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2.
J Prim Care Community Health ; 12: 21501327211005303, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33759622

RESUMEN

As the COVID-19 health crisis continues to reshape healthcare, systems across the country face increasing pressure to adapt their models of care to expand access to care, while also improving efficiency and quality in the face of limited resources. Consequently, many have shown a growing interest and receptivity to the expansion of telehealth models to help meet these demands. Electronic consultations (eConsults) are a telehealth modality that allow for a non-face-to-face asynchronous consultation between a primary care provider (PCP) and a specialist aimed at facilitating specialist input without the need for a patient visit. The aim of this case study is to describe eConsults, how they differ from traditional in person models of care and other models of telemedicine and to review the evidence related to the effectiveness of eConsults by PCPs and clinicians from multiple specialties at the University of Colorado School of Medicine. We have worked to develop an infrastructure, delivery system integration, and care model adaptations that aim to improve delivery system performance by ensuring proper care in appropriate settings and lowering costs through reduced utilization. Lastly, we have increased care coordination, improved collaboration and better care transitions through strengthening of relationships between community-based PCPs and academic medical center-based specialists. This work has resulted in cost savings to patients and positive provider satisfaction.


Asunto(s)
Centros Médicos Académicos , Creación de Capacidad , Prestación de Atención de Salud/métodos , Atención Primaria de Salud , Derivación y Consulta , Consulta Remota , Especialización , Colorado , Conducta Cooperativa , Prestación de Atención de Salud/normas , Eficiencia , Electrónica , Reforma de la Atención de Salud , Accesibilidad a los Servicios de Salud , Humanos , Relaciones Interprofesionales , Pandemias , Aceptación de la Atención de Salud , Médicos de Atención Primaria , Facultades de Medicina
3.
JAMA Netw Open ; 4(3): e212382, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33739431

RESUMEN

Importance: The 2017-2018 influenza season in the US was marked by a high severity of illness, wide geographic spread, and prolonged duration compared with recent previous seasons, resulting in increased strain throughout acute care hospital systems. Objective: To characterize self-reported experiences and views of hospital capacity managers regarding the 2017-2018 influenza season in the US. Design, Setting, and Participants: In this qualitative study, semistructured telephone interviews were conducted between April 2018 and January 2019 with a random sample of capacity management administrators responsible for throughput and hospital capacity at short-term, acute care hospitals throughout the US. Main Outcomes and Measures: Each participant's self-reported experiences and views regarding high patient volumes during the 2017-2018 influenza season, lessons learned, and the extent of hospitals' preparedness planning for future pandemic events. Interviews were recorded and transcribed and then analyzed using thematic content analysis. Outcomes included themes and subthemes. Results: A total of 53 key hospital capacity personnel at 53 hospitals throughout the US were interviewed; 39 (73.6%) were women, 48 (90.6%) had a nursing background, and 29 (54.7%) had been in the occupational role for more than 4 years. Participants' experiences were categorized into several domains: (1) perception of strain, (2) effects of influenza and influenza-like illness on staff and patient care, (3) immediate staffing and capacity responses to influenza and influenza-like illness, and (4) future staffing and capacity preparedness for influenza and influenza-like illness. Participants reported experiencing perceived strain associated with concerns about preparedness for seasonal influenza and influenza-like illness as well as concerns about staffing, patient care, and capacity, but future pandemic planning within hospitals was not reported as being a high priority. Conclusions and Relevance: The findings of this qualitative study suggest that during the 2017-2018 influenza season, there were systemic vulnerabilities as well as a lack of hospital preparedness planning for future pandemics at US hospitals. These issues should be addressed given the current coronavirus disease 2019 pandemic.


Asunto(s)
Creación de Capacidad , Gestión del Cambio , Defensa Civil/organización & administración , Planificación en Desastres/métodos , Brotes de Enfermedades , Gripe Humana , /epidemiología , Creación de Capacidad/métodos , Creación de Capacidad/organización & administración , Brotes de Enfermedades/prevención & control , Brotes de Enfermedades/estadística & datos numéricos , Fuerza Laboral en Salud/organización & administración , Humanos , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Gripe Humana/terapia , Administración de Personal/métodos , Investigación Cualitativa , Estaciones del Año , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiología
4.
Med J (Ft Sam Houst Tex) ; (PB 8-21-01/02/03): 79-82, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33666916

RESUMEN

BACKGROUND: Keller Army Community Hospital, a 12-bed community hospital located in the Hudson Valley of New York State, within the pandemic epicenter anticipated the surge of critically ill patients, which would overwhelm local resources during the coronavirus pandemic sweeping across the globe. In this facility, there were no Intensive Care Unit (ICU) beds and resources were mobilized in order to create a negative pressure Corona Virus Unit (CVU) consisting of seven ICU beds and two step-down beds. Although the creation of the CVU decreased the non-COVID inpatient capacity to five beds, the hospital also formulated a plan to expand overall bed capacity from 12 inpatient beds to 45 beds within 24 hours. OBJECTIVE: To create a ICU embedded within a CVU and implement a three day curriculum to prepare four mixed teams of critical care and non-critical care staff nurses to manage critically ill patients with the novel coronavirus disease 2019 (COVID-19). METHODS: Nursing leaders and hospital education staff developed a critical care curriculum utilizing Elsevier didactic, the DoD COVID-19 Practice Guide, and hands-on training for 34 nurses.1,2 Nurses had varied scope of practice levels from licensed practical nurses to advance practice nurses, with diverse critical care expertise to non-critical care nursing staff from the primary care medical home (PCMH), all of which participated in the cross-leveling to the CVU unit during the pandemic response. Educational elements included PPE donning and doffing, mechanical ventilation, central venous catheter maintenance, arterial catheter management, hemodynamics, and critical care pharmacotherapy. A medical model skills station with common critical care equipment such as ventilators allowed for instantaneous feedback and 13 hands-on skills training. RESULTS: A fully functional ICU and CVU was created with thirty-four nurses who completed training within seven days with a didactic completing rate of 94.65 % and 100% hands-on skills. The program endures with monthly tailored re-fresher training to improve efficiency and maintain critical competencies. The team maintained operational readiness through the surge and remain resolute for the next surge. CONCLUSIONS: On-going program execution and evaluation continues to develop new staff members due to permanent change of station, recent on-boarding, or because of evidence based clinical guideline changes. Training has continued, but shifted to include normal inpatient operations over the summer of 2020. Re-fresher classes covering the treatment and care of COVID patients continue with the anticipation of a second wave surge of COVID-19 cases emerges this fall based on epidemiology predictions.


Asunto(s)
/terapia , Creación de Capacidad/organización & administración , Cuidados Críticos/organización & administración , Curriculum , Hospitales Militares , Capacidad de Reacción/organización & administración , /epidemiología , Capacidad de Camas en Hospitales , Hospitales Comunitarios , Humanos , New York
7.
Emerg Infect Dis ; 27(4)2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33755009

RESUMEN

We analyzed feasibility of pooling saliva samples for severe acute respiratory syndrome coronavirus 2 testing and found that sensitivity decreased according to pool size: 5 samples/pool, 7.4% reduction; 10 samples/pool, 11.1%; and 20 samples/pool, 14.8%. When virus prevalence is >2.6%, pools of 5 require fewer tests; when <0.6%, pools of 20 support screening strategies.


Asunto(s)
/métodos , Saliva/virología , Manejo de Especímenes/métodos , /diagnóstico , Creación de Capacidad/métodos , Asignación de Recursos para la Atención de Salud , Humanos , Límite de Detección , Asignación de Recursos/métodos , Sensibilidad y Especificidad , Estados Unidos
8.
Front Public Health ; 9: 640598, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33681137

RESUMEN

Developing countries struggle to provide high-quality, equitable care to all. Challenges of resource allocation frequently lead to ethical concerns of healthcare inequity. To tackle this, such developing nations continually need to implement healthcare innovation, coupled with capacity building to ensure new strategies continue to be developed and executed. The COVID-19 pandemic has made significant demands of healthcare systems across the world-to provide equitable healthcare to all, to ensure public health principles are followed, to find novel solutions for previously unencountered healthcare challenges, and to rapidly develop new therapeutics and vaccines for COVID-19. Countries worldwide have struggled to accomplish these demands, especially the latter two, considering that few nations had long-standing systems in place to ensure processes for innovation were on-going before the pandemic struck. The crisis represents a critical juncture to plan for a future. This future needs to incorporate a vision for the implementation of healthcare innovation, coupled with capacity building to ensure new strategies continue to be developed and executed. In this paper, the case of the massive Indian healthcare system is utilized to describe how it could implement this vision. An inclusive, ethically-resilient framework has been broadly laid out for healthcare innovation in the future, thereby ensuring success in both the short- and the long-term.


Asunto(s)
Prestación de Atención de Salud , Planificación en Salud , Innovación Organizacional , Creación de Capacidad , Difusión de Innovaciones , Política de Salud , Humanos , India , Aprendizaje Automático , Salud Pública , Calidad de la Atención de Salud
9.
Emerg Infect Dis ; 27(4): 1146-1150, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33754989

RESUMEN

The expense of saliva collection devices designed to stabilize severe acute respiratory syndrome coronavirus 2 RNA is prohibitive to mass testing. However, virus RNA in nonsupplemented saliva is stable for extended periods and at elevated temperatures. Simple plastic tubes for saliva collection will make large-scale testing and continued surveillance easier.


Asunto(s)
/métodos , ARN Viral , Saliva/virología , /diagnóstico , /virología , Creación de Capacidad/métodos , Humanos , Estabilidad del ARN , ARN Viral/aislamiento & purificación , ARN Viral/fisiología , Reproducibilidad de los Resultados , Asignación de Recursos , /aislamiento & purificación , Manejo de Especímenes/economía , Manejo de Especímenes/instrumentación , Manejo de Especímenes/métodos
11.
Nurs Adm Q ; 45(2): 102-108, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33570876

RESUMEN

As hospitals across the world realized their surge capacity would not be enough to care for patients with coronavirus disease-2019 (COVID-19) infection, an urgent need to open field hospitals prevailed. In this article the authors describe the implementation process of opening a Boston field hospital including the development of a culture unique to this crisis and the local community needs. Through first-person accounts, readers will learn (1) about Boston Hope, (2) how leaders managed and collaborated, (3) how the close proximity of the care environment impacted decision-making and management style, and (4) the characteristics of leaders under pressure as observed by the team.


Asunto(s)
/epidemiología , Creación de Capacidad/organización & administración , Arquitectura y Construcción de Hospitales/métodos , Unidades Móviles de Salud/organización & administración , Boston , Femenino , Humanos , Liderazgo , Masculino , Unidades Móviles de Salud/estadística & datos numéricos , Pandemias , Incertidumbre
12.
Nurs Adm Q ; 45(2): 126-134, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33570880

RESUMEN

This article describes how a national nursing association and a major academic medical center responded to the coronavirus disease-2019 (COVID-19) pandemic during the first wave of the outbreak in the United States (January to August 2020). The organizations share their lived experiences as they quickly found themselves at the forefront of the crisis. The article discusses how early warning signs from a world away sparked collaboration, innovation, and action that grew to a coordinated, organization-wide response. It also explores how leaders in 2 distinct but interrelated environments rose to the challenge to leverage the best their organizations had to offer, relying on the expertise of each to navigate changes that were made to almost every aspect of work. From tentative first steps to rapid implementation of innovative policies and procedures, the organizations share lessons learned and benefits reaped. The article includes practical crisis response strategies for the nursing profession and health care systems moving forward.


Asunto(s)
Centros Médicos Académicos/organización & administración , American Nurses' Association/organización & administración , Prestación de Atención de Salud/organización & administración , Liderazgo , Creación de Capacidad/organización & administración , Humanos , Ciudad de Nueva York/epidemiología , Pandemias
13.
Nurs Adm Q ; 45(2): 85-93, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33570875

RESUMEN

When the Covid 19 pandemic affected New York State, Federal and mostly State, mandates were given to hospitals to prepare for the expected influx of patients. This is a community hospital's planning journey that includes preparing for placing patients, educating caregivers, matching the abilities of the available caregivers with the needs of the patients, securing needed equipment and supplies, and caring for the caregivers. Planning for patient placement resulted in a phased-in guide, accommodating seriously and critically ill affected patients. Education and training were initial and ongoing, rapidly changing as new information became available. Effective care delivery models that focused on team were modified depending on the needs of patients and staff competence. Securing and maintaining equipment and supplies were challenging and caring for the caregivers was a priority. Working as a team, this community hospital developed a road map that was effective in planning for the surge and allowed the hospital to maintain a safe environment for staff and patients who received quality care in difficult time.


Asunto(s)
/epidemiología , Creación de Capacidad/organización & administración , Personal de Salud/educación , Hospitales Comunitarios/organización & administración , Humanos , New York/epidemiología , Pandemias , Equipo de Protección Personal/provisión & distribución
15.
J Am Board Fam Med ; 34(Suppl): S48-S54, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33622818

RESUMEN

BACKGROUND: Because of the Coronavirus disease 2019 (COVID 19) pandemic, many primary care practices have transitioned to telehealth visits to keep patients at home and decrease the transmission of the disease. Yet, little is known about the nationwide capacity for delivering primary care services via telehealth. METHODS: Using the 2016 National Ambulatory Medical Survey we estimated the number and proportion of reported visits and services that could be provided via telehealth. We also performed cross-tabulations to calculate the number and proportion of physicians providing telephone visits and e-mail/internet encounters. RESULTS: Of the total visits (nearly 400 million) to primary care physicians, 42% were amenable to telehealth and 73% of the total services rendered could be delivered through telehealth modalities. Of the primary care physicians, 44% provided telephone consults and 19% provided e-consults. DISCUSSION: This study underscores how and where primary care services could be delivered. It provides the first estimates of the capacity of primary care to provide telehealth services for COVID-19 related illness, and for several other acute and chronic medical conditions. It also highlights the fact that, as of 2016, most outpatient telehealth visits were done via telephone. CONCLUSIONS: This study provides an estimate of the primary care capacity to deliver telehealth and can guide practices and payers as care delivery models change in a post-COVID 19 environment.


Asunto(s)
Creación de Capacidad , Atención Primaria de Salud/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Bases de Datos Factuales , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pandemias , Atención Primaria de Salud/tendencias , Encuestas y Cuestionarios , Telemedicina/tendencias , Estados Unidos/epidemiología , Adulto Joven
16.
J Am Board Fam Med ; 34(Suppl): S55-S60, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33622819

RESUMEN

BACKGROUND: The COVID-19 (C-19) pandemic required swift response from health care organizations to mitigate spread and impact. A large integrated health network rapidly deployed and operationalized multiple access channels to the community, allowing assessment and triage to occur virtually. These channels were characterized by swift implementation of virtual models, including asynchronous e-visits and video visits for C-19 screening. PURPOSE: (1) Evaluate implementation characteristics of C-19 screening e-visits and video visits. (2) Identify volume of C-19 screening and other care provided via e-visits and video visits. (3) Discuss future implications of expanded virtual access models. METHODS: Retrospective analysis of implementation data for C-19 screening e-visits and video visits, including operational characteristics and visit/screening volumes conducted. RESULTS: Virtual channels were implemented and rapidly expanded during the first week C-19 testing was made available. During the study period, primary care clinicians conducted 10,673 e-visits and 31,226 video visits with 9,126 and 26,009 patients, respectively. Within these 2 virtual modalities, 4,267 C-19 tests were ordered (10% of visits). Four hundred forty-eight clinicians supported 24/7 access to these virtual modalities. DISCUSSION: Given ongoing patient interest and opportunity, virtual health care services will continue to be available for an expanded number of symptoms and diagnoses.


Asunto(s)
Creación de Capacidad/organización & administración , Prestación Integrada de Atención de Salud/métodos , Telemedicina/métodos , /epidemiología , Humanos , Tamizaje Masivo/métodos , Pandemias , Atención Primaria de Salud/organización & administración , Estudios Retrospectivos
17.
J Am Board Fam Med ; 34(Suppl): S85-S94, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33622823

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak poses serious health risks, particularly for older adults and persons with underlying chronic medical conditions. Community health centers (CHCs) serve as the patient medical home for populations that are disproportionately more susceptible to COVID-19; yet, there is a lack of understanding of current efforts in place by CHCs to prepare for and respond to the pandemic. METHODS: We used a comprehensive cross-sectional survey and focus groups with health care personnel to understand the needs and current efforts in place by CHCs, and we derived themes from the focus group data. RESULTS: Survey respondents (n = 234; 19% response rate) identified COVID-19 infection prevention and control (76%), safety precautions (72%), and screening, diagnostic testing, and management of patients (66%) as major educational needs. Focus group findings (n = 39) highlighted 5 key themes relevant to readiness: leadership, resources, workforce capacity, communication, and formal policies and procedures. CONCLUSION: The COVID-19 pandemic has exacerbated long-standing CHC capacity issues making it challenging for them to adequately respond to the outbreak. Policies promoting greater investment in CHCs may strengthen them to better meet the needs of the most vulnerable members of society, and thereby help flatten the curve.


Asunto(s)
Creación de Capacidad , Centros Comunitarios de Salud/organización & administración , Prestación de Atención de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/organización & administración , /economía , Centros Comunitarios de Salud/economía , Estudios Transversales , Grupos Focales , Humanos , Pandemias , Investigación Cualitativa , Encuestas y Cuestionarios , Recursos Humanos/organización & administración
18.
J Am Board Fam Med ; 34(Suppl): S217-S221, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33622841

RESUMEN

The University of Colorado family medicine residency watched along with the rest of the nation as the first cases of COVID-19 were being reported in the United States in March 2020. Concern grew as epidemiological models began to predict alarming hospital bed shortages for the state. Massive scheduling adjustments were needed as faculty and residents found themselves in groups at high risk for severe COVID-19 and residents found themselves dismissed from nonessential learning experiences in an effort to conserve personal protective equipment and limit exposures. A dedicated surge team was formed to tackle these issues while continuing to support our goals of maximizing patient safety, resident education, and physician wellness. The surge team created a plan that was implemented in 2 main phases. Phase 1 assumed business as usual with increased layers of backup for both residents and faculty. Phase 2 redistributed unassigned residents and inpatient faculty to increase capacity for adult medicine and COVID-19 patients on our essential services. Lessons learned from these surge efforts may help inform similar decisions being made by other residency programs presently and in the future.


Asunto(s)
/terapia , Creación de Capacidad , Medicina Familiar y Comunitaria/educación , Internado y Residencia/organización & administración , /epidemiología , Colorado/epidemiología , Humanos , Comunicación Interdisciplinaria , Pandemias , Admisión y Programación de Personal/organización & administración
19.
BMC Med Educ ; 21(1): 136, 2021 Feb 27.
Artículo en Inglés | MEDLINE | ID: mdl-33639921

RESUMEN

BACKGROUND: Low- and Middle-income countries (LMIC) face considerable health and nutrition challenges, many of which can be addressed through strong academic leadership and robust research translated into evidence-based practice. A North-South-South partnership between three universities was established to implement a master's programme in nutritional epidemiology at the Kinshasa School of Public Health (KSPH), Democratic Republic of Congo (DRC). The partnership aimed to develop academic leadership and research capacity in the field of nutrition in the DRC. In this article we describe the educational approach and processes used, and discuss successes, challenges, and lessons learned. METHODS: Self-administered questionnaires, which included both open and closed questions, were sent to all graduates and students on the master's programme to explore students' experiences and perceptions of all aspects of the educational programme. Quantitative data was analysed using frequencies, and a thematic approach was used to analyse responses to open-ended questions. RESULTS: A two-year master's programme in Nutritional Epidemiology was established in 2014, and 40 students had graduated by 2020. Key elements included using principles of authentic learning, deployment of students for an internship at a rural residential research site, and support of selected students with bursaries. Academic staff from all partner universities participated in teaching and research supervision. The curriculum and teaching approach were well received by most students, although a number of challenges were identified. Most students reported benefits from the rural internship experience but were challenged by the isolation of the rural site, and felt unsupported by their supervisors, undermining students' experiences and potentially the quality of the research. Financial barriers were also reported as challenges by students, even among those who received bursaries. CONCLUSION: The partnership was successful in establishing a Master Programme in Nutritional Epidemiology increasing the number of nutrition researchers in the DRC. This approach could be used in other LMIC settings to address health and nutrition challenges.


Asunto(s)
Educación de Postgrado/normas , Epidemiología/educación , Ciencias de la Nutrición/educación , Evaluación de Programas y Proyectos de Salud , Estudiantes/psicología , Creación de Capacidad , Estudios Transversales , Curriculum , República Democrática del Congo , Femenino , Humanos , Liderazgo , Masculino , Desarrollo de Programa
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