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1.
Women Birth ; 32(2): 168-177, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30150149

RESUMEN

BACKGROUND: Despite well-known benefits of continuity of midwifery care, less than 10% of women have access to this model of care in Australia. Staff retention and satisfaction are strongly related to the quality of management; however, little is known about the attributes required to effectively manage a midwifery group practice. PURPOSE: To explore the attributes midwifery group practice managers require to be effective managers and how these attributes can be developed to promote service sustainability. METHODS: A qualitative interpretive approach, employing in-depth interviews with eight midwifery leaders was undertaken and analysed using thematic analysis. RESULTS: The overarching theme described the ideal midwifery group practice manager as someone who stands up for midwives and women and is 'Holding the ground for midwifery, for women'. Subthemes demonstrate midwifery group practice management is complex: 'having it', describes the intrinsic traits of an effective leader; 'someone with their hand on the steering wheel' illustrates the day to day job of being a manager and the role of 'juggling the forces' that surround group practice; 'helping managers to manage better' explored the need for managers to be educated and supported for the role. CONCLUSIONS: Managers require certain attributes to effectively manage these unique services, whilst also juggling the needs of the organisation as a whole. Having transformational leadership qualities with vision to lead the practice into the future are key. There needs to be better support and preparation for the role if midwifery group practice is to be a sustainable option for women and midwives.


Asunto(s)
Práctica de Grupo/organización & administración , Liderazgo , Partería/organización & administración , Anciano , Australia , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Encuestas y Cuestionarios
3.
Curr Psychiatry Rep ; 19(3): 19, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28290063

RESUMEN

There is increasing interest in methods to improve access to behavioral health services for children and adolescents. Children's Community Pediatric Behavioral Health Service (CCPBHS) is an integrated behavioral health service whose method of (a) creating a leadership team with empowered administrative and clinical stakeholders who can act on a commitment to change and (b) having a clear mission statement with integrated administrative and clinical care processes can serve as a model for implementing integration efforts within the medical home. Community Pediatrics Behavioral Health Service (CPBHS) is a sustainable initiative that improved the utilization of physical health and behavioral health systems for youth and improved the utilization of evidence-based interventions for youth served in primary care.


Asunto(s)
Medicina de la Conducta/organización & administración , Servicios Comunitarios de Salud Mental/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Práctica de Grupo/organización & administración , Trastornos Mentales/terapia , Atención Dirigida al Paciente/organización & administración , Atención Primaria de Salud/organización & administración , Adolescente , Niño , Terapia Combinada , Práctica Clínica Basada en la Evidencia/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Grupo de Atención al Paciente/organización & administración , Pennsylvania , Psicotrópicos/uso terapéutico , Derivación y Consulta/organización & administración
4.
Women Birth ; 29(6): 494-502, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27199172

RESUMEN

BACKGROUND: Midwifery group practice (MGP) is a care model offered by a primary midwife in a small team. Evidence confirms MGP is acceptable to women, safe and cost effective. METHODS: We aimed to provide a systematic overview of the first 'no exit' MGP in a Western Australian (WA) tertiary maternity hospital, using a mixed methods approach, involving four phases. Between July 2013 and June 2014: phase one assessed MGP characteristics, obstetric and neonatal outcomes by parity; phase two examined women's satisfaction by mode of delivery; and phase three qualitatively explored perceptions of care. Phase four compared the proportion of MGP women and the 2012 WA birthing population. FINDINGS: Phase one included 232 MGP women; 87% achieved a vaginal birth. Phase two included 97% (226 of 232) women, finding 98% would recommend the service. Phase three analysis of 62 interviews revealed an overarching theme 'Continuity with Midwives' encompassing six sub-themes: only a phone call away; home away from home; knowing me; a shared view; there for me; and letting it happen. Phase four compared the MGP cohort to 33,393 WA women. Intrapartum MGP women were more likely than the WA population to have a vaginal birth (87% vs 65%, P≤0.001) and intact perineum (49% vs 36%, P≤0.001) and less likely to use epidural/spinal analgesia (34% vs 59%, P≤0.001), or have a caesarean (13% vs 35%, P≤0.001). CONCLUSIONS: Mixed methods enabled systematic examination of this new 'no exit' MGP confirming safety and acceptability. Findings contribute to our knowledge of MGP models.


Asunto(s)
Continuidad de la Atención al Paciente , Práctica de Grupo/organización & administración , Maternidades/organización & administración , Partería/métodos , Satisfacción Personal , Australia , Continuidad de la Atención al Paciente/organización & administración , Femenino , Humanos , Paridad , Parto , Embarazo , Estudios Prospectivos , Encuestas y Cuestionarios , Centros de Atención Terciaria , Australia Occidental
11.
Open Med ; 7(2): e40-55, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24348884

RESUMEN

BACKGROUND: Large multispecialty physician group practices, with a central role for primary care practitioners, have been shown to achieve high-quality, low-cost care for patients with chronic disease. We assessed the extent to which informal multispecialty physician networks in Ontario could be identified by using health administrative data to exploit natural linkages among patients, physicians, and hospitals based on existing patient flow. METHODS: We linked each Ontario resident to his or her usual provider of primary care over the period from fiscal year 2008/2009 to fiscal year 2010/2011. We linked each specialist to the hospital where he or she performed the most inpatient services. We linked each primary care physician to the hospital where most of his or her ambulatory patients were admitted for non-maternal medical care. Each resident was then linked to the same hospital as his or her usual provider of primary care. We computed "loyalty" as the proportion of care to network residents provided by physicians and hospitals within their network. Smaller clusters were aggregated to create networks based on a minimum population size, distance, and loyalty. Networks were not constrained geographically. RESULTS: We identified 78 multispecialty physician networks, comprising 12,410 primary care physicians, 14,687 specialists, and 175 acute care hospitals serving a total of 12,917,178 people. Median network size was 134,723 residents, 125 primary care physicians, and 143 specialists. Virtually all eligible residents were linked to a usual provider of primary care and to a network. Most specialists (93.5%) and primary care physicians (98.2%) were linked to a hospital. Median network physician loyalty was 68.4% for all physician visits and 81.1% for primary care visits. Median non-maternal admission loyalty was 67.4%. Urban networks had lower loyalties and were less self-contained but had more health care resources. INTERPRETATION: We demonstrated the feasibility of identifying informal multispecialty physician networks in Ontario on the basis of patterns of health care-seeking behaviour. Networks were reasonably self-contained, in that individual residents received most of their care from providers within their respective networks. Formal constitution of networks could foster accountability for efficient, integrated care through care management tools and quality improvement, the ideas behind "accountable care organizations."


Asunto(s)
Organizaciones Responsables por la Atención/organización & administración , Enfermedad Crónica/terapia , Prestación Integrada de Atención de Salud/organización & administración , Médicos/organización & administración , Atención Primaria de Salud/organización & administración , Organizaciones Responsables por la Atención/normas , Análisis por Conglomerados , Redes Comunitarias , Prestación Integrada de Atención de Salud/normas , Manejo de la Enfermedad , Práctica de Grupo/organización & administración , Práctica de Grupo/normas , Relaciones Médico-Hospital , Humanos , Relaciones Interprofesionales , Registro Médico Coordinado , Ontario , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/normas , Atención Primaria de Salud/normas , Especialización , Recursos Humanos
13.
Women Birth ; 26(4): 235-9, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24074760

RESUMEN

BACKGROUND: Around-the-clock access to a known midwife is a distinct feature of Midwifery Group Practice (MGP) and caseload midwifery settings; although the literature suggests this aspect of working life may hinder recruitment and retention to this model of care. Mobile technologies, known as mHealth where they are used in health care, facilitate access and hence communication, however little is known about this area of midwifery practice. RESEARCH QUESTION: Which communication modalities are used, and most frequently, by MGP midwives and clients? METHODS: A prospective, cross sectional design included a purposive sample of MGP midwives from an Australian tertiary maternity hospital. Data on modes of midwife-client contact were collected 24h/day, for two consecutive weeks, and included: visits, phone-calls, texts and emails. Demographic data were also collected. FINDINGS: Details about 1442 midwife-client contacts were obtained. The majority of contact was via text, between the hours of 07:00 and 14:59, with primiparous women, when the primary midwife was on-call. An average of 96 contacts per fortnight occurred. CONCLUSION: The majority of contact was between the midwife and their primary clients, reiterating a key tenet of caseload models and confirming mobile technologies as a significant and evolving aspect of practice. The pattern of contact within social (or daytime) hours is reassuring for midwives considering caseload midwifery, who are concerned about the on-call burden. The use of text as the preferred communication modality raises issues regarding data security and retrieval, accountability, confidentiality and text management during off-duty periods. The development of Australian-wide guidelines to inform local policies and best practice is recommended.


Asunto(s)
Teléfono Celular , Comunicación , Partería/métodos , Telemedicina/métodos , Envío de Mensajes de Texto/estadística & datos numéricos , Adulto , Australia , Continuidad de la Atención al Paciente/organización & administración , Estudios Transversales , Femenino , Práctica de Grupo/organización & administración , Accesibilidad a los Servicios de Salud , Humanos , Servicios de Salud Materna/organización & administración , Persona de Mediana Edad , Partería/organización & administración , Relaciones Enfermero-Paciente , Embarazo , Estudios Prospectivos , Carga de Trabajo/psicología
14.
J Am Pharm Assoc (2003) ; 53(1): 78-84, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23636160

RESUMEN

OBJECTIVE: To assess the impact of ambulatory clinical pharmacist medication therapy assessment and reconciliation for patients postdischarge in terms of hospital readmission rates, financial savings, and medication discrepancies. SETTING: Group Health Cooperative (Group Health) in Washington State, from September 2009 through February 2010. PRACTICE DESCRIPTION: Group Health is a nonprofit integrated group practice and health plan, operating 25 primary care medical centers and 5 specialty centers. Group Health's practice design is a patient-centered medical home model. PRACTICE INNOVATION: All patients identified as high risk for readmission were followed by Group Health care management. Patients in care management who received a phone call from a pharmacist 3 to 7 days postdischarge for medication therapy assessment and reconciliation were identified as the medication review group (n = 243). Patients who did not receive clinical pharmacist intervention were included in the comparison group (n = 251). MAIN OUTCOME MEASURES: Readmission rates, financial savings, and medication discrepancies. RESULTS: Patients who received medication therapy assessment and reconciliation had decreased readmission rates at 7, 14, and 30 days postdischarge, with statistical significance at 7 and 14 days. Medication review versus comparison readmission rates were as follows: 7 days: 0.8% vs. 4% ( P = 0.01); 14 days: 5% vs. 9% ( P = 0.04); and 30 days: 12% vs. 14% ( P = 0.29). Financial savings for Group Health per 100 patients who received medication reconciliation was an estimated $35,000, translating to more than $1,500,000 in savings annually. Of patients, 80% had at least one medication discrepancy upon discharge. CONCLUSION: Most literature on medication reconciliation evaluates inpatient processes, whereas data on medication reconciliation postdischarge are limited. Our data support the hypothesis that medication assessment and reconciliation by pharmacists 3 to 7 days postdischarge can decrease readmissions and provide cost savings.


Asunto(s)
Conciliación de Medicamentos/métodos , Readmisión del Paciente/estadística & datos numéricos , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/economía , Atención Ambulatoria/métodos , Ahorro de Costo , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/organización & administración , Femenino , Práctica de Grupo/economía , Práctica de Grupo/organización & administración , Humanos , Masculino , Persona de Mediana Edad , Alta del Paciente , Atención Dirigida al Paciente/economía , Atención Dirigida al Paciente/organización & administración , Estudios Retrospectivos , Factores de Tiempo
16.
J Urol ; 190(1): 97-101, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23399652

RESUMEN

PURPOSE: National attention has focused on whether urology-radiation oncology practice integration, known as integrated prostate cancer centers, contributes to the use of intensity modulated radiation therapy, a common and expensive prostate cancer treatment. MATERIALS AND METHODS: We examined prostate cancer treatment patterns before and after conversion of a urology practice to an integrated prostate cancer center in July 2006. Using the SEER (Statistics, Epidemiology and End Results)-Medicare database, we identified patients 65 years old or older in 1 statewide registry diagnosed with nonmetastatic prostate cancer between 2004 and 2007. We classified patients into 3 groups, including 1--those seen by integrated prostate cancer center physicians (exposure group), 2--those living in the same hospital referral region who were not seen by integrated prostate cancer center physicians (hospital referral region control group) and 3--those living elsewhere in the state (state control group). We compared changes in treatment among the 3 groups, adjusting for patient, clinical and socioeconomic factors. RESULTS: Compared with the 8.1 ppt increase in adjusted intensity modulated radiation therapy use in the state control group, the use of this therapy increased 20.3 ppts (95% CI 13.4, 27.1) in the integrated prostate cancer center group and 19.2 ppts (95% CI 9.6, 28.9) in the hospital referral region control group. Androgen deprivation therapy, for which Medicare reimbursement decreased sharply, similarly decreased in integrated prostate cancer center and hospital referral region controls. Prostatectomy decreased significantly in the integrated prostate cancer center group. CONCLUSIONS: Coincident with the conversion of a urology group practice to an integrated prostate cancer center, we observed an increase in intensity modulated radiation therapy and a decrease in androgen deprivation therapy in patients seen by integrated prostate cancer center physicians and those seen in the surrounding health care market that were not observed in the remainder of the state.


Asunto(s)
Práctica de Grupo/organización & administración , Oncología Médica/organización & administración , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía , Oncología por Radiación/organización & administración , Anciano , Anciano de 80 o más Años , Biopsia con Aguja , Instituciones Oncológicas/organización & administración , Bases de Datos Factuales , Prestación Integrada de Atención de Salud/organización & administración , Supervivencia sin Enfermedad , Humanos , Relaciones Interprofesionales , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina , Pronóstico , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/patología , Calidad de la Atención de Salud , Radioterapia de Intensidad Modulada/métodos , Medición de Riesgo , Programa de VERF , Análisis de Supervivencia , Resultado del Tratamiento , Urología
17.
Women Birth ; 26(1): 87-9, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22464949

RESUMEN

The following article describes a midwife's experience in the adaption of the CenteringPregnancy model into her own group practice to provide education and support to the women in her care. Using personal experience and feedback from women and midwifery students the author describes not only the process of group care in her work context but the apparent benefits to women, families', midwifery students and herself. Antenatal group care was so successful for the author that it extended to postnatal group care and student group care, all well attended and sought after groups. This is an exciting and innovative way to provide care for women and families and the author encourages other midwives and group practices to consider how they can adapt and progress similar group care into their own practice.


Asunto(s)
Práctica de Grupo/organización & administración , Partería/métodos , Madres/psicología , Enfermeras Obstetrices/psicología , Atención Prenatal/métodos , Femenino , Humanos , Relaciones Interpersonales , Partería/organización & administración , Modelos de Enfermería , Modelos Organizacionales , Madres/educación , Rol de la Enfermera , Educación del Paciente como Asunto/organización & administración , Embarazo , Apoyo Social , Encuestas y Cuestionarios
18.
Health Aff (Millwood) ; 31(11): 2379-87, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23129667

RESUMEN

Cigna's Collaborative Accountable Care initiative provides financial incentives to physician groups and integrated delivery systems to improve the quality and efficiency of care for patients in commercial open-access benefit plans. Registered nurses who serve as care coordinators employed by participating practices are a central feature of the initiative. They use patient-specific reports and practice performance reports provided by Cigna to improve care coordination, identify and close care gaps, and address other opportunities for quality improvement. We report interim quality and cost results for three geographically and structurally diverse provider practices in Arizona, New Hampshire, and Texas. Although not statistically significant, these early results revealed favorable trends in total medical costs and quality of care, suggesting that a shared-savings accountable care model and collaborative support from the payer can enable practices to take meaningful steps toward full accountability for care quality and efficiency.


Asunto(s)
Organizaciones Responsables por la Atención/organización & administración , Conducta Cooperativa , Costos de la Atención en Salud , Administración de la Práctica Médica/organización & administración , Calidad de la Atención de Salud , Arizona , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/normas , Femenino , Práctica de Grupo/organización & administración , Humanos , Modelos Logísticos , Masculino , Programas Controlados de Atención en Salud/organización & administración , New Hampshire , Planes de Incentivos para los Médicos/organización & administración , Pautas de la Práctica en Medicina/economía , Evaluación de Programas y Proyectos de Salud , Texas
20.
Women Birth ; 25(4): 187-93, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22169396

RESUMEN

BACKGROUND: Midwifery-led models of care, specifically Midwifery Group Practices (MGPs), have been promoted as one way to address the increasing caesarean rate. Whilst women report a high level of satisfaction, and experience lower rates of induction and epidural analgesia, a Cochrane review reported no differences in mode of birth. METHOD: A retrospective cohort study was performed using routinely collected de-identified data of all term births between 2006 and 2010. Outcomes for 1545 women under MGP model were compared with 13,880 women cared for in all other models. Primary outcome measure was unassisted vaginal birth. Predictors investigated were model of care, induction and epidural analgesia. Both bivariate analysis and multivariate logistic regression analysis was undertaken (controlling for important confounders) with adjusted odds ratios (aOR) and 95% confidence intervals (CI) presented. FINDINGS: Significant differences were demonstrated in the demographic and clinical characteristics of the groups. Compared with those in other models of care, women in MGP care had similar rates of induction but significantly fewer received epidural analgesia (28.4% vs 33.5%; p<0.001). There was no difference in the mode of birth. When adjusted for confounders, women in MGP care were no more or less likely to have an unassisted vaginal birth (aOR 1.07; 95% CI 0.92-1.24; p=0.397), birth assisted by instrument (aOR 1.02; 95% CI 0.86-1.21; p=0.852) or emergency caesarean section (aOR 0.89; 95% CI 0.74-1.06; p=0.193). However, in the subgroup of women who did not receive epidural analgesia, women in MGP care had an increased likelihood of an unassisted vaginal birth (aOR 1.29; 95% CI 1.06-1.58; p=0.013). CONCLUSION: Women in MGP care are no more or less likely to have an unassisted vaginal birth.


Asunto(s)
Parto Obstétrico/métodos , Práctica de Grupo/organización & administración , Partería/organización & administración , Adulto , Australia , Continuidad de la Atención al Paciente , Parto Obstétrico/estadística & datos numéricos , Femenino , Encuestas de Atención de la Salud , Humanos , Modelos Logísticos , Modelos de Enfermería , Oportunidad Relativa , Evaluación de Procesos y Resultados en Atención de Salud , Embarazo , Resultado del Embarazo , Estudios Retrospectivos , Adulto Joven
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