Hospital-physician integration and clinical volume in traditional Medicare.

OBJECTIVE: To test the effect of hospital-physician integration on primary care physicians' (PCP) clinical volume in traditional Medicare. DATA SOURCES AND STUDY SETTING: Nationwide retrospective longitudinal study using Medicare claims and other data sources from 2010 to 2016. STUDY DESIGN: We identified 70,000 PCPs, some of whom remained non-integrated and some who became hospital-integrated during this study period. We used an event study design to identify the effect of integration on key measures of physicians' clinical volume, including the number of claims, work-relative value units (RVUs), professional revenue generated, number of patients treated, and facility fee revenue generated. PRINCIPAL FINDINGS: Per-physician clinical volume declined by statistically and economically significant margins. Relative to the comparison group who remained non-integrated, work RVUs fell by 7% (95% confidence interval [CI]: -8.6% to -5.5%); the number of patients treated fell by 4% (95% CI: -5.8% to -2.6%); and claims volume among PCPs who became hospital-integrated fell by over 15% (95% CI: -16.8% to -13.5%). Though professional revenue declined by $29,165 (95% CI: -$32,286 to -$26,044), this loss was almost entirely offset by increased facility fee revenue of $28,556 (95% CI: 26,909 to 30,203). CONCLUSIONS: Hospital-physician integration may affect the quantity of clinical services delivered by PCPs to traditional Medicare beneficiaries. Reductions in clinical volume associated with integration may have long-term consequences for the supply of physician services and patient access to primary care. Future research on physician time use and patient access following hospital integration would further add to the evidence base.

Hospital-cardiologist integration often occurs without a practice acquisition.

OBJECTIVE: To describe how much of the recent increase in hospital-cardiologist integration has come from acquisitions of physician practices compared to individual employment decisions. While the role of physician practice acquisitions has received considerable attention in the news, integration may also be driven by individual physicians accepting employment at hospital-based practices. DATA SOURCES: American Medical Association Physician Masterfile and Medicare data. STUDY DESIGN: Analysis of changes in hospital-cardiologist integration from 2011 to 2018. We measured increases in integration and changes in the number of independent and hospital-owned practices. DATA COLLECTION/EXTRACTION METHODS: Not applicable. PRINCIPAL FINDINGS: In 2011, 18% of cardiologists were integrated, rising to 25% in 2016. Of this rise, 48% occurred with no acquisitions. Physicians who had completed residencies in the past 5 years (early career physicians) had higher rates of integration that also increased over time: the percentage of early career physicians joining hospital systems rose from 25% to 32%, indicating rapid growth in the number of physicians who began their careers working in hospital-based sites. CONCLUSIONS: A large and growing portion of hospital-cardiologist integration came from hospital employment at the individual physician level. Future policies focused on preserving competition and affordability may benefit from better understanding this form of consolidation.

One-Third of Family Physicians Remain in Independently Owned Practice, 2017-2019.

The rise of health system and hospital ownership of primary care practices raises policy questions about the survival of independent physician-owned practices. Our data indicate that a substantial proportion of FPs in 2017-2019 remained in independently owned practice: 81% of solo practitioners and 35% of FPs in practices with 2-5 clinicians. These findings suggest that independent practice is surviving, and that it's incumbent on researchers, payers, and policymakers to better understand their unique contributions and challenges in the effort to improve primary care access, quality, and cost.

Effective academic-practice partnership models in nursing students' clinical placement: A systematic literature review.

OBJECTIVES: This systematic review examines the effectiveness of academic-practice partnership models which include clinical faculty and clinical mentor roles in improving nursing students' clinical learning when compared with traditional models. REVIEW METHODS: PubMed, CINAHL, PsycINFO and Cochrane Library were searched to locate Randomized Control Trials and quasi-experimental studies published from 1999 to 2020. The Joanna Briggs Institute critical appraisal tools were used to ensure methodological quality. RESULTS: Fourteen studies were included in the review. The Collaborative Teaching Model and the Dedicated Education Unit model were tested in randomized controlled trials. Dedicated Education Unit, Dedicated Education Centre, Clinical Education Units, Education Partnership model, Collaborative educational-practice model and Collaborative clinical practicum model were evaluated in four experimental studies and ten quasi-experimental studies. Studies did not include patient participation, and staff and faculty had anecdotal presence. CONCLUSION: There is limited evidence on the effectiveness of academic-practice partnership models. However, the complementary roles of clinical faculty and clinical mentor, in addition to education and health institutions managers commitment could successfully facilitate students' clinical learning.

Delivering Midwifery: A Scoping Review of Employment Models in Canada.

The majority of Canadian Provinces have regulated and publicly funded midwifery. No comprehensive review has summarized and compared the various types of employment models, practice organizations, and compensation for midwives across Canada. The aim of this scoping review was to gain an understanding of evidence related to funding models, organization of practice models, and compensation for midwives. The Arksey and O'Malley five-stage framework for conducting scoping reviews guided our methodology. The constructs of interest for inquiry related to Canadian midwifery were the following: (1) employment models, (2) organization of practice, and (3) compensation. The study selection was an iterative search process. After duplicates were removed from both database and grey literature sources, a total of 1540 records were initially screened. After final screening was complete, a total of 111 records were included that contained content related to constructs of interest. Currently, midwifery services are publicly funded in Alberta, British Columbia, Manitoba, Ontario, Québec, Nunavut, Nova Scotia, Northwest Territories, and Saskatchewan. The four types of employment models in which midwives work are private practice, private fee for service (deemed as course of care), course of care, and salaried. Compensation varies by province depending on the model of employment. This review of publicly available literature illustrates the range of employment, practice models, and compensation of regulated midwifery across Canada, as well as the evolution of the profession in the past 27 years. This type of information is relevant to inform health workforce planning for midwifery services across the country (Canadian Task Force Classification III).

Effect of Blocked Versus Random Practice on Physical Therapy Students' Manual Force Modulation.

This study examined (a) the effect of practice organization on learning to modulate manual force, and (b) the effect of force magnitude on ability to accurately reproduce force. I randomly assigned 52 novice physical therapy students to either blocked or random practice schedules as they learned to apply different manual forces. I tested students immediately after training and one week later, using a three-way mixed design analysis of variance to assess the effects of practice organization (random vs. blocked), test (immediate posttest vs. retention test), and force (high vs. low) on ability to modulate manual forces. I found that blocked versus random practice, led to more accurate force application at the posttest and retention test, F(1, 50) = 5.57, p < .05; both practice groups performed more accurately at the posttest than at the retention test, F(1, 50) = 5.6, p < .05, and both performed more accurately at the lower, compared with the higher, force level, F(1, 50) = 60.9, p < .05. These findings support use of a blocked' practice schedule for this motor training, though relevant contextual interference moderators may include such variables as nature of the task, learners' skill levels, and practice time. In addition, higher forces resulted in greater errors and must be considered in preparing for and engaging in clinical practice.

The effect of constant practice in transfer tests

Abstract BACKGROUND There is aconsensus that repetition observed in constant practice producesminimalbenefits to the transfer of learning. OBJECTIVE The purpose of this study was to investigatein 3 experiments the effects of constant practicein transfer contexts. METHODOLOGY Participants were asked during acquisition phase, in all experiments, to press four keys sequentially with different requirements of absolute timing in a same relative timing structure. In the transfer tests, they were tested in a novel absolute timing criterion. RESULTS The results of experiment 1 and 2 showed that the relative timing structure was maintained only when the transfer required parameter scaling close to the parameter value practiced in acquisition. The transfer parameter that is far to the parameter practiced did not affect the movement parameterization. The result of experiment 3 showed that relative timing structure is disrupted in the transfer test when constant practice has high and low amount of practice. CONCLUSION Some specific aspects interfere in the transfer test when constant practice is experienced.(AU)

Exploring the dynamic nature of contextual interference: previous experience affects current practice but not learning.

There is evidence that the learning benefits of contextual interference (CI) are moderated by experience, yet we do not know if these experiences are related to specific practice with random schedules. In two experiments, CI practice schedule was manipulated on Day 1. We evaluated its impact on 3 new tasks on Day 2; in the same or different practice schedule (Experiment 1) or when participants chose their practice (Experiment 2). Typical CI effects were observed for both sets of tasks, although on Day 2, there were no longer any costs from random practice. Previous practice affected how practice was scheduled. The prior random group switched more than the prior blocked group. Although switching was related to retention, overall the groups did not differ. Therefore, specific experiences with a method of practice influence later choices about how to practice, performance in practice, but not necessarily what is retained.

NIOSH health and safety practices survey of healthcare workers: training and awareness of employer safety procedures.

BACKGROUND: The Health and Safety Practices Survey of Healthcare Workers describes current practices used to minimize chemical exposures and barriers to using recommended personal protective equipment for the following: antineoplastic drugs, anesthetic gases, high level disinfectants, surgical smoke, aerosolized medications (pentamidine, ribavirin, and antibiotics), and chemical sterilants. METHODS: Twenty-one healthcare professional practice organizations collaborated with NIOSH to develop and implement the web-based survey. RESULTS: Twelve thousand twenty-eight respondents included professional, technical, and support occupations which routinely come in contact with the targeted hazardous chemicals. Chemical-specific safe handling training was lowest for aerosolized antibiotics (52%, n = 316), and surgical smoke (57%, n = 4,747). Reported employer procedures for minimizing exposure was lowest for surgical smoke (32%, n = 4,746) and anesthetic gases (56%, n = 3,604). CONCLUSIONS: Training and having procedures in place to minimize exposure to these chemicals is one indication of employer and worker safety awareness. Safe handling practices for use of these chemicals will be reported in subsequent papers.

Views of patients and general dental practitioners on the organizational aspects of a general dental practice.

OBJECTIVE: To examine the views of patients and general dental practitioners (GDPs) on the organizational aspects of a general dental practice and to see whether their views differ. BACKGROUND: Health care has increasingly centred on the patient over the last two decades, and the patients' opinions have been taken more seriously. Although in other health-care sectors research on organizational aspects has been performed, research in dental care is lacking on this subject. DESIGN: We developed two questionnaires covering 41 organizational aspects of a general dental practice: one for GDPs and one for dental patients. The questionnaires were handed out in dental practices to 5000 patients and sent to 500 GDPs. RESULTS: We describe the results of the organizational aspects mentioned most by 25% of the dental patients. For most aspects, the views of the patients and GDPs differed significantly. However, both respondent groups mentioned the same category the most. CONCLUSIONS: The results of this study could be used on a policy level for the development of guidelines and on a practice level for individual GDPs to adjust practice management to the preferences of patients.

Patient satisfaction with care in office-based oncology practices.

INTRODUCTION: The purpose of patient surveys is to measure the quality of health care from the patient's point of view. They are recommended as a way to detect the strengths and weaknesses of patient care and to locate areas of potential improvement. METHODS: In the autumn of 2006, patients undergoing care in subspecialty oncology practices across Germany were given a questionnaire to be answered in writing. A total of 15 272 patients participated (response rate, 68.8%). The questionnaire addressed patient satisfaction with practice staff and organization as well as with the treating physicians themselves. RESULTS: The practices, their staffs, and the doctors were generally rated at least "good" in all aspects of patient care. Less highly rated aspects of practice organization, despite overall satisfaction, were waiting times and accessibility in emergencies. Appointment scheduling was considered good. Patients were particularly satisfied with the time their doctors devoted to them, but less satisfied with their advice about "alternative" treatments. The doctors involved them in the treatment process to differing extents and gave a variable degree of psychosocial care. CONCLUSION: The questionnaires documented high overall satisfaction with oncology practices with little variation among the individual items. There were a few specific areas that accounted for the differences between well and poorly rated practices and physicians; in these areas, there is a potential for improvement.

Do the Principles of Motor Program Editing Apply to Longer Sequences of Rapid Aiming Movements? Part II.

In Part I of this study, it was shown that performing a shorter distance aiming movement prior to a longer distance aiming movement resulted in overshooting of the short movement and undershooting of the longer movement compared to control conditions. However, the finding was limited, unexpectedly, to the nondominant hand. To replicate the prior result and to determine the effect of practice organization on movement accuracy, right-handed (n =24) participants (aged 18-22) produced a sequence of three rapid lever reversals combining short (20°) and long (60°) movements with an intermovement interval of 2.5 s with the dominant hand. Greater overshooting of the short movements and greater undershooting of the long movement was shown with random practice compared to blocked practice for both same distance and different distance sequences, although spatial errors were greater in the different conditions compared to the same conditions. Overall, the experiment demonstrated parameter value switching and practice organization as two major sources of spatial inaccuracy in sequential aiming movements.