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1.
Am J Med Qual ; 36(2): 73-83, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33830094

RESUMEN

The health care sector has made radical changes to hospital operations and care delivery in response to the coronavirus disease (COVID-19) pandemic. This article examines pragmatic applications of simulation and human factors to support the Quadruple Aim of health system performance during the COVID-19 era. First, patient safety is enhanced through development and testing of new technologies, equipment, and protocols using laboratory-based and in situ simulation. Second, population health is strengthened through virtual platforms that deliver telehealth and remote simulation that ensure readiness for personnel to deploy to new clinical units. Third, prevention of lost revenue occurs through usability testing of equipment and computer-based simulations to predict system performance and resilience. Finally, simulation supports health worker wellness and satisfaction by identifying optimal work conditions that maximize productivity while protecting staff through preparedness training. Leveraging simulation and human factors will support a resilient and sustainable response to the pandemic in a transformed health care landscape.


Asunto(s)
/epidemiología , Prestación de Atención de Salud/organización & administración , Administración Hospitalaria/normas , Entrenamiento Simulado/organización & administración , Ahorro de Costo , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/normas , Humanos , Satisfacción en el Trabajo , Pandemias , Seguridad del Paciente/normas , Salud Poblacional , Indicadores de Calidad de la Atención de Salud , Entrenamiento Simulado/normas , Flujo de Trabajo
3.
Glob Heart ; 16(1): 18, 2021 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-33833942

RESUMEN

The current pandemic of SARS-COV 2 infection (Covid-19) is challenging health systems and communities worldwide. At the individual level, the main biological system involved in Covid-19 is the respiratory system. Respiratory complications range from mild flu-like illness symptoms to a fatal respiratory distress syndrome or a severe and fulminant pneumonia. Critically, the presence of a pre-existing cardiovascular disease or its risk factors, such as hypertension or type II diabetes mellitus, increases the chance of having severe complications (including death) if infected by the virus. In addition, the infection can worsen an existing cardiovascular disease or precipitate new ones. This paper presents a contemporary review of cardiovascular complications of Covid-19. It also specifically examines the impact of the disease on those already vulnerable and on the poorly resourced health systems of Africa as well as the potential broader consequences on the socio-economic health of this region.


Asunto(s)
/fisiopatología , Enfermedades Cardiovasculares/fisiopatología , Síndrome Coronario Agudo/economía , Síndrome Coronario Agudo/etiología , Síndrome Coronario Agudo/fisiopatología , África , Antimaláricos/efectos adversos , Arritmias Cardíacas/economía , Arritmias Cardíacas/etiología , Arritmias Cardíacas/fisiopatología , /economía , Enfermedades Cardiovasculares/economía , Enfermedades Cardiovasculares/etiología , Cloroquina/efectos adversos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Prestación de Atención de Salud/economía , Recesión Económica , Producto Interno Bruto , Recursos en Salud/economía , Recursos en Salud/provisión & distribución , Insuficiencia Cardíaca/economía , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Hidroxicloroquina/efectos adversos , Inflamación , Isquemia Miocárdica/economía , Isquemia Miocárdica/etiología , Isquemia Miocárdica/fisiopatología , Miocarditis/economía , Miocarditis/etiología , Miocarditis/fisiopatología , Síndrome Respiratorio Agudo Grave/complicaciones , Síndrome Respiratorio Agudo Grave/fisiopatología , Factores Socioeconómicos , Cardiomiopatía de Takotsubo/economía , Cardiomiopatía de Takotsubo/etiología , Cardiomiopatía de Takotsubo/fisiopatología
4.
Cien Saude Colet ; 26(3): 1013-1022, 2021 Mar.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-33729355

RESUMEN

The article aims to discuss the care provided by female healthcare workers in Brazil during the Covid-19 pandemic, based on a sociological analysis by authors who discuss such care as devalued and poorly paid work performed to a large extent by low-income women. The work involves social constructions of emotions and has used the body as a work instrument in care for others. In addition, the increasingly precarious nature of health work in Brazilian society, aggravated in recent decades, with an increase in temporary contracts, loss of labor rights, overload of tasks, and adverse work conditions, among others, adds to the increase in medical and hospital care in the Covid-19 pandemic. In this context, female healthcare workers experience lack of personal protective equipment, fear of coronavirus infection, concerns with their children and other family members, and illness and death of coworkers and themselves. The article highlights the need for government attention and management of healthcare work and professional societies, analyzing the work conditions female healthcare workers are experiencing in confronting the pandemic.


Asunto(s)
/epidemiología , Prestación de Atención de Salud , Personal de Salud , Pandemias , Actitud Frente a la Muerte , Brasil/epidemiología , /transmisión , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/normas , Prestación de Atención de Salud/tendencias , Familia , Miedo , Femenino , Personal de Salud/economía , Personal de Salud/psicología , Humanos , Programas Nacionales de Salud , Equipo de Protección Personal/provisión & distribución , Salarios y Beneficios/tendencias , Factores Sexuales , Factores Sociológicos , Lugar de Trabajo/psicología , Lugar de Trabajo/normas
5.
Lancet Public Health ; 6(5): e272-e282, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33765453

RESUMEN

BACKGROUND: Reaching the UN General Assembly High-Level Meeting on Tuberculosis target of providing tuberculosis preventive treatment to at least 30 million people by 2022, including 4 million children under the age of 5 years and 20 million other household contacts, will require major efforts to strengthen health systems. The aim of this study was to evaluate the effectiveness and cost-effectiveness of a health systems intervention to strengthen management for latent tuberculosis infection (LTBI) in household contacts of confirmed tuberculosis cases. METHODS: ACT4 was a cluster-randomised, open-label trial involving 24 health facilities in Benin, Canada, Ghana, Indonesia, and Vietnam randomly assigned to either a three-phase intervention (LTBI programme evaluation, local decision making, and strengthening activities) or control (standard LTBI care). Tuberculin and isoniazid were provided to control and intervention sites if not routinely available. Randomisation was stratified by country and restricted to ensure balance of index patients with tuberculosis by arm and country. The primary outcome was the number of household contacts who initiated tuberculosis preventive treatment at each health facility within 4 months of the diagnosis of the index case, recorded in the first or last 6 months of our 20-month study. To ease interpretation, this number was standardised per 100 newly diagnosed index patients with tuberculosis. Analysis was by intention to treat. Masking of staff at the coordinating centre and sites was not possible; however, those analysing data were masked to assignment of intervention or control. An economic analysis of the intervention was done in parallel with the trial. ACT4 is registered at ClinicalTrials.gov, NCT02810678. FINDINGS: The study was done between Aug 1, 2016, and March 31, 2019. During the first 6 months of the study the crude overall proportion of household contacts initiating tuberculosis preventive treatment out of those eligible at intervention sites was 0·21. After the implementation of programme strengthening activities, the proportion initiating tuberculosis preventive treatment increased to 0·35. Overall, the number of household contacts initiating tuberculosis preventive treatment per 100 index patients with tuberculosis increased between study phases in intervention sites (adjusted rate difference 60, 95% CI 4 to 116), while control sites showed no statistically significant change (-12, -33 to 10). There was a difference in rate differences of 72 (95% CI 10 to 134) contacts per 100 index patients with tuberculosis initiating preventive treatment associated with the intervention. The total cost for the intervention, plus LTBI clinical care per additional contact initiating treatment was estimated to be CA$1348 (range 724 to 9708). INTERPRETATION: A strategy of standardised evaluation, local decision making, and implementation of health systems strengthening activities can provide a mechanism for scale-up of tuberculosis prevention, particularly in low-income and middle-income countries. FUNDING: Canadian Institutes of Health Research.


Asunto(s)
Prestación de Atención de Salud/economía , Prestación de Atención de Salud/organización & administración , Tuberculosis Latente/prevención & control , Canadá/epidemiología , Trazado de Contacto , Análisis Costo-Beneficio , Composición Familiar , Salud Global/estadística & datos numéricos , Humanos , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/epidemiología , Evaluación de Programas y Proyectos de Salud
6.
J Subst Abuse Treat ; 124: 108270, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33771275

RESUMEN

The COVID-19 pandemic created a number of rapidly emerging and unprecedented challenges for those engaged in substance use disorder (SUD) treatment, forcing service providers to improvise their treatment strategies as the crisis deepened. Drawing from five ongoing federally funded SUD projects in Appalachian Tennessee and hundreds of hours of meetings and interviews, this article explores the pandemic's impact on an already structurally disadvantaged region, its recovery community, and those who serve it. More specifically, we note detrimental effects of increased isolation since the implementation of COVID-19 safety measures, including stakeholders' reports of higher incidences of relapse, overdose, and deaths in the SUD population. Treatment providers have responded with telehealth services, but faced barriers in technology access and computer literacy among clients. Providers have also had to restrict new clients to accommodate social distancing, faced delays in health screening those they can accept, and denied family visitations, which has affected retention. In light of these challenges, several promising lessons for the future emerged--such as preparing for an influx of new and returning clients in need of SUD treatment; making arrangements for long-term housing and facility modification; developing a hybrid care delivery model, taking advantage of new regulations enabling telemedicine; budgeting for and storing personal protective equipment (PPE) and related supplies; and developing disaster protocols to withstand threats to intake, retention, and financial solvency.


Asunto(s)
Prestación de Atención de Salud/economía , Accesibilidad a los Servicios de Salud/economía , Trastornos Relacionados con Sustancias/rehabilitación , Telemedicina/economía , Región de los Apalaches , Humanos , Equipo de Protección Personal/provisión & distribución , Trastornos Relacionados con Sustancias/economía , Tennessee
7.
J Hosp Med ; 16(4): 223-226, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33734985

RESUMEN

Children's hospitals responded to COVID-19 by limiting nonurgent healthcare encounters, conserving personal protective equipment, and restructuring care processes to mitigate viral spread. We assessed year-over-year trends in healthcare encounters and hospital charges across US children's hospitals before and during the COVID-19 pandemic. We performed a retrospective analysis, comparing healthcare encounters and inflation-adjusted charges from 26 tertiary children's hospitals reporting to the PROSPECT database from February 1 to June 30 in 2019 (before the COVID-19 pandemic) and 2020 (during the COVID-19 pandemic). All children's hospitals experienced similar trends in healthcare encounters and charges during the study period. Inpatient bed-days, emergency department visits, and surgeries were lower by a median 36%, 65%, and 77%, respectively, per hospital by the week of April 15 (the nadir) in 2020 compared with 2019. Across the study period in 2020, children's hospitals experienced a median decrease of $276 million in charges.


Asunto(s)
/economía , Prestación de Atención de Salud , Costos de la Atención en Salud , Hospitales Pediátricos/economía , Pacientes Internos/estadística & datos numéricos , Niño , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/estadística & datos numéricos , Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Estudios Retrospectivos
8.
Ciênc. Saúde Colet ; 26(3): 1013-1022, mar. 2021.
Artículo en Portugués | LILACS | ID: biblio-1153827

RESUMEN

Resumo Este texto tem como finalidade discutir o cuidado de trabalhadoras da área da saúde em face da Covid-19, sob a análise sociológica de autoras que o vêm discutindo enquanto um trabalho que é desempenhado, na sua maioria, pelas mulheres das classes populares, é desvalorizado e sofre baixa remuneração. É uma atividade que envolve as construções sociais das emoções e tem utilizado o corpo como um instrumento de trabalho no cuidado com o outro. Além disso, a precarização do trabalho em saúde na sociedade brasileira acirrada nas últimas décadas, como o aumento de contratos temporários, perdas de direitos trabalhistas, a sobrecarga das atividades, condições de trabalho precárias, dentre outros, soma-se com o aumento dos atendimentos médico-hospitalares diante da pandemia da Covid-19. Neste contexto, as trabalhadoras em saúde vivenciam as ausências de equipamentos de proteção individual, medo de contaminação pelo vírus, preocupações com filhos e familiares, vivências diante da morte e do adoecimento de si e de colegas de profissão. Este texto aponta para a necessidade de atenção governamental, bem como para a gestão do trabalho em saúde e dos órgãos de classe profissional, analisando as condições de trabalho que as trabalhadoras em saúde estão vivendo no enfrentamento da pandemia.


Abstract The article aims to discuss the care provided by female healthcare workers in Brazil during the Covid-19 pandemic, based on a sociological analysis by authors who discuss such care as devalued and poorly paid work performed to a large extent by low-income women. The work involves social constructions of emotions and has used the body as a work instrument in care for others. In addition, the increasingly precarious nature of health work in Brazilian society, aggravated in recent decades, with an increase in temporary contracts, loss of labor rights, overload of tasks, and adverse work conditions, among others, adds to the increase in medical and hospital care in the Covid-19 pandemic. In this context, female healthcare workers experience lack of personal protective equipment, fear of coronavirus infection, concerns with their children and other family members, and illness and death of coworkers and themselves. The article highlights the need for government attention and management of healthcare work and professional societies, analyzing the work conditions female healthcare workers are experiencing in confronting the pandemic.


Asunto(s)
Humanos , Femenino , Personal de Salud/economía , Personal de Salud/psicología , Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/normas , Prestación de Atención de Salud/tendencias , Pandemias , Salarios y Beneficios/tendencias , Brasil/epidemiología , Actitud Frente a la Muerte , Familia , Factores Sexuales , Lugar de Trabajo/normas , Lugar de Trabajo/psicología , Infecciones por Coronavirus/psicología , Infecciones por Coronavirus/transmisión , Miedo , Factores Sociológicos , Equipo de Protección Personal/provisión & distribución , Programas Nacionales de Salud
10.
Healthc Policy ; 16(3): 6-15, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33720819

RESUMEN

In 2020, the COVID-19 pandemic unexpectedly upended everyone's life, from sudden mass unemployment to family separations. In spite of this upheaval, health systems and services research carried on. Often, these efforts supported public health efforts to slow the spread of the virus.


Asunto(s)
/prevención & control , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/organización & administración , Investigación sobre Servicios de Salud/economía , Investigación sobre Servicios de Salud/organización & administración , /epidemiología , Canadá/epidemiología , Costos y Análisis de Costo , Humanos
11.
J Am Coll Surg ; 232(5): 793-796, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592250

RESUMEN

The US is facing the most significant health challenge since the 1918-1919 flu pandemic. A response commensurate with this challenge requires engaged leadership and organization across private and public sectors that span federal agencies, public and private healthcare systems, professional organizations, and industry. In the trauma and emergency care communities, we have long discussed the tension between competition in healthcare and the need for regional cooperation to respond to large-scale disasters. The response to COVID-19 has required unprecedented coordination of private and public sector entities. Given the competitive nature of the US health system, these sectors do not regularly work together despite the requirement to do so during a national emergency. This crisis has exposed how structural aspects of the present healthcare system have limited our ability to rapidly transition to a whole-nation response during a national crisis. We propose a renewed focus on the intersection of the healthcare system and national security, with the express goal of creating a public-private partnership focused on leveraging our healthcare infrastructure to support the national security interests of the US.


Asunto(s)
/prevención & control , Prestación de Atención de Salud/organización & administración , Pandemias/prevención & control , Asociación entre el Sector Público-Privado , /epidemiología , Prestación de Atención de Salud/economía , Planificación en Desastres/economía , Planificación en Desastres/organización & administración , Humanos , Liderazgo , Medidas de Seguridad/economía , Medidas de Seguridad/organización & administración , Estados Unidos/epidemiología
12.
J Hist Med Allied Sci ; 76(2): 147-166, 2021 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-33598699

RESUMEN

At the turn of the twentieth century, Faith Tabernacle Congregation's commitment to medical abstinence was an economically rational practice. To the working poor of Philadelphia, who constituted the earliest members, Faith Tabernacle's therapy was financially attainable, psychologically supportive, and physically rejuvenating. Orthodox medicine was deficient in these three areas based on the patient narratives (i.e., testimonies) published in the church's monthly periodical Sword of the Spirit and testimony book Words of Healing. First, some early members spent all their money on orthodox medical care without relief causing significant financial hardship, while others found medical care prohibitive. Second, many early members experienced a great loss of hope because orthodox physicians ended treatment due to chronic or critical illness, both of which were interpreted as psychologically harmful. Third, early members of the church perceived getting physically worse by physicians because of low quality care, which was compounded by low access to orthodox medicine. Faith Tabernacle alternatively provided care that - in the patient narratives of the earliest members - helped them improve and get back to work faster.


Asunto(s)
Prestación de Atención de Salud/historia , Aceptación de la Atención de Salud/psicología , Protestantismo/psicología , Prestación de Atención de Salud/economía , Costos de la Atención en Salud/historia , Historia del Siglo XX , Humanos , Aceptación de la Atención de Salud/estadística & datos numéricos , Philadelphia
13.
Medicine (Baltimore) ; 100(7): e24838, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607853

RESUMEN

ABSTRACT: More than 70% of tuberculosis (TB) cases diagnosed in the United States (US) occur in non-US-born persons, and this population has experienced less than half the recent incidence rate declines of US-born persons (1.5% vs 4.2%, respectively). The great majority of TB cases in non-US-born persons are attributable to reactivation of latent tuberculosis infection (LTBI). Strategies to expand LTBI-focused TB prevention may depend on LTBI positive non-US-born persons' access to, and ability to pay for, health care.To examine patterns of health insurance coverage and usual sources of health care among non-US-born persons with LTBI, and to estimate LTBI prevalence by insurance status and usual sources of health care.Self-reported health insurance and usual sources of care for non-US-born persons were analyzed in combination with markers for LTBI using 2011-2012 National Health and Nutrition Examination Survey (NHANES) data for 1793 sampled persons. A positive result on an interferon gamma release assay (IGRA), a blood test which measures immunological reactivity to Mycobacterium tuberculosis infection, was used as a proxy for LTBI. We calculated demographic category percentages by IGRA status, IGRA percentages by demographic category, and 95% confidence intervals for each percentage.Overall, 15.9% [95% confidence interval (CI) = 13.5, 18.7] of non-US-born persons were IGRA-positive. Of IGRA-positive non-US-born persons, 63.0% (95% CI = 55.4, 69.9) had insurance and 74.1% (95% CI = 69.2, 78.5) had a usual source of care. IGRA positivity was highest in persons with Medicare (29.1%; 95% CI: 20.9, 38.9).Our results suggest that targeted LTBI testing and treatment within the US private healthcare sector could reach a large majority of non-US-born individuals with LTBI. With non-US-born Medicare beneficiaries' high prevalence of LTBI and the high proportion of LTBI-positive non-US-born persons with private insurance, future TB prevention initiatives focused on these payer types are warranted.


Asunto(s)
Prestación de Atención de Salud/economía , Emigrantes e Inmigrantes/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Tuberculosis Latente/epidemiología , Adolescente , Adulto , Anciano , Niño , Estudios Transversales , Prestación de Atención de Salud/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Incidencia , Cobertura del Seguro/tendencias , Ensayos de Liberación de Interferón gamma/métodos , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/prevención & control , Masculino , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Mycobacterium tuberculosis/inmunología , Encuestas Nutricionales/métodos , Prevalencia , Estados Unidos/epidemiología , Adulto Joven
14.
JAMA Netw Open ; 4(2): e210055, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33625510

RESUMEN

Importance: Mobile integrated health care (MIH) is a new model of community-based health care to provide on-site urgent or nonurgent care. Niagara emergency medical services (NEMS) started MIH in 2018 to serve the Niagara region of Ontario, Canada. However, its economic impact is unknown. Objective: To compare time on task and cost between MIH and ambulance delivered by NEMS from a public payer's perspective. Design, Setting, and Participants: This economic evaluation was an analysis of the NEMS databases regarding responses to emergency calls by the NEMS from 2016 to 2019. Emergency calls serviced by MIH in 2018 to 2019 were used as an intervention cohort. Propensity score matching was used to identify a 1:1 matched cohort of calls serviced by regular ambulance response for the same period and 2 years prior. Statistical analyses were performed from January to April 2020. Exposures: MIH compared with matched ambulance services. Main Outcomes and Measures: The main outcomes were the time on task (including time on scene and time at hospital) and costs. Costs were calculated in 2019 Canadian dollars using cost per minute and compared with the 3 ambulance cohorts. Results: In 2018 to 2019, there were 1740 calls serviced by MIH for which a matched ambulance cohort was identified for the same period and 2 years prior. The mean (SD) time on task was 72.7 (51.0) minutes for MIH, compared with 84.1 (52.0) minutes, 84.3 (54.1) minutes, and 79.4 (42.0) minutes for matched ambulance in 2018 to 2019, 2017 to 2018, and 2016 to 2017, respectively. Of calls serviced by MIH, 498 (28.6%) required ED transport (ie, after MIH team assessment, transport to ED was deemed to be necessary or demanded by the patient), compared with 1300 (74.7%) calls serviced by ambulance in 2018 to 2019, 1294 (74.4%) in 2017 to 2018, and 1359 (78.1%) in 2016 to 2017. The mean (SD) total cost per 1000 calls was $122 760 ($78 635) for MIH compared with $294 336 ($97 245), $299 797 ($104 456), and $297 269 ($81 144) for regular ambulance responses in the 3 matched cohorts, respectively. Conclusions and Relevance: Compared with regular ambulance response, MIH was associated with a substantial reduction in the proportion of patients transported to the ED, leading to a substantial saving in total costs. This finding suggests that the MIH model is a promising and viable solution to meeting urgent health care needs in the community, while substantially improving the use of scarce health care resources.


Asunto(s)
Servicios de Salud Comunitaria/economía , Prestación de Atención de Salud/economía , Servicios Médicos de Urgencia/economía , Unidades Móviles de Salud/economía , Adulto , Anciano , Anciano de 80 o más Años , Ambulancias , Atención Ambulatoria , Servicios de Salud Comunitaria/métodos , Análisis Costo-Beneficio , Prestación de Atención de Salud/métodos , Servicios Médicos de Urgencia/métodos , Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Ontario , Puntaje de Propensión
15.
Am J Manag Care ; 27(2): e54-e63, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33577162

RESUMEN

OBJECTIVES: To describe real-time changes in medical visits (MVs), visit mode, and patient-reported visit experience associated with rapidly deployed care reorganization during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: Cross-sectional time series from September 29, 2019, through June 20, 2020. METHODS: Responding to official public health and clinical guidance, team-based systematic structural changes were implemented in a large, integrated health system to reorganize and transition delivery of care from office-based to virtual care platforms. Overall and discipline-specific weekly MVs, visit mode (office-based, telephone, or video), and associated aggregate measures of patient-reported visit experience were reported. A 38-week time-series analysis with March 8, 2020, and May 3, 2020, as the interruption dates was performed. RESULTS: After the first interruption, there was a decreased weekly visit trend for all visits (ß3 = -388.94; P < .05), an immediate decrease in office-based visits (ß2 = -25,175.16; P < .01), increase in telephone-based visits (ß2 = 17,179.60; P < .01), and increased video-based visit trend (ß3 = 282.02; P < .01). After the second interruption, there was an increased visit trend for all visits (ß5 = 565.76; P < .01), immediate increase in video-based visits (ß4 = 3523.79; P < .05), increased office-based visit trend (ß5 = 998.13; P < .01), and decreased trend in video-based visits (ß5 = -360.22; P < .01). After the second interruption, there were increased weekly long-term visit trends for the proportion of patients reporting "excellent" as to how well their visit needs were met for all visits (ß5 = 0.17; P < .01), telephone-based visits (ß5 = 0.34; P < .01), and video-based visits (ß5 = 0.32; P < .01). Video-based visits had the highest proportion of respondents rating "excellent" as to how well their scheduling and visit needs were met. CONCLUSIONS: COVID-19 required prompt organizational transformation to optimize the patient experience.


Asunto(s)
Citas y Horarios , Prestación de Atención de Salud/organización & administración , Programas Controlados de Atención en Salud/organización & administración , Visita a Consultorio Médico/tendencias , Telemedicina/tendencias , /epidemiología , Estudios Transversales , Prestación de Atención de Salud/economía , Humanos , Análisis de Series de Tiempo Interrumpido , Programas Controlados de Atención en Salud/economía , Mid-Atlantic Region
16.
Artículo en Inglés | MEDLINE | ID: mdl-33546467

RESUMEN

In Poland, as in many other countries, the use of capitation payment schemes in primary health care is popular. Despite this popularity, the subject literature discusses its role in decreasing the quality of primary medical services. This problem is particularly important during COVID-19, when medical entities provide telehealth services to patients. The objective of the study is to examine the effects of COVID-19 pandemic on the performance of the primary health care providers in Poland under a capitation payment scheme. In this study the authors use data from interviews with personnel of medical entities and financial and administrative reports of primary health care providers in order to identify how this crisis situation impacts the performance of primary health care entities, under capitation payment system. The performance indicators include both the financial and quality measures. Selected to the case study primary health care service providers significantly improved their profitability due to considerable costs savings and reduction of services provided to patients in a time of COVID-19 pandemic. Capitation payment system proved to be inefficient, in the studied pandemic period, in terms of the services provided by primary health care service providers to patients and the funds paid to them, in exchange, by the government entities.


Asunto(s)
Capitación , Prestación de Atención de Salud/economía , Atención Primaria de Salud/economía , Humanos , Pandemias , Polonia
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