Deep Learning Approach to Parse Eligibility Criteria in Dietary Supplements Clinical Trials Following OMOP Common Data Model.

Dietary supplements (DSs) have been widely used in the U.S. and evaluated in clinical trials as potential interventions for various diseases. However, many clinical trials face challenges in recruiting enough eligible patients in a timely fashion, causing delays or even early termination. Using electronic health records to find eligible patients who meet clinical trial eligibility criteria has been shown as a promising way to assess recruitment feasibility and accelerate the recruitment process. In this study, we analyzed the eligibility criteria of 100 randomly selected DS clinical trials and identified both computable and non-computable criteria. We mapped annotated entities to OMOP Common Data Model (CDM) with novel entities (e.g., DS). We also evaluated a deep learning model (Bi-LSTM-CRF) for extracting these entities on CLAMP platform, with an average F1 measure of 0.601. This study shows the feasibility of automatic parsing of the eligibility criteria following OMOP CDM for future cohort identification.

Long-term tracking demonstrates effectiveness of a partnership-led training program to advance the careers of biomedical researchers from underrepresented groups.

The demographic profile of the biomedical workforce in the U.S. does not reflect the population at large, raising concerns that there will be insufficient trained researchers in the future, and the scope of research interests will not be sufficiently broad. To diversify and expand the pool of researchers trained to conduct research on cancer and cancer health disparities, a series of training activities to recruit and train primarily Hispanic students at both the undergraduate and graduate level were developed. The strengths of both a Hispanic Serving Institution and an NIH-designated Comprehensive Cancer Center were leveraged to develop appropriate research training and professional development activities. The career progression of the participants and degree completion rates was tracked, along with persistent interest in biomedical research in general and cancer and cancer health disparities research in particular for these underrepresented individuals. Finally, this report demonstrates that these training activities increased general knowledge about cancer among participants.

Integrated Medical-Dental Delivery Systems: Models in a Changing Environment and Their Implications for Dental Education.

Models and systems of the dental care delivery system are changing. Solo practice is no longer the only alternative for graduating dentists. Over half of recent graduates are employees, and more than ever before, dentists are practicing in groups. This trend is expected to increase over the next 25 years. This article examines various models of dental care delivery, explains why it is important to practice in integrated medical-dental teams, and defines person-centered care, contrasting it with patient-centered care. Systems of care in which teams are currently practicing integrated oral health care delivery are described, along with speculation on the future of person-centered care and the team approach. Critical steps in the education of dental and other health care professionals and the development of clinical models of care in moving forward are considered. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Partnerships Between Podiatrists and Vascular Surgeons in Building Effective Wound Care Centers.

This practice memo, a collaborative effort between the Young Physicians' Program of the American Podiatric Medical Association (APMA) and the Young Surgeons Committee of the Society for Vascular Surgery (SVS), is intended to aid podiatrists and vascular surgeons in the early years of their respective careers, especially those involved in the care of patients with chronic wounds. During these formative years, learning how to successfully establish an inter-professional partnership is crucial in order to provide the best possible care to this important patient population.

Partnerships between podiatrists and vascular surgeons in building effective wound care centers.

This practice memo, a collaborative effort between the Young Physicians' Program of the American Podiatric Medical Association and the Young Surgeons Committee of the Society for Vascular Surgery, is intended to aid podiatrists and vascular surgeons in the early years of their respective careers, especially those involved in the care of patients with chronic wounds. During these formative years, learning how to successfully establish an interprofessional partnership is crucial to provide the best possible care to this important population of patients.

Improving physical activity program adoption using integrated research-practice partnerships: an effectiveness-implementation trial.

Integrated research-practice partnerships (IRPPs) may improve adoption of evidence-based programs. The aim of this study is to compare adoption of an IRPP-developed physical activity (PA) program (Fit Extension, FitEx) to a typical efficacy-effectiveness-dissemination pipeline model program (Active Living Every Day, ALED). Guided by the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework, a randomized controlled trial assigned health educators (HEs) to FitEx (n = 18) or ALED (n = 18). Fourteen HEs adopted FitEx, while two HEs adopted ALED (χ 2 = 21.8; p < 0.05). FitEx HEs took less time to deliver (p < 0.05), stated greater intentions for continued program delivery (p < 0.05), and reached more participants (n = 1097 total; 83 % female; 70 % Caucasian; M age = 44 ± 11.8) per HE than ALED (n = 27 total; 60 % female; 50 % Caucasian; M age = 41 ± 11.3). No significant difference existed in FitEx or ALED participants' increased PA (M increase = 9.12 ±29.09  min/day; p > 0.05). IRPP-developed programs may improve PA program adoption, implementation, and maintenance and may also result in programs that have higher reach-without reducing effectiveness.

Opinions of professionals about integrating midwife- and obstetrician-led care in The Netherlands.

OBJECTIVE: the current division between midwife-led and obstetrician-led care creates fragmentation in maternity care in the Netherlands. This study aims to gain insight into the level of consensus among maternity care professionals about facilitators and barriers related to integration of midwife-led and obstetrician-led care. Integration could result in more personal continuity of care for women who are referred during labour. This may lead to better birth experiences, fewer interventions and better outcomes for both mother and infant. DESIGN: a descriptive study using a questionnaire survey of 300 primary care midwives, 100 clinical midwives and 942 obstetricians. SETTING: the Netherlands in 2013. PARTICIPANTS: 131 (response 44%) primary care midwives, 51 (response 51%) clinical midwives and 242 (response 25%) obstetricians completed the questionnaire. FINDINGS: there was consensus about the clinical midwife caring for labouring women at moderate risk of complications. Although primary care midwives themselves were willing to expand their tasks there was no consensus among respondents on the tasks and responsibilities of the primary care midwife. Professionals agreed on the importance of good collaboration between professionals who should work together as a team. Respondents also agreed that there are conflicting interests related to the payment structure, which are a potential barrier for integrating maternity care. KEY CONCLUSIONS: this study shows that professionals are positive regarding an integrated maternity care system but primary care midwives, clinical midwives and obstetricians have different opinions about the specifications and implementation of this system. IMPLICATION FOR PRACTICE: our findings are in accordance with earlier research, showing that it is too early to design a blueprint for an integrated maternity care model in the Netherlands. To bring about change in the maternity care system, an implementation strategy should be chosen that accounts for differences in interests and opinions between professionals.

From the trunk of a Volkswagen beetle: a mobile nursing clinic in Appalachia.

Access to health care has been a factor for patients living in isolated mountain regions. The Frontier Nursing service was a pioneer in reaching those patients living in the most remote regions of Appalachia. Geography, demographics, and culture present obstacles for rural residents and health care providers. This article identifies and describes the roles nurses and nurse practitioners played in caring for Appalachian families through a roving Health Wagon in the 1980s and 1990s in Southwest Virginia. Family nurse practitioner Sister Bernadette Kenny was instrumental in bringing care on wheels to rural residents living in the Appalachian mountainous region of southwest Virginia.

Medication Safety in Primary Care Practice: results from a PPRNet quality improvement intervention.

Reducing medication errors is a fundamental patient safety goal; however, few improvement interventions have been evaluated in primary care settings. The Medication Safety in Primary Care Practice project was designed to test the impact of a multimethod quality improvement intervention on 5 categories of preventable prescribing and monitoring errors in 20 Practice Partner Research Network (PPRNet) practices. PPRNet is a primary care practice-based research network among users of a common electronic health record (EHR). The intervention was associated with significant improvements in avoidance of potentially inappropriate therapy, potential drug-disease interactions, and monitoring of potential adverse events over 2 years. Avoidance of potentially inappropriate dosages and drug-drug interactions did not change over time. Practices implemented a variety of medication safety strategies that may be relevant to other primary care audiences, including use of EHR-based audit and feedback reports, medication reconciliation, decision-support tools, and refill protocols.

Assisted-living spaces for end-users with complex needs: a proposed implementation and delivery model.

An assisted living space (ALS) is a technology-enabled environment designed to allow people with complex health or social care needs to remain, and live independently, in their own home for longer. However, many challenges remain in order to deliver usable systems acceptable to a diverse range of stakeholders, including end-users, and their families and carers, as well as health and social care services. ALSs need to support activities of daily-living while allowing end-users to maintain important social connections. They must be dynamic, flexible and adaptable living environments. In this article, we provide an overview of the technological landscape of assisted-living technology (ALT) and recent policies to promote an increased adoption of ALT in Scotland. We discuss our experiences in implementing technology-supported ALSs and emphasise key lessons. Finally, we propose an iterative and pragmatic user-centred implementation model for delivering ALSs in complex-needs scenarios. This empirical model is derived from our past ALS implementations. The proposed model allows project stakeholders to identify requirements, allocate tasks and responsibilities, and identify appropriate technological solutions for the delivery of functional ALS systems. The model is generic and makes no assumptions on needs or technology solutions, nor on the technical knowledge, skills and experience of the stakeholders involved in the ALS design process.

Care partnerships between family physicians and rheumatologists.

OBJECTIVE: To describe care partnerships between family physicians and rheumatologists. METHODS: A random sample (20%, n = 478) of family physicians was mailed a questionnaire, asking if there was at least 1 particular rheumatologist to whom the physician tended to refer patients. If the answer was affirmative, the physician would be considered as having a "care partnership" with that rheumatologist. The family physician then rated, on a 5-point scale, factors of importance regarding the relationship with that rheumatologist. RESULTS: The questionnaire was completed by 84/462 (18.2%) of family physicians; 52/84 (61.9%) reported having rheumatology care partnerships according to our definition. Regarding interactions with rheumatologists, most respondents rated the following as important (score ≥ 4): adequate communication and information exchange (44/50, 88.0%); waiting time for new patients (40/50, 80.0%); clear and appropriate balance of responsibilities (39/49, 79.6%); and patient feedback and preferences (34/50, 68%). Male family physicians were more likely than females to accord high importance to personal knowledge of the rheumatologist, and to physical proximity of the rheumatologist's practice. Regarding relationships with rheumatologists, 30/50 (60.0%) of respondents felt communication and information exchange were adequate, and 35/50 (70.0%) felt they had a clear balance of responsibilities. CONCLUSION: Almost two-thirds of family physicians have rheumatology care partnerships, according to our definition. In this partnership, establishing adequate communication and shorter waiting time seem of paramount importance to family physicians. A balanced sharing of responsibilities and patients' preferences are also valued. Although many physicians reported adequate communication and clear and appropriate balance of responsibilities in their current interactions with rheumatologists, there appears to be room for improvement.

Palliative care and oncology partnerships in real practice.

This article addresses the practical application of palliative care (PC) in the outpatient oncology setting. While information on this topic is scarce, data published by a few outpatient practices provide the basis for potential models of integrated care. In general, the perceived impact of integrating PC into standard oncology practice is positive for patients, providers, oncology practices, and the healthcare system as a whole. As the benefits of integrating PC into oncology practice continue to be realized, more data will become available.

Physician collective bargaining.

Current antitrust enforcement policy unduly restricts physician collaboration, especially among small physician practices. Among other matters, current enforcement policy has hindered the ability of physicians to implement efficient healthcare delivery innovations, such as the acquisition and implementation of health information technology (HIT). Furthermore, the Federal Trade Commission and Department of Justice have unevenly enforced the antitrust laws, thereby fostering an increasingly severe imbalance in the healthcare market in which dominant health insurers enjoy the benefit of largely unfettered consolidation at the cost of both consumers and providers. This article traces the history of antitrust enforcement in healthcare, describe the current marketplace, and suggest the problems that must be addressed to restore balance to the healthcare market and help to ensure an innovative and efficient healthcare system capable of meeting the demands of the 21st century. Specifically, the writer explains how innovative physician collaborations have been improperly stifled by the policies of the federal antitrust enforcement agencies, and recommend that these policies be relaxed to permit physicians more latitude to bargain collectively with health insurers in conjunction with procompetitive clinical integration efforts. The article also explains how the unbridled consolidation of the health insurance industry has resulted in higher premiums to consumers and lower compensation to physicians, and recommends that further consolidation be prohibited. Finally, the writer discusses how health insurers with market power are improperly undermining the physician-patient relationship, and recommend federal antitrust enforcement agencies take appropriate steps to protect patients and their physicians from this anticompetitive conduct. The article also suggests such steps will require changes in three areas: (1) health insurers must be prohibited from engaging in anticompetitive activity; (2) the continuing improper consolidation of the health insurance industry must be curtailed; and (3) the physician community must be permitted to undertake the collaborative activity necessary for the establishment of a transparent, coordinated, and efficient delivery system.

Small steps to health: building sustainable partnerships in pediatric obesity care.

BACKGROUND: Given the prevalence of childhood obesity and the limited support for preventing and managing obesity in primary care settings, the Seattle Children's Hospital's Children's Obesity Action Team has partnered with Steps to Health King County to develop a pediatric obesity quality-improvement project. METHODS: Primary care clinics joined year-long quality-improvement collaboratives to integrate obesity prevention and management into the clinic setting by using the chronic-disease model. Sustainability was enhanced through integration at multiple levels by emphasizing small, consistent behavior changes and self-regulation of eating/feeding practices with children, teenagers, and families; building local community partnerships; and encouraging broader advocacy and policy change. Cultural competency and attention to disparities were integrated into quality-improvement efforts. RESULTS: . Participating clinics were able to increase BMI measurement and weight classification; integrate management of overweight/obese children and family and self-management support; and grow community collaborations. Over the course of 4 years, this project grew from a local effort involving 3 clinics to a statewide program recently adopted by the Washington State Department of Health. CONCLUSIONS: This model can be used by other states/regions to develop pediatric obesity quality-improvement programs to support the assessment, prevention, and management of childhood obesity. Furthermore, these health care efforts can be integrated into broader community-wide childhood-obesity action plans.

[The importance of integrated health care for private hospital owners]. / Bedeutung der Integrierten Versorgung in der Kardiologie für private Klinikträger.

About 60 to 70% of hospital services are non-urgent, elective procedures. At least in those indications, insurance companies can deliberately choose their partners among the providers. This forces hospital owners and other providers to enhance their performance, to sharpen their profile and to improve their image in the emerging market. Image in the market of health care is only acceptable as a race for improved quality and evidence-based clinical pathways with defined steps with full disclosure of the agreed indications. The next step will lead to management corporations as a link between partners, who will take over responsibility for reimbursement, reinsurance and all management tasks. Integrated Health Care is a promising first step.

Collaborating while competing? The sustainability of community-based integrated care initiatives through a health partnership.

BACKGROUND: To improve health-care delivery, care providers must base their services on community health needs and create a seamless continuum of care in which these needs can be met. Though, it is not obvious that providers apply this vision. Experiments with regulated competition in the health systems of many industrialized countries trigger providers to optimize individual organizational goals rather than improve population health from a community perspective. Thus, a tension exists between the need to collaborate and the need to compete. Despite or because of this tension, community health partnerships are being promoted, and this should enforce a needs-based and integrated care delivery. METHODS: In this single case study, we retrospectively explored how local health-care providers in Amsterdam collaborated for more than 30 years, interacting with the changes to the national health-care system. In-depth analysis of interviews, documents and literature focused on the complex relationship between the activities of this health partnership, its nature and its changing context. RESULTS: The findings revealed that the partnership itself was successful and sustainable over time, although the partnership lost its initial broad explorative nature and narrowed its strategic focus towards care of the elderly. Furthermore, the realized projects--although they enforced integrated care--lost their community-based character. This declining scope of community-based integrated care seems to have been influenced by the incremental introduction of regulated competition in Dutch health care. This casts doubts on the ability of health partnerships to apply a vision of community-based integrated care within the context of competition. CONCLUSION: Collaborating health-care providers can build seamless continuums of care in a competitive environment, although these will not automatically maximize community health with limited resources. Active policies with regard to health system design, incentive structures and population-based performance measures are warranted in order to insure that community-based integrated care through health partnerships will be more than just policy rhetoric.

A comparison of the outcomes of partnership caseload midwifery and standard hospital care in low risk mothers.

BACKGROUND: Maternal and infant clinical outcomes were compared for low risk mothers receiving a partnership caseload model of midwifery care, known as Primary Health Midwifery Care (PHMC), and standard hospital care (SHC). METHODS: Using secondary analysis of data from the Obstet Data System routine collection (PHMC n=976, SHC n=976) from a large metropolitan hospital, maternal and infant clinical outcomes were examined. RESULTS: Odds ratios (OR) demonstrated reduced rates of interventions for multiparous women (OR 0.62 [CI 0.49-0.80]), with multiparous women receiving PHMC being more likely to have a normal delivery (OR 1.75 [CI 1.22-2.5]). A higher proportion of both primiparous and multiparous women receiving PHMC received pethidine during labour (OR 1.78 [1.33-2.39], OR 1.55 [1.19-2.01] respectively). Primiparous women receiving PHMC underwent fewer episiotomies with an associated increase in the proportion of women experiencing perineal tears (OR 1.93, CI 2.35-2.78), although perineum trauma rates were similar for both care models. Similar and very small numbers of infants in both parity groups and care models had an Apgar of less than seven at five minutes or were admitted to the neonatal intensive care unit or special care unit. CONCLUSION: This study, within the limitations of its design, supports the safety of the partnership caseload midwifery care model, in addition to reduced rates of interventions experienced by multiparous women and fewer episiotomies in primiparous low risk English-speaking women receiving caseload care.

International educational partnership for practice: Brazil and the United Kingdom.

BACKGROUND: To enhance healthcare globally, successful academic partnerships between institutes of higher education are crucial to strengthen collaboration between countries and identify new ways of working. The desire to reduce maternal mortality and morbidity among childbearing women in north-east Brazil urged professional nurses to seek new ways of working through such a partnership. Reflections on the success of the link identify the key qualities uniting the partnership. AIMS: This paper explores the key qualities of a higher education partnership between the United Kingdom and north-east Brazil. These qualities can act as a guide to other faculties engaged in such links to facilitate successful collaborative working for gains on both sides. RESULTS: Critical reflections from both partners revealed that the key qualities identified are effective communication, deep commitment and the need for both partners to understand each other's context of care. CONCLUSIONS: Examination of each of these qualities illustrates that the shared perspectives, mutual respect and enriched educational experience are valuable and essential to successful partnership working. This critical reflection illustrates the process of success and how others can benefit from the lessons learned, whatever the nature of partnership. Understanding the nature of collaborative working has strengthened each education and practice community, encouraged them to take risks, and remain committed to collective success.