ, MS (512) 221-6345/2324 HSHA-IHC DD Form 1473, JUN 86 Previous editions are

  20. City of Portland: Businesses for an environmentally sustainable tomorrow

    SciTech Connect

    1995-12-01

    The sustainable business development program in Portland (OR) is known as BEST. BEST stands for Businesses for an Environmentally Sustainable Tomorrow. The Portland Energy Office operates BEST as a {open_quotes}one-stop service center{close_quotes} for business owners and managers. BEST provides information and assistance on resource efficient buildings and business practices. The results of BEST`s two years of operation have been generally impressive. Nearly 150 new or expanding businesses have been connected with utility design assistance programs. Businesses have also received assistance with water conservation, telecommuting, construction debris recycling, and alternative fuel vehicles. BEST has received local and national publicity and BEST services have been the topic at more than a dozen conferences, meetings, or other speaking engagements. A guidebook for communities wishing to start a similar program will be available in early 1996.

  1. The decade of the nineties at the UCLA Medical Center: responses to dramatic marketplace changes.

    PubMed

    Karpf, M; Schultze, R G; Levey, G

    2000-08-01

    The evolution of the health care marketplace in the nineties in Southern California is described, including the dominance of managed care at the decade's end. The marketplace, especially in Los Angeles, is now one of the most complex, competitive, and challenging medical marketplaces in the country. The University of California, Los Angeles (UCLA) Medical Center and the academic health center of which it is a part have had to respond appropriately and vigorously to survive and to position themselves for the future. This article focuses on the responses of the medical center to these marketplace pressures. The center has recognized single-signature contracting, cost containment, and an emphasis on ambulatory care as fundamental success factors for survival in a complex, organized managed care environment. Data on the medical, financial, and educational performances of the medical center are presented in terms of its responses to the marketplace. Preliminary information about quality of care is presented for three patient-population groups that have been heavily affected by managed care. The need for emphasis on quality and service for future success and the attendant need for emphasis on information systems are discussed. The importance of fundamental understanding of markets is also reviewed. The concomitant approaches to securing the center's academic missions are described, including changes in institutional governance for the entire health sciences center of which the medical center is a part and the establishment of priorities in research, clinical care, and teaching programs, especially teaching programs in primary care.

  2. Portland outlines waste reduction program

    SciTech Connect

    Rifer, W.

    1986-09-01

    Plans for solid waste systems must reflect the preferences and values of the community they serve. The Metropolitan Service District (Metro), an elected regional government for the Portland (Oregon) area, has launched an ambitious effort to reduce the amount of solid waste being landfilled. The current solid waste system in the Portland area consists of: (1) a healthy private recycling program which is achieving a nearly 22% reduction of waste, (2) a private garbage collection system which is regulated by local governments (half franchised and half competitive), and (3) a regional disposal system operated by Metro which relies on landfilling. The system envisioned by the Metro Waste Reduction Program will add significant diversity to the disposal system, and will, by necessity, involve the collection, recycling and disposal systems in a coordinated partnership. The total volume of waste to be handled through the Waste Reduction Program is approximately 962,000 tons/year. Currently, 755,000 tons/year are disposed of in a landfill and the remainder is recycled through various methods.

  3. Medical trainees' formal and informal incident reporting across a five-hospital academic medical center.

    PubMed

    Logio, Lia S; Ramanujam, Rangaraj

    2010-01-01

    Despite the importance of incident reporting for promoting patient safety, the extent to which residents and fellows (trainees) in graduate medical education (GME) programs report incidents is not well understood. A study was conducted to determine the prevalence of and variations in incident reporting across hospitals in an academic medical center. Trainees enrolled in GME programs sponsored by the Indiana University School of Medicine (IUSM) completed (1) the Behavior Index Survey (BIS), which asked respondents if they knew how to locate incident forms and if they ever submitted an incident form, and (2) the Safety Culture Survey (SCS), which asked about the frequencies of their formal and informal incident reporting behaviors. Some 443 of 992 invited trainees (45% response rate) participated in the study. Of the 305 BIS respondents who rotated through all five hospitals, varying proportions knew how to locate an incident form (22.3%-31.5%) and had completed an incident form (6.2%-20%) in each hospital. Incident report completion rates were higher (20.1%-81.3%) among trainees who knew how to locate an incident form. Higher proportions of the 443 SCS respondents had informally discussed an incident with other trainees (90%), faculty physicians (70%), and at resident meetings and conferences (73%). The study confirms that GME trainees formally report incidents rarely. The flow of communication to and from trainees about patient safety and incidents is low, despite an organizational focus on safety and quality. Discussion of safety issues among trainees occurs more informally among colleagues and peers than with faculty or through formal reporting mechanisms. The data suggest a number of strategies to increase the culture of safety among GME trainees.

  4. [Analysis of the transfer of the world medical scientific center until modern times].

    PubMed

    Zuo, Han-bin

    2010-03-01

    Since the 16th century, the world medical scientific center has transferred from Italy, Netherlands, the United Kingdom, France and Germany to the United States. The standards by which the above-mentioned countries became the medical scientific center during a certain historical period were not only the number of achievements of the scientific research and the talents, what was more important was their position and function in the leading disciplines. The background of the transfer of the medical scientific center was the economic, cultural and political rise of these countries, and the most important foundation was the innovation of personnel training systems.

  5. The Patient-Centered Medical Home and Meaningful Use: a challenge for better care.

    PubMed

    Coffin, Janis; Duffie, Carla; Furno, Megan

    2014-01-01

    This article discusses and illustrates the alignment between the National Committee for Quality Assurance's Patient-Centered Medical Home and Meaningful Use. In addition to the various overlaps, there is also significant discussion about Patient-Centered Medical Home and Meaningful Use as well as their distinct requirements. With impending deadlines for Meaningful Use and potential penalties being imposed, this article provides a layout of dates, stages, and incentive payments and penalties for Meaningful Use, and discusses how obtaining Patient-Centered Medical Home recognition could be beneficial to achieving Meaningful Use.

  6. Frequency of and risk factors for medication errors by pharmacists during order verification in a tertiary care medical center.

    PubMed

    Gorbach, Christy; Blanton, Linda; Lukawski, Beverly A; Varkey, Alex C; Pitman, E Paige; Garey, Kevin W

    2015-09-01

    The frequency of and risk factors for medication errors by pharmacists during order verification in a tertiary care medical center were reviewed. This retrospective, secondary database study was conducted at a large tertiary care medical center in Houston, Texas. Inpatient and outpatient medication orders and medication errors recorded between July 1, 2011, and June 30, 2012, were reviewed. Independent variables assessed as risk factors for medication errors included workload (mean number of orders verified per pharmacist per shift), work environment (type of day, type of shift, and mean number of pharmacists per shift), and nonmodifiable characteristics of the pharmacist (type of pharmacy degree obtained, age, number of years practicing, and number of years at the institution). A total of 1,887,751 medication orders, 92 medication error events, and 50 pharmacists were included in the study. The overall error rate was 4.87 errors per 100,000 verified orders. An increasing medication error rate was associated with an increased number of orders verified per pharmacist (p = 0.007), the type of shift (p = 0.021), the type of day (p = 0.002), and the mean number of pharmacists per shift (p = 0.001). Pharmacist demographic variables were not associated with risk of error. The number of orders per shift was identified as a significant independent risk factor for medication errors (p = 0.019). An increase in the number of orders verified per shift was associated with an increased rate of pharmacist errors during order verification in a tertiary care medical center. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  7. A profile of women medical directors in community and migrant health centers.

    PubMed

    Samuels, M E; Cochran, C R; Shi, L

    2001-01-01

    This article looks at the nation's community and migrant health centers, where substantial numbers of female physicians are medical directors, the second highest executive position, in search of insights for managed care organizations for recruiting and retaining women medical directors. This paper provides the first comparative national profile of women and men community and migrant health center (C/MHC) medical directors in terms of their personal and work characteristics, as well as job satisfaction. The study findings indicate that, for the most part, female medical directors do not differ much from their male colleagues in issues of work characteristics or job satisfaction.

  8. A regional poison information center IVR medication identification system: does it accomplish its goal?

    PubMed

    Krenzelok, Edward P; Mrvos, Rita

    2011-11-01

    The 2009 AAPCC NPDS report identified 1,057,632 medication identification requests to poison information centers. This represents 24.7% of all calls to US poison information centers. To reduce the impact of medication identification requests on a poison information center, a regional poison information center developed and implemented an automated medication identification system that utilized an interactive voice response (IVR) system. The objective of this project was to describe how the IVR affected the regional poison information center medication identification request call volume and workload of the staff. All documented medication identification request inquiries from January 1, 2007 through June 30, 2011 were extracted from the RPIC Visual Dotlab electronic medical record system. Descriptive statistics, presented as means, were used to characterize the monthly call volume inquiries. Over the 18 months (January, 2007 to June, 2008) preceding the implementation of the IVR medication identification request system, a mean of 4,389.6 medication identification requests per month required manual electronic documentation by SPI. In the immediate 12 months (August, 2008 to July, 2009) following the IVR medication identification request system implementation, a mean of 2132.6 inquiries per month (54% reduction) were managed by the IVR. During the 12 month period of July, 2010 through June, 2011, the combined monthly mean of medication identification requests documented by SPI and the IVR decreased to a total of 686.7 compared to the mean pre-implementation monthly total of 4,389.6. The IVR medication identification request system was successful in reducing the number of medication identification requests that required manual electronic documentation by SPI and freed up a substantial amount of time for SPI to perform other critical patient care-related responsibilities. The enhanced technology that was implemented to improve efficiency came with the unintended

  9. 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.

  10. 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…

  11. 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…

  12. National Imperative to Establish a Domestic Medical Intelligence Center

    DTIC Science & Technology

    2007-09-01

    Quality Reports Human and Veterinarian Health Surveillance Indicators Coordination with other TEW Cells Exploring Medical and Public Health...and territorial governments, animal shelters, the American Society for the Prevention of Cruelty to Animals, veterinarians , and other sources...General medicine/family practice 63 • Hematology • Infectious disease • Internal medicine • Nephrology • Nuclear medicine o In-vivo

  13. Emergency department discharge prescription errors in an academic medical center

    PubMed Central

    Belanger, April; Devine, Lauren T.; Lane, Aaron; Condren, Michelle E.

    2017-01-01

    This study described discharge prescription medication errors written for emergency department patients. This study used content analysis in a cross-sectional design to systematically categorize prescription errors found in a report of 1000 discharge prescriptions submitted in the electronic medical record in February 2015. Two pharmacy team members reviewed the discharge prescription list for errors. Open-ended data were coded by an additional rater for agreement on coding categories. Coding was based upon majority rule. Descriptive statistics were used to address the study objective. Categories evaluated were patient age, provider type, drug class, and type and time of error. The discharge prescription error rate out of 1000 prescriptions was 13.4%, with “incomplete or inadequate prescription” being the most commonly detected error (58.2%). The adult and pediatric error rates were 11.7% and 22.7%, respectively. The antibiotics reviewed had the highest number of errors. The highest within-class error rates were with antianginal medications, antiparasitic medications, antacids, appetite stimulants, and probiotics. Emergency medicine residents wrote the highest percentage of prescriptions (46.7%) and had an error rate of 9.2%. Residents of other specialties wrote 340 prescriptions and had an error rate of 20.9%. Errors occurred most often between 10:00 am and 6:00 pm. PMID:28405061

  14. Crozer-Chester Medical Center Burn Research Project

    DTIC Science & Technology

    2010-07-18

    computer system designed to collect data from this equipment at the bedside. Study 2: “Evaluation of Xxx Dressing for Autogenous Skin Donor...Quarter 1) Study 2, Protocol Title: “Evaluation of Xxx for Autogenous Skin Donor Sites” Task 1: Enroll up to 30 patients in this multi-center

  15. Changing Economics of Health Care Are Devastating Academic Medical Centers.

    ERIC Educational Resources Information Center

    van der Werf, Martin

    1999-01-01

    Once a financially healthy part of American universities, many academic health centers are struggling to survive. Many are merging with for-profit chains or declaring bankruptcy. The advance of managed care and insurance companies focusing on reducing costs appears to be affecting teaching hospitals more than community hospitals. (MSE)

  16. 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.

  17. 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)

  18. Nonpsychiatric medication interventions initiated by a postgraduate year 2 psychiatric pharmacy resident in a patient-centered medical home.

    PubMed

    Williams, Andrew M; Dopheide, Julie A

    2014-01-01

    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. 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. 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. 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 efforts are needed to promote

  19. Dealing with the flood crisis of 1993. A medical center's account.

    PubMed

    Ramsey, D S

    1994-01-01

    On Saturday, 10 July 1993, Iowans were assaulted by the greatest natural disaster in the state's history when virtually all rain-swollen rivers and creeks in the Midwest spilled over their banks. In Des Moines, the Iowa Methodist Medical Center was suddenly surrounded by flood waters and stripped of power, water, computer, and telephone communication. Striving to deliver quality patient care in the face of the crisis, medical staff, administrators, and employees at the center achieved recovery in record time.

  20. Crozer-Chester Medical Center Burn Research Project

    DTIC Science & Technology

    2013-09-01

    exchange plasmids and transposons with other Gram-negative bacteria . Both PA and Enterobacter species accepted resistance genes from AB, but persistence...of resistant clones containing these genes was not evident. Plasmids and transposons have specific compatibility regions for which a bacteria may...Enterobacter species when compared to AB may explain the failure of these two Gram-negative bacteria to take residence in our burn center. CONCLUSIONS A

  1. 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.

  2. 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.

  3. Optimizing Dam Operations for Power and for Fish: an Overview of the US Department of Energy and US Army Corps of Engineers ADvanced Turbine Development R&D. A Pre-Conference Workshop at HydroVision 2006, Oregon Convention Center, Portland, Oregon July 31, 2006

    SciTech Connect

    Dauble, Dennis D.

    2006-08-01

    This booklet contains abstracts of presentations made at a preconference workshop on the US Department of Energy and US Army Corps of Engineers hydroturbine programs. The workshop was held in conjunction with Hydrovision 2006 July 31, 2006 at the Oregon Convention Center in Portland Oregon. The workshop was organized by the Corps of Engineers, PNNL, and the DOE Wind and Hydropower Program. Presenters gave overviews of the Corps' Turbine Survival Program and the history of the DOE Advanced Turbine Development Program. They also spoke on physical hydraulic models, biocriteria for safe fish passage, pressure investigations using the Sensor Fish Device, blade strike models, optimization of power plant operations, bioindex testing of turbine performance, approaches to measuring fish survival, a systems view of turbine performance, and the Turbine Survival Program design approach.

  4. City of Faith Medical and Research Center, Tulsa, Oklahoma.

    PubMed

    1984-01-01

    The gold towers of the City of Faith command the viewer's attention as they soar into the Tulsa sky. Built by Evangelist Oral Roberts, the City of Faith combines a 60-story clinic and diagnostic center, a 30-story full-service hospital and a 20-story research center on one 80-acre site adjacent to the Oral Roberts University campus. Due in part to their futuristic architectural features, the campus and the City of Faith are one of the top tourist attractions in Oklahoma. Construction began in early 1978. The clinic, first opened in June 1981 with nine physicians, is now staffed with more than 80, all with faculty appointments to the Oral Roberts School of Medicine. The hospital accepted its first patient in November, 1981 and is currently certified for 294 beds (final plans call for a total of 777). The research center began operations last June and focuses on cancer, heart disease, arthritis, diabetes and geriatrics. Built entirely through contributions from followers of the Oral Roberts Ministries, the debt-free City of Faith is expected to cost more than $500 million when completed in 1988.

  5. 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

    ... replacement and upgrading of equipment at Veterans Memorial Medical Center. 17.351 Section 17.351 Pensions... Philippines § 17.351 Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center... rehabilitating the physical plant and facilities of the Veterans Memorial Medical Center, which the Secretary...

  6. 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

    ... replacement and upgrading of equipment at Veterans Memorial Medical Center. 17.351 Section 17.351 Pensions... Philippines § 17.351 Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center... rehabilitating the physical plant and facilities of the Veterans Memorial Medical Center, which the Secretary...

  7. Introducing Quality Assurance and Medical Audit into the UCSF Medical Center Curriculum

    ERIC Educational Resources Information Center

    Barbaccia, Joseph C.

    1976-01-01

    The experience gained by a medical school faculty in developing and piloting a course for undergraduate medical students in medical care evaluation at the University of California at San Francisco (UCSF) led to a similar effort for house staff. The preclinical and clinical courses developed are described and key factors in their success or failure…

  8. 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

  9. Teaching professional writing in an academic health sciences center: the Writing Center model at the Medical University of South Carolina.

    PubMed

    Smith, Tom G; Ariail, Jennie; Richards-Slaughter, Shannon; Kerr, Lisa

    2011-01-01

    Writing is taught as professional competency in higher education generally, but the health science education literature emphasizes writing as a pedagogical means rather than a professional end. The Medical University of South Carolina established a Writing Center in 1994 to teach professional writing. This report describes the rationale for profession-specific, graduate-level writing instruction; summarizes the Writing Center model; and reports usage data. Students have reported improvement in particular texts and said they would be better able to complete writing tasks in the future. Interventions modeled after the Writing Center and staffed with professionally trained writing teachers may provide a means to pool resources to teach writing as professional competency. The Writing Center has provided the expertise to teach professional writing without demanding curricular revision.

  10. National survey on excellence centers and reference centers for hypertension diagnosis and treatment: geographical distribution, medical facilities and diagnostic opportunities.

    PubMed

    Tocci, Giuliano; De Luca, Nicola; Sarzani, Riccardo; Ambrosioni, Ettore; Borghi, Claudio; Cottone, Santina; Cuspidi, Cesare; Fallo, Francesco; Ferri, Claudio; Morganti, Alberto; Muiesan, Maria Lorenza; Sechi, Leonardo; Virdis, Agostino; Mancia, Giuseppe; Volpe, Massimo

    2014-03-01

    Blood pressure (BP) control is poorly achieved in Western Countries, including Italy. Several interventions have been proposed at national and local level to improve BP control rate. This survey of the Italian Society of Hypertension (SIIA) is aimed at analysing the number and the distribution of reference centers and excellence centers for the diagnosis and treatment of arterial hypertension (hypertension centers) in Italy. In October 2011, a specifically designed survey questionnaire was developed by SIIA National Committee, both to evaluate geographical distribution of the reference hypertensive population and to assess general requirements (days of activity, number of active physicians, medical facilities, diagnostic opportunities, use of electronic support), deemed necessary to identify an outpatient clinic as hypertension center in Italy. This questionnaire was locally distributed by regional coordinators of the Society and all collected data were centrally analysed by two independent study coordinators. From October 2011 to September 2012, 89 centers with clinical expertise in the diagnosis and treatment of hypertension provided data on their own activity. Among these, 45 (50.5 %) centers are located in the North, 20 (22.5 %) in the Center and 24 (27.0 %) in the South of Italy. Approximately 50 % of the hypertensive outpatients who are referred from general practitioners to hypertension centers are living in the province and about one third in the region. More than half of the centers is active for 3-5 days per week, and approximately 40 % of the centers have 3-5 active physicians. Beyond outpatient visits for hypertension, these centers are able to organize day hospital (25 %), day service (29 %), or hospital admission (29 %) for advanced diagnostic evaluation or therapeutic interventions. All centers collect data from clinic and 24-hour ambulatory BP measurements, and almost all (95 %) centers are able to perform a standard 12-lead

  11. Identification of Asthma Phenotypes in a Tertiary Care Medical Center

    PubMed Central

    Kuhlen, James Lee; Wahlquist, Amy E.; Nietert, Paul J.; Bains, Sonia N.

    2015-01-01

    Background Asthma affects 5–10% of the population and its severity is assessed using four parameters: lung function, symptom frequency, rescue inhaler use, and number of asthma exacerbations1–2. Asthma is increasingly recognized as a clinical syndrome rather than a single disease3. However, the current classification system fails to reflect the heterogeneous characteristics of the disease4. Methods A retrospective chart review of 139 patients with mild, moderate, and severe persistent asthma was performed. Variables including baseline and maximal FEV1 (percent predicted), and age of asthma onset were used to classify patients. Results This yielded five clusters(C) similar to SARP. Subjects in C1 (n=32) and C2 (n= 47) had early onset atopic asthma and reduced lung function but differed in medication requirement and health care utilization (HCU). C3 (n=32) consisted of older obese women with late onset asthma, less atopy, and mildly reduced FEV1. Members of C4 (n=20) and C5 (n=8) had atopic asthma with severe obstruction but differed in bronchodilator response, age of onset, and oral corticosteroid use. Compared to SARP, our subjects were older, had a higher percentage of African Americans and obesity, and less severe asthma (p <0.05).The observed clusters differed from SARP clusters in the following: 1) More frequent asthma exacerbations and medication use among C1 and 2, 2) Lower medication use in C3 and 4, 3) Although total HCU was similar, there were fewer ED visits in C3 (p<0.05). Conclusion The SARP algorithm may be used to classify diverse asthmatic populations into a clinically reproducible phenotypic cluster. PMID:25319436

  12. The Medical Library and Media Center of Keio University in Tokyo: report on a visit.

    PubMed Central

    Accart, J P

    1995-01-01

    The Medical Library and Media Center at Keio University in Tokyo offers many facilities to its users: access to medical information within a large catalog of monographs and journals, online searching and CD-ROM databases, and a dynamic interlibrary loan service. This article is a report of a professional visit to the library on September 30, 1993. PMID:7703947

  13. 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,…

  14. 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,…

  15. An Evaluation of Ambulance Services at the Naval Regional Medical Center, Charleston, South Carolina.

    DTIC Science & Technology

    1980-08-01

    appropriate configuration for the ambulance program which balances medical benefits, J customer expectations, and available recources . This section...ambulance resources for this area at the Medical Center will result in greater efficiency of capital investment, and conservation of scarce human

  16. The University of New Mexico Medical Center Library's Health Information Services Outreach Program.

    ERIC Educational Resources Information Center

    Chamberlin, Susan B.; And Others

    Begun in 1980, the University of New Mexico Medical Center Library's statewide Outreach Program is a composite of many services and projects designed to meet the medical and health information needs of the state's diverse and scattered population. The only major biomedical library in New Mexico, the Library has built the program on existing…

  17. 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…

  18. 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)

  19. 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…

  20. [THE IMPLEMENTATION OF "EFFECTIVE CONTRACT" EXEMPLIFIED BY THE MEDICAL CENTER OF YAKUTSK].

    PubMed

    Borisova, E A; Savvina, N V; Lutskan, I P; Timofeev, L F

    2015-01-01

    The article considers issue of implementation of employment agreement by way of effective contract exemplified by the Yakutsk medical center of the Republic Sakha (Yakutia). The new job descriptions, criteria of effectiveness, ratings of implementation of functions of medical job position were developed. At that, mechanisms of registration and implementation of social guarantees in respect of health workers were proposed.

  1. 77 FR 4006 - Foreign-Trade Zone 45-Portland, Oregon; Expansion of Manufacturing Authority; Epson Portland, Inc...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-26

    ... Foreign-Trade Zones Board Foreign-Trade Zone 45--Portland, Oregon; Expansion of Manufacturing Authority; Epson Portland, Inc. (Inkjet Ink Manufacturing); Portland, OR An application has been submitted to the... of the scope of manufacturing authority approved within Subzone 45F, on behalf of Epson Portland,...

  2. 33 CFR 165.1326 - Regulated Navigation Areas; Port of Portland Terminal 4, Willamette River, Portland, OR.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... of Portland Terminal 4, Willamette River, Portland, OR. 165.1326 Section 165.1326 Navigation and... Areas Thirteenth Coast Guard District § 165.1326 Regulated Navigation Areas; Port of Portland Terminal 4... navigation area: (1) All waters of the Willamette River in the head of the Port of Portland's Terminal 4 Slip...

  3. 33 CFR 165.1326 - Regulated Navigation Areas; Port of Portland Terminal 4, Willamette River, Portland, OR.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... of Portland Terminal 4, Willamette River, Portland, OR. 165.1326 Section 165.1326 Navigation and... Areas Thirteenth Coast Guard District § 165.1326 Regulated Navigation Areas; Port of Portland Terminal 4... navigation area: (1) All waters of the Willamette River in the head of the Port of Portland's Terminal 4 Slip...

  4. 33 CFR 165.1326 - Regulated Navigation Areas; Port of Portland Terminal 4, Willamette River, Portland, OR.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... of Portland Terminal 4, Willamette River, Portland, OR. 165.1326 Section 165.1326 Navigation and... Areas Thirteenth Coast Guard District § 165.1326 Regulated Navigation Areas; Port of Portland Terminal 4... navigation area: (1) All waters of the Willamette River in the head of the Port of Portland's Terminal 4 Slip...

  5. 33 CFR 165.1326 - Regulated Navigation Areas; Port of Portland Terminal 4, Willamette River, Portland, OR.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... of Portland Terminal 4, Willamette River, Portland, OR. 165.1326 Section 165.1326 Navigation and... Areas Thirteenth Coast Guard District § 165.1326 Regulated Navigation Areas; Port of Portland Terminal 4... navigation area: (1) All waters of the Willamette River in the head of the Port of Portland's Terminal 4 Slip...

  6. 33 CFR 165.1326 - Regulated Navigation Areas; Port of Portland Terminal 4, Willamette River, Portland, OR.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... of Portland Terminal 4, Willamette River, Portland, OR. 165.1326 Section 165.1326 Navigation and... Areas Thirteenth Coast Guard District § 165.1326 Regulated Navigation Areas; Port of Portland Terminal 4... navigation area: (1) All waters of the Willamette River in the head of the Port of Portland's Terminal 4 Slip...

  7. Building on a commitment: new housing, education center a model for rural medical training.

    PubMed

    Ortolon, Ken

    2010-02-01

    The East Texas community of Crockett showed its growing commitment to medical education earlier this year when it launched construction of a Rural Physicians Education Center to provide housing for Texas College of Osteopathic Medicine students and family medicine residents from the Texas A&M Health Science Center doing one- to two-month rotations.

  8. 75 FR 6401 - Medical Devices Regulated by the Center for Biologics Evaluation and Research; Availability of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-09

    ... HUMAN SERVICES Food and Drug Administration Medical Devices Regulated by the Center for Biologics Evaluation and Research; Availability of Summaries of Safety and Effectiveness Data for Premarket Approval... the Center for Biologics Evaluation and Research (CBER). This list is intended to inform the public...

  9. The Institute for Safe Medication Practices and Poison Control Centers: Collaborating to Prevent Medication Errors and Unintentional Poisonings.

    PubMed

    Vaida, Allen J

    2015-06-01

    This article provides an overview on the Institute for Safe Medication Practices (ISMP), the only independent nonprofit organization in the USA devoted to the prevention of medication errors. ISMP developed the national Medication Errors Reporting Program (MERP) and investigates and analyzes errors in order to formulate recommendations to prevent further occurrences. ISMP works closely with the US Food and Drug Administration (FDA), drug manufacturers, professional organizations, and others to promote changes in package design, practice standards, and healthcare practitioner and consumer education. By collaborating with ISMP to share and disseminate information, Poison Control centers, emergency departments, and toxicologists can help decrease unintentional and accidental poisonings.

  10. Research centers and institutes in U.S. medical schools: a descriptive analysis.

    PubMed

    Mallon, William T; Bunton, Sarah A

    2005-11-01

    Research centers and institutes are a common mechanism to organize and facilitate biomedical research at medical schools and universities. The authors report the results of a study on the size, scope, and range of activities of 604 research centers and institutes at research-intensive U.S. medical schools and their parent universities. Centers and institutes with primary missions of patient care, education, or outreach were not included. The findings indicate that, in addition to research, centers and institutes are involved in a range of activities, including education, service, and technology transfer. The centers and institutes the authors studied were more interdisciplinary than those included in previous studies on this topic. Most research centers and institutes did not have authority comparable to academic departments. Only 22% of centers directly appointed faculty members, and most center directors reported to a medical school dean or a department chair. A small group of centers and institutes ("power centers"), however, reported to a university president or provost, and may have considerable power and influence in academic decision making and resource allocation. Two main types of centers and institutes emerge from this research. The first type, which includes the vast of majority of centers, is modest in its scope and marginal in its influence. The second type--with greater amounts of funding, larger staffs, and direct access to institutional decisionmakers--may have a more significant role in the organization and governance of the medical school and university and in the ways that researchers interact within and across academic divisions.

  11. Effects of Patient-Centered Medical Home Attributes on Patients’ Perceptions of Quality in Federally Supported Health Centers

    PubMed Central

    Lebrun-Harris, Lydie A.; Shi, Leiyu; Zhu, Jinsheng; Burke, Matthew T.; Sripipatana, Alek; Ngo-Metzger, Quyen

    2013-01-01

    PURPOSE We sought to assess patients’ ratings of patient-centered medical home (PCMH) attributes and overall quality of care within federally supported health centers. METHODS Data were collected through the 2009 Health Center Patient Survey (n = 4,562), which consisted of in-person interviews and included a nationally representative sample of patients seen in health centers. Quality measures included patients’ perceptions of overall quality of services, perceptions of quality of clinician advice/treatment, and likelihood of referring friends and relatives to the health center. PCMH attributes included (1) access to care getting to health center, (2) access to care during visit, (3) patient-centered communication with health care clinicians, (4) patient-centered communication with support staff, (5) self-management support for chronic conditions, (6) self-management support for behavioral risks, and (7) comprehensive preventive care. Bivariate analysis and logistic regressions were used to examine associations between patients’ perceptions of PCMH attributes and patient-reported quality of care. RESULTS Eighty-four percent of patients reported excellent/very good overall quality of services, 81% reported excellent/very good quality of clinician care, and 84% were very likely to refer friends and relatives. Higher patient ratings on the access to care and patient-centered communication attributes were associated with higher odds of patient-reported high quality of care on the 3 outcome measures. CONCLUSIONS More than 80% of patients perceived high quality of care in health centers. PCMH attributes related to access to care and communication were associated with greater likelihood of patients reporting high-quality care. PMID:24218374

  12. Portland Water Fluoridation: A Newspaper Analysis.

    PubMed

    Bianchi, Allison; Bergren, Martha Dewey; Lewis, Patricia Ryan

    2017-03-01

    Portland, Oregon is the largest city in the United States without community water fluoridation (CWF). A newspaper analysis was conducted of the failed 2013 CWF campaign to evaluate anti-fluoridation and pro-fluoridation messaging provided by newspapers during the campaign. News content was categorized by type and slant (pro-fluoridation, anti-fluoridation, or neutral) and 34 variables were tabulated (23 anti-fluoridation, 11 pro-fluoridation). Results showed overall messaging was slightly pro-fluoridation, as compared to anti-fluoridation or neutral content (35%, 32%, and 33% respectively). Editorial content was 85% pro-fluoridation and 15% anti-fluoridation. The most frequent anti-fluoridation variables were alternatives to water fluoridation, mass/forced medication and concerns about the political process. Conversely, tooth decay and social justice were the most commonly cited pro-fluoridation variables. Newspapers can be influential in shaping public policy opinions in the fight for community water fluoridation. © 2016 Wiley Periodicals, Inc.

  13. Implementing RECONSIDER, a diagnostic prompting computer system, at the Georgetown University Medical Center.

    PubMed

    Broering, N C; Corn, M; Ayers, W R; Mistry, P

    1988-04-01

    RECONSIDER, a computer program for diagnostic prompting developed at the University of California, San Francisco, has been implemented at the Georgetown University Medical Center as part of the Integrated Academic Information Management System Model Development grant project supported by the National Library of Medicine. The system is available for student use in the Biomedical Information Resources Center of the Dahlgren Memorial Library. Instruction on use of the computer system is provided by the library and instruction on medical use of the knowledge base is directed by the faculty. The implementation, capabilities, enhancements such as the addition of Current Medical Information and Terminology (5th ed.), and evaluation of the system are reported.

  14. Predictors of early faculty attrition at one Academic Medical Center

    PubMed Central

    2014-01-01

    Background Faculty turnover threatens the research, teaching and clinical missions of medical schools. We measured early attrition among newly-hired medical school faculty and identified personal and institutional factors associated with early attrition. Methods This retrospective cohort study identified faculty hired during the 2005–2006 academic year at one school. Three-year attrition rates were measured. A 40-question electronic survey measured demographics, career satisfaction, faculty responsibilities, institutional/departmental support, and reasons for resignation. Odds ratios (ORs) and 95 percent confidence intervals (95% CI) identified variables associated with early attrition. Results Of 139 faculty, 34% (95% CI = 26-42%) resigned within three years of hire. Attrition was associated with: perceived failure of the Department Chair to foster a climate of teaching, research, and service (OR = 6.03; 95% CI: 1.84, 19.69), inclusiveness, respect, and open communication (OR = 3.21; 95% CI: 1.04, 9.98). Lack of professional development of the faculty member (OR = 3.84; 95% CI: 1.25, 11.81); institutional recognition and support for excellence in teaching (OR = 2.96; 95% CI: 0.78, 11.19) and clinical care (OR = 3.87; 95% CI: 1.04, 14.41); and >50% of professional time devoted to patient care (OR = 3.93; 95% CI: 1.29, 11.93) predicted attrition. Gender, race, ethnicity, academic degree, department type and tenure status did not predict early attrition. Of still-active faculty, an additional 27 (48.2%, 95% CI: 35.8, 61.0) reported considering resignation within the 5 years. Conclusions In this pilot study, one-third of new faculty resigned within 3 years of hire. Greater awareness of predictors of early attrition may help schools identify threats to faculty career satisfaction and retention. PMID:24512629

  15. Conflict of interest issues pertinent to Veterans Affairs Medical Centers.

    PubMed

    Hanna, Jennifer; Simiele, Ernest; Lawson, D Curtis; Tyler, Douglas

    2011-09-01

    Conflicts of interest exist when an arrangement potentially exerts inappropriate influence on decision making or professional judgment, or is perceived to do so, and can thus damage the public trust and undermine the integrity of those decisions. Concerns regarding financial conflicts of interest in the medical arena have reached their height as of late, given that physicians now function in a milieu of complex and delicate relationships with pharmaceutical, biotechnology, and medical device industries. Even when such relationships do not correlate with actual compromise of judgment or patient care, it threatens the credibility of both the health care professional and the institution because of the social perception of the effect of these relationships. Although most institutions in the Western world set forth a code of ethics and conflict-of-interest policies to be followed under threat of termination, the Veterans Health Administration (VHA) presents itself as a unique environment in which conflicts of interest are subject to governmental laws, violation of which may not only result in employment-related discipline, but may be sanctioned by civil and criminal penalties. Moreover, these provisions are developed by a national authoritative organization rather than being institution-specific guidelines. Given that many academic physicians working within the VHA may also have a component of their practice in a University setting, it becomes important to understand the differences in policy between these contexts so as not to threaten the public trust in the veracity of decisions made and, therefore, maintain the integrity of the relationship between physician and patient. This article will review aspects of conflict-of-interest policies in the realm of research, financial relationships, foreign travel, and vendor contracting that are particular to the VHA and make it a unique environment to function in as a physician and scientist.

  16. Introducing quality assurance and medical audit into the UCSF medical center curriculum.

    PubMed

    Barbaccia, J C

    1976-05-01

    The experience gained by a medical school faculty in developing and piloting a course for undergraduate medical students in medical care evaluation led to a similar effort for house staff. It is recognized that if the profession is to fulfill the demand by society for social accountability in the use of resources for health care, medical care assessment and quality assurance mechanisms must become an intimate part of the clinical experience of medical students and house officers. Teaching these subjects requires a theoretical framework; introduction of content and skills appropriate to the level of the student and continuation of progressively more advanced training throughout medical education; use of assessment and quality assurance techniques by clinician-teachers themselves to provide models for the student; and continued evolution of pedagogic approach and course content based on developments in the area.

  17. 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.

  18. 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.

  19. Physician Payment Methods and the Patient-Centered Medical Home: Comment on "A Troubled Asset Relief Program for the Patient-Centered Medical Home".

    PubMed

    Quinn, Kevin

    This commentary analyzes the patient-centered medical home (PCMH) model within a framework of the 8 basic payment methods in health care. PCMHs are firmly within the fee-for-service tradition. Changes to the process and structure of the Resource Based Relative Value Scale, which underlies almost all physician fee schedules, could make PCMHs more financially viable. Of the alternative payment methods being considered, shared savings models are unlikely to transform medical practice whereas capitation models place unrealistic expectations on providers to accept epidemiological risk. Episode payment may strike a feasible balance for PCMHs, with newly available episode definitions presenting opportunities not previously available.

  20. Cancer Care Initiative: Creation of a Comprehensive Cancer Center at Naval Medical Center Dan Diego

    DTIC Science & Technology

    2008-06-24

    Roundtable (2004) found that sickle - cell anemia patients required 53% less pain medication when treated in a home-like environment. Distress is also an...more often than not, have had a positive impact on quality of care. In any case, there remains no one magic cure to fixing systems; single interventions

  1. Centralized Outpatient Education Center for Patients with Diabetes at Walter Reed Army Medical Center

    DTIC Science & Technology

    1984-05-16

    Center." Arizona Medicine. 37, no. 6 (1980): 431-32. Boutaugh, Michele L.; Hull, Alan L.; and Davis, Wayne K. "An Examina- tion of Diabetes Educational ... Assessment Forms." The Diabetes Educator. 7 (Winter, 1982): 29-34. Chang, Betty L. "Evaluation of Health Care Professionals in Facilita- ting Self-Care

  2. Occupational exposure to formaldehyde in a medical center autopsy service

    SciTech Connect

    Coldiron, V.R.; Ward, J.B. Jr.; Trieff, N.M.; Janssen, H.E. Jr.; Smith, J.H.

    1983-07-01

    The formaldehyde exposures occurring in the autopsy service of a medical complex were evaluated as part of a study to detect genetically harmful effects of chemical exposures. Determination of time-weighted average (TWA) exposures and characterization of the patterns of exposure experienced by individuals with different work responsibilities in this occupational setting were sought. Both general area and breathing zone samples were evaluated. Estimated weekly time-weighted average exposures for pathologists, residents and technicians were determined to be between 0.61 and 1.32 parts per million with little difference between work roles. While the averages were similar, the patterns of exposure of technicians and physicians were different. Technicians were exposed to a baseline level of formaldehyde for a prolonged period of time. In contrast, physicians were exposed for shorter times but experienced higher levels during specific tasks, particularly tissue-sectioning and examination. Evaluations of work procedures and environmental conditions in autopsy services are recommended to reduce personnel exposure to formaldehyde vapor.

  3. Composition of cardioplegic solutions used in nine medical centers.

    PubMed

    Klamerus, K J; Munger, M A

    1986-06-01

    Eleven institutions that participated in the Coronary Artery Surgery Study (CASS) were surveyed to obtain information about the types of cardioplegic solutions used at these institutions. A short-answer questionnaire designed to obtain specific information about the composition and method of preparation of cardioplegic solutions was sent to each institution. Institutions that did not reply within four weeks were sent a second questionnaire. Nine institutions returned completed questionnaires. Four institutions used several different cardioplegic solutions, resulting in a total of 14 evaluable solutions. Six hospitals used a chemical-based cardioplegic solution, one used a blood-based solution, and two used a combination of blood and chemicals as a cardioplegic-solution base. Chloride and potassium were found in all 14 solutions, although the amounts varied widely. Dextrose was included in eight of the nine chemical-based solutions, and bicarbonate and sodium were each used in seven of the nine solutions. Centers using chemical-based cardioplegic solutions compounded them daily or froze them with a one-week expiration date; blood-based solutions had to be prepared daily. Although interinstitutional differences in dosage were evident, the cardioplegic solutions used in the institutions participating in the CASS had many similar components. Data on the composition of these solutions can be used as a guideline for developing a cardioplegic solution.

  4. Impact of a pharmacy technician-centered medication reconciliation program on medication discrepancies and implementation of recommendations.

    PubMed

    Kraus, Sarah K; Sen, Sanchita; Murphy, Michelle; Pontiggia, Laura

    2017-01-01

    To evaluate the impact of a pharmacy-technician centered medication reconciliation (PTMR) program by identifying and quantifying medication discrepancies and outcomes of pharmacist medication reconciliation recommendations. A retrospective chart review was performed on two-hundred patients admitted to the internal medicine teaching services at Cooper University Hospital in Camden, NJ. Patients were selected using a stratified systematic sample approach and were included if they received a pharmacy technician medication history and a pharmacist medication reconciliation at any point during their hospital admission. Pharmacist identified medication discrepancies were analyzed using descriptive statistics, bivariate analyses. Potential risk factors were identified using multivariate analyses, such as logistic regression and CART. The priority level of significance was set at 0.05. Three-hundred and sixty-five medication discrepancies were identified out of the 200 included patients. The four most common discrepancies were omission (64.7%), non-formulary omission (16.2%), dose discrepancy (10.1%), and frequency discrepancy (4.1%). Twenty-two percent of pharmacist recommendations were implemented by the prescriber within 72 hours. A PTMR program with dedicated pharmacy technicians and pharmacists identifies many medication discrepancies at admission and provides opportunities for pharmacist reconciliation recommendations.

  5. Comprehensive quality of discharge summaries at an academic medical center

    PubMed Central

    Horwitz, Leora I.; Jenq, Grace Y.; Brewster, Ursula C.; Chen, Christine; Kanade, Sandhya; Van Ness, Peter H.; Araujo, Katy L. B.; Ziaeian, Boback; Moriarty, John P.; Fogerty, Robert; Krumholz, Harlan M.

    2013-01-01

    Background Discharge summaries are essential to safe transitions from hospital to home. Objective To conduct a comprehensive quality assessment of discharge summaries. Design Prospective cohort study. Subjects 377 patients discharged home after hospitalization for acute coronary syndrome, heart failure or pneumonia. Measures Discharge summaries were assessed for timeliness of dictation, transmission of the summary to appropriate outpatient clinicians and presence of key content, including elements required by The Joint Commission and elements endorsed by six medical societies in the Transitions of Care Consensus Conference (TOCCC). Results A total of 376 of 377 patients had completed discharge summaries. A total of 174 (46.3%) summaries were dictated on the day of discharge; 93 (24.7%) were completed more than a week after discharge. A total of 144 (38.3%) discharge summaries were not sent to any outpatient physician. On average, summaries included 5.6 of 6 Joint Commission elements and 4.0 of 7 TOCCC elements. Summaries dictated by hospitalists were more likely to be timely and to include key content than summaries dictated by house staff or advanced practice nurses. Summaries dictated on the day of discharge were more likely to be sent to outside physicians and to include key content. No summary met all three quality criteria of timeliness, transmission and content. Conclusions Discharge summary quality is inadequate in many domains. This may explain why individual aspects of summary quality such as timeliness or content have not been associated with improved patient outcomes. However, improving discharge summary timeliness may also improve content and transmission. PMID:23526813

  6. Cancers in Eastern Libya: First results from Benghazi Medical Center

    PubMed Central

    Bodalal, Zuhir; Azzuz, Raouf; Bendardaf, Riyad

    2014-01-01

    AIM: To study the pattern of cancer incidence and determine the incidence rates in Eastern Libya (for the first time in a decade). METHODS: A hospital-based registry of cancer patients was formed using records from the primary oncology center in eastern Libya - focusing on those diagnosed in the year 2012. RESULTS: The most common malignancies in men were cancers of the colon (22.3%, n = 90), lung (20.3%, n = 82), prostate (16.1%, n = 65), pancreas (4.2%, n = 17) and liver (4.2%, n = 17). For women, they were found to be cancers of the breast (41.5%, n = 213), colon (16.4%, n = 84), uterus (8%, n = 41), ovary (5.5%, n = 28) and pancreas (3.1%, n = 16). Additionally age-standardized rates (ASR) were determined for Libya. The different cities and towns in eastern Libya were compared for any variation. The city of Beida in particular was found to have a remarkably high incidence of gastric cancer. The different findings were discussed and comparisons were made with past literature as well as the incidence rates for neighbouring countries. The incidence rates given for the eastern region showed differences from previously reported values (i.e., the rate of colon cancer was the highest in North Africa whereas other malignancies occurred less frequently). Potential explanations for the urban-rural difference as well as the difference in incidence rates were put forth. The significance of this study is that it establishes a baseline of cancer incidence which should be the backbone for any future national cancer plan in Libya. CONCLUSION: Proper surveillance programs need to be in place and healthcare policy should be adjusted to take into account the more prevalent and pressing cancers in society. PMID:24876750

  7. Cancers in Eastern Libya: first results from Benghazi Medical Center.

    PubMed

    Bodalal, Zuhir; Azzuz, Raouf; Bendardaf, Riyad

    2014-05-28

    To study the pattern of cancer incidence and determine the incidence rates in Eastern Libya (for the first time in a decade). A hospital-based registry of cancer patients was formed using records from the primary oncology center in eastern Libya - focusing on those diagnosed in the year 2012. The most common malignancies in men were cancers of the colon (22.3%, n = 90), lung (20.3%, n = 82), prostate (16.1%, n = 65), pancreas (4.2%, n = 17) and liver (4.2%, n = 17). For women, they were found to be cancers of the breast (41.5%, n = 213), colon (16.4%, n = 84), uterus (8%, n = 41), ovary (5.5%, n = 28) and pancreas (3.1%, n = 16). Additionally age-standardized rates (ASR) were determined for Libya. The different cities and towns in eastern Libya were compared for any variation. The city of Beida in particular was found to have a remarkably high incidence of gastric cancer. The different findings were discussed and comparisons were made with past literature as well as the incidence rates for neighbouring countries. The incidence rates given for the eastern region showed differences from previously reported values (i.e., the rate of colon cancer was the highest in North Africa whereas other malignancies occurred less frequently). Potential explanations for the urban-rural difference as well as the difference in incidence rates were put forth. The significance of this study is that it establishes a baseline of cancer incidence which should be the backbone for any future national cancer plan in Libya. Proper surveillance programs need to be in place and healthcare policy should be adjusted to take into account the more prevalent and pressing cancers in society.

  8. Development of a postexposure biologic treatment algorithm on a medical center campus.

    PubMed

    Hansen-Cain, Kristine M; Smith, Stephen B; Paules, Catharine I; Smith, Philip W

    2013-01-01

    To describe the development of an easily accessible online biologic exposure algorithm to guide postexposure medical evaluation and treatment of medical research personnel and health care workers in a Midwest medical center campus. We describe the steps involved in the creation of a biologic exposure algorithm from design through implementation. One point of contact allows phone evaluation and immediate triage, providing effective and timely medical care for exposed employees as well as important guidance for clinicians. The algorithm and exposure response system achieved the goal of integrating clinical and research laboratory exposure response. Development of an integrated clinical and research exposure protocol may be an efficient way to maximize biosafety for workers.

  9. 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.

  10. What do clinicians want? Interest in integrative health services at a North Carolina academic medical center

    PubMed Central

    Kemper, Kathi J; Dirkse, Deborah; Eadie, Dee; Pennington, Melissa

    2007-01-01

    Background Use of complementary medicine is common, consumer driven and usually outpatient focused. We wished to determine interest among the medical staff at a North Carolina academic medical center in integrating diverse therapies and services into comprehensive care. Methods We conducted a cross sectional on-line survey of physicians, nurse practitioners and physician assistants at a tertiary care medical center in 2006. The survey contained questions on referrals and recommendations in the past year and interest in therapies or services if they were to be provided at the medical center in the future. Results Responses were received from 173 clinicians in 26 different departments, programs and centers. There was strong interest in offering several specific therapies: therapeutic exercise (77%), expert consultation about herbs and dietary supplements (69%), and massage (66%); there was even stronger interest in offering comprehensive treatment programs such as multidisciplinary pain management (84%), comprehensive nutritional assessment and advice (84%), obesity/healthy lifestyle promotion (80%), fit for life (exercise and lifestyle program, 76%), diabetes healthy lifestyle promotion (73%); and comprehensive psychological services for stress management, including hypnosis and biofeedback (73%). Conclusion There is strong interest among medical staff at an academic health center in comprehensive, integrated services for pain, obesity, and diabetes and in specific services in fitness, nutrition and stress management. Future studies will need to assess the cost-effectiveness of such services, as well as their financial sustainability and impact on patient satisfaction, health and quality of life. PMID:17291340

  11. The role of academic medical centers in delivery of primary care: an urban study.

    PubMed

    Garfield, R; Broe, D; Albano, B

    1995-05-01

    Washington Heights-Inwood is a multiethnic community in northern Manhattan served by an academic medical center, the Columbia-Presbyterian Medical Center. Two random, stratified household surveys were carried out in 1989-1990 and 1992. Results were compared with institutional utilization data to identify major changes in patterns of utilization of primary care since 1989. A total of 629 households completed interviews for the first survey, and 544 completed interviews for the second survey; respectively, 33% and 14.5% of the dwellings contacted did not complete interviews. During 1989-1990 the last physician visit for most people in this community was not provided at the academic medical center. Off-site, community-based services reached far fewer patients than did private doctors without local affiliations and out-of-area hospitals. Changes in utilization in the early 1990s considerably altered this picture. Many people who previously had received care outside the area either shifted to care in the area or went without care by 1992. Despite a rapid rise in services provided at community-based facilities associated with the Columbia-Presbyterian Medical Center, unmet needs continue to be great. A model for provision of service by academic medical centers in underserved urban communities is examined.

  12. 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

  13. Ambulatory Medication Reconciliation: Using a Collaborative Approach to Process Improvement at an Academic Medical Center.

    PubMed

    Keogh, Caroline; Kachalia, Allen; Fiumara, Karen; Goulart, Dorothy; Coblyn, Jonathan; Desai, Sonali P

    2016-04-01

    Incomplete medication reconciliation has been identified as a source of adverse drug events and a threat to patient safety. How best to measure and improve rates of medication reconciliation in ambulatory care remains unknown. An institutional collaborative improvement effort to develop and implement medication reconciliation processes was designed and facilitated across all 148 Brigham and Women's Hospital (Boston) ambulatory specialty practices: 63 underwent a more rigorous approach, a modified approach was undertaken in another 71 specialty practices, and a less intensive approach took place in the 14 primary care practices. The level of intervention varied on the basis of preexisting improvement infrastructure and practice prescription rates. Two electronically measured metrics were created to evaluate ambulatory visits to a provider in which there was a medication change: (1) Measure 1: the percentage of active medications prescribed by that provider that were reconciled; and (2) Measure 2: how often all the medications prescribed by that provider were reconciled. After the collaborative was completed, performance data were routinely shared with frontline staff and hospital leadership, and medication reconciliation rates became part of an institutional financial incentive program. For Measure 1, specialty practices improved from 71% to 90% (September 2012-August 2014; 24-month period). Primary care practice performance improved from 62% to 91% (December 2012-August 2014; 20-month period). For Measure 2, overall performance across all ambulatory practices increased from 81% to 90% during the first 12 months of the financial incentive program (October 2013- September 2014). A collaborative model of process improvement paired with financial incentives can successfully increase rates of ambulatory medication reconciliation.

  14. Impact of a Centralized Inpatient Hospice Unit in an Academic Medical Center.

    PubMed

    Jegier, Briana J; O'Mahony, Sean; Johnson, Julie; Flaska, Rita; Perry, Anthony; Runge, Mary; Sommerfeld, Teri

    2016-09-01

    Rush University Medical Center (RUMC) and Horizon Hospice opened the first centralized inpatient hospice unit (CIPU) in a Chicago academic medical center in 2012. This study examined if there was a difference in cost or length of stay (LOS) in a CIPU compared to hospice care in scattered beds throughout RUMC. This retrospective, cross-sectional study compared cost and LOS for patients admitted to the CIPU (n = 141) and those admitted to hospice scattered beds (SBM) throughout RUMC (n = 56). The CIPU patients had a median LOS of 6.0 days versus 2.0 days for SBM patients. The CIPU patients had longer hospice LOS but lower hospital costs. Academic medical centers may benefit from aggregating hospice beds. © The Author(s) 2015.

  15. Outcomes Achieved by Private Alternative Schools September 1987 to December 1988 in the Portland Public Schools.

    ERIC Educational Resources Information Center

    Yagi, Kan

    The outcomes for the 1987-88 school year achieved by eight private alternative schools that have contracted with the Portland (Oregon) Public Schools (PPS) to provide educational services to students are reported. The schools are: (1) Albina Youth Opportunity School (AYOS); (2) AYOS-Genesis; (3) DePaul Center Youth Treatment Services; (4) Lents…

  16. 33 CFR 167.51 - In the approaches to Portland, ME: Precautionary area.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...: Precautionary area. 167.51 Section 167.51 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND... Separation Schemes and Precautionary Areas § 167.51 In the approaches to Portland, ME: Precautionary area. A precautionary area is established with a radius of 5.45 miles centered upon geographical position 43°31.60′ N...

  17. 33 CFR 167.51 - In the approaches to Portland, ME: Precautionary area.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...: Precautionary area. 167.51 Section 167.51 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND... Separation Schemes and Precautionary Areas § 167.51 In the approaches to Portland, ME: Precautionary area. A precautionary area is established with a radius of 5.45 miles centered upon geographical position 43°31.60′ N...

  18. 33 CFR 167.51 - In the approaches to Portland, ME: Precautionary area.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...: Precautionary area. 167.51 Section 167.51 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND... Separation Schemes and Precautionary Areas § 167.51 In the approaches to Portland, ME: Precautionary area. A precautionary area is established with a radius of 5.45 miles centered upon geographical position 43°31.60′ N...

  19. Luxury primary care, academic medical centers, and the erosion of science and professional ethics.

    PubMed

    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.

  20. Challenges and Opportunities to Improve Cervical Cancer Screening Rates in US Health Centers through Patient-Centered Medical Home Transformation

    PubMed Central

    Makaroff, Laura; Chung, Michelle; Lin, Sue C.

    2015-01-01

    Over the last 50 years, the incidence of cervical cancer has dramatically decreased. However, health disparities in cervical cancer screening (CCS) persist for women from racial and ethnic minorities and those residing in rural and poor communities. For more than 45 years, federally funded health centers (HCs) have been providing comprehensive, culturally competent, and quality primary health care services to medically underserved communities and vulnerable populations. To enhance the quality of care and to ensure more women served at HCs are screened for cervical cancer, over eight HCs received funding to support patient-centered medical home (PCMH) transformation with goals to increase CCS rates. The study conducted a qualitative analysis using Atlas.ti software to describe the barriers and challenges to CCS and PCMH transformation, to identify potential solutions and opportunities, and to examine patterns in barriers and solutions proposed by HCs. Interrater reliability was assessed using Cohen's Kappa. The findings indicated that HCs more frequently described patient-level barriers to CCS, including demographic, cultural, and health belief/behavior factors. System-level barriers were the next commonly cited, particularly failure to use the full capability of electronic medical records (EMRs) and problems coordinating with external labs or providers. Provider-level barriers were least frequently cited. PMID:25685561

  1. Undergoing transformation to the patient centered medical home in safety net health centers: perspectives from the front lines.

    PubMed

    Quinn, Michael T; Gunter, Kathryn E; Nocon, Robert S; Lewis, Sarah E; Vable, Anusha M; Tang, Hui; Park, Seo-Young; Casalino, Lawrence P; Huang, Elbert S; Birnberg, Jonathan; Burnet, Deborah L; Summerfelt, W Thomas; Chin, Marshall H

    2013-01-01

    Safety net health centers (SNHCs), which include federally qualified health centers (FQHCs) provide primary care for underserved, minority and low income patients. SNHCs across the country are in the process of adopting the patient centered medical home (PCMH) model, based on promising early implementation data from demonstration projects. However, previous demonstration projects have not focused on the safety net and we know little about PCMH transformation in SNHCs. This qualitative study characterizes early PCMH adoption experiences at SNHCs. We interviewed 98 staff (administrators, providers, and clinical staff) at 20 of 65 SNHCs, from five states, who were participating in the first of a five-year PCMH collaborative, the Safety Net Medical Home Initiative. We conducted 30-45 minute, semi-structured telephone interviews. Interview questions addressed benefits anticipated, obstacles encountered, and lessons learned in transition to PCMH. Anticipated benefits for participating in the PCMH included improved staff satisfaction and patient care and outcomes. Obstacles included staff resistance and lack of financial support for PCMH functions. Lessons learned included involving a range of staff, anticipating resistance, and using data as frequent feedback. SNHCs encounter unique challenges to PCMH implementation, including staff turnover and providing care for patients with complex needs. Staff resistance and turnover may be ameliorated through improved health care delivery strategies associated with the PCMH. Creating predictable and continuous funding streams may be more fundamental challenges to PCMH transformation.

  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. 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…

  4. Cultural diversity process improves organizational community in urban teaching medical center.

    PubMed

    Carter, R; Spence, M M

    1996-01-01

    An urban teaching facility with nearly 3,000 employees had communication problems associated with race, gender and other cultural differences. It also competed for health care dollars and faced possible reduction in federal funding. The medical center instituted mandatory training in cultural diversity and customer service-and integrated the training process with the hospital's overall quality improvement plan and marketing strategy. The integrated approach affected the bottom line-Hurley's patient base has increased, and the medical center operates in the black. Training in cultural diversity and customer service is an effective tool to improve employee communication and improve financial outlook.

  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.

  6. Can Japanese students embrace learner-centered methods for teaching medical interviewing skills? Focus groups.

    PubMed

    Saiki, Takuya; Mukohara, Kei; Otani, Takashi; Ban, Nobutaro

    2011-01-01

    Students' perceptions of learner-centered methods for teaching medical interviewing skills have not been fully explored. To explore Japanese students' perceptions of learner-centered methods for teaching medical interviewing skills such as role play with student-created scenarios, peer-assisted video reviews, and student-led small group debriefing. We conducted three focus groups with a total of 15 students who participated in the learner-centered seminars on medical interviewing skills at the Nagoya University School of Medicine. The transcripts were analyzed by two authors independently. Keywords and concepts were identified and a thematic framework was developed. Overall, students valued the experience of writing their own scenarios for role play, but some questioned their realism. Many students commented that peer-assisted video reviews provided them with more objective perspectives on their performance. However, some students expressed concerns about competitiveness during the video reviews. While students appreciated teachers' minimum involvement in the group debriefing, some criticized that teachers did not explain the objectives of the seminar clearly. Many students had difficulties in exchanging constructive feedback. We were able to gain new insights into positive and negative perceptions of students about learner-centered methods for teaching medical interviewing skills at one medical school in Japan.

  7. 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.

  8. An Evaluation of the Navy Family Advocacy Program at Naval Regional Medical Center, Camp Pendleton, California.

    DTIC Science & Technology

    1982-08-01

    family life. The family is now seen as a nurturing center for human development and the primary agent for basic mental, as well as physical, health.2...community. The finite nature of its resources and the many dif- ferent programs which the medical center must support pose a significant management...registry.4 1 Because of the prospective nature of the review, Project CARE was able to obtain the needed information from the various case records

  9. Access to patient-centered medical home among Ohio's Children with Special Health Care Needs.

    PubMed

    Conrey, Elizabeth J; Seidu, Dazar; Ryan, Norma J; Chapman, Dj Sam

    2013-06-01

    Medical homes deliver primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective. Children with special health care needs (CSHCN) require a wide range of support to maintain health, making medical home access particularly important. We sought to understand independent risk factors for lacking access. We analyzed Ohio, USA data from the National Survey of Children with Special Health Care Needs (2005-2006). Among CSHCN, 55.6% had medical home access. The proportion achieving each medical home component was highest for having a personal doctor/nurse and lowest for receiving coordinated care, family-centered care and referrals. Specific subsets of CSHCN were significantly and independently more likely to lack medical home access: Hispanic (AOR=3.08), moderate/high severity of difficulty (AOR=2.84), and any public insurance (AOR=1.60). Efforts to advance medical home access must give special attention to these CSHCN populations and improvements must be made to referral access, family-centered care, and care coordination.

  10. Collaborative governance of multiinstitutional graduate medical education: lessons from the McGaw Medical Center of Northwestern University.

    PubMed

    Curry, Raymond H; Burgener, Alan J; Dooley, Sharon L; Christopher, Robert P

    2008-06-01

    The governance of graduate medical education (GME) and management of its interface with clinical care is a shared responsibility of teaching hospitals and medical educators. Significant changes in the structure and financing of medical care over the last few decades, along with a recent shift in the educational paradigm for GME, have made this collaboration all the more challenging. Calls for increased institutional accountability for GME from the Association of American Medical Colleges and the Accreditation Council on Graduate Medical Education have highlighted the need for more effective models of GME governance. With these challenges in mind, this article examines the recent experiences of The McGaw Medical Center of Northwestern University, a multiinstitutional, not-for-profitcorporation that serves as the vehicle for educational collaboration between Northwestern University Feinberg School of Medicine and the teaching hospitals/health systems that provide the clinical homes for McGaw-sponsored GME programs. The authors explore the rationale for pursuing a new model of GME governance at McGaw, and various factors important to its success. These "critical success factors" may be of use in other, similarly complex GME settings.

  11. Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center

    PubMed Central

    Detweiler, Mark B.; Pagadala, Bhuvaneshwar; Candelario, Joseph; Boyle, Jennifer S.; Detweiler, Jonna G.; Lutgens, Brian W.

    2016-01-01

    The effectiveness of medications for PTSD in general has been well studied, but the effectiveness of medicatio.ns prescribed specifically for post-traumatic stress disorder (PTSD) nightmares is less well known. This retrospective chart review examined the efficacy of various medications used in actual treatment of PTSD nightmares at one Veteran Affairs Hospital. Records at the Salem, VA Veterans Affairs Medical Center (VAMC) were examined from 2009 to 2013 to check for the efficacy of actual treatments used in comparis.on with treatments suggested in three main review articles. The final sample consisted of 327 patients and 478 separate medication trials involving 21 individual medications plus 13 different medication combinations. The three most frequently utilized medications were prazosin (107 trials), risperidone (81 trials), and quetiapine (72 trials). Five medications had 20 or more trials with successful results (partial to full nightmare cessation) in >50% of trials: risperidone (77%, 1.0–6.0 mg), clonidine (63%, 0.1–2.0 mg), quetiapine (50%, 12.5–800.0 mg), mirtazapine (50%; 7.5–30.0 mg), and terazosin (64%, 50.0–300.0 mg). Notably, olanzapine (2.5–10.0) was successful (full remission) in all five prescription trials in five separate patients. Based on the clinical results, the use of risperidone, clonidine, terazosin, and olanzapine warrants additional investigation in clinically controlled trials as medications prescribed specifically for PTSD nightmares. PMID:27999253

  12. Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center.

    PubMed

    Detweiler, Mark B; Pagadala, Bhuvaneshwar; Candelario, Joseph; Boyle, Jennifer S; Detweiler, Jonna G; Lutgens, Brian W

    2016-12-16

    The effectiveness of medications for PTSD in general has been well studied, but the effectiveness of medicatio.ns prescribed specifically for post-traumatic stress disorder (PTSD) nightmares is less well known. This retrospective chart review examined the efficacy of various medications used in actual treatment of PTSD nightmares at one Veteran Affairs Hospital. Records at the Salem, VA Veterans Affairs Medical Center (VAMC) were examined from 2009 to 2013 to check for the efficacy of actual treatments used in comparis.on with treatments suggested in three main review articles. The final sample consisted of 327 patients and 478 separate medication trials involving 21 individual medications plus 13 different medication combinations. The three most frequently utilized medications were prazosin (107 trials), risperidone (81 trials), and quetiapine (72 trials). Five medications had 20 or more trials with successful results (partial to full nightmare cessation) in >50% of trials: risperidone (77%, 1.0-6.0 mg), clonidine (63%, 0.1-2.0 mg), quetiapine (50%, 12.5-800.0 mg), mirtazapine (50%; 7.5-30.0 mg), and terazosin (64%, 50.0-300.0 mg). Notably, olanzapine (2.5-10.0) was successful (full remission) in all five prescription trials in five separate patients. Based on the clinical results, the use of risperidone, clonidine, terazosin, and olanzapine warrants additional investigation in clinically controlled trials as medications prescribed specifically for PTSD nightmares.

  13. 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…

  14. 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…

  15. 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.

  16. 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

  17. Improving the transition of care in patients transferred through the ochsner medical center transfer center.

    PubMed

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

    2012-01-01

    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. 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. 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). 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.

  18. Clinical case management and navigation for colonoscopy screening in an academic medical center.

    PubMed

    Cavanagh, Mary F; Lane, Dorothy S; Messina, Catherine R; Anderson, Joseph C

    2013-08-01

    One of 5 nationally funded Centers for Disease Control and Prevention Colorectal Cancer (CRC) Screening Demonstration Programs, Project SCOPE, was conducted at an academic medical center and provided colonoscopy screening at no cost to underserved minority patients from local community health centers. Established barriers to CRC screening (eg, financial, language, transportation) among the target population were addressed through clinical coordination of care by key project staff. The use of a clinician with a patient navigator allowed for the performance of precolonoscopy "telephone visits" instead of office visits to the gastroenterologist in virtually all patients. The clinician elicited information relevant to making screening decisions (eg, past medical and surgical history, focused review of systems, medication/supplement use, CRC screening history). The patient navigator reduced barriers, including, but not limited to, scheduling, transportation, and physical navigation of the medical center on the day of colonoscopy. Preprogram preparation was vital in laying groundwork for the project, yet enhancements to the program were ongoing throughout the screening period. Detailed referral forms from primary care physicians, coupled with information obtained during telephone interviews, facilitated high colonoscopy completion rates and excellent patient satisfaction. Similarly valuable was the employment of a bilingual patient navigator, who provided practical and emotional patient support. Academic medical centers can be efficient models for providing CRC screening to disadvantaged populations. Coordination of care by a preventive medicine department, directing the recruitment, scheduling, prescreening education, and the evaluation and preparation of target populations had an overall positive effect on CRC screening with colonoscopy among patients from a community health center. © 2013 American Cancer Society.

  19. 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.

  20. 5. Photocopy of plat (from Portland Registry of Deeds, Book ...

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

    5. Photocopy of plat (from Portland Registry of Deeds, Book 148, Page 385) delineator and date unknown 'COPY OF PLAN OF PARK STREET PROPRIETARY' - Park Street Block, Park, Spring & Gray Streets, Portland, Cumberland County, ME

  1. 77 FR 41685 - Drawbridge Operation Regulation; Willamette River, Portland, OR

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-16

    ... Willamette River, mile 13.1, at Portland, OR. This deviation is necessary to accommodate Portland's Big Float..., uninterrupted roadway passage of participants of the Big Float event. The Hawthorne Bridge crosses the...

  2. MedReach: building an Area Health Education Center medical information outreach system for northwest Ohio.

    PubMed

    Steiner, Victoria; Hartmann, Jonathan; Ronau, Theodore

    2002-07-01

    In collaboration with regional partners in northwest Ohio, the Area Health Education Center (AHEC) program at the Medical College of Ohio (MCO) at Toledo is reaching out to underserved areas, helping to provide educational opportunities to health care professionals in these communities. This paper describes the development of MedReach, a medical information outreach system that connects regional AHEC sites to MCO via the Internet. MedReach provides physicians and other health care professionals access and support to search computerized textbooks and databases for current information on medical diagnoses, treatments, and research. A unique aspect of the MedReach project is that users are able to receive personal help with information retrieval by calling or emailing MCO's outreach librarian. Periodically, the AHEC program and the Mulford Library at MCO also sponsor an educational program, titled "Medical Applications of Computers," for regional practitioners. Current feedback on both the medical information outreach system and the educational program has been positive.

  3. The Impact of Managed Care on Internal Medicine Graduate Medical Education at Brooke Army Medical Center

    DTIC Science & Technology

    2000-06-01

    managed care among residents and staff physicians (Simon, Pan , Sullivan, Clark-Chiarelli, Connelly, Peters, Singer, Inui, and Block, 1999). In fact...have Internal Medicine GME 11 shown that managed care has decreased time for research and teaching (Simon, Pan , Sullivan, Clark-Chiarelli, Connely...Residents on Operational Medicine, Managed Care, Graduate Medical Education, and Continued Military Service. Military Medicine, 163(6), 392. Simon, S. R., Pan

  4. Delinquent Medical Service Accounts at William Beaumont Army Medical Center Need Additional Management Oversight

    DTIC Science & Technology

    2014-09-16

    collection. This is the second in a series of reports concerning delinquent medical service accounts ( MSAs ). This report provides the results of our...review performed at WBAMC. We reviewed the 25 highest-dollar delinquent MSAs valued at $525,209. Finding WBAMC Uniform Business Office (UBO...management did not effectively manage delinquent MSAs . As of May 29, 2013, 1,688 of WBAMC MSAs , valued at $857,003, were more than 180 days delinquent

  5. 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

  6. 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.

  7. Rural Medical Service Funding: Issues and Alternatives. Rural Information Center Publication Series, No. 7.

    ERIC Educational Resources Information Center

    Kane, John D. H., III, Comp.; Leuci, Mary Simon, Comp.

    By almost any definition, rural America has been medically underserved. This bibliography includes materials available from the National Agricultural Library's (NAL) Rural Information Center. The listed materials include approximately 36 books and monographs, 106 articles, and the names and addresses of 17 related associations. Certain local…

  8. Research Strategies for Academic Medical Centers: A Framework for Advancements toward Translational Excellence

    ERIC Educational Resources Information Center

    Haley, Rand; Champagne, Thomas J., Jr.

    2017-01-01

    This review article presents a simplified framework for thinking about research strategy priorities for academic medical centers (AMCs). The framework can serve as a precursor to future advancements in translational medicine and as a set of planning guideposts toward ultimate translational excellence. While market pressures, reform uncertainties,…

  9. Periodical Utilization Study: Saint Elizabeth Hospital Medical Center, School of Nursing Library, Youngstown, Ohio.

    ERIC Educational Resources Information Center

    Ryan, Holly

    The Saint Elizabeth Hospital Medical Center School of Nursing Library has a strong collection of nursing and nursing management journals. With the rising subscription costs of periodicals, it was necessary to evaluate the collection of periodicals. This study was done to evaluate the periodicals that the library has in paper form. The study…

  10. 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…

  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. Impact of Institution of a Stroke Program upon Referral Bias at a Rural Academic Medical Center

    ERIC Educational Resources Information Center

    Riggs, Jack E.; Libell, David P.; Brooks, Claudette E.; Hobbs, Gerald R.

    2005-01-01

    Context: Referral bias reflecting the preferential hospital transfer of patients with intracerebral hemorrhage (ICH) has been demonstrated as the major contributing factor for an observed high nonrisk-adjusted in-hospital crude acute stroke mortality rate at a rural academic medical center. Purpose: This study was done to assess the impact of a…

  13. 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…

  14. Impact of Institution of a Stroke Program Upon Referral Bias at a Rural Academic Medical Center

    ERIC Educational Resources Information Center

    Riggs, Jack E.; Libell, David P.; Brooks, Claudette E.; Hobbs, Gerald R.

    2005-01-01

    Context: Referral bias reflecting the preferential hospital transfer of patients with intracerebral hemorrhage (ICH) has been demonstrated as the major contributing factor for an observed high nonrisk-adjusted in-hospital crude acute stroke mortality rate at a rural academic medical center. Purpose: This study was done to assess the impact of a…

  15. 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…

  16. 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…

  17. 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…

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

    USDA-ARS?s Scientific Manuscript database

    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...

  19. Impact of Institution of a Stroke Program upon Referral Bias at a Rural Academic Medical Center

    ERIC Educational Resources Information Center

    Riggs, Jack E.; Libell, David P.; Brooks, Claudette E.; Hobbs, Gerald R.

    2005-01-01

    Context: Referral bias reflecting the preferential hospital transfer of patients with intracerebral hemorrhage (ICH) has been demonstrated as the major contributing factor for an observed high nonrisk-adjusted in-hospital crude acute stroke mortality rate at a rural academic medical center. Purpose: This study was done to assess the impact of a…

  20. Impact of Institution of a Stroke Program Upon Referral Bias at a Rural Academic Medical Center

    ERIC Educational Resources Information Center

    Riggs, Jack E.; Libell, David P.; Brooks, Claudette E.; Hobbs, Gerald R.

    2005-01-01

    Context: Referral bias reflecting the preferential hospital transfer of patients with intracerebral hemorrhage (ICH) has been demonstrated as the major contributing factor for an observed high nonrisk-adjusted in-hospital crude acute stroke mortality rate at a rural academic medical center. Purpose: This study was done to assess the impact of a…

  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. Implementation of an Employee Work Environment Survey at Landstuhl Regional Medical Center Landstuhl, Germany.

    DTIC Science & Technology

    1996-06-01

    The purpose of this study was to assess the organizational climate at Landstuhl Regional Medical Center (LRMC) through the use of a Work Environment Scale...An additional set of questions were specifically developed for the LRMC work environment . These questions included demographic items to assist in the

  3. 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…

  4. Building Brains, Forging Futures: A Call to Action for the Family-Centered Medical Home

    ERIC Educational Resources Information Center

    Kraft, Colleen

    2013-01-01

    The family-centered medical home describes an approach to providing comprehensive primary care. Research advances in developmental neuroscience, genetics, and epigenetics offer a framework for understanding the dynamic process of brain development. It is this process that sets the life-course trajectory for an individual; in turn, a child's…

  5. 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…

  6. 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…

  7. Veterans Affairs and Academic Medical Center Affiliations: The North Texas Experience

    ERIC Educational Resources Information Center

    Mohl, Paul Cecil; Hendrickse, William; Orsak, Catherine; Vermette, Heidi

    2009-01-01

    Objective: The authors review the more than 30-year history of the academic affiliation between the Department of Psychiatry at the University of Texas Southwestern Medical Center in Dallas and the Mental Health Service at the Veterans Affairs North Texas Health Care System. Methods: The authors interviewed individuals involved at various stages…

  8. 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…

  9. 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…

  10. 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…

  11. Patching the safety net: establishing a free specialty care clinic in an academic medical center.

    PubMed

    Shuman, Andrew G; Aliu, Oluseyi; Simpson, Katherine; Salow, Paul; Morgenstern, Kara; Jennings, Edward J; Cederna, Jean; McKean, Erin L; Bradford, Carol R; Cederna, Paul S

    2014-11-01

    We describe the collaboration between an academic medical center and a free primary care clinic that provides multi-specialty services to indigent community members. Complementary components of both institutions have engendered a system in which they broaden the array of available services, providing a prototype for other institutions to collaborate similarly.

  12. Patching the safety net: establishing a free specialty care clinic in an academic medical center.

    PubMed

    Shuman, Andrew G; Aliu, Oluseyi; Simpson, Katherine; Salow, Paul; Morgenstern, Kara; Jennings, Edward J; Cederna, Jean; McKean, Erin L; Bradford, Carol R; Cederna, Paul S

    2014-08-01

    We describe the collaboration between an academic medical center and a free primary care clinic that provides multi-specialty services to indigent community members. Complementary components of both institutions have engendered a system in which they broaden the array of available services, providing a prototype for other institutions to consider.

  13. 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…

  14. 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 ...

  15. 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)

  16. Building Brains, Forging Futures: A Call to Action for the Family-Centered Medical Home

    ERIC Educational Resources Information Center

    Kraft, Colleen

    2013-01-01

    The family-centered medical home describes an approach to providing comprehensive primary care. Research advances in developmental neuroscience, genetics, and epigenetics offer a framework for understanding the dynamic process of brain development. It is this process that sets the life-course trajectory for an individual; in turn, a child's…

  17. Veterans Affairs and Academic Medical Center Affiliations: The North Texas Experience

    ERIC Educational Resources Information Center

    Mohl, Paul Cecil; Hendrickse, William; Orsak, Catherine; Vermette, Heidi

    2009-01-01

    Objective: The authors review the more than 30-year history of the academic affiliation between the Department of Psychiatry at the University of Texas Southwestern Medical Center in Dallas and the Mental Health Service at the Veterans Affairs North Texas Health Care System. Methods: The authors interviewed individuals involved at various stages…

  18. 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 ...

  19. Transformation of an academic medical center: lessons learned from restructuring and downsizing.

    PubMed

    Woodard, B; Fottler, M D; Kilpatrick, A O

    1999-01-01

    This article reviews management literature on health care transformation and describes the processes, including restructuring, job redesign, and downsizing, involved in one academic medical center's experience. The article concludes with lessons learned at each of the stages of the transformation process: planning, implementation, and process continuation. Managerial implications for similar transformation efforts in other health care organizations are suggested.

  20. Hemophilus influenzae meningitis at the Children's Hospital Medical Center in Boston, 1958 to 1973.

    PubMed

    Peter, G; Smith, D H

    1975-04-01

    Three hundred ninety-seven children were admitted to the Children's Hospital Medical Center, Boston between 1958 and 1973 with H. influenzae meningitis. The annual rate of admission and the percent of all cases of bacterial meningitis were not changed from that of the preceding decade. The age incidence was strikingly similar to that reported from this hospital for 1920 to 1932.

  1. Developing physician leaders in academic medical centers. Part 1: Their changing role.

    PubMed

    Bachrach, D J

    1996-01-01

    While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management, intramurally conducted courses in leadership skill development; management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. This article article was prepared by the author from research into and presentation of a thesis entitled. "The Importance of Leadership Training And Development For Physicians In Academic Medical Centers In An Increasingly Complex Healthcare Environment, " prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in the College (ACHE). Part 2 will appear in the next issue of the Journal.

  2. 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

  3. Managing knowledge and technology to foster innovation at the Ohio State University Medical Center.

    PubMed

    Cain, Timothy J; Rodman, Ruey L; Sanfilippo, Fred; Kroll, Susan M

    2005-11-01

    Biomedical knowledge is expanding at an unprecedented rate-one that is unlikely to slow anytime in the future. While the volume and scope of this new knowledge poses significant organizational challenges, it creates tremendous opportunities to release and direct its power to the service of significant goals. The authors explain how the Center for Knowledge Management at The Ohio State University Medical Center, created during the academic year 2003-04, is doing just that by integrating numerous resource-intensive, technology-based initiatives-including personnel, services and infrastructure, digital repositories, data sets, mobile computing devices, high-tech patient simulators, computerized testing, and interactive multimedia-in a way that enables the center to provide information tailored to the needs of students, faculty and staff on the medical center campus and its surrounding health sciences colleges. The authors discuss how discovering, applying, and sharing new knowledge, information assets, and technologies in this way is a collaborative process. This process creates open-ended opportunities for innovation and a roadmap for working toward seamless integration, synergy, and substantial enhancement of the academic medical center's research, educational, and clinical mission areas.

  4. Nurse-managed health centers and patient-centered medical homes could mitigate expected primary care physician shortage.

    PubMed

    Auerbach, David I; Chen, Peggy G; Friedberg, Mark W; Reid, Rachel; Lau, Christopher; Buerhaus, Peter I; Mehrotra, Ateev

    2013-11-01

    Numerous forecasts have predicted shortages of primary care providers, particularly in light of an expected increase in patient demand resulting from the Affordable Care Act. Yet these forecasts could be inaccurate because they generally do not allow for changes in the way primary care is delivered. We analyzed the impact of two emerging models of care--the patient-centered medical home and the nurse-managed health center--both of which use a provider mix that is richer in nurse practitioners and physician assistants than today's predominant models of care delivery. We found that projected physician shortages were substantially reduced in plausible scenarios that envisioned greater reliance on these new models, even without increases in the supply of physicians. Some less plausible scenarios even eliminated the shortage. All of these scenarios, however, may require additional changes, such as liberalized scope-of-practice laws; a larger supply of medical assistants, licensed practical nurses, and aides; and payment changes that reward providers for population health management.

  5. 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.

  6. Progress of Ontario's Family Health Team model: a patient-centered medical home.

    PubMed

    Rosser, Walter W; Colwill, Jack M; Kasperski, Jan; Wilson, Lynn

    2011-01-01

    Ontario's Family Health Team (FHT) model, implemented in 2005, may be North America's largest example of a patient-centered medical home. The model, based on multidisciplinary teams and an innovative incentive-based funding system, has been developed primarily from fee-for-service primary care practices. Nearly 2 million Ontarians are served by 170 FHTs. Preliminary observations suggest high satisfaction among patients, higher income and more gratification for family physicians, and trends for more medical students to select careers in family medicine. Popular demand is resulting in expansion to 200 FHTs. We describe the development, implementation, reimbursement plan, and current status of this multidisciplinary model, relating it to the principles of the patient-centered medical home. We also identify its potential to provide an understanding of many aspects of primary care.

  7. 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.

  8. 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

  9. Using a medical simulation center as an electronic health record usability laboratory

    PubMed Central

    Landman, Adam B; Redden, Lisa; Neri, Pamela; Poole, Stephen; Horsky, Jan; Raja, Ali S; Pozner, Charles N; Schiff, Gordon; Poon, Eric G

    2014-01-01

    Usability testing is increasingly being recognized as a way to increase the usability and safety of health information technology (HIT). Medical simulation centers can serve as testing environments for HIT usability studies. We integrated the quality assurance version of our emergency department (ED) electronic health record (EHR) into our medical simulation center and piloted a clinical care scenario in which emergency medicine resident physicians evaluated a simulated ED patient and documented electronically using the ED EHR. Meticulous planning and close collaboration with expert simulation staff was important for designing test scenarios, pilot testing, and running the sessions. Similarly, working with information systems teams was important for integration of the EHR. Electronic tools are needed to facilitate entry of fictitious clinical results while the simulation scenario is unfolding. EHRs can be successfully integrated into existing simulation centers, which may provide realistic environments for usability testing, training, and evaluation of human–computer interactions. PMID:24249778

  10. Fellowship candidate selection at the BEST Medical Center: A novel process.

    PubMed

    Cohen, Philip R

    Dr. Ida Lystic completed her MD degree at the prestigious Harvey Medical School (which has since been renamed the Harvey Provider School) and her residency in internal medicine and gastroenterology fellowship at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center. She was subsequently hired as an assistant professor at the BEST (Byron Edwards and Samuel Thompson) Medical Center in 2015. After eventually completing an extensive list of employment requirements, she was able to begin seeing patients. She had not anticipated a change in the electronic medical record systems-from the user-friendly intuitive SIMPLE (Succinct Input Making Patients' Lives Electronic) system to the complicated and challenging LEGEND (perhaps, as her colleagues had suggested, Lengthy and Excessively Graded Evaluation and Nomenclature for Diagnosis) system. Nor had she expected some of the challenges encountered in her daily clinic routine: The lack of schedulers for her patients (based on recommendations by the Optima Efficiency Consultant Group and incorporated by the BEST efficiency department) and the addition of egg timers on the doors along with a compliance spreadsheet and corrective action plan for the tardy physicians to complete to encourage punctuality (based on the assessment of the Wait Time Committee). She joined the LOST (Laboratory OverSight and Testing) Committee, because participation to support BEST Medical Center practices is strongly suggested for faculty seeking promotion; however, when the new committee chairman-who is a surgeon-was elected, the noon meetings were rescheduled for 6:00 am each month. At the request of her recently divorced department chairman, the philandering Dr. Seymore Fox, she became deputy head of the Gastroenterology Fellowship Selection Committee; she recently coordinated the selection of the physicians for next year's fellowship. The fellowship candidate selection process at the BEST Medical School is probably similar to that performed

  11. Not the same everywhere. Patient-centered learning environments at nine medical schools.

    PubMed

    Haidet, Paul; Kelly, P Adam; Bentley, Susan; Blatt, Benjamin; Chou, Calvin L; Fortin, Auguste H; Gordon, Geoffrey; Gracey, Catherine; Harrell, Heather; Hatem, David S; Helmer, Drew; Paterniti, Debora A; Wagner, Dianne; Inui, Thomas S

    2006-05-01

    Learning environments overtly or implicitly address patient-centered values and have been the focus of research for more than 40 years, often in studies about the "hidden curriculum." However, many of these studies occurred at single medical schools and used time-intensive ethnographic methods. This field of inquiry lacks survey methods and information about how learning environments differ across medical schools. To examine patient-centered characteristics of learning environments at 9 U.S. medical schools. Cross-sectional internet-based survey. Eight-hundred and twenty-three third- and fourth-year medical students in the classes of 2002 and 2003. We measured the patient-centeredness of learning environments with the Communication, Curriculum, and Culture (C3) Instrument, a 29-item validated measure that characterizes the degree to which a medical school's environment fosters patient-centered care. The C3 Instrument contains 3 content areas (role modeling, students' experiences, and support for students' patient-centered behaviors), and is designed to measure these areas independent of respondents' attitudes about patient-centered care. We also collected demographic and attitudinal information from respondents. The variability of C3 scores across schools in each of the 3 content areas of the instrument was striking and statistically significant (P values ranged from .001 to .004). In addition, the patterns of scores on the 3 content areas differed from school to school. The 9 schools demonstrated unique and different learning environments both in terms of magnitude and patterns of characteristics. Further multiinstitutional study of hidden curricula is needed to further establish the degree of variability that exists, and to assist educators in making informed choices about how to intervene at their own schools.

  12. 54. Photocopy of diagram (from Station 'L' office files, Portland, ...

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

    54. Photocopy of diagram (from Station 'L' office files, Portland, Oregon) General Electric Company pamphlet, c.1930 SECTIONAL ELEVATION OF THE 35,000 KW GENERATOR BUILDING L5 - Portland General Electric Company, Station "L", 1841 Southeast Water Street, Portland, Multnomah County, OR

  13. 53. Photocopy of diagram (from Station 'L' office files, Portland, ...

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

    53. Photocopy of diagram (from Station 'L' office files, Portland, Oregon) General Electric Company pamphlet, c.1925 SECTIONAL ELEVATION OF THE 20,000 KW GENERATOR BUILDING L1 - Portland General Electric Company, Station "L", 1841 Southeast Water Street, Portland, Multnomah County, OR

  14. 51. Photocopy of diagram (from Station 'L' office files, Portland, ...

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

    51. Photocopy of diagram (from Station 'L' office files, Portland, Oregon) General Electric Company pamphlet, c.1923 SECTIONAL ARRANGEMENT OF THE 6,000 KW TURBINE GENERATOR BUILDING L1 - Portland General Electric Company, Station "L", 1841 Southeast Water Street, Portland, Multnomah County, OR

  15. 23. Photocopy of photograph (from Station 'L' office files, Portland, ...

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

    23. Photocopy of photograph (from Station 'L' office files, Portland, Oregon) Photographer unknown, c.1930 BUCKET USED TO UNLOAD SAWDUST FROM BARGES ONTO CONVEYORS, CONVEYORS LED TO EITHER THE SAWDUST PILE OR DIRECTLY TO THE BOILER FURNACES - Portland General Electric Company, Station "L", 1841 Southeast Water Street, Portland, Multnomah County, OR

  16. Delinquent Medical Service Accounts at David Grant Air Force Medical Center Need Additional Management Oversight

    DTIC Science & Technology

    2015-09-24

    facilities. DGMC provides a full spectrum of care to a prime service area of more than 106,000 Tricare-eligible patients in the San Francisco-Sacramento...area and 370,000 patients from the Department of Veterans Affairs Northern California Health Care System that covers more than 40,000 square miles and...members of the Military Services and others entitled to or eligible for DoD medical care and benefits. U.S. Treasury FedDebt FedDebt is an online

  17. Substantial variation in the acceptance of medically complex live kidney donors across US renal transplant centers

    PubMed Central

    Reese, PP; Feldman, HI; McBride, MA; Anderson, K; Asch, DA; Bloom, RD

    2008-01-01

    Concern exists about accepting live kidney donation from “medically complex donors” -those with risk factors for future kidney disease. This study’s aim was to examine variation in complex kidney donor use across United States (US) transplant centers. We conducted a retrospective cohort study of live kidney donors using Organ Procurement and Transplantation Network data. Donors with hypertension, obesity, or estimated glomerular filtration rate (eGFR) <60 ml/minute/1.73m2 were considered medically complex. Among 9319 donors, 2254 (24.2%) were complex: 1194 (12.8%) were obese, 956 (10.3%) hypertensive, and 392 (4.2%) had low eGFR. The mean proportion of medically complex donors at a center was 24% (range 0 – 65%.) In multivariate analysis, donor characteristics associated with medical complexity included spousal relationship to the recipient (OR 1.29, CI 1.06-1.56, p<0.01), low education (OR 1.19, CI 1.04-1.37, p=0.01), older age (OR 1.01 per year, CI 1.01-1.02, p<0.01), and non-US citizenship (OR 0.70, CI 0.51-0.97, p=0.01). Renal transplant centers with the highest transplant volume (OR 1.26, CI 1.02-1.57, p=0.03), and with a higher proportion of (living donation)/(all kidney transplants) (OR 1.97, CI 1.23-3.16, p<0.01) were more likely to use medically complex donors. Though controversial, the use of medically complex donors is widespread and varies widely across centers. PMID:18727695

  18. Inpatient pharmacological sleep aid utilization is common at a tertiary medical center.

    PubMed

    Gillis, Christine M; Poyant, Janelle O; Degrado, Jeremy R; Ye, Lichuan; Anger, Kevin E; Owens, Robert L

    2014-10-01

    Sleep is known to be poor in the hospital. Patients frequently request pharmacological sleep aids, despite the risk of altered mental status (delirium) and falls. Little is known about the scope of pharmacological sleep aid use in hospitalized patients. We performed a single center, retrospective review of all patients admitted to the general adult (age >18 years) medical and surgical units of a tertiary care center during a recent 2-month period (January 2013-February 2013). Review of the electronic medication administration system was performed to assess for medications administered for sleep. Of 642 unique admissions, 168 patients (26.2%) received a medication for sleep. Most (n = 115, 68.5%) had no known history of insomnia or regular prior sleep medication use. Patients most frequently were treated with trazodone (30.4%; median dose, 50 mg; range, 12.5-450 mg), lorazepam (24.4%; median, 0.5 mg; range, 0.25-2 mg), and zolpidem tartrate (17.9%; median, 10 mg; range, 2.5-10 mg). Of the medications given, 36.7% were given early (before 9 pm) or late (after midnight). Of patients not known to be previously taking a pharmacological sleep aid, 34.3% of them were discharged with a prescription for one. Despite increasing evidence of risks such as delirium or falls, pharmacological sleep aid use in general wards remains common, even in elderly patients. Medication administration time is frequently suboptimal. Many previously sleep medication-naïve patients leave the hospital with a sleep aid prescription. Further research is needed to understand the factors that contribute to the high rate of sleep medication use in hospitalized patients. © 2014 Society of Hospital Medicine.

  19. 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

  20. The Fontan Patient: Inconsistencies in Medication Therapy Across Seven Pediatric Heart Network Centers

    PubMed Central

    Anderson, Page A. W.; McCrindle, Brian W.; Sleeper, Lynn A.; Atz, Andrew M.; Hsu, Daphne T.; Lu, Minmin; Margossian, Renee; Williams, Richard V.

    2011-01-01

    Patients who have undergone the Fontan procedure are at risk for thrombosis, ventricular dysfunction, and valve regurgitation, but data to guide the medical treatment and prevention of these adverse outcomes in this population are lacking. This analysis examined medication usage among Fontan patients by putative indication and by study center. The medical history and current medications of 546 Fontan subjects, ages 6–18 years, were assessed in a Pediatric Heart Network multicenter cross-sectional study. Cardiac imaging was performed within 3 months of enrollment. The majority of the subjects (64%) were taking two or more medications. Antithrombotics were taken by 86% of those with a history of stroke, thrombosis, or both and 67% of those without such a history (P = 0.01). Conversely, 14% of those with a history of stroke, thrombosis, or both were taking no antithrombotic. Angiotensin-converting enzyme inhibitor (ACEi) therapy was independently associated with moderate or severe atrioventricular valve regurgitation (P = 0.004), right ventricular morphology (P < 0.001), and shorter time since Fontan (P = 0.004) but not with ventricular systolic dysfunction. Glycoside therapy and diuretic therapy each was associated with older age at Fontan (P = 0.001 and P = 0.023, respectively) and a history of post-Fontan arrhythmia (P < 0.001 and P = 0.003, respectively) but not with ventricular systolic dysfunction. Medication use rates varied widely among the centers, even with controls for center differences in patient characteristics. Prospective therapeutic trials are needed to guide the medical treatment of Fontan patients. PMID:20938655

  1. 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

  2. Prevalence and associated factors of polypharmacy among adult Saudi medical outpatients at a tertiary care center

    PubMed Central

    Salih, Salih Bin; Yousuf, Muhammad; Durihim, Huda; Almodaimegh, Hind; Tamim, Hani

    2013-01-01

    Objective: The objective of this study was to assess the prevalence of polypharmacy (PP) and the associated factors in medical outpatients. Materials and Methods: A cross-sectional, observational, descriptive study was carried out in adult medical outpatients attending internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 1 March 2009 to 31 December 2009. PP was defined as the concomitant use of ≥5 medications daily. The number of medications being currently taken by patient was recorded. Effect of patients’ age, gender, educational level, number of prescribers, disease load and disease type on PP was assessed by multivariate analysis using Statistical Package for Social Sciences Incorporated (SPSS Inc) Version 18. Results: Out of 766 patients included in the study, 683 (89%) had PP. The mean number of prescribed medications, oral pills and doses was 8.8, 9.6 and 12.1, respectively. Factors significantly associated with PP included age (≥61 years), disease load and the number of prescribers. Gender had no impact on PP while education beyond primary education significantly decreased PP. Hypertension, diabetes mellitus and dyslipidemia alone and as a cluster increased PP. Conclusion: We found an extremely high level of PP in medical outpatients at our tertiary care center. The impact of PP on medication compliance and control of underlying diseases in Saudi Arabia is unknown and needs to be studied at different levels of care. PMID:24672273

  3. Information Roundup: A Continuing Education Session on Microforms and Data Processing in the Library and Information Center: Costs/Benefits/History/Trends. Proceedings of the ASIS Mid-Year Meeting (4th, Portland, Oregon, May 15-17, 1975).

    ERIC Educational Resources Information Center

    Spigai, Frances G., Ed.; And Others

    Sixteen papers are presented which focus on microforms and data processing in library and information centers. Articles include discussions of cost analysis, decision making and program planning, library automation, information retrieval, indexing, cataloging, and computer services for libraries. (CH)

  4. Implementation and Impact of Psychiatric Electronic Medical Records in a Public Medical Center

    PubMed Central

    Xiao, Anna Q.; Acosta, Frank X.

    2016-01-01

    Objectives This study describes the efforts to implement electronic charting in a large public psychiatric outpatient clinic with the objective to improve clinical documentation. Methods Data made available through the quality review process are utilized to evaluate the effectiveness of the electronic intervention. The study is a comparative analysis of the three years before and three years after the point of implementation of electronic charting. Results Statistical analyses indicate significant findings (p <.0001) in the comparison of the periods before and after implementation in terms of note completion and documentation of medication management, supporting the study's hypothesis that electronic intervention will improve the quality of clinical documentation. Conclusions This study contributes new knowledge to improve our understanding of the barriers and benefits of implementing and maintaining electronic charting in mental health settings. PMID:27843422

  5. Community health centers employ diverse staffing patterns, which can provide productivity lessons for medical practices.

    PubMed

    Ku, Leighton; Frogner, Bianca K; Steinmetz, Erika; Pittman, Patricia

    2015-01-01

    Community health centers are at the forefront of ambulatory care practices in their use of nonphysician clinicians and team-based primary care. We examined medical staffing patterns, the contributions of different types of staff to productivity, and the factors associated with staffing at community health centers across the United States. We identified four different staffing patterns: typical, high advanced-practice staff, high nursing staff, and high other medical staff. Overall, productivity per staff person was similar across the four staffing patterns. We found that physicians make the greatest contributions to productivity, but advanced-practice staff, nurses, and other medical staff also contribute. Patterns of community health center staffing are driven by numerous factors, including the concentration of clinicians in communities, nurse practitioner scope-of-practice laws, and patient characteristics such as insurance status. Our findings suggest that other group medical practices could incorporate more nonphysician staff without sacrificing productivity and thus profitability. However, the new staffing patterns that evolve may be affected by characteristics of the practice location or the types of patients served. Project HOPE—The People-to-People Health Foundation, Inc.

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

    PubMed

    Davari, Fereshteh; Zahed, Arash

    2015-09-01

    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. 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. 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. 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.

  8. Montefiore Medical Center in The Bronx, New York: improving health in an urban community.

    PubMed

    Foreman, Spencer

    2004-12-01

    The author calls on academic medical centers that serve urban communities to go beyond the traditional mission of patient care, teaching, and research by accepting responsibility to build community-based care systems that are capable of improving the health of underserved populations within their reach. The experience of Montefiore Medical Center in the Bronx, New York, is presented to illustrate the nature, scope, and complexity of the undertaking that is required. Eight initiatives are described: expanding the primary care network, creating The Children's Hospital at Montefiore and the Child Health Network, responding to the needs of other high-risk populations, integrating the network with health information technology, using care-management systems to improve quality, reinforcing ethical allocation of resources, building teaching and research into the network, and preserving community vitality. The author believes that the current health care environment offers opportunities that may help to stimulate change in the direction of community-based systems. Managed care provides financial incentives to academic centers that are willing to accept risk and responsibly manage the care of a defined community, and advanced information technologies can support them in that endeavor. The author concludes that for academic medical centers with the proper systems in place, accepting responsibility for the community is not only the right thing to do, it is the strategic thing to do.

  9. 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.

  10. Directory of Tribal Officials. Portland Area.

    ERIC Educational Resources Information Center

    Bureau of Indian Affairs (Dept. of Interior), Portland, OR.

    This tribal directory lists the specific Indian agency, Indian tribe, and all administrative offices and divisions of the Portland Area Office, Bureau of Indian Affairs. The following Indian agencies, with superintendent's name, address, and telephone number are listed: Colville, Fort Hall, Northern Idaho, Spokane, Umatilla, Warm Springs, Western…

  11. Portland, Oregon: Solar in Action (Brochure)

    SciTech Connect

    Not Available

    2011-10-01

    This brochure provides an overview of the challenges and successes of Portland, OR, a 2007 Solar America City awardee, on the path toward becoming a solar-powered community. Accomplishments, case studies, key lessons learned, and local resource information are given.

  12. How Valid Are the Portland Baseline Essays?

    ERIC Educational Resources Information Center

    Martel, Erich

    1991-01-01

    Portland, Oregon's "African-American Baseline Essays," widely used in creating multicultural curricula, inaccurately depicts ancient Egyptians as black people and Olmec civilization as derived from African influences. The authors advance racial theories long abandoned by mainline Africa scholars, attribute mystical powers to pyramids,…

  13. Portland's Gypsies See School in Their Future.

    ERIC Educational Resources Information Center

    Egan, Yvonne Michie

    1980-01-01

    Gypsy children have been disadvantaged in education by poor attendance and parental attitudes toward education and child rearing. The Portland Schools' Gypsy Education Project attempts the gradual mainstreaming of Gypsies into regular classrooms through special group instruction within a normal elementary school environment. (SK)

  14. Implementation and evaluation of carousel dispensing technology in a university medical center pharmacy.

    PubMed

    Temple, Jack; Ludwig, Brad

    2010-05-15

    The implementation of carousel dispensing technology (CDT) at a university medical center pharmacy and the associated changes in drug distribution are described. An evaluation of CDT was conducted in three phases: before implementation, during implementation, and after implementation. The preimplementation phase consisted of data collection and facility planning leading up to the physical installation. The implementation phase included the physical installation, carousel medication assignment, and user training. The postimplementation phase included data collection and analysis. The data collected were used to compare preimplementation and postimplementation time studies, labor requirements, inventory turns, and accuracy rates. The estimated labor savings comparing the preimplementation and postimplementation time studies for automated dispensing cabinet (ADC) refills, first-dose requests, supplemental cart fill, and medication procurement totaled 2.6 full-time equivalents (FTEs). After departmental reorganization, a net reduction of 2.0 technician FTEs was achieved. The average turnaround time for stat medication requests using CDT was 7.19 minutes, and the percentage of doses filled in less than 20 minutes was 95.1%. After implementing CDT, the average accuracy rate for all dispense requests increased from 99.02% to 99.48%. The inventory carrying cost was reduced by $25,059. CDT improved the overall efficiency and accuracy of medication dispensing in a university medical center pharmacy. Workflow efficiencies achieved in ADC refill, first-dose dispensing, supplemental cart fill, and the medication procurement process allowed the department to reduce the amount of technician labor required to support the medication distribution process, as well as reallocate technician labor to other areas in need.

  15. Critical Care Organizations in Academic Medical Centers in North America: A Descriptive Report.

    PubMed

    Pastores, Stephen M; Halpern, Neil A; Oropello, John M; Kostelecky, Natalie; Kvetan, Vladimir

    2015-10-01

    With the exception of a few single-center descriptive reports, data on critical care organizations are relatively sparse. The objectives of our study were to determine the structure, governance, and experience to date of established critical care organizations in North American academic medical centers. A 46-item survey questionnaire was electronically distributed using Survey Monkey to the leadership of 27 identified critical care organizations in the United States and Canada between September 2014 and February 2015. A critical care organization had to be headed by a physician and have primary governance over the majority, if not all, of the ICUs in the medical center. We received 24 responses (89%). The majority of the critical care organizations (83%) were called departments, centers, systems, or operations committees. Approximately two thirds of respondents were from larger (> 500 beds) urban institutions, and nearly 80% were primary university medical centers. On average, there were six ICUs per academic medical center with a mean of four ICUs under critical care organization governance. In these ICUs, intensivists were present in-house 24/7 in 49%; advanced practice providers in 63%; hospitalists in 21%; and telemedicine coverage in 14%. Nearly 60% of respondents indicated that they had a separate hospital budget to support data management and reporting, oversight of their ICUs, and rapid response teams. The transition from the traditional model of ICUs within departmentally controlled services or divisions to a critical care organization was described as gradual in 50% and complete in only 25%. Nearly 90% indicated that their critical care organization governance structure was either moderately or highly effective; a similar number suggested that their critical care organizations were evolving with increasing domain and financial control of the ICUs at their respective institutions. Our survey of the very few critical care organizations in North American

  16. [E-learning in ENT: Usage in University Medical Centers in Germany].

    PubMed

    Freiherr von Saß, Peter; Klenzner, Thomas; Scheckenbach, Kathrin; Chaker, Adam

    2017-01-18

    E-learning is an essential part of innovative medical teaching concepts. The challenging anatomy and physiology in ENT is considered particularly suitable for self-assessed and adaptive e-learning. Usage and data on daily experience with e-learning in German ENT-university hospitals are currently unavailable and the degree of implementation of blended learning including feed-back from medical students are currently not known. We investigated the current need and usage of e-learning in academic ENT medical centers in Germany. We surveyed students and chairs for Otorhinolaryngology electronically and paperbased during the summer semester 2015. Our investigation revealed an overall heterogenous picture on quality and quantity of offered e-learning applications. While the overall amount of e-learning in academic ENT in Germany is rather low, at least half of the ENT-hospitals in medical faculties reported that e-learning had improved their own teaching activities. More collaboration among medical faculties and academic ENT-centers may help to explore new potentials, overcome technical difficulties and help to realize more ambitious projects.

  17. A clinical pathway for guardianship at Dartmouth-Hitchcock Medical Center.

    PubMed

    Chen, Jasper J; Blanchard, Michele A; Finn, Christine T; Plunkett, Margaret L; Homa, Karen; Fournier, Debra A; Gregoire, James F; Handley, Miranda M; Stedina, Elizabeth A; Suresh, Gautham K; Nugent, William C

    2014-09-01

    Guardianship may be necessary when inpatients lack medical decision-making capacity and are unwilling to go home to be cared for by interested proxy decision makers. Interventions, centered on a clinical pathway, were conducted at Dartmouth-Hitchcock Medical Center (DHMC; Lebanon, New Hampshire). Because guardianship occurs at the interface of clinical care and governmental bureaucracy, quality improvement efforts focused on "in-hospital" processes, while actions were taken to improve communication between clinical teams and the legal system. A multidisciplinary quality improvement team mapped the DHMC guardianship process and analyzed the causes for delays before creating the clinical pathway. Specific interventions were designed and implemented to address the identified improvement areas. For the 26 guardianship patients during a two-year period (May 1, 2011-May 1, 2013), the charges incurred totaled approximately $4,000,000--for an average of more than $150,000 per patient. The medically unnecessary days of their length of hospital stay decreased from an average of 27.8 to 11.3, a statistically significant result as demonstrated by statistical process control analysis. The shorter hospitalizations of the last 13 patients amounted to 214.5 medically unnecessary hospital days saved and more than $1.2 million in charges reduced during the two-year period. Guardianship is a complex process that generates significant delays in appropriate care and increases in charges. The redesigned, standardized guardianship process, as defined in the clinical pathway, reduced associated medically unnecessary days of hospitalization.

  18. 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.

  19. Diseases pattern among patients attending Holy Mosque (Haram) Medical Centers during Hajj 1434 (2013)

    PubMed Central

    Bakhsh, Abdulrahman R.; Sindy, Abdulfattah I.; Baljoon, Mostafa J.; Dhafar, Khalid O.; Gazzaz, Zohair J.; Baig, Mukhtiar; Deiab, Basma A.; Hothali, Fauzea T. Al

    2015-01-01

    Objective: To evaluate the diseases pattern among pilgrims attending the 2 Holy Mosque (Haram) Health Care Centers during the Hajj season 2013 (Hijra 1434). Methods: In this cross-sectional study, data was collected from 2 medical centers located in the Holy Mosque in Makkah city, Saudi Arabia, from the first of Dhul-Hijjah to sixteenth Dhul-Hijjah 1434. The present study was completed in 16 days (6th October to 21st October 2013). Results: Over 16 days, 1008 patients attended the medical centers during Hajj 1434, (2013), out of which 554 (55%) were males and 454 (45%) were females. Most of the patients were Egyptians (n=242, 24%), followed by Saudis (n=116, 11.5%), Pakistani (n=114, 11.3%), Turkish (n=50, 5%), and other nationalities (n=404). According to age distribution, mostly were in the 51-60 years age group (n=237, 23.5%), followed by other age groups. Out of 1008 patients, 842 (83.5%) patients were treated and subsequently discharged, while 166 patients (16.5%) were referred to the tertiary centers. According to the diseases pattern, most of the patients were suffering from respiratory problems (n=177, 17.6%) followed by skin diseases (n=158, 15.7%), gastrointestinal tract (GIT) diseases (n=133, 13.2%), and others. Conclusion: Most of the patients were suffering from respiratory problems followed by skin and GIT diseases, and <25% of patients were referred to tertiary care centers. PMID:26219447

  20. A new concept for medical imaging centered on cellular phone technology.

    PubMed

    Granot, Yair; Ivorra, Antoni; Rubinsky, Boris

    2008-04-30

    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.

  1. 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.

  2. Funding Instability Reduces the Impact of the Federal Teaching Health Center Graduate Medical Education Program.

    PubMed

    Kurz, Troy; Liaw, Winston; Wingrove, Peter; Petterson, Stephen; Bazemore, Andrew

    2017-01-01

    The Teaching Health Center Graduate Medical Education (THCGME) program is a decentralized residency training component of the Affordable Care Act, created to combat critical shortages and maldistribution of primary care physicians. The Accreditation Council of Graduate Medical Education and federal data reveal that the THCGME program accounted for 33% of the net increase in family medicine residency positions between 2011 and 2015. However, amid concerns about the program's stability, the contribution of the THCGME program to the net increase fell to 7% after 2015. © Copyright 2017 by the American Board of Family Medicine.

  3. Examining the discharge practices of surgeons at a large medical center.

    PubMed

    Anderson, David; Price, Carter; Golden, Bruce; Jank, Wolfgang; Wasil, Edward

    2011-12-01

    We investigate the discharge practices at a large medical center. Specifically, we look for indications that patients are being discharged sooner because of hospital bed-capacity constraints. Using survival analysis techniques, we find statistically significant evidence to indicate that surgeons adjust their discharge practices to accommodate the surgical schedule and number of available recovery beds. We find higher discharge rates on days when utilization is high. We also find an increased discharge rate on days when more surgeries are scheduled. Our findings suggest that discharge decisions are made with bed-capacity constraints in mind. We discuss possible explanations for this, as well as the medical and managerial implications of our findings.

  4. 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.

  5. 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…

  6. 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…

  7. Hurley Medical Center report makes fund-raising look like fun. Hackensack, CMH use styles suited to their donors.

    PubMed

    Botvin, J D

    2000-01-01

    Myriad elements go into making a great fund-raising publication. Judges singled out three reports with content and design clearly aimed at thanking supporters and stimulating the flow of contributions. They are: Hurley Medical Center, Grand Rapids, Mich., first place; Hackensack University Medical Center, Hackensack, N.J., second place; and Clinton Memorial Healthcare Regional Health System Foundation, Wilmington, Ohio, third place.

  8. Serving Medically Frail Individuals: Five Case Studies of Deaths of Residents of the Terence Cardinal Cooke Health Care Center.

    ERIC Educational Resources Information Center

    Sundram, Clarence J.

    The deaths of five resident clients at the Terence Cardinal Cooke Health Care Center (New York), a residential program for profoundly impaired and medically fragile individuals with developmental disabilities, in March and April of 1989 were investigated. Methods of study included examination of medical records from the Cooke Center and other…

  9. Development and operation of the Loma Linda University Medical Center proton facility.

    PubMed

    Slater, Jerry D

    2007-08-01

    The Proton Treatment Center at Loma Linda University Medical Center, the world's first hospital-based proton facility, opened in 1990 after two decades of development. Its early years were marked by a deliberately cautious approach in clinical utilization of protons, with intent to establish hospital-based proton therapy on a scientific basis. The facility was designed to be upgradeable, and development since 1990 has proceeded in three distinct phases of upgrades, both in technology and clinical applications. Upgrades continue, all of them based on an underlying program of basic and clinical research; future new applications of proton radiation therapy are expected to follow.

  10. Patient-centered Outcomes of Medication Adherence Interventions: Systematic Review and Meta-Analysis

    PubMed Central

    Conn, Vicki S.; Ruppar, Todd M.; Enriquez, Maithe; Cooper, Pamela S.

    2016-01-01

    Objectives This systematic review used meta-analytic procedures to synthesize changes in patient-centered outcomes following medication adherence interventions. Methods Strategies to locate studies included online searches of 13 databases and 19 research registries, hand searches of 57 journals, and author and ancestry searches of all eligible studies. Search terms included patient compliance, medication adherence, and related terms. Searches were conducted for all studies published since 1960. Eligible published or unpublished primary studies tested medication adherence interventions and reported medication knowledge, quality of life, physical function, and symptom outcomes. Primary study attributes and outcome data were reliably coded. Overall standardized mean differences (SMDs) were analyzed using random-effects models. Dichotomous and continuous moderator analyses and funnel plots were used to explore risks of bias. Results Thorough searching located eligible 141 reports. The reports included 176 eligible comparisons between treatment and control subjects across 23,318 subjects. Synthesis across all comparisons yielded statistically significant SMDs for medication knowledge (d = 0.449), quality of life (d = 0.127), physical function (d = 0.142), and symptoms (d = 0.182). The overall SMDs for studies focusing on subsamples of patients with specific illnesses were more modest but also statistically significant. Of specific symptoms analyzed (depression, anxiety, pain, energy/vitality, cardiovascular, and respiratory), only anxiety failed to show a significant improvement following medication adherence interventions. Most SMDs were significantly heterogeneous, and risk of bias analyses suggested links between study quality and SMDs. Conclusions Modest but significant improvements in patient-centered outcomes followed medication adherence interventions. PMID:27021763

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

    PubMed

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

    2016-01-01

    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. 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. 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. 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.

  12. 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

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

    PubMed

    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.

  14. 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.

  15. The Patient-Centered Medical Home as a Community-based Strategy

    PubMed Central

    Franz, Berkeley A; Murphy, John W

    2017-01-01

    Increasing attention has been devoted to the important role that primary care will play in improving population health. One innovation, the patient-centered medical home (PCMH), aims to unite a variety of professionals with patients in the prevention and treatment of illness. Although patient perspectives are critical to this model, this article questions whether the PCMH in practice is truly community-based. That is, do physicians, planners, and other health care professionals take seriously the value of integrating local knowledge into medical care? The argument presented is that community-based philosophy contains a foundational principle that the perspectives of health care practitioners and community members must be integrated. Although many proponents of the PCMH aim to offer patient-centered and sustainable health care, focusing on this philosophical shift will ensure that services are organized by communities in collaboration with health care professionals. PMID:28746023

  16. 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

  17. Reorganizing departments of psychiatry, hospitals, and medical centers for the 21st century.

    PubMed

    Schreter, R K

    1998-11-01

    Market forces are reshaping health care, transforming it from a public service into a product that is sold in a highly competitive marketplace. This transformation has been particularly disruptive for hospital departments of psychiatry and medical centers that were the early targets for managed care efforts at cost containment. To survive, health care institutions have embarked on a clinical and administrative re-engineering process. The author describes a series of steps for reconfiguring departments, hospitals, and medical centers as they enter the 21st century. The steps include identifying the leadership team, formulating a mission statement and strategic plan, creating a legal entity capable of achieving the organization's goals, drawing up an organizational chart, and developing the provider network. Other steps in the process include enhancing the continuum of services offered, developing administrative capability, dealing with managed care, paying attention to fundamental business practices, integrating psychiatric services into the health care system, and marketing psychiatric services.

  18. Becoming a patient-centered medical home: a 9-year transition for a network of Federally Qualified Health Centers.

    PubMed

    Calman, Neil S; Hauser, Diane; Weiss, Linda; Waltermaurer, Eve; Molina-Ortiz, Elizabeth; Chantarat, Tongtan; Bozack, Anne

    2013-01-01

    The patient-centered medical home (PCMH) model has great potential for optimizing the care of chronically ill patients, yet there is much to be learned about various implementations of this model and their impact on patient care processes and outcomes. We examined changes in patterns of health care use in a network of Federally Qualified Health Centers throughout a 9-year period of practice transformation that included recognition of all centers by the National Committee for Quality Assurance (NCQA) as Level 3 PCMH practices. We analyzed deidentified data from electronic health records for the period 2003 to 2011 to identify patterns of service use for all 4,595 patients with diabetes. We also examined a subsample of 545 patients who were in care throughout the study period to track improvement in glycated hemoglobin levels as a clinical measure over time. Through the transition to a PCMH, the mean number of encounters with outreach, diabetes educators, and psychosocial services increased for all diabetic patients; virtually all patients had visits with a primary care clinician, but the mean number of visits decreased slightly. Among patients in the subsample, mean annual levels of glycated hemoglobin decreased steadily during the 9-year study period, mainly driven by a reduction in patients having baseline levels exceeding 9%. This retrospective study conducted in a real-world setting using electronic health record data demonstrates a shift in resource use by diabetic patients from the primary care clinician to other members of the care team. The findings suggest that PCMH implementation has the potential to alter processes of care and improve outcomes of care, especially among those with higher disease burden.

  19. Technology complementing military behavioral health efforts at tripler army medical center.

    PubMed

    Stetz, Melba C; Folen, Raymond A; Yamanuha, Bronson K

    2011-06-01

    The purpose of this article is to provide a short narrative on the ways that behavioral health professionals and their patients are currently benefitting from the use of technology. Examples stem from applications of technology to patients/research participants at the Tripler Army Medical Center. The paper also discusses how current use of this technology has made it possible to serve individuals in their own cultural environment, providing a cost-effective means of providing mental health services.

  20. 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.

  1. Establishment of a Separate Optometry Service at Tripler Army Medical Center

    DTIC Science & Technology

    1989-07-01

    Optometry; Ophthalmology; Staff satisfaction ; Patient satisfactton 19. ABSTRACT (Continue on reverse if necessary and identify by block number). - At...Tripler Army Medical Center (TAM), a separate Optcaetry Service ues established in May, 1988. An implementation plan was developed as well as an...measures of ccmplaints, staff satisfaction , patient satisfaction , access, and external/internal quality review of the Optanetry Service were examined. ’The

  2. Baseline Waste Anesthetic Gas Survey David Grant Medical Center Surgical Suite, Travis AFB, California.

    DTIC Science & Technology

    1984-08-01

    Inquiries regarding this policy should be referred to Head- quarters Air Force Medical Service Center, Bioenvironmental Engineering Division (EQ AFMSC ... AFMSC /SGPA letter, 14 Nov 80, Control of Exposures to Anesthetic Gases. 2. USAF DGMC/SGPB letter, 18 San 83, Baseline Anesthetic Gas Industrial...ventilation surveys, 22 Nov, 15 Dec and 20 Dec 83. 10. EQ AFMSC /SGPA letter, 14 Nov 80, Control of Exposures to Anesthetic Gases, (Atch 1). 11. Ibid

  3. Improving Management of Pediatric Patients with Attention- Deficit/Hyperactivity Disorder at Naval Medical Center Portsmouth

    DTIC Science & Technology

    2004-04-30

    customers would be the inclusion of NMCP’s capabilities to diagnose and treat ADHD more effectively than network providers into existing marketing efforts...the selection of a primary care or psychiatrist provider, is significantly different between direct care and network providers, given similar...Pediatric Patients Managed by Providers at Naval Medical Center Portsmouth and Network Providers Introduction Attention-deficit hyperactivity disorder (ADHD

  4. 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

  5. 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.

  6. Prescribing pharmacists in the ambulatory care setting: Experience at the University of North Carolina Medical Center.

    PubMed

    Hawes, Emily M; Misita, Caron; Burkhart, Jena Ivey; McKnight, Lauren; Deyo, Zachariah M; Lee, Ruth-Ann; Howard, Caroline; Eckel, Stephen F

    2016-09-15

    The prescribing authorities, clinical activities, and productivity documentation strategies of ambulatory care clinic-based pharmacists practicing within a large academic health system are described. North Carolina law encourages progressive pharmacy practice through acquisition of the clinical pharmacist practitioner (CPP) designation. Qualified CPPs are authorized to provide collaborative drug therapy management services, including medication prescribing and ordering of laboratory tests, according to defined protocols and under physician supervision. The University of North Carolina Medical Center has approximately 30 CPPs deployed across a wide range of ambulatory care clinical practice sites. This article describes (1) the pharmacy department's implementation of an ambulatory care practice model, (2) the credentialing and privileging process leading to granting of prescribing privileges, (3) metrics used to demonstrate the impact of CPP activities, (4) recommended general criteria for ambulatory care practice site identification, and (5) strategies for overcoming barriers to successful implementation of ambulatory care-focused clinical pharmacist services. Aggregated intervention-tracking data compiled by seven of the medical center's CPP ambulatory care practice sites indicate extensive CPP involvement in direct patient care encounters and patient or provider consultations, with large numbers of medication-related interventions to support institutional cost-avoidance and revenue goals. CPPs deployed at the medical center's ambulatory care clinics have had a positive impact on clinical and cost outcomes, improving patient care through interventions, contributing to readmission reduction efforts, generating indirect revenue through cost avoidance, and generating new revenue through billing for patient visits. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  7. Burnout among nurses working in medical and educational centers in Shahrekord, Iran

    PubMed Central

    Moghaddasi, Jaefar; Mehralian, Hossein; Aslani, Yousef; Masoodi, Reza; Amiri, Masoud

    2013-01-01

    Background: Nursing burnout is the main characteristic of job stress that is a delayed reaction to chronic stressful situations in the workplace which could affect nurses who do not have sufficient emotional energy to cope and communicate with different types of patients. There is also sometimes this belief that they do not have the required capabilities for their jobs. The aim of this study was the evaluation of burnout among nurses working in medical and educational centers in Shahrekord. Materials and Methods: This descriptive study was performed on 340 nurses working in medical and educational centers in Shahrekord in 2009. Samples were selected using proportionate random sampling. Demographic information and the Maslach Burnout Inventory (MBI) were filled in for all nurses. Results: Burnout was considerable among nurses. The results showed that 34.6, 28.8, and 95.7% of the nurses had emotional exhaustion (EE), high depersonalization (DP), and high reduced personal accomplishment (PA), respectively. The mean scores (± standard deviation) for EE, DP, and PA were 22.77 (12.44), 6.99 (6.23), and 32.20 (9.26), respectively. Conclusions: Our results showed that burnout was noticeable among nurses working in medical and educational centers in Shahrekord. Disproportionate relationship between the number of nurses, workload, and income was the most important factor affecting nursing burnout. Due to the importance of nursing in the health-care system, policy makers should adopt suitable strategies for increasing the satisfaction of nurses. PMID:24403925

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

    PubMed

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

    2016-01-01

    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. 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. 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. 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.

  9. Characterizing complexity in socio-technical systems: a case study of a SAMU Medical Regulation Center.

    PubMed

    Righi, Angela Weber; Wachs, Priscila; Saurin, Tarcísio Abreu

    2012-01-01

    Complexity theory has been adopted by a number of studies as a benchmark to investigate the performance of socio-technical systems, especially those that are characterized by relevant cognitive work. However, there is little guidance on how to assess, systematically, the extent to which a system is complex. The main objective of this study is to carry out a systematic analysis of a SAMU (Mobile Emergency Medical Service) Medical Regulation Center in Brazil, based on the core characteristics of complex systems presented by previous studies. The assessment was based on direct observations and nine interviews: three of them with regulator of emergencies medical doctor, three with radio operators and three with telephone attendants. The results indicated that, to a great extent, the core characteristics of complexity are magnified) due to basic shortcomings in the design of the work system. Thus, some recommendations are put forward with a view to reducing unnecessary complexity that hinders the performance of the socio-technical system.

  10. 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.

  11. Gatekeepers as Care Providers: The Care Work of Patient-centered Medical Home Clerical Staff.

    PubMed

    Solimeo, Samantha L; Ono, Sarah S; Stewart, Kenda R; Lampman, Michelle A; Rosenthal, Gary E; Stewart, Greg L

    2017-03-01

    International implementation of the patient-centered medical home (PCMH) model for delivering primary care has dramatically increased in the last decade. A majority of research on PCMH's impact has emphasized the care provided by clinically trained staff. In this article, we report our ethnographic analysis of data collected from Department of Veterans Affairs staff implementing PACT, the VA version of PCMH. Teams were trained to use within-team delegation, largely accomplished through attention to clinical licensure, to differentiate staff in providing efficient, patient-centered care. In doing so, PACT may reinforce a clinically defined culture of care that countermands PCMH ideals. Such competing rubrics for care are brought into relief through a focus on the care work performed by clerks. Ethnographic analysis identifies clerks' care as a kind of emotional dirty work, signaling important areas for future anthropological study of the relationships among patient-centered care, stigma, and clinical authority. © 2016 by the American Anthropological Association.

  12. Readiness for meaningful use of health information technology and patient centered medical home recognition survey results.

    PubMed

    Shin, Peter; Sharac, Jessica

    2013-01-01

    Determine the factors that impact HIT use and MU readiness for community health centers (CHCs). The HITECH Act allocates funds to Medicaid and Medicare providers to encourage the adoption of electronic health records (EHR), in an effort to improve health care quality and patient outcomes, and to reduce health care costs. We surveyed CHCs on their Readiness for Meaningful Use (MU) of Health Information Technology (HIT) and Patient Centered Medical Home (PCMH) Recognition, then we combined responses with 2009 Uniform Data System data to determine which factors impact use of HIT and MU readiness. Nearly 70% of CHCs had full or partial EHR adoption at the time of survey. Results are presented for centers with EHR adoption, by the length of time that their EHR systems have been in operation.

  13. Perspective: Malpractice in an academic medical center: a frequently overlooked aspect of professionalism education.

    PubMed

    Hochberg, Mark S; Seib, Carolyn D; Berman, Russell S; Kalet, Adina L; Zabar, Sondra R; Pachter, H Leon

    2011-03-01

    Understanding how medical malpractice occurs and is resolved is important to improving patient safety and preserving the viability of a physician's career in academic medicine. Every physician is likely to be sued by a patient, and how the physician responds can change his or her professional life. However, the principles of medical malpractice are rarely taught or addressed during residency training. In fact, many faculty at academic medical centers know little about malpractice.In this article, the authors propose that information about the inciting causes of malpractice claims and their resolution should be incorporated into residency professionalism curricula both to improve patient safety and to decrease physician anxiety about a crucial aspect of medicine that is not well understood. The authors provide information on national trends in malpractice litigation and residents' understanding of malpractice, then share the results of their in-depth review of surgical malpractice claims filed during 2001-2008 against their academic medical center. The authors incorporated those data into an evidence-driven curriculum for residents, which they propose as a model for helping residents better understand the events that lead to malpractice litigation, as well as its process and prevention.

  14. 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

  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. [Emergencies and urgent medical-surgical conditions attended at a comprehensive cancer center].

    PubMed

    Valdespino-Gómez, Victor M; López-Garza, Juan Ramón; González-Alemán, Julio C; Valdespino-Castillo, Victor E

    2006-01-01

    The global incidence of emergencies and urgent medical?surgical conditions in cancer patients has not been well described. The aim of the study was to identify the main symptoms and diagnoses in patients seen for consultation at the Urgent Care Service in a Mexican Comprehensive Cancer Center. This was a retrospective observational study. The information was obtained from the Continuous Admission Service daily consultation records at the Oncology Hospital, National Medical Center "21st Century," Institute of Social Security, Mexico City. During a 6-month period, 4937 patients were seen for consultation. True oncologic emergencies were 3.7%, urgencies 52.5% and non-urgent were 43.7%. Most common symptoms for emergency and urgency patient consultations were severe pain (69.5%) and dehydration with electrolyte imbalance (11.4%). Prevalent symptoms were associated with the primary tumor or metastatic dissemination (89% cases). The most frequent baseline diseases were breast, colorectal, cervical, lung and stomach carcinomas. Defined oncologic emergencies in this series were septic shock and severe neutropenia (20%), hypovolemic shock due to severe bleeding (16.5%), and severe dyspnea due to pneumonia or pleural efusion (12%). Data evaluating the use of analgesic drug therapy for cancer pain alone indicate that 80% of patients report adequate analgesia. Analgesia failures were associated with an insufficient prescription or with inadequate consumption of opioid analgesics. The Urgent Care Center at a Comprehensive Cancer Center offers the best opportunity for diagnosis and treatment of emergencies and urgent care conditions in cancer patients.

  17. Ten trends transforming cancer care and their effects on space planning for academic medical centers.

    PubMed

    Bloom, Mara; Markovitz, Sarah; Silverman, Susan; Yost, Carl

    2015-01-01

    This article aims to define the major trends currently affecting space needs for academic medical center (AMC) cancer centers. It will distinguish between the trends that promote the concentration of services with those that promote decentralization as well as identify opportunities for achieving greater effectiveness in cancer care space planning. Changes in cancer care-higher survival rates, increased clinical trials, new technology, and changing practice models-increasingly fill hospitals' and clinicians' schedules and strain clinical space resources. Conflicts among these trends are concentrating some services and dispersing others. As a result, AMCs must expand and renovate intelligently to continue providing state-of-the-art, compassionate care. Although the typical AMC cancer center can expect to utilize more space than it would have 10 years ago, a deeper understanding of the cancer center enterprise can lead to opportunities for more effectively using available facility resources. Each AMC must determine for itself the appropriate balance of patient volume, clinical activity, and services between its main hospital campus and satellite branches. As well, space allocation should be flexible, as care trends, medical technology, and the provider's own priorities shift over time. The goal isn't necessarily more space-it's better space. © The Author(s) 2015.

  18. Assessment of adverse drug events among patients in a tertiary care medical center.

    PubMed

    Johnston, Philip E; France, Daniel J; Byrne, Daniel W; Murff, Harvey J; Lee, Byron; Stiles, Renee A; Speroff, Theodore

    2006-11-15

    Specific patient and clinical characteristics associated with an increased risk of sustaining an adverse event (AE) were identified. AE reports for patients in a 658-bed tertiary care medical center between January 1, 2000, and June 30, 2002, were analyzed. The data collected from each report included medical record number, patient sex, patient age, clinical service, date of occurrence, diagnoses, type of error, suspected medication, and severity of the AE. A three-stage logistic regression model with high-risk indicators was used to evaluate key indicators of the most vulnerable patient populations. The number of control patients and those with AEs totaled 60,206. This population was then randomly split into two equal groups of patients: the training data set (n = 30,103) and the validation data set (n = 30,103). AEs occurred in a higher percentage of patients who were age <1 year, 1-15, 47-59, and > or =60 years than in other groups. A higher percentage of AEs were reported in men than women, but the groups were not significantly different when comparing those with an AE and those without an AE. Asian Indian patients demonstrated a high rate of AEs, but this may be a statistical artifact, reflecting their very small percentage in the study. Evaluation of admission sources revealed that doctors' offices, clinic referrals, and local hospital transfers accounted for higher rates of AEs than other sources. Certain age groups, diagnoses, admission sources, types of insurance, and the use of specific medications or medication classes were associated with increased AE rates at a tertiary care medical center.

  19. 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.

  20. Utility of the Mayo-Portland adaptability inventory-4 for self-reported outcomes in a military sample with traumatic brain injury.

    PubMed

    Kean, Jacob; Malec, James F; Cooper, Douglas B; Bowles, Amy O

    2013-12-01

    To investigate the psychometric properties of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) obtained by self-report in a large sample of active duty military personnel with traumatic brain injury (TBI). Consecutive cohort who completed the MPAI-4 as a part of a larger battery of clinical outcome measures at the time of intake to an outpatient brain injury clinic. Medical center. Consecutively referred sample of active duty military personnel (N=404) who suffered predominantly mild (n=355), but also moderate (n=37) and severe (n=12), TBI. Not applicable. MPAI-4 RESULTS: Initial factor analysis suggested 2 salient dimensions. In subsequent analysis, the ratio of the first and second eigenvalues (6.84:1) and parallel analysis indicated sufficient unidimensionality in 26 retained items. Iterative Rasch analysis resulted in the rescaling of the measure and the removal of 5 additional items for poor fit. The items of the final 21-item Mayo-Portland Adaptability Inventory-military were locally independent, demonstrated monotonically increasing responses, adequately fit the item response model, and permitted the identification of nearly 5 statistically distinct levels of disability in the study population. Slight mistargeting of the population resulted in the global outcome, as measured by the Mayo-Portland Adaptability Inventory-military, tending to be less reflective of very mild levels of disability. These data collected in a relatively large sample of active duty service members with TBI provide insight into the ability of patients to self-report functional impairment and the distinct effects of military deployment on outcome, providing important guidance for the meaningful measurement of outcome in this population. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  1. Medical center characteristics associated with PSA screening in elderly veterans with limited life expectancy.

    PubMed

    So, Cynthia; Kirby, Katharine A; Mehta, Kala; Hoffman, Richard M; Powell, Adam A; Freedland, Stephen J; Sirovich, Brenda; Yano, Elizabeth M; Walter, Louise C

    2012-06-01

    Although guidelines recommend against prostate-specific antigen (PSA) screening in elderly men with limited life expectancy, screening is common. We sought to identify medical center characteristics associated with screening in this population. We conducted a prospective study of 622,262 screen-eligible men aged 70+ seen at 104 VA medical centers in 2003. Primary outcome was the percentage of men at each center who received PSA screening in 2003, based on VA data and Medicare claims. Men were stratified into life expectancy groups ranging from favorable (age 70-79 with Charlson score = 0) to limited (age 85+ with Charlson score ≥1 or age 70+ with Charlson score ≥4). Medical center characteristics were obtained from the 1999-2000 VA Survey of Primary Care Practices and publicly available VA data sources. Among 123,223 (20%) men with limited life expectancy, 45% received PSA screening in 2003. Across 104 VAs, the PSA screening rate among men with limited life expectancy ranged from 25-79% (median 43%). Higher screening was associated with the following center characteristics: no academic affiliation (50% vs. 43%, adjusted RR = 1.14, 95% CI 1.04-1.25), a ratio of midlevel providers to physicians ≥3:4 (55% vs. 45%, adjusted RR = 1.20, 95% CI 1.09-1.32) and location in the South (49% vs. 39% in the West, adjusted RR = 1.25, 95% CI 1.12-1.40). Use of incentives and high scores on performance measures were not independently associated with screening. Within centers, the percentages of men screened with limited and favorable life expectancies were highly correlated (r = 0.90). Substantial practice variation exists for PSA screening in older men with limited life expectancy across VAs. The high center-specific correlation of screening among men with limited and favorable life expectancies indicates that PSA screening is poorly targeted according to life expectancy.

  2. Immobilization and fixation of molybdenum (6) by Portland cement

    SciTech Connect

    Kindness, A.; Lachowski, E.E.; Minocha, A.K.; Glasser, F.P. . Dept. of Chemistry)

    1994-01-01

    The immobilization of molybdenum (6) in Portland cement has been studied. Analytical methods are reviewed. As a precursor to studies using commercial cements, the cement constituent phases Ca[sub 3]Al[sub 2]O[sub 6] and Ca[sub 3]SiO[sub 5] and mixtures of Ca[sub 3]Al[sub 2]O[sub 6] and gypsum (CaSO[sub 4][center dot]2H[sub 2]O) have been synthesized and subsequently hydrated with an aqueous solution containing initially 2,000 ppm Mo. The aqueous Mo contents decrease slowly over the first 12 days before attaining a steady-state concentration, ca. 40--50 ppm. Its main speciation is as molybdate, MoO[sub 4][sup 2[minus

  3. Quality improvement in healthcare delivery utilizing the patient-centered medical home model.

    PubMed

    Akinci, Fevzi; Patel, Poonam M

    2014-01-01

    Despite the fact that the United States dedicates so much of its resources to healthcare, the current healthcare delivery system still faces significant quality challenges. The lack of effective communication and coordination of care services across the continuum of care poses disadvantages for those requiring long-term management of their chronic conditions. This is why the new transformation in healthcare known as the patient-centered medical home (PCMH) can help restore confidence in our population that the healthcare services they receive is of the utmost quality and will effectively enhance their quality of life. Healthcare using the PCMH model is delivered with the patient at the center of the transformation and by reinvigorating primary care. The PCMH model strives to deliver effective quality care while attempting to reduce costs. In order to relieve some of our healthcare system distresses, organizations can modify their delivery of care to be patient centered. Enhanced coordination of services, better provider access, self-management, and a team-based approach to care represent some of the key principles of the PCMH model. Patients that can most benefit are those that require long-term management of their conditions such as chronic disease and behavioral health patient populations. The PCMH is a feasible option for delivery reform as pilot studies have documented successful outcomes. Controversy about the lack of a medical neighborhood has created concern about the overall sustainability of the medical home. The medical home can stand independently and continuously provide enhanced care services as a movement toward higher quality care while organizations and government policy assess what types of incentives to put into place for the full collaboration and coordination of care in the healthcare system.

  4. Hazardous Materials Hazard Analysis, Portland, Oregon.

    DTIC Science & Technology

    1981-06-01

    regional equipment, crossings , and other aspects of overall system safety. For further information: Henry Jacobs, Hazardous Materials Inspector U.S... cross -tralning and an Increased in- spection effort. In the last year, twelve Oregon State Police Officers who patrol highways around the Portland area...Response System:, The International Fire Chlef (date unknown). Lee, Myra T. and Roe, Penelope G. Hazardous Materials Management System: A Guide for Local

  5. 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.

  6. Regional variations in pediatric medication exposure: Spatial analysis of poison center utilization in western Pennsylvania.

    PubMed

    Nguyen, Margaret B; Pizon, Anthony F; Branas, Charles C; Fabio, Anthony

    2016-01-01

    Medication drug exposures among young children continue to rise despite current poison prevention efforts. These exposures result in increased healthcare utilization and medical costs. New tactics are needed to reduce injuries related to pediatric drug exposures. We aimed to identify cluster patterns in: (1) calls for pediatric medication drug exposures and (2) a subset of calls that resulted in medical evaluation referrals. We identified and evaluated population characteristics associated with cluster patterns. We analyzed 26,685 pharmaceutical drug exposures involving children <5 years of age based on calls reported to the Pittsburgh Poison Center from 1 January 2006 to 31 December 2010. We performed spatial statistics to assess for clustering. We used logistic regression to estimate population characteristics associated with clustering. Spatial analysis identified 22 exposure clusters and five referral clusters. Sixty-five percent of 89 ZIP codes in the clusters of drug exposure with healthcare facility (HCF) referral were not identified in the exposure clusters. ZIP codes in the HCF referral clusters were characterized as rural, impoverished, and with high rates of unemployment and school dropouts. Our principal findings demonstrate pediatric drug exposures do exist in discrete geographic clusters and with distinct socioeconomic characteristics. This study offers a starting point for subsequent investigations into the geographic and social context of pediatric medication drug exposures. This is an important step in revising pediatric poison prevention strategies.

  7. 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.

  8. Association Between Patient-Centered Medical Home Capabilities and Outcomes for Medicare Beneficiaries Seeking Care from Federally Qualified Health Centers.

    PubMed

    Timbie, Justin W; Hussey, Peter S; Setodji, Claude M; Kress, Amii; Malsberger, Rosalie; Lavelle, Tara A; Friedberg, Mark W; Wensky, Suzanne G; Giuriceo, Katherine D; Kahn, Katherine L

    2017-05-26

    Patient-centered medical home (PCMH) models of primary care have the potential to expand access, improve population health, and lower costs. Federally qualified health centers (FQHCs) were early adopters of PCMH models. We measured PCMH capabilities in a diverse nationwide sample of FQHCs and assessed the relationship between PCMH capabilities and Medicare beneficiary outcomes. Cross-sectional, propensity score-weighted, multivariable regression analysis. A convenience sample of 804 FQHC sites that applied to a nationwide FQHC PCMH initiative and 231,163 Medicare fee-for-service beneficiaries who received a plurality of their primary care services from these sites. PCMH capabilities were self-reported using the National Committee for Quality Assurance's (NCQA's) 2011 application for PCMH recognition. Measures of utilization, continuity of care, quality, and Medicare expenditures were derived from Medicare claims covering a 1-year period ending October 2011. Nearly 88% of sites were classified as having PCMH capabilities equivalent to NCQA Level 1, 2, or 3 PCMH recognition. These more advanced sites were associated with 228 additional FQHC visits per 1000 Medicare beneficiaries (95% CI: 176, 278), compared with less advanced sites; 0.02 points higher practice-level continuity of care (95% CI: 0.01, 0.03); and a greater likelihood of administering two of four recommended diabetes tests. However, more advanced sites were also associated with 181 additional visits to specialists per 1000 beneficiaries (95% CI: 124, 232) and 64 additional visits to emergency departments (95% CI: 35, 89)-but with no differences in inpatient utilization. More advanced sites had higher Part B expenditures ($111 per beneficiary [95% CI: $61, $158]) and total Medicare expenditures of $353 [95% CI: $65, $614]). Implementation of PCMH models in FQHCs may be associated with improved primary care for Medicare beneficiaries. Expanded access to care, in combination with slower development of key

  9. Comparison and alignment of an academic medical center's strategic goals with ASHP initiatives.

    PubMed

    Engels, Melanie J; Chaffee, Bruce W; Clark, John S

    2015-12-01

    An academic medical center's strategic goals were compared and aligned with the 2015 ASHP Health-System Pharmacy Initiative and the Pharmacy Practice Model Initiative (PPMI). The department's pharmacy practice model steering committee identified potential solutions to narrow prioritized gaps using a modified nominal group technique and a multivoting dot technique. Five priority solutions were identified and assigned to work groups to develop business plans, which included admission medication history and reconciliation for high-risk patients and those with complex medication regimens, pharmacist provision of discharge counseling to high-risk patients and those with complex medication regimens, improved measurement and reporting of the impact of PPMI programs on patient outcomes, implementation of a departmentwide formalized peer review and evaluation process, and the greeting of every patient at some time during his or her visit by a pharmacy team member. Stakeholders evaluated the business plans based on feasibility, financial return on investment, and anticipated safety enhancements. The solution that received the highest priority ranking and was subsequently implemented was "improved measurement and reporting of the impact of PPMI programs on patient outcomes." A defined process was followed for identifying gaps among current practices at an academic medical center and the 2015 ASHP Health-System Pharmacy Initiative and the PPMI. A key priority to better document the impact of pharmacists on patient care was identified for our department by using a nominal group technique brainstorming process and a multivoting dot technique and creating standardized business plans for five potential priority projects. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  10. Expediting Time from Symptoms to Medical Contact Utilizing a Telemedicine Call Center.

    PubMed

    Leshem-Rubinow, Eran; Assa, Eyal Ben; Shacham, Yacov; Zatelman, Avivit; Oren-Shamir, Ayelet; Malov, Nomi; Golovner, Michal; Roth, Arie

    2015-10-01

    No definitive solution has been forthcoming for the often dangerously long interval between symptom onset and seeking medical care in the prehospital setting. We examined the implementation of telemedicine technology and characterization of its utilizers for its efficacy in reducing this possibly life-threatening time lag. A retrospective observational study was performed on the working database of an operational telemedicine facility that included all subscribers. Time-to-contact measurements throughout 2012 were retrieved from its medical files, and data on age, gender, medical history, and main complaint were analyzed. Throughout 2012, 22,274 of a total of 46,556 calls (47.8%) were made ≤60 min from symptom onset. It is important that 26.9% of all calls (12,522/46,556) were made in <15 min. Significantly more males (10,794/22,229 [49%]) contacted in ≤60 min compared with females (11,480/24,327 [47%], p<0.03). Subjects <60 years of age (2,889/5,717 [51%]) called earlier than those >60 years (19,386/40,839 [47%], p<0.001). Patients with prior resuscitation and/or myocardial infarction contacted significantly more rapidly than those with other cardiac diseases. Over one-half of patients with cardiac complaints contacted the call center ≤60 min from symptom onset, as did those who suffered physical trauma, but not patients with gastrointestinal symptoms or pain elsewhere. A telemedicine system with rapid accessibility to a professional call center and prompt triage thereafter could be an additional promising strategy for shortening the interval between symptom onset and call for medical assistance. Implementation of a widespread telemedicine infrastructure may bridge the unmet gap between occurrence of symptoms to initiation of medical treatment.

  11. Evaluation of the ASCO Value Framework for Anticancer Drugs at an Academic Medical Center.

    PubMed

    Wilson, Leslie; Lin, Tracy; Wang, Ling; Patel, Tanuja; Tran, Denise; Kim, Sarah; Dacey, Katie; Yuen, Courtney; Kroon, Lisa; Brodowy, Bret; Rodondi, Kevin

    2017-02-01

    Anticancer drug prices have increased by an average of 12% each year from 1996 to 2014. A major concern is that the increasing cost and responsibility of evaluating treatment options are being shifted to patients. This research compared 2 value-based pricing models that were being considered for use at the University of California, San Francisco (UCSF) Medical Center to address the growing burden of high-cost cancer drugs while improving patient-centered care. The Medication Outcomes Center (MOC) in the Department of Clinical Pharmacy, University of California, San Francisco (UCSF), School of Pharmacy focuses on assessing the value of medication-related health care interventions and disseminating findings to the UCSF Medical Center. The High Cost Oncology Drug Initiative at the MOC aims to assess and adopt tools for the critical assessment and amelioration of high-cost cancer drugs. The American Society of Clinical Oncology (ASCO) Value Framework (2016 update) and a cost-effectiveness analysis (CEA) framework were identified as potential tools for adoption. To assess 1 prominent value framework, the study investigators (a) asked 8 clinicians to complete the ASCO Value Framework for 11 anticancer medications selected by the MOC; (b) reviewed CEAs assessing the drugs; (c) generated descriptive statistics; and (d) analyzed inter-rater reliability, convergence validity, and ranking consistency. On the scale of -20 to 180, the mean ASCO net health benefit (NHB) total score across 11 drugs ranged from 7.6 (SD = 7.8) to 53 (SD = 9.8). The Kappa coefficient (κ) for NHB scores across raters was 0.11, which is categorized as "slightly reliable." The combined κ score was 0.22, which is interpreted as low to fair inter-rater reliability. Convergent validity indicates that the correlation between NHB scores and CEA-based incremental cost-effectiveness ratios (ICERs) was low (-0.215). Ranking of ICERs, ASCO scores, and wholesale acquisition costs indicated different results

  12. [Replantation and revascularization in acute upper limb amputation--the Sheba Medical Center experience].

    PubMed

    Oron, Amir; Yaffe, Batia

    2008-01-01

    Replantation and revascularization in acute upper-limb amputations are well-accepted surgical techniques in hand surgery. All medical staff members treating patients in emergency settings should be familiar with the indications, timetable, setup and transportation of patients rendered suitable for such surgery. While replantation surgery is not considered a simple surgical procedure by any means, viability rates approach ninety percent. The amputated part should be wrapped with gauze soaked in saline, placed in a sterile plastic bag and then put in an ice-filled container. The patient should be transferred to a medical center with a team dedicated to performing replantation procedures, following notification in advance. Time from the initial insult to the initiation of treatment should be minimized. Combined efforts employed by the primary caregivers and the microsurgical team will lead to optimization of patient treatment and improve the final outcome. During the years 1991-2007 a total of 383 upper limb replantation or revascularization procedures were performed at the Sheba Medical Center and are presented in this article.

  13. 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.

  14. Electronic health communication: an educational application for this principle of the Patient-centered Medical Home.

    PubMed

    Barnhart, Amber; Lausen, Harald; Smith, Tracey; Lopp, Lauri

    2010-05-01

    The Patient-centered Medical Home (PCMH) relies on comprehensive, consistent, and accessible communication for the patient with all members of their health care team. "E-medicine" and health information technology (HIT) create many new possibilities in addition to standard face-to-face encounters. There is interest by both physicians and patients for enhanced access through electronic communication. However, there is little published literature regarding specific educational programs for medical professionals using electronic communication with patients. Faculty in a required 6-week family medicine clerkship developed, implemented, and evaluated an electronic health communication curriculum. This curriculum consists of a didactic session on electronic health communication including anticipated errors of communication and common clinical pitfalls. Each clerkship student receives a weekly e-mail from a standardized patient centered on a clinical question. Additionally, each e-mail contains a different communication challenge or predicted error. Students receive feedback each week on the e-mails and are evaluated with an objective structured clinical exam (OSCE) during the final week. The results of the weekly e-mails and the final OSCE show that students improve overall but continue to make predicted errors in communication despite didactic instruction and actual practice. These results reinforce the need for medical student education on electronic health communication with patients.

  15. Reengineering clinical psychiatry in academic medical centers: processes and models of change.

    PubMed

    Hoge, M A; Flaherty, J A

    2001-01-01

    Managed care poses a major threat to the future of clinical psychiatry in academic settings. High costs and an aversion to the business aspects of service delivery have left academic departments at a disadvantage in the marketplace. However, numerous departments have attempted to adapt to the current health care environment. On the basis of a review of these efforts, the authors identify the processes of change and seven models of change being employed to reengineer psychiatry within academic medical centers. The models are labeled transform, build, manage, buy, partner or affiliate, sell or lease, and consult. The authors discuss the strengths and weaknesses of these efforts and suggest three approaches to establishing the unique value of academic clinical services for purchasers and for the public. The first is to enhance productivity and clinical effectiveness through greater integration of clinical care, research, and training. The second is to take a leadership role in managing care, and the third is to advance the integration of behavioral health care with primary medical care and other specialties in the medical center.

  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. 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.

  18. An experience of liver transplantation in Latin America: a medical center in Colombia

    PubMed Central

    Londoño, Mauricio; Marín, Juan; Muñoz, Octavio; Mena, Álvaro; Guzmán, Carlos; Hoyos, Sergio; Restrepo, Juan; Arbeláez, María; Correa, Gonzalo

    2015-01-01

    Objectives: Liver transplantation is the treatment of choice for acute and chronic liver failure, for selected cases of tumors, and for conditions resulting from errors in metabolism. This paper reports the experience of a medical center in Latin America. Methods: Were conducted 305 orthotopic liver transplantations on 284 patients between 2004 and 2010. Of these patients, 241 were adults undergoing their first transplantation. Results: The average age of patients was 52 years old, and 62% of the individuals were male. The most common indication was alcoholic cirrhosis. The rate of patient survival after 1 and 5 years was 82 and 72% respectively. The rate of liver graft survival after 1 and 5 years was 78 and 68% respectively. The main cause of death was sepsis. Complications in the hepatic artery were documented for 5% of the patients. Additionally, 14.5% of the patients had complications in the biliary tract. Infections were found in 41% of the individuals. Acute rejection was observed in 30% of the subjects, and chronic rejection in 3%. Conclusion: In conclusion, liver transplantation at our medical center in Colombia offers good mid-term results, with a complication rate similar to that reported by other centers around the world. PMID:26019379

  19. 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.

  20. [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