Value-Based Proposition of an Adapted Integrated Care Telehealth Service for Accountable Care Organization Members.

The authors describe a real-world application of virtually integrated primary and behavioral health care implemented within an accountable care organization (ACO) system. Cost-of-care data from before and after a 6-month intervention were analyzed for 121 Medicaid and Child Health Plan Plus ACO members. The intervention was associated with a significant shift in the distribution of health care costs, from inpatient and emergency care to outpatient and preventive care. The program demonstrates a flexible and replicable approach to integration that can help expand effective primary care.

What is your research question? A mixed methods evaluation of an academic statistical consulting center.

Academic consulting centers on research and statistics are the bridge between applied researchers and statisticians and thus at the core of university-wide research. The client-centered evaluation focused on investigating the perspective of the clients in university research and statistical consulting center. A mixed-methods methodology was used in this study, specifically a concurrent triangulation design was implemented to have multiple data sources collected and analyzed simultaneously in order to identify areas of overlapping information. The Research Consulting Scale (RCS) instrument was developed and analyzed using an exploratory factor analysis with 129 participants and resulted in two factors: consulting experience, and consulting facilities. The internal consistency reliability of the scores for these two factors was 0.89 and .86 respectively. These results support the RCS has strong internal consistency. Additionally, client interviews were conducted sampling from those who had responded to the survey in order to gather additional data. Thematic analysis was performed to interview data and resulted in two major themes: consultant expertise and consultancy skills. The results provide a survey instrument and key themes for university consulting centers to focus and assess their efficiency through client's perspectives.

Patient Reported Outcome Measures in the Foot and Ankle: Normative Values Do Not Reflect 100% Full Function.

PURPOSE: The primary purpose of this study was to determine normative values for foot and ankle ability measure (FAAM), activities of daily living (ADL), FAAM/foot and ankle disability (FADI) Sport, Tegner activity scale, SF-12 physical component summary (PCS) and mental component summary (MCS) in individuals who are representative of the "normal" adult population in the United States. The secondary purpose was to perform a confirmatory factor analysis (CFA) of ankle functional ability to provide evidence of reliability and validity of commonly used orthopaedic outcome scores. Our hypothesis was that normative values will differ based on patient characteristics and demographics, and that the selected commonly used foot and ankle outcomes scores will demonstrate acceptable reliability and validity estimates. METHODS: There were 271 persons in this study (101 women, 170 men, average age = 31.4 (SD = 15.1) years, average BMI = 25.9 (SD = 5.9)). Age, sex and BMI were documented. Comparisons of outcome scores were made between cohorts. CFA was performed to test factor structure of ankle functional ability. RESULTS: There was no significant difference in FAAM ADL between women and men (n.s.) or FAAM Sport (n.s.). Women had significantly higher SF-12 PCS (P = 0.001). Men had significantly higher SF-12 MCS (P < 0.001) and Tegner (P = 0.024). FAAM ADL, FAAM Sport and SF-12 PCS scores were significantly higher in people who did not have previous ankle surgery. Younger people and those with lower BMI had significantly higher ankle function. Reliability was excellent, and the CFA had excellent model fit demonstrating evidence of validity. CONCLUSIONS: This study revealed that normative values of foot and ankle outcome measures did not reflect 100% function and differed by sex, previous ankle surgery status, age and BMI. Individuals who did not have previous ankle surgery were younger, and had lower BMI and higher functional levels. Reliability was excellent, and the CFA model demonstrated excellent fit, providing evidence for validity, and lending support to use aggregated outcome measures as one scale. This study is unique in that it provides surgeons with normative ankle values in commonly reported outcome measures including the FAAM, FADI SF-12 and Tegner activity scale, in the normal population, based on BMI, age, gender and previous ankle surgery status. This information can be a very useful tool in the clinical setting for patient expectations counseling. In addition, surgeons and clinicians can feel confident using these outcome scores to assess their patients' progress through the continuum of care. LEVEL OF EVIDENCE: Level II.

Practice analysis and changes to the Chiropractic Board of Clinical Nutrition diplomate exam.

OBJECTIVE: The main objective of this study was to report results of the practice analysis survey and to provide insights into the average levels of performance and the importance of professional tasks executed by chiropractic nutritionists. In addition, this study informs the chiropractic community of the changes made to the Chiropractic Board of Clinical Nutrition diplomate exam. METHODS: Seventy-eight practicing chiropractic nutritionists responded to the practice analysis survey. Their responses were analyzed, and conclusions about frequency and importance of performance tasks were reached. A panel of subject matter experts provided a qualitative review of the survey responses. The quantitative and qualitative analyses of the survey responses indicated that minor changes to the test plan were needed. RESULTS: Descriptive statistical techniques were employed to analyze the survey responses. The qualitative panel suggested reducing the number of domains on the nutrition exam from 7 to 6 by combining Laboratory and Nutrition-Specific Testing and Imaging and Other Special Studies domains. Additionally, the panel decided on the final distribution of weights combining the quantitative results with qualitative perspectives. CONCLUSION: The practice analysis is a first step in the definition of the skills required for practicing chiropractic nutritionists. The analysis becomes one of the references and a decision-making tool used by the board for developing and administrating quality assessments.