Crossing the quality chasm: creating the ideal patient care experience.

To create a health system that better meets patients' needs requires a fundamental redesign of our care delivery system and a new framework. Without a payment mechanism to reflect the value of care provided other than the face-to-face visit, adoption of advanced medical home principles will be challenging. The hand-off of the patient between providers and settings of care is a critical time for the patient and its effectiveness impacts patient care outcomes. The appropriate utilization of hospital and other health system resources is crucial, especially as hospitals, emergency departments, and other health care venues increasingly face capacity constraints and throughput challenges. It becomes the responsibility of the multidisciplinary team of providers to ensure that patients being discharged have an identified personal physician or team who will provide a medical home, and that the handoff to this medical home is thorough and well coordinated. An ideal patient care experience is one in which all systems and processes are geared to meet the needs of the patient: a safety-oriented system that provides standardized, evidence-based care supported by technology, but that recognizes and responds to individual needs.

Dangers of used sharps in household trash: implications for home care.

Between 8 and 9 million Americans are self-injecting medication at home, and the majority of the needles used are being thrown into the household trash. It is up to all stakeholders, including healthcare professionals, to help change the way these dangerous needles and other sharps are discarded. Are you giving your patients the correct information?

Behavior changes in patients with diabetes and hypertension after experiencing shared medical appointments.

PURPOSE: This project examined recently implemented shared medical appointments (SMAs) at a free clinic for patients with diabetes and/or hypertension. Changes in patients' self-managing behaviors, specifically exercise and goal-setting activity, were explored after participating in SMAs for 4 months. DATA SOURCES: The study employed a pretest-posttest quasi-experimental design. Participants completed a questionnaire of their self-managing behaviors and a behavioral action plan at each SMA. The SMAs were facilitated in English, Spanish, and bilingually (English and Spanish) with a total of 37 participants. CONCLUSIONS: Descriptive analysis showed a significant increase in exercise time with a mean increase of 86 min per week at post-SMA (p= .002, 95% confidence interval [CI]). Each participant identified a measurable goal, and 97% of participants reported achieving or almost achieving their goals. Males reported a significantly (p= .002, 95% CI) larger increase in exercise time than women. Variance of self-managing behaviors among the English, Spanish, and bilingual SMAs was statistically not significant. IMPLICATIONS FOR PRACTICE: Though much evidence exists demonstrating that SMAs provide effective quality care, literature is lacking in examining patients' self-managing behaviors after participation in language-specific SMAs. Understanding patients' response to programs that address the needs of the individual leads to more effective programs.

Analysis: the impact of needle, syringe, and lancet disposal on the community.

There are over 7.5 billion needles and syringes used outside of the health care system each year by individuals with diabetes, migraines, allergies, infertility, arthritis, HIV, hepatitis, multiple sclerosis, osteoporosis, psoriasis, or other conditions. Disposal of needles, syringes, lancets, and other medical products are not regulated in the home, while these same products used in health care facilities are strictly regulated. Home-generated medical waste is routinely placed into curbside trash, placing sanitation workers and custodial personnel at personal risk of a needle-stick injury. The Coalition for Safe Community Needle Disposal is working to establish a solution that is satisfactory to all stakeholders, sharing the burden of these programs with the pharmaceutical industry, medical device industry, waste management industry, recycling companies, and local and state governments.