Critical preparedness and operational response actions directed for the acute and post-acute COVID-19 pandemic in Brazil: the experience of a nationwide outpatient healthcare group.

ABSTRACT: While the new Coronavirus Disease 2019 (COVID-19) pandemic rapidly spread across the world, South America was reached later in relation to Asia, Europe and the United States of America (USA). Brazil concentrates now the largest number of cases in the continent and, as the disease speedily progressed throughout the country, prompt and challenging operational strategies had to be taken by institutions caring for COVID-19 and non-COVID-19 patients in order to assure optimal workflows, triage, and management. Although hospitals in the USA, Europe and Asia have shared their experience on this subject, little has been discussed about such strategies in South America or by the perspective of outpatient centers, which are paramount in the radiology field. This article shares the guidelines adopted early in the pandemic by a nationwide outpatient healthcare center composed by a network of more than 200 patient service centers and nearly 2,000 radiologists in Brazil, discussing operational and patient management strategies, staff protection, changes adopted in the fellowship program, and the effectiveness of such measures.

Academic success plans in advanced pharmacy practice experiences to promote self-awareness and improve performance.

INTRODUCTION: Pharmacy schools should encourage self-awareness, provide exposure to the continuous professional development cycle, and intervene early when students exhibit performance deficiencies. Academic success plans (ASPs) have been shown in other disciplines to be successful intervention tools which encourage student reflection and self-awareness. This study evaluates the impact of ASPs used during the advanced pharmacy practice experience (APPE) curriculum at two schools. METHODS: ASPs were assigned to students who had either a "needs development" or lower documented for the same learning outcome during more than one APPE, for poor overall performance during an APPE, or for documented professionalism issues. Average scores were calculated by assigning point values to each learning outcome assessment score (exceeds expectations = 1; competent = 0; needs development, needs significant development, remediation required = -1). RESULTS: During AY2014-2015 and AY2015-2016, 104 ASPs were assigned to 75 students (13.5% of students). The majority (89.6%) were assigned due to repeated deficiencies in the same learning outcome(s), with the most frequent being "Develop, Implement, and Monitor Drug Therapy Plans." After completion of an ASP, average scores significantly improved (p < 0.05) in 9 out of 12 learning outcomes among all students who completed an ASP. Thirteen students completed 15 ASPs for professionalism reasons, most commonly punctuality. CONCLUSIONS: Prior to 2015, Experiential Education Office interventions were primarily grades-based, not necessarily based on achievement of specific learning outcomes. ASPs were successfully used to allow students to practice self-awareness skills, to engage in the CPD process, and to improve APPE performance.

The new frontier of strategic alliances in health care: New partnerships under accountable care organizations.

Accountable care organizations (ACOs) and similar reforms aim to improve coordination between health care providers; however, due to the fragmented nature of the US health care system, successful coordination will hinge in large part on the ability of health care organizations to successfully partner across organizational boundaries. Little is known about new partnerships formed under the ACO model. We use mixed methods data from the National Survey of ACOs, Medicare ACO performance data and interviews with executive leaders across 31 ACOs to examine the prevalence, characteristics, and capabilities of partnership ACOs and why and how ACO partnerships form. We find that a striking percentage of ACOs - 81% - involve new partnerships between independent health care organizations. These "partnership ACOs" generally report lower capabilities on care management, care coordination, and health information technology. Additionally, under Medicare ACO programs partnership ACO achieved somewhat lower quality performance. Qualitative interviews revealed that providers are motivated to partner for resource complementarity, risk reduction, and legislative requirements, and are using a variety of formal and informal accountability mechanisms. Most partnership ACOs were formed out of existing, positive relationships, but a minority of ACOs formed out of previously competitive or conflictual relationships. Our findings suggests that the success of the ACO model will hinge in large part upon the success of new partnerships, with important implications for understanding ACO readiness and capabilities, the relatively small savings achieved to date by ACO programs, and the path to providers bearing more risk for population health management. In addition, ACO partnerships may provide an important window to monitor a potential wave of health care consolidation or, in contrast, a new model of independent providers successfully coordinating patient care.

Utilizing Strategic and Operational Methods for Whole-Community Disaster Planning.

Analysis of response and recovery efforts to disasters over the past 2 decades has identified a consistent gap that plagues the nation in regard to persons with access and functional needs. This gap can be highlighted by Hurricane Katrina, where the majority of those killed were a part of the access and functional needs population. After a disaster, many individuals with access and functional needs require assistance recovering but often have difficulty accessing services and resources. These difficulties are due to a combination of issues, such as health problems and the disruption of community support services. We sought to help bridge this gap by focusing on strategic and operational methods used while planning for the whole community. This article highlights the many partnerships that must be fostered for successful whole-community planning. These partnerships include, but are not limited to, local government departments, health agencies, nonprofit and nongovernmental organizations, and other volunteer organizations. We showcase these methods by using a developmental Post-Disaster Canvassing Plan to highlight planning methods that may aid jurisdictions across the United States in disaster planning for the whole community. (Disaster Med Public Health Preparedness. 2017;11:741-746).

Orthopaedic Trauma Care Capacity Assessment and Strategic Planning in Ghana: Mapping a Way Forward.

BACKGROUND: Orthopaedic conditions incur more than 52 million disability-adjusted life years annually worldwide. This burden disproportionately affects low and middle-income countries, which are least equipped to provide orthopaedic care. We aimed to assess orthopaedic capacity in Ghana, describe spatial access to orthopaedic care, and identify hospitals that would most improve access to care if their capacity was improved. METHODS: Seventeen perioperative and orthopaedic trauma care-related items were selected from the World Health Organization's Guidelines for Essential Trauma Care. Direct inspection and structured interviews with hospital staff were used to assess resource availability and factors contributing to deficiencies at 40 purposively sampled facilities. Cost-distance analyses described population-level spatial access to orthopaedic trauma care. Facilities for targeted capability improvement were identified through location-allocation modeling. RESULTS: Orthopaedic trauma care assessment demonstrated marked deficiencies. Some deficient resources were low cost (e.g., spinal immobilization, closed reduction capabilities, and prosthetics for amputees). Resource nonavailability resulted from several contributing factors (e.g., absence of equipment, technology breakage, lack of training). Implants were commonly prohibitively expensive. Building basic orthopaedic care capacity at 15 hospitals without such capacity would improve spatial access to basic care from 74.9% to 83.0% of the population (uncertainty interval [UI] of 81.2% to 83.6%), providing access for an additional 2,169,714 Ghanaians. CONCLUSIONS: The availability of several low-cost resources could be better supplied by improvements in organization and training for orthopaedic trauma care. There is a critical need to advocate and provide funding for orthopaedic resources. These initiatives might be particularly effective if aimed at hospitals that could provide care to a large proportion of the population.

What are the best strategies for ensuring quality in hospitals?

Ensuring the safety of patients and personnel and improving quality have become important objectives for national health systems in developed and developing countries alike, in response to research highlighting poor quality, increasing patient expectations, and media reports. There is a general belief, supported by growing research literature, that there are effective methods to improve quality and safety.