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Prev Med ; 112: 207-208, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29723553


Health systems are focusing attention on the role that social determinants of health (SDOH) can and should play in health care delivery. This is especially true among accountable care organizations (ACOs) and Medicaid ACOs in particular. In crafting SDOH strategies, senior leadership teams may face an organizational tension in aiming to cede control over dollars, data and patient experience to community-based organizations (CBOs) while also maintaining financial accountability for health outcomes. We review the history of neighborhood health centers (NHCs) in order to foreshadow the types of critiques ACOs are likely to face in working with CBOs. We conclude by suggesting a several strategies by which ACOs may be lessen accountability concerns, including raising the issue with regulators, using low-risk dollars to fund joint-work, working through an intermediary, providing technical assistance and viewing the relationship as a partnership rather than contract.

Organizações de Assistência Responsáveis/organização & administração , Liderança , Determinantes Sociais da Saúde , Responsabilidade Social , Humanos , Medicaid/organização & administração , Medicare/organização & administração , Saúde Pública , Estados Unidos
Glob Adv Health Med ; 4(6): 6-7, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26665014
Glob Adv Health Med ; 4(6): 20-1, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26665018
Glob Adv Health Med ; 3(4): 20-6, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25105072


BACKGROUND: Chronic pain affects millions of racially diverse Americans. Evidence suggests that group medical visits are effective for treating chronic pain; similarly, a number of studies demonstrate the effectiveness of certain evidence-based complementary therapies in managing pain. OBJECTIVES: The primary goal of this study is to evaluate the feasibility of the integrative medical group visit (IMGV) care model in an inner-city racially diverse outpatient clinic. IMGV combines patient-centered, non-pharmacologic strategies and principles of mindfulness-based stress-reduction with a group medical visit to reduce pain and associated symptoms. METHODS: We surveyed patients pre and post an 8-session IMGV program to evaluate changes in pain in the last week (0-10 point scale) and comorbid symptoms including depression (Patient Health Questionaire-8 [PHQ-8]), perceived stress, and sleep quality. We also recorded referrals to the program, patients screened for eligibility, total enrollment, loss to follow-up, and attendance. RESULTS: Seventy patients joined IMGV, and of these, 65 (93%) enrolled in the study. Over the course of 12 months, 7 groups met (median 9 patients/group; range 8-13 participants). Mean difference in pain level for all patients between baseline and 8 weeks was 0.7 (SD=2.0, P=.005). Mean difference in PHQ-8 depression score for patients with baseline score ≥5 was 2.6 (SD=4.6, P<.001). Statistically significant improvements were also seen in sleep quality and perceived stress. CONCLUSION: A group visits program combining conventional and integrative medicine for predominantly racially diverse patients is feasible.

Glob Adv Health Med ; 3(6): 8-10, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25568827
J Gen Intern Med ; 21(5): 481-5, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16704392


INTRODUCTION: Governing bodies for medical education recommend that spirituality and medicine be incorporated into training. AIM: To pilot a workshop on spirituality and medicine on a convenience sample of preclinical medical students and internal medicine residents and determine whether content was relevant to learners at different levels, whether preliminary evaluation was promising, and to generate hypotheses for future research. SETTING: Private medical school and university primary care internal medicine residency program, both in the Northeast. CURRICULUM DESCRIPTION: The authors designed and implemented a required 2-hour workshop for all second-year medical students and a separate required 1.5-hour workshop for all primary care internal medicine house staff. The workshops used multiple educational strategies including lecture, discussion, and role-play to address educational objectives. PROGRAM EVALUATION: Learners completed optional, anonymous pre and postworkshop surveys with six 5-point Likert-rated statements and space to cite the most useful part of the curriculum and their remaining questions. One hundred and thirty-seven learners participated and 100 completed both surveys. Medical students and residents had increased (all P< or =.002): agreement regarding the appropriateness of inquiring about spiritual and religious beliefs in the medical encounter, their perceived competence in taking a spiritual history, and their perceived knowledge of available pastoral care resources. Medical students, but not residents, had an increase in their perceived comfort in working with hospital chaplains. DISCUSSION: A brief pilot workshop on spirituality and medicine had a modest effect in improving attitudes and perceived competence of both medical students and residents.

Educação de Graduação em Medicina , Medicina Interna/educação , Internato e Residência , Religião e Medicina , Espiritualidade , Currículo , Humanos , Projetos Piloto , Desenvolvimento de Programas , Estudantes de Medicina/psicologia , Inquéritos e Questionários , Estados Unidos