Preparing the Allergist/Immunologist for the Next Pandemic.

The COVID-19 pandemic had a profound impact on society in general and allergists' practices in particular. The adverse effects included a loss of practice productivity and income, staffing, and in-office procedures due to concerns about the spread of infection and the need for social/physical distancing as well as isolation. Allergy training programs and research activities also suffered. Federal financial assistance, rapid adoption of telehealth with Medicare waivers, and adaptation of practice sites, training programs, and research activities allowed for some return to normal, although still with significant restrictions in staffing and in-office procedures. There were positive aspects to the pandemic in the form of telehealth initiatives, pathways for rapid development and approval of tests and treatments, opportunities for new collaborations, and expertise in vaccines. Preparation for the next pandemic needs to be considered now to avoid the mistakes and missteps that occurred with the COVID-19 pandemic. On a national level, a strategy to overcome the societal divisions, misinformation/disinformation, and distrust of science needs to be developed based on better communication, as well as advocacy for continued improvement in our public health system. Practices and training programs as well as research centers need to institutionalize changes made during the pandemic so they can quickly be reinitiated when necessary.

Office "Phone First" Systems Reduce Emergency Department/Urgent Care Utilization by Medicaid-Enrolled Children.

BACKGROUND: Emergency department and urgent care (ED/UC) visits for common conditions can be more expensive with less continuity than office care provided by primary care physicians. METHODS: We used quality-improvement methods to enhance telephone triage for pediatric patients by adding additional "Phone First" services including: 1) enhanced office-hours telephone triage and advice with available same-day appointments, 2) follow-up calls to parents of children self-referred to an ED/UC, and 3) parent education to telephone the office for advice prior to seeking acute care. We hypothesized that enhanced office services would reduce ED/UC utilization and cost. We compared changes in ED/UC encounter rates between intervention and regional practices for 4 years (2014-2017) using general linear models, and evaluated balancing measures (after-hour phone calls, acute care phone calls, acute care visits, well child visits) for Medicaid-enrolled and commercially-insured children. RESULTS: The study practices dramatically increased office-hours acute care phone triage and advice which correlated with 23.8% to 80.5% (P < 0.001) reductions in ED/UC rates for Medicaid-enrolled children. Office acute care visits decreased modestly. ED/UC visits did not decrease for children in the comparison region. In phone surveys, 94% of parents indicated satisfaction with the ED/UC follow-up call. The decrease in ED/UC visits resulted in an estimated annual cost of care savings for Medicaid-enrolled children in 2017 of $12.61 per member per month which projected to $169 million cost of care savings in Colorado and $6.8 billion in the United States. CONCLUSION: "Phone First" services in pediatric practices during office-hours reduced ED/UC encounters and cost of care for Medicaid-enrolled children.

[Outpatient urology in Europe]. / Ambulante Urologie in Europa.

In the care for patients with urological diseases, outpatient urology secures a near-to-home treatment by specialists in urology and is located between general practitioner and urological clinic. Comparably little is known about the structure and fields of work in this area of urology. A survey of the EAU Section ESUO of outpatient and office urology ( https://uroweb.org/section/esuo/ ) shows the diversity in terms of content and organisation of this sector in Europe, in which more than 16,500 outpatient urologists and thus about half of all professional urologists work full-time. This diversity is related to the diagnostic and therapeutic methods in outpatient urology and to the working conditions of outpatient urologists. For comparison, this information about European countries is contrasted with data from the German office urology as one type of outpatient urology.

Basics of practice management: managing many for the care of one.

In today's changing health care landscape, it has become necessary that providers have a fundamental understanding of practice management as pertinent to the care they provide. The reproductive endocrinology and infertility (REI) practice is a uniquely complex setting with many component parts, necessitating frequent assessment and collaboration to provide safe, quality, and cost-effective care. In this review, we aim to describe the basics of medical practice management, divided into six sections: practice models; operations; patient safety; patient experience; employee recruitment; development, and satisfaction; and technology. These topics will be presented with a focus on the application of these principles to the REI practice.

Referral and Management Considerations for a Biopsy: Why Choose the Oral and Maxillofacial Surgeon.

Traditional oral and maxillofacial surgeon office practice spans the full scope of patient management. Most surgeons practicing in the United States dedicate their primary focus to the needs of patients referred by our dental colleagues. Dentoalveolar surgical practice remains the mainstay of office-based care. Oral cavity disease typically occurs from chronic bacterial infections of carious teeth, chronic periodontitis, fractured teeth. Recognition of oral disease patterns occurs by medical and dental clinicians. Oral and maxillofacial surgeon practice is uniquely designed to provide choice for the diagnosis and management of oral cavity disease, including neoplastic oral cavity and maxillofacial mucocutaneous disease.

Colorectal Cancer Screening.

This article focuses on programmatic and opportunistic colorectal cancer screening. The pathogenesis and risk factors for colon cancer are discussed. Specific screening tests, screening in high-risk groups, and surveillance recommendations are reviewed. Important considerations for office practice, including improving screening implementation and cost issues, are addressed.

Real-time patient survey data during routine clinical activities for rapid-cycle quality improvement.

BACKGROUND: Surveying patients is increasingly important for evaluating and improving health care delivery, but practical survey strategies during routine care activities have not been available. OBJECTIVE: We examined the feasibility of conducting routine patient surveys in a primary care clinic using commercially available technology (Web-based survey creation, deployment on tablet computers, cloud-based management of survey data) to expedite and enhance several steps in data collection and management for rapid quality improvement cycles. METHODS: We used a Web-based data management tool (survey creation, deployment on tablet computers, real-time data accumulation and display of survey results) to conduct four patient surveys during routine clinic sessions over a one-month period. Each survey consisted of three questions and focused on a specific patient care domain (dental care, waiting room experience, care access/continuity, Internet connectivity). RESULTS: Of the 727 available patients during clinic survey days, 316 patients (43.4%) attempted the survey, and 293 (40.3%) completed the survey. For the four 3-question surveys, the average time per survey was overall 40.4 seconds, with a range of 5.4 to 20.3 seconds for individual questions. Yes/No questions took less time than multiple choice questions (average 9.6 seconds versus 14.0). Average response time showed no clear pattern by order of questions or by proctor strategy, but monotonically increased with number of words in the question (<20 words, 21-30 words, >30 words)-8.0, 11.8, 16.8, seconds, respectively. CONCLUSIONS: This technology-enabled data management system helped capture patient opinions, accelerate turnaround of survey data, with minimal impact on a busy primary care clinic. This new model of patient survey data management is feasible and sustainable in a busy office setting, supports and engages clinicians in the quality improvement process, and harmonizes with the vision of a learning health care system.

Consultorio de Atención Pediátrica Ambiental en un hospital de alta complejidad / Clinic of environmental pediatric care in a high complexity hospital

La Organización Mundial de la Salud considera la salud ambiental infantil como uno de los principales retos de la salud pública del siglo XXI y promueve el desarrollo de programas que permitan abordar, divulgar o mitigar el impacto en la salud de los contaminantes ambientales en todos los niveles de atención pediátrica. El consultorio de Atención Pediátrica Ambiental (APA) que funciona en el Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" se organizó con el objetivo de atender las demandas de aquellos pacientes con sospechada o comprobada exposición a riesgos ambientales. Se utilizó una historia clínica ambiental pediátrica, elaborada para tal fin

Children environmental health is considered by The World Health Organization as one of the main challenges of Public Health during the Century XXI. They promote the development of programs that allow approaching, disclosure or mitigation of the impact of polluting agents on health at every level of pediatric attention. The Children Hospital "Prof. Dr. Juan P. Garrahan" has created an Environmental Health Office in order to address the demands of those patients with suspected or verified exposure to environmental risks. An Environmental Clinical History has been elaborated with this purpose.

Legal aspects of ambulatory anesthesia.

This article informs anesthesiologists of some of the legal issues they may encounter in connection with ambulatory surgical center-based or office-based practice. The primary legal issues that anesthesiologists face in connection with practice in such settings can be broken down into practice-related issues and ownership-related issues. Given the complexity of legal issues relating to ambulatory anesthesia, anesthesiologists are advised to consult counsel at an early stage so as to understand the issues that may apply to their practices.