RESUMO
Patient demand for integrative medicine is increasing, and presents a service opportunity for health care systems. Implementing integrative medicine in an allopathic health care setting poses unique challenges. Addressing organizational culture, finances, patient experience/physical space, and credentialing issues can help ensure success.
Assuntos
Medicina Integrativa , HumanosAssuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Administração Hospitalar/normas , Corpo Clínico Hospitalar/organização & administração , Gestão da Qualidade Total/normas , Organizações de Assistência Responsáveis/economia , Organizações de Assistência Responsáveis/normas , Organizações de Assistência Responsáveis/tendências , Diretores de Hospitais , Prestação Integrada de Cuidados de Saúde/normas , Prestação Integrada de Cuidados de Saúde/tendências , Eficiência Organizacional , Administração Hospitalar/economia , Administração Hospitalar/tendências , Reestruturação Hospitalar/economia , Reestruturação Hospitalar/métodos , Reestruturação Hospitalar/normas , Humanos , Relações Interinstitucionais , Corpo Clínico Hospitalar/economia , Corpo Clínico Hospitalar/psicologia , Inovação Organizacional/economia , Satisfação do Paciente , Autonomia Profissional , Gestão da Qualidade Total/economia , Gestão da Qualidade Total/tendências , Aquisição Baseada em Valor/economia , Aquisição Baseada em Valor/normas , Aquisição Baseada em Valor/tendências , WashingtonRESUMO
Today, hospitals and physicians are reorganizing themselves in novel ways to take advantage of payment incentives that reward shared accountability for the total health care experience. These delivery system changes will take place with our without physician leadership. To optimize change on behalf of patients, physicians must play a conscious role in shaping future health care delivery organizations. As physician leaders of three of the nation׳s largest integrated health care delivery systems - Kaiser Permanente, Virginia Mason Medical Center, and the Mayo Clinic Health System - we call on physicians to view leadership and the development of leaders as key aspects of their role as patient advocates.
RESUMO
The implementation of a breast clinic based on the use of an advanced registered nurse practitioner at Virginia Mason Medical Center in Seattle, Washington, substantially improved care timeliness and efficiency for women with symptomatic benign breast conditions. Women received their final benign diagnosis in an average of four rather than sixteen days, with fewer imaging studies and physician visits, when compared to a control group. Savings to the employer were estimated at $316 per woman, primarily from increased work productivity. Direct care costs decreased an estimated 19 percent, to $213 per woman. By decreasing both direct medical costs and indirect costs such as work absenteeism and presenteeism, the Virginia Mason Breast Clinic has created substantial savings for providers and employers while delivering care that patients rate highly. This model demonstrates the feasibility of achieving higher quality at lower cost through integrated care.
Assuntos
Doenças Mamárias/economia , Doenças Mamárias/enfermagem , Neoplasias da Mama/economia , Neoplasias da Mama/enfermagem , Profissionais de Enfermagem/economia , Profissionais de Enfermagem/organização & administração , Padrões de Prática em Enfermagem/economia , Padrões de Prática em Enfermagem/organização & administração , Melhoria de Qualidade/economia , Melhoria de Qualidade/organização & administração , Doenças Mamárias/diagnóstico , Neoplasias da Mama/diagnóstico , Estudos de Coortes , Redução de Custos , Diagnóstico Tardio , Atenção à Saúde/economia , Atenção à Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/organização & administração , Eficiência Organizacional/economia , Estudos de Viabilidade , Feminino , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Satisfação do Paciente/economia , Estudos Retrospectivos , WashingtonAssuntos
Prestação Integrada de Cuidados de Saúde/tendências , Liderança , Qualidade da Assistência à Saúde , Lista de Checagem , Controle de Custos , Tomada de Decisões , Revelação , Custos de Cuidados de Saúde , Gastos em Saúde , Prioridades em Saúde , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Melhoria de Qualidade , Estados UnidosRESUMO
Virginia Mason Medical Center in Seattle has worked in collaboration with health plans and employers to facilitate development of standardized approaches to care of patients with common conditions. These efforts have eliminated unnecessary treatment and decreased costs to employers, health plans, patients, and providers. We describe our collaborative approach and illustrate it with the example of improved treatment for patients with uncomplicated headache, for which we have achieved 91 percent patient satisfaction, decreased use of advanced imaging by 23 percent, and provided same-day appointments in 95 percent of cases. As a model for improving quality while reducing cost, the Virginia Mason experience demonstrates that a multispecialty group practice, hospital, employers, and health plans can define quality and align performance and payment along common goals.
Assuntos
Comportamento Cooperativo , Prestação Integrada de Cuidados de Saúde/economia , Planos de Assistência de Saúde para Empregados , Pessoal de Saúde , Seguro Saúde , Garantia da Qualidade dos Cuidados de Saúde , Controle de Custos/métodos , Hospitais Filantrópicos , Humanos , Modelos Organizacionais , Estudos de Casos Organizacionais , WashingtonRESUMO
Clinical interventions which produce cue and contextual extinction learning can reduce craving and relapse in substance abuse and inhibit conditioned fear responses in anxiety disorders. In both types of disorders, classical conditioning links unconditioned drug or fear responses to associated contextual cues and result in enduring pathological responses to multiple stimuli. Extinction therapy countermeasures seek to reduce conditioned responses using a set of techniques in which patients are repeatedly exposed to conditioned appetitive or aversive stimuli using imaginal imagery, in vivo exposure, or written scripts. Such interventions allow patients to rehearse more adaptive responses to conditioned stimuli. The ultimate goal of these interventions, extinction of the original conditioned response, is a new learning process that results in a decrease in frequency or intensity of conditioned responses to drug or fear cues. This review explores extinction approaches in conditioned drug reward and fear responses. The behavioral, neuroanatomical and neurochemical mechanisms of conditioned reward and fear responses and their extinction are derived from our understanding of the animal literature. Extensive neuroscience research shows that even though many mechanisms differ in conditioned fear and reward, converging prefrontal cortical glutamatergic pathways underlie extinction learning. Efficacy of pharmacological and behavioral treatment approaches in addiction and anxiety disorders may be optimized by enhancing extinction and weakening the bond between the original conditioned stimuli and conditioned responses. Adjunctive pharmacotherapy approaches using agents which alter glutamate or γ-aminobutyric acid signaling or epigenetic mechanisms in prefrontal cortical pathways can enhance extinction learning. A comparative study of extinction processes and its neural mechanisms can be translated into more effective behavioral and pharmacological treatment approaches in substance abuse and anxiety.
Assuntos
Ansiedade/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Animais , Ansiedade/psicologia , Condicionamento Clássico , Medo , Humanos , Motivação , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
Virginia Mason Health System's vision to be the quality leader in healthcare means continually adopting new ways of thinking. One change has been shifting from believing defects are to be expected to believing zero defects in healthcare is not only possible, but also necessary. Generally, healthcare has advanced in technology and understanding of disease, but its business and management systems have changed little since the 1950s. Virginia Mason realized it needed a management method to help make real and measurable improvements in safety, quality, service and staff satisfaction.
Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Hospitais Filantrópicos/organização & administração , Qualidade da Assistência à Saúde , Prestação Integrada de Cuidados de Saúde/normas , Hospitais Filantrópicos/normas , Humanos , Estudos de Casos Organizacionais , Inovação Organizacional , WashingtonAssuntos
Alcoolismo/reabilitação , Baclofeno/uso terapêutico , Transtorno Bipolar/reabilitação , Transtornos Relacionados ao Uso de Cocaína/reabilitação , Agonistas GABAérgicos/uso terapêutico , Antidepressivos de Segunda Geração/uso terapêutico , Antipsicóticos/uso terapêutico , Comorbidade , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Fluoxetina/uso terapêutico , Seguimentos , Humanos , Assistência de Longa Duração , Masculino , Abuso de Maconha/reabilitação , Pessoa de Meia-Idade , Risperidona/uso terapêutico , Prevenção SecundáriaRESUMO
PURPOSE: We undertook this study to investigate the characteristics of blinking activity in healthy human fetuses. METHODS: Blinking activity was studied sonographically in healthy fetuses between 33 and 42 weeks' menstrual age. Horizontal and coronal sonographic views of the eye were obtained and videotaped. Fetal blinking movements were analyzed by reviewing the videotape in slow motion. Fetal vibroacoustic stimulation was also used when clinically indicated. RESULTS: We examined a total of 18 healthy fetuses. Fetal blinking was detected in 89% of cases, with a mean frequency of 6.2 movements per 60-minute observation period. Vibroacoustic stimulation was associated with increased fetal blinking in the 6 fetuses in which it was applied (mean, 15.3 movements per 60-minute observation period). CONCLUSIONS: Blinking is a normal fetal activity. The increased frequency of blinking activity associated with vibroacoustic stimulation may be considered a part of the normal startle reflex.