RESUMO
BACKGROUND: The patient-centered medical home (PCMH) model is a holistic multidisciplinary approach to providing care in the primary care setting. Provider-led teams engage the patient and family in their own health care plan. It is linked to improve continuity of care and enhance access. OBJECTIVE: This article describes comparison outcomes in access to care, emergency department (ED) utilization, and population health management 2 fiscal years before and after implementation of the PCMH. Staff satisfaction was measured after implementation. DESIGN: A mixed study design approach was elected. De-identified aggregate data were mined from the Command's Business Report portal, from the pay-for-performance-based "Get to Goal" report, and through an anonymous voluntary questionnaire survey providing both qualitative and quantitative data interpretation. RESULT: Access to care increased by 7%, ED utilization decreased by 75.3%, and population health/healthcare effectiveness data and information set (HEDIS) measures improved overall. Seventy-five percent of the staff who volunteered to be surveyed was satisfied with the PCMH. CONCLUSION: After 2 years of implementation, the PCMH was associated with improvement in access to care, reduction of ED visits, improvement in population health/HEDIS measures, and a high degree of staff satisfaction.
Assuntos
Medicina Militar/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Assistência Centrada no Paciente , Continuidade da Assistência ao Paciente/organização & administração , Mineração de Dados , Serviço Hospitalar de Emergência/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Medicina Militar/normas , Assistência Centrada no Paciente/organização & administração , Assistência Centrada no Paciente/normas , Estados UnidosRESUMO
Complementary modalities, used alone or in combination with pharmacologic therapies, play an important role in the prevention and management of postoperative nausea and vomiting (PONV) and post discharge nausea and vomiting (PDNV). This article will review the evidence for the effective use of complementary modalities: acupuncture and related techniques, aromatherapy, and music therapy that may be integrated in the perianesthesia nurse's plan of care to prevent or manage PONV.
Assuntos
Terapias Complementares , Náusea e Vômito Pós-Operatórios/prevenção & controle , Terapia por Acupuntura , Aromaterapia , Zingiber officinale , Humanos , Musicoterapia , Fitoterapia , Preparações de Plantas/uso terapêuticoRESUMO
Vocal cord dysfunction (VCD) is a respiratory condition characterized by the paradoxical closure of the vocal cords. This condition results in a myriad of symptoms that would be expected from an upper airway obstruction including anxiety, hyperventilation, wheezing, stridor, shortness of breath, dyspnea, and suprasternal and neck muscle retraction. with known VCD who underwent local anesthesia with intravenous sedation for perianal skin tag removal. Postoperatively, the patient experienced respiratory distress, prompting interventions and investigation. A review of the literature revealed limited information on VCD, and no anesthesia literature was found regarding this entity.