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1.
PLoS One ; 15(7): e0235861, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706774

RESUMO

BACKGROUND: To support the rising need for testing and to standardize tumor DNA sequencing practices within the U.S. Department of Veterans Affairs (VA)'s Veterans Health Administration (VHA), the National Precision Oncology Program (NPOP) was launched in 2016. We sought to assess oncologists' practices, concerns, and perceptions regarding Next-Generation Sequencing (NGS) and the NPOP. MATERIALS AND METHODS: Using a purposive total sampling approach, oncologists who had previously ordered NGS for at least one tumor sample through the NPOP were invited to participate in semi-structured interviews. Questions assessed the following: expectations for the NPOP, procedural requirements, applicability of testing results, and the summative utility of the NPOP. Interviews were assessed using an open coding approach. Thematic analysis was conducted to evaluate the completed codebook. Themes were defined deductively by reviewing the direct responses to interview questions as well as inductively by identifying emerging patterns of data. RESULTS: Of the 105 medical oncologists who were invited to participate, 20 (19%) were interviewed from 19 different VA medical centers in 14 states. Five recurrent themes were observed: (1) Educational Efforts Regarding Tumor DNA Sequencing Should be Undertaken, (2) Pathology Departments Share a Critical Role in Facilitating Test Completion, (3) Tumor DNA Sequencing via NGS Serves as the Most Comprehensive Testing Modality within Precision Oncology, (4) The Availability of the NPOP Has Expanded Options for Select Patients, and (5) The Completion of Tumor DNA Sequencing through the NPOP Could Help Improve Research Efforts within VHA Oncology Practices. CONCLUSION: Medical oncologists believe that the availability of tumor DNA sequencing through the NPOP could potentially lead to an improvement in outcomes for veterans with metastatic solid tumors. Efforts should be directed toward improving oncologists' understanding of sequencing, strengthening collaborative relationships between oncologists and pathologists, and assessing the role of comprehensive NGS panels within the battery of precision tests.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Sequenciamento de Nucleotídeos em Larga Escala/normas , Neoplasias/genética , Oncologistas/psicologia , Análise de Sequência de DNA/normas , United States Department of Veterans Affairs , Adulto , Detecção Precoce de Câncer/normas , Feminino , Testes Genéticos/normas , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Medicina de Precisão/normas , Planos Governamentais de Saúde , Inquéritos e Questionários , Estados Unidos
2.
Stud Health Technol Inform ; 269: 294-302, 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-32594004

RESUMO

Located in the northeastern part of the United States, New York State is extremely diverse - from the perspectives of culture, history, language, geography, economy, to name a few. Spreading across approximately 55,000 miles and taking into consideration the diversity of health needs across the state, the New York State Department of Health (NYS DOH) is dedicated to improving the health of all New Yorkers. This is evident in a Prevention Agenda which is New York State's health improvement plan, the blueprint for state and local actions to improve the health and well-being of all New Yorkers, and to promote health equity in all populations who experience disparities [1]. In addition, strategies for successful partnerships include long standing relationships with local health departments, community health centers, hospital systems, community-based organizations, individuals and groups who rely on the State Department of Health for quality services to achieve health equity and eliminate health disparities. This report provides an overview of previous, current, and forthcoming health literacy activities spearheaded by the New York State Department of Health Office of Minority Health and Health Disparities Prevention that support the importance of effective communication and health literacy across the Department.


Assuntos
Letramento em Saúde , Equidade em Saúde , Humanos , New York , Saúde Pública , Planos Governamentais de Saúde , Estados Unidos
4.
J Bone Joint Surg Am ; 102(11): 942-945, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: covidwho-526116

RESUMO

BACKGROUND: The SARS-CoV-2 (COVID-19) pandemic has resulted in widespread cancellation of elective orthopaedic procedures. The guidance coming from multiple sources frequently has been difficult to assimilate as well as dynamic, with constantly changing standards. We seek to communicate the current guidelines published by each state, to discuss the impact of these guidelines on orthopaedic surgery, and to provide the general framework used to determine which procedures have been postponed at our institution. METHODS: An internet search was used to identify published state guidelines regarding the cancellation of elective procedures, with a publication cutoff of March 24, 2020, 5:00 P.M. Eastern Daylight Time. Data collected included the number of states providing guidance to cancel elective procedures and which states provided specific guidance in determining which procedures should continue being performed as well as to orthopaedic-specific guidance. RESULTS: Thirty states published guidance regarding the discontinuation of elective procedures, and 16 states provided a definition of "elective" procedures or specific guidance for determining which procedures should continue to be performed. Only 5 states provided guidelines specifically mentioning orthopaedic surgery; of those, 4 states explicitly allowed for trauma-related procedures and 4 states provided guidance against performing arthroplasty. Ten states provided guidelines allowing for the continuation of oncological procedures. CONCLUSIONS: Few states have published guidelines specific to orthopaedic surgery during the COVID-19 outbreak, leaving hospital systems and surgeons with the responsibility of balancing the benefits of surgery with the risks to public health.


Assuntos
Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/normas , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Planos Governamentais de Saúde/legislação & jurisprudência , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Masculino , Saúde do Trabalhador , Procedimentos Ortopédicos/normas , Procedimentos Ortopédicos/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Segurança do Paciente , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Formulação de Políticas , Estados Unidos
6.
Otolaryngol Head Neck Surg ; 162(6): 800-803, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-52515

RESUMO

Coronavirus disease 2019 (COVID-19) is a novel coronavirus resulting in high mortality in the adult population but low mortality in the pediatric population. The role children and adolescents play in COVID-19 transmission is unclear, and it is possible that healthy pediatric patients serve as a reservoir for the virus. This article serves as a summary of a single pediatric institution's response to COVID-19 with the goal of protecting both patients and health care providers while providing ongoing care to critically ill patients who require urgent interventions. A significant limitation of this commentary is that it reflects a single institution's joint effort at a moment in time but does not take into consideration future circumstances that could change practice patterns. We still hope dissemination of our overall response at this moment, approximately 8 weeks after our region's first adult case, may benefit other pediatric institutions preparing for COVID-19.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Hospitais Pediátricos/organização & administração , Otolaringologia/organização & administração , Pandemias/prevenção & controle , Pediatria/normas , Pneumonia Viral/prevenção & controle , Adolescente , Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , Infecção Hospitalar/prevenção & controle , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Prevenção Primária/métodos , Estudos Retrospectivos , Planos Governamentais de Saúde/organização & administração , Washington
7.
J Bone Joint Surg Am ; 102(11): 942-945, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32282419

RESUMO

BACKGROUND: The SARS-CoV-2 (COVID-19) pandemic has resulted in widespread cancellation of elective orthopaedic procedures. The guidance coming from multiple sources frequently has been difficult to assimilate as well as dynamic, with constantly changing standards. We seek to communicate the current guidelines published by each state, to discuss the impact of these guidelines on orthopaedic surgery, and to provide the general framework used to determine which procedures have been postponed at our institution. METHODS: An internet search was used to identify published state guidelines regarding the cancellation of elective procedures, with a publication cutoff of March 24, 2020, 5:00 P.M. Eastern Daylight Time. Data collected included the number of states providing guidance to cancel elective procedures and which states provided specific guidance in determining which procedures should continue being performed as well as to orthopaedic-specific guidance. RESULTS: Thirty states published guidance regarding the discontinuation of elective procedures, and 16 states provided a definition of "elective" procedures or specific guidance for determining which procedures should continue to be performed. Only 5 states provided guidelines specifically mentioning orthopaedic surgery; of those, 4 states explicitly allowed for trauma-related procedures and 4 states provided guidance against performing arthroplasty. Ten states provided guidelines allowing for the continuation of oncological procedures. CONCLUSIONS: Few states have published guidelines specific to orthopaedic surgery during the COVID-19 outbreak, leaving hospital systems and surgeons with the responsibility of balancing the benefits of surgery with the risks to public health.


Assuntos
Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/normas , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Planos Governamentais de Saúde/legislação & jurisprudência , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Masculino , Saúde do Trabalhador , Procedimentos Ortopédicos/normas , Procedimentos Ortopédicos/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Segurança do Paciente , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Formulação de Políticas , Estados Unidos
8.
Otolaryngol Head Neck Surg ; 162(6): 800-803, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32286910

RESUMO

Coronavirus disease 2019 (COVID-19) is a novel coronavirus resulting in high mortality in the adult population but low mortality in the pediatric population. The role children and adolescents play in COVID-19 transmission is unclear, and it is possible that healthy pediatric patients serve as a reservoir for the virus. This article serves as a summary of a single pediatric institution's response to COVID-19 with the goal of protecting both patients and health care providers while providing ongoing care to critically ill patients who require urgent interventions. A significant limitation of this commentary is that it reflects a single institution's joint effort at a moment in time but does not take into consideration future circumstances that could change practice patterns. We still hope dissemination of our overall response at this moment, approximately 8 weeks after our region's first adult case, may benefit other pediatric institutions preparing for COVID-19.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/prevenção & controle , Hospitais Pediátricos/organização & administração , Otolaringologia/organização & administração , Pandemias/prevenção & controle , Pediatria/normas , Pneumonia Viral/prevenção & controle , Adolescente , Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , Infecção Hospitalar/prevenção & controle , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias/estatística & dados numéricos , Prevenção Primária/métodos , Estudos Retrospectivos , Planos Governamentais de Saúde/organização & administração , Washington
10.
Rev. baiana saúde pública ; 44(supl.1): 1-184, jan.-mar. 2020. ilus, mapas, graf, tab
Artigo em Português | LILACS, Coleciona SUS, CONASS, SES-BA | ID: biblio-1118122

RESUMO

O Plano Estadual de Saúde (PES) 2020-2023 é um instrumento de gestão direcionado a orientar as ações a serem desenvolvidas por todos os profissionais e gestores da Sesab, visando a efetivação do direito à saúde e o fortalecimento do sistema estadual de saúde. Desse modo, as ações elencadas neste documento têm o firme propósito de oferecer uma saúde mais humanizada e resolutiva, contribuindo para a melhoria das condições de vida da população baiana


Assuntos
Humanos , Planos Governamentais de Saúde , Sistema Único de Saúde , Gestão em Saúde , Políticas Públicas de Saúde , Planejamento em Saúde/organização & administração , Serviços de Saúde
11.
Med Care ; 58(5): 453-460, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32049877

RESUMO

OBJECTIVES: We describe payor for contraceptive visits 2013-2014, before and after Medicaid expansion under the Affordable Care Act (ACA), in a large network of safety-net clinics. We estimate changes in the proportion of uninsured contraceptive visits and the independent associations of the ACA, Title X, and state family planning programs. METHODS: Our sample included 237 safety net clinics in 11 states with a common electronic health record. We identified contraception-related visits among women aged 10-49 years using diagnosis and procedure codes. Our primary outcome was an indicator of an uninsured visit. We also assessed payor type (public/private). We included encounter, clinic, county, and state-level covariates. We used interrupted time series and logistic regression, and calculated multivariable absolute predicted probabilities. RESULTS: We identified 162,666 contraceptive visits in 219 clinics. There was a significant decline in uninsured contraception-related visits in both Medicaid expansion and nonexpansion states, with a slightly greater decline in expansion states (difference-in-difference: -1.29 percentage points; confidence interval: -1.39 to -1.19). The gap in uninsured visits between expansion and nonexpansion states widened after ACA implementation (from 2.17 to 4.1 percentage points). The Title X program continues to fill gaps in insurance in Medicaid expansion states. CONCLUSIONS: Uninsured contraceptive visits at safety net clinics decreased following Medicaid expansion under the ACA in both expansion and nonexpansion states. Overall, levels of uninsured visits are lower in expansion states. Title X continues to play an important role in access to care and coverage. In addition to protecting insurance gains under the ACA, Title X and state programs should continue to be a focus of research and advocacy.


Assuntos
Anticoncepção/economia , Pessoas sem Cobertura de Seguro de Saúde , Provedores de Redes de Segurança , Adolescente , Adulto , Criança , Estudos de Coortes , Serviços de Planejamento Familiar/legislação & jurisprudência , Feminino , Humanos , Medicaid , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act , Planos Governamentais de Saúde , Estados Unidos/epidemiologia , Adulto Jovem
12.
Cien Saude Colet ; 24(12): 4415-4426, 2019 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31778492

RESUMO

This study aims to analyze regional trends and patterns of health revenues and expenditure in the Brazilian states from 2006 to 2016. This is an exploratory and descriptive study based on secondary national data and selected indicators. Higher per capita net current revenues for all states and regions, with decreasing levels in specific years associated with the crises of 2008-2009 and 2015-2016 were observed. Per capita health expenditure showed an increasing trend, even in times of economic crisis and declining collection. Diversity of sources and heterogeneity of health revenues and expenditures, as well as different impacts of the crisis on the regional budgets, were observed. The results suggest the protective effect of constitutional health linkage, spending commitments and priorities, and compensation mechanisms of fiscal federalism revenue sources in state health expenditures. However, challenges remain for the implementation of a transfer system that reduces inequalities and establishes greater cooperation among entities, in a context of austerity and strong public health financing constraints in Brazil.


Assuntos
Financiamento Governamental/tendências , Gastos em Saúde/tendências , Financiamento da Assistência à Saúde , Renda/tendências , Planos Governamentais de Saúde/economia , Planos Governamentais de Saúde/tendências , Brasil , Governo Federal , Financiamento Governamental/economia , Humanos , Fatores de Tempo
13.
Cien Saude Colet ; 24(12): 4509-4518, 2019 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31778501

RESUMO

Since 2014, Brazil has been experiencing an economic-fiscal-political-institutional crisis. This study evaluates whether the implementation of crisis responses contributed to weaken SUS regional and federative governance. This is an implementation study, and two theoretical categories of public health, the power in Testa and the subject in Campos have been incorporated. It presumes that the implementation shifts power and develops subjects. We analyzed public data from 2014 to 2018, organized into four axes of analysis: a) instruments for implementing crisis response; b) parliament and judicial interference in investments; c) legal frameworks of regionalization; d) federative actors and possible defense coalitions. Results show reduced federal resources, specifically for regional care networks; increased parliament and judicial interference with health resources, due to the evolution of congressional amendments and lawsuits, and changes in SUS regionalization guidelines. There is a shift of power from federative regional arrangements to the central government, parliament, the judiciary, and isolated local services. It is concluded that the response to the crisis weakened the regional federative governance of SUS, aggravating the impacts of the crisis on health.


Assuntos
Política de Saúde , Programas Nacionais de Saúde , Política Pública , Planos Governamentais de Saúde , Brasil , Tomada de Decisões Gerenciais , Recessão Econômica , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Humanos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Política Organizacional , Política Pública/economia , Política Pública/legislação & jurisprudência , Planos Governamentais de Saúde/economia , Planos Governamentais de Saúde/legislação & jurisprudência
14.
Cien Saude Colet ; 24(12): 4519-4527, 2019 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31778502

RESUMO

The creation of consensus and agreement among managers of the Unified Health System (SUS) was analyzed in Regional Interagency Commissions of two metropolitan scenarios, by means of a multiple case study for comparative analysis between the Metropolitan Region of Fortaleza-Ceará and the Metropolitan Region of Salvador-Bahia. The theoretical reference used was based on Mario Testa's work and on Habermas' Theory of Communicative Action. The data production merged documental analysis, interviews with managers of state, municipal and federal levels with direct observation of meetings of the Regional Interagency Commission, the State Health Council, the Bipartite Interagency Commission, meetings between central and regional levels, in addition to extended meetings of the Health Municipal Offices Council, in both states. The problems related to Agreed and Integrated Programming and to the underfunding of SUS were common points in the scenarios studied. Such problems are interlinked and interfere in an important way in the interinstitutional relations between the municipalities, highlighting the dispute for resources as an obstacle for the creation of consensus and agreement, based on the dialogue and understanding between actors.


Assuntos
Consenso , Administradores de Instituições de Saúde , Relações Interinstitucionais , Negociação , Planos Governamentais de Saúde , Brasil , Planos de Sistemas de Saúde , Humanos , Estudos de Casos Organizacionais
15.
Cien Saude Colet ; 24(12): 4527-4540, 2019 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31778503

RESUMO

This paper analyzes policies and management tools aimed at the regional organization of specialized care in Ceará. A case study was developed in a health region based on 18 interviews with regional and municipal managers and health professionals and visits to services. Several factors enabled advances in the organization of specialized care: the preponderant role of the State Health Secretariat in the regional health coordination of actions and services, providing infrastructure, financing with redistribution of resources and technical support to municipalities; implantation of regional Polyclinic and Specialized Dental Care Centers through the Public Health Consortium; and logistics support of transport system. The institutional framework of Municipal Health Secretaries Council and the participatory functioning of the Regional Interagency Committee provided adequate space for the regional governance. Challenges remain for the integration of the network, qualification of care regulation, and provision of hospital care in the region. The results reinforce the importance of public and universal arrangements for the provision of comprehensive health care that can reduce inequities.


Assuntos
Assistência Integral à Saúde/organização & administração , Regionalização/organização & administração , Planos Governamentais de Saúde/organização & administração , Brasil , Tomada de Decisões Gerenciais , Assistência à Saúde/organização & administração , Política de Saúde , Acesso aos Serviços de Saúde , Humanos , Programas Nacionais de Saúde/organização & administração , Estudos de Casos Organizacionais
16.
Cien Saude Colet ; 24(12): 4541-4554, 2019 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31778504

RESUMO

In the context of crisis and resource constraints, it is reasonable to assume the deteriorated weaknesses of the Unified Health System (SUS), such as regional inequalities, underfinancing, and care quality issues. This study explored the application of easily comprehensible and calculated access and effectiveness indicators that could reflect the hospital network crisis. Five indicators extracted from the Hospital Information System, related to Brazil and states of the Southeastern region, were analyzed in the 2009-2018 period: hospitalizations resulting in death; surgical hospitalizations resulting in death; elective surgeries in the total of surgical hospitalizations; hip prostheses in the senior population; and angioplasties in the population aged 20 years and over. Statistical control charts were used to compare indicators between states, before and from 2014. In Brazil, overall hospital deaths had a slight increase while surgical deaths declined; elective surgeries and hipprosthesis also decreased. In Southeastern Brazil, Rio de Janeiro was the worst performer, especially the decrease of the elective surgeries. The results illustrate the potential of indicators to monitor crisis effects on hospital care.


Assuntos
Recessão Econômica , Acesso aos Serviços de Saúde , Pacientes Internados , Programas Nacionais de Saúde , Planos Governamentais de Saúde , Adulto , Idoso , Angioplastia/estatística & dados numéricos , Artroplastia de Quadril/estatística & dados numéricos , Brasil/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde , Disparidades em Assistência à Saúde , Sistemas de Informação Hospitalar , Mortalidade Hospitalar/tendências , Humanos , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Qualidade da Assistência à Saúde , Alocação de Recursos , Procedimentos Cirúrgicos Operatórios/mortalidade , Procedimentos Cirúrgicos Operatórios/tendências
17.
Cien Saude Colet ; 24(12): 4593-4598, 2019 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31778509

RESUMO

This paper addresses the primary health care crisis of Rio de Janeiro public health system as of 2018. This municipality has experienced a robust primary care expansion since 2009, adopting Social Organizations for recruiting professionals and managing services, qualifying the infrastructure of units and prioritizing family and community medicine, as well as adopting management practices such as standardized offers, evaluation and pay-for-performance compensation, marketing, among others. Given the recent economic crisis, the municipal manager decided to reduce family health teams, considering the current National Policy of Primary Care and arguing that it is possible to optimize resources (doing more with less). In this process, he faced resistance that was not enough to stop him. Due to the resonance of this city (second largest in Brazil and prominent in the national press) and based on public documents and formulations on management, the crisis expressed in the primary health care of this city was debated around the implications of the adoption of Social Organizations in the sustainability of health services, conducting management processes and their rationalities, as well as the political action of social agents advocating for the SUS and primary care in particular.


Assuntos
Recessão Econômica , Atenção Primária à Saúde/economia , Alocação de Recursos/economia , Planos Governamentais de Saúde/economia , Brasil , Cidades , Saúde da Família/economia , Acesso aos Serviços de Saúde/economia , Humanos , Downsizing Organizacional/economia , Atenção Primária à Saúde/organização & administração , Alocação de Recursos/organização & administração , Responsabilidade Social , Planos Governamentais de Saúde/organização & administração , Desenvolvimento Sustentável
18.
Hosp Pediatr ; 9(11): 897-902, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31645359

RESUMO

OBJECTIVES: As obesity rates rise in children, it is likely that the number of hospitalized children with obesity is also increasing. However, characterization of the inpatient population with obesity as a whole has not been reported. We aimed to examine trends in the annual prevalence of obesity in hospitalized children and to identify demographic and clinical characteristics associated with higher obesity prevalence in children who are hospitalized. METHODS: We completed a retrospective cohort analysis of children aged 2 to 19 years admitted to a single tertiary children's hospital system for any reason in 2009-2016. Body mass index was calculated from documented height and weight. Children with obesity were defined by using age- and sex-specific body mass index percentile guidelines established by the Centers for Disease Control and Prevention. Annual obesity prevalence was calculated on the encounter level for service line and All Patients Refined Diagnosis-Related Groups (diagnosis groups). χ2 tests were used to determine statistical differences between groups, and the Cochran-Armitage test of trend was used to describe changes in obesity over time. RESULTS: Of 83 329 children who were hospitalized, 17.0% had obesity, increasing from 16.5% of hospitalizations in 2009-2010 to 17.3% in 2015-2016 (P = .002). Service lines with the highest obesity prevalence included orthopedics (22.1%), infectious disease (20.6%), and neuroscience (18.7%). Diagnosis groups with the highest obesity prevalence included cellulitis (22.5%), tonsil/adenoid procedures (22.0%), and some orthopedic procedures (28.7%). CONCLUSIONS: Some groups of children who were hospitalized experience higher obesity prevalence, including children hospitalized with orthopedic, infectious disease, and neurologic problems. In future research, investigators should target disproportionately affected groups by examining health outcomes, patient safety, and satisfaction issues.


Assuntos
Hospitalização , Obesidade Pediátrica/epidemiologia , Adenoidectomia/estatística & dados numéricos , Adolescente , Índice de Massa Corporal , Celulite (Flegmão)/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Grupos de Populações Continentais/estatística & dados numéricos , Feminino , Cefaleia/epidemiologia , Humanos , Masculino , Medicaid , Missouri/epidemiologia , Procedimentos Ortopédicos/estatística & dados numéricos , Envenenamento/epidemiologia , Prevalência , Estudos Retrospectivos , Infecções dos Tecidos Moles/epidemiologia , Planos Governamentais de Saúde , Tonsilectomia/estatística & dados numéricos , Estados Unidos , Adulto Jovem
19.
Hosp Pediatr ; 9(11): 834-843, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31636126

RESUMO

OBJECTIVES: Medicaid and Children's Health Insurance Program plans publicly report quality measures, including follow-up care after psychiatric hospitalization. We aimed to understand failure to meet this measure, including measurement definitions and enrollee characteristics, while investigating how follow-up affects subsequent psychiatric hospitalizations and emergency department (ED) visits. METHODS: Administrative data representing Alabama's Children's Health Insurance Program from 2013 to 2016 were used to identify qualifying psychiatric hospitalizations and follow-up care with a mental health provider within 7 to 30 days of discharge. Using relaxed measure definitions, follow-up care was extended to include visits at 45 to 60 days and visits to a primary care provider. Logit regressions estimated enrollee characteristics associated with follow-up care and, separately, the likelihood of subsequent psychiatric hospitalizations and/or ED visits within 30, 60, and 120 days. RESULTS: We observed 1072 psychiatric hospitalizations during the study period. Of these, 356 (33.2%) received follow-up within 7 days and 566 (52.8%) received it within 30 days. Relaxed measure definitions captured minimal additional follow-up visits. The likelihood of follow-up was lower for both 7 days (-18 percentage points; 95% confidence interval [CI] -26 to -10 percentage points) and 30 days (-26 percentage points; 95% CI -35 to -17 percentage points) regarding hospitalization stays of ≥8 days. Meeting the measure reduced the likelihood of subsequent psychiatric hospitalizations within 60 days by 3 percentage points (95% CI -6 to -1 percentage point). CONCLUSIONS: Among children, receipt of timely follow-up care after a psychiatric hospitalization is low and not sensitive to measurement definitions. Follow-up care may reduce the need for future psychiatric hospitalizations and/or ED visits.


Assuntos
Continuidade da Assistência ao Paciente , Hospitalização , Serviços de Saúde Mental , Adolescente , Alabama , Criança , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Alta do Paciente , Indicadores de Qualidade em Assistência à Saúde , Planos Governamentais de Saúde , Adulto Jovem
20.
Prim Care ; 46(4): 561-574, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31655752

RESUMO

There is growing recognition that social determinants of health influence individual and population health. A well-designed population health management strategy can yield improved outcomes for a given community, while improving the financial health of health care systems and providers. This article provides an overview of aligned care delivery, community engagement, education, technology, and other key strategies required to address the needs of patients and communities. A holistic vision incorporating social factors can lead to a return on investment and improvement in the health of a community, at the same time decreasing health care costs for the population managed.


Assuntos
Medicaid/organização & administração , Determinantes Sociais da Saúde , Disparidades em Assistência à Saúde , Humanos , Programas de Assistência Gerenciada/organização & administração , Medicare/organização & administração , Gestão da Saúde da População , Determinantes Sociais da Saúde/economia , Planos Governamentais de Saúde/organização & administração , Estados Unidos
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