A tool lets patients with chronic diseases and their physicians test hypotheses about changes that might affect their conditions.
The Personalized Learning System allows patients with chronic diseases to work collaboratively with their clinicians to identify issues of importance to them, track outcomes, and learn both from the routine changes patients make in everyday life (e.g., diet changes, travel, sleep patterns) and formal planned experiments aimed at improving the outcomes most important to them. A web-based interface permits patients and providers to set shared goals and co-design experiments and lets patients customize data collection via cellular short messaging system (SMS), e-mail, web-survey, and commercially available biosensor devices (e.g., Fitbit). The web interface also provides graphical reports of data collected by patients in real time for immediate review by patients and providers and provides tools for patients and providers to chronicle their observations.
Numeracy, even more so than general health literacy, is a strong predictor of comprehension and decision-making in making comparative health care decisions.
When we ask patients to participate in decision-making, we’re relying on their ability to understand and manipulate numerical data. A patient might be called on to choose hospitals and physicians based on quality of care metrics, to evaluate the results of screening tests using an intuitive grasp of sensitivity and specificity, or evaluate probabilistic risks and benefits of different treatments. All of this presumes both clear communication of statistical data as well as a level of patient sophistication – two assumptions that are often in fact, untrue.
Discusses mammogram, an X-ray test of the breasts used to screen for breast problems. Covers at what ages women should have a mammogram. Discusses how it is done and how to prepare for it. Covers possible results.
The traditional doctor’s visit is ripe for reinvention—both because it is such a valuable interaction, and because we know there are ways to make it better.
We believe that new tools, technologies, and strategies can empower people to be more informed and more engaged when they walk into the doctor’s office and better equipped to improve their health when they walk out the door. And we believe that doctors, nurses, and other care providers can improve the ways they communicate with and engage patients during visits, and they can take advantage of new tools for monitoring, supporting, and connecting with their patients outside of the office, too.
We think that by tapping into these strategies, we could to turn the provider-patient interaction on its head—and promote better, and relationships while doing so.
PubMed comprises more than 23 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.
Doctor visits should be meaningful. All too often, they're not, says Thomas Goetz, RWJF Entrepreneur in Residence. How can we change the way we deliver primary care?
Consider the doctor’s office: the sanctum of care in American medicine, where a patient enters with a need—a question, or an ailment, or a concern—and leaves with an answer, a diagnosis, or a treatment. That room, with its emblematic atmosphere of exam table and tiny sink and bottles of antiseptic, is in many ways the engine of our health care system, the locus of all our collective knowledge and all our collective resources. It’s where health care happens
This course guide is for a course on racial and ethnic disparities in healthcare and health status. The guide is intended for use with the book “Minority Populations and Health: An introduction to health disparities in the United States.” The book was written based on the course that I teach in the program of public health studies at Johns Hopkins University. My course is for upper-division undergraduates (juniors and seniors). This course and book can also be used as an introductory course for graduate students in public health, medicine, nursing or other related fields (social work, policy studies, ethnic studies, etc.).
I use both lecture and seminar format. I teach both an undergraduate and graduate-level version of the course. I teach an undergraduate course during Spring Semester, an advanced graduate seminar during 4th quarter (April-May) and a 3-day mini course which is a graduate-level introductory course.
For the advanced graduate seminar, the majority of the course consists of student-led seminar style discussions of the assigned readings. For this course I use “Race, Ethnicity and Health” (Jossey-Bass Publishers October 2003 ISBN: 0-7879-6451-4. If you are interested in the course guide for the advanced graduate seminar, click here.
For the undergraduate course I mainly lecture. I also include occasional films and some times guest lecturers, but I rarely use more than one or two guest lecturers in a semester-long format. I like the continuity of having one teacher. I think it makes for a much better experience for students. For this course I use “Minority Populations and Health” as the required text.
The 3-day mini-course is mostly lecture format, but there are some class discussions as well. For this class I use “Minority Populations and Health” as the required text and I also use “Race, Ethnicity and Health” as additional reading.
The attempts to “fix” the U.S. healthcare system have taken at least one well-worn market-based path: strive for economies of scale. Hospital consolidation is on the rise, a trend that shows no signs of abating as providers try to streamline back-end operations and deploy big data analytics in hopes of improving outcomes and lowering costs. Businesses try this every day.
However some primary care physicians are looking at the exact opposite approach: de-scaling and taking cost out by radically simplifying their practices as a way to make them clinically, financially, and personally sustainable.
What makes these practices different? 1) Each is based on relationship quality rather than production volume; as a result, each is smaller than the average U.S. practice; 2) Visits are longer and the doctor may provide a broader range of services with minimal support staff; 3) They have business plans that demonstrate how their model can be financially sustainable; and 4) Each used their variation on the general model to offer greater satisfaction to their patients as well as to their own personal and professional lives.
My colleagues Leonard Marcus, Barry Dorn, and I met three such physicians in the course of researching our book, Renegotiating Healthcare: Resolving Conflict to Build Collaboration. We recently revisited them to see how the evolution of their distinct approaches to primary care might inform the larger discussion of the future of healthcare.
The following educational interventions were used in the Men's Health Study - "Pairing physician education with patient activation to improve shared decisions around prostate cancer screening: a cluster randomized controlled trial"
Questions about these materials may be directed to Drs. Michael Wilkes (email@example.com) or Frank Day (firstname.lastname@example.org).
Each of the following links will open a new browser window to display it's content. To return to this Main Menu, click on the
Educational Intervention for PatientsStart the "Men's Health Education Tool"
(approximately 18 minutes duration)
Educational Intervention for PhysiciansStart the "Essentials of Screening Tests" Movie
(approximately 22 minutes duration to view all 6 sections)
The relationship between clinician and patient has been the bedrock of the global health equity movement. It was the call for access to basic medical services for patients—and patients demanding empowerment for their community health workers—that drove the Health for All movement in the 1970s. It was the insistence by patients, activists, and clinicians for all people with AIDS to receive treatment that led to the transformation in access starting just 10 years ago in the developing world. That insistence will continue to be the energy and lifeblood of the movement—patients claiming their rights, and physicians supporting their patients—together advocating for a world in which a child born anywhere can have a life of opportunity, dignity, and access to quality health care.
The theoretical constructs of allostasis and allostatic load (AL) have contributed to our understanding of how constantly changing social and environmental factors impact physiological functioning and shape health and aging disparities, particularly along socioeconomic, gendered, racial, and ethnic lines. AL represents the cumulative dysregulation of biological systems with prolonged or poorly regulated allostatic responses. Nearly two decades of empirical research has focused on operationalizing the AL construct for examining the antecedents and health outcomes accompanying multisystem biological dysregulation. The purpose of this systematic review is to examine the empirical literature that quantifies the AL construct; the review also evaluates the social, environmental, and genetic antecedents of AL as well as its predictive utility for a variety of health outcomes. A total of 58 articles published between 1997 and 2012 were retrieved, analyzed, and synthesized. The results revealed considerable heterogeneity in the operationalization of AL and the measurement of AL biomarkers, making interpretations and comparisons across studies challenging. There is, however, empirical substantiation for the relationships between AL and socioeconomic status, social relationships, workplace, lifestyle, race/ethnicity, gender, stress exposure, and genetic factors. The literature also demonstrated associations between AL and physical and mental health and all-cause mortality. Targeting the antecedents of AL during key developmental periods is essential for improving public health. Priorities for future research include conducting prospective longitudinal studies, examining a broad range of antecedent allostatic challenges, and collecting reliable measures of multisystem dysregulation explicitly designed to assess AL, at multiple time points, in population-representative samples.
Perspective from The New England Journal of Medicine — Taking Our Medicine — Improving Adherence in the Accountability Era
Our hope is that providers, hospitals, and health systems participating in new payment models will find economies of scale in working together to improve adherence. Groups that previously functioned independently, such as pharmacists, pharmacy benefit managers, and doctors, will share a business interest in fostering population health and have added incentives to communicate and collaborate. Already, new marketplace solutions are emerging for using data and predictive analytics more effectively to support targeted interventions. As integrated health systems spread, providers may well invest in studying lower-cost ways to help patients be healthier.
For example, a practice could easily provide its physicians with monthly data on their patients' pharmacy claims. This approach has shown promise among early adopters of new care-coordination efforts. For instance, Community Care of North Carolina, a group of 14 physician networks serving Medicaid patients, paid physicians a monthly fee for care coordination; collected data on patients' prescription-filling rates; and had clinical pharmacists reach out to patients, explain the need for the medications, and often reduce a regimen's complexity. This approach led to a 5-to-7% improvement in adherence.4
A lo largo de este artículo se expone que es la metodología Crowd y en qué medida puede contribuir de forma efectiva en la investigación sanitaria, en la prevención y control máxime en tiempos de crisis y de recortes en presupuestarios.
A lo largo de este artículo se expone que es la metodología Crowd y en qué medida puede contribuir de forma efectiva en la investigación sanitaria, en la prevención y control máxime en tiempos de crisis y de recortes en presupuestarios. Como ejemplo se comenta la aplicación de esta metodología en el caso de la investigación y tratamiento de la malaria. Actualmente, la malaria es uno de los problemas de salud a escala mundial más devastadores. Si bien puede afectar a cualquier persona independientemente de su edad y sexo, a nivel infantil es considerada la tercera causa de mortalidad en todo el mundo. A pesar de que actualmente puede ser tratada con cierta eficacia, el cambio de patrón en esta enfermedad, y el desarrollo de cierta resistencia a los medicamentos, dificulta mucho la investigación. Aunque insuficiente, la financiación internacional ha sido responsable de muchos de los avances en esta lucha. Sin embargo, el panorama financiero actual no es muy alentador y prevé serios recortes en esta materia. A pesar del progreso realizado hasta la actualidad aún queda mucho camino por recorrer para conseguir erradicar el paludismo.
A listing of resources that provide information about the structural determinants of poverty in the United States.
The Office of Socioeconomic Status is pleased to provide this annotated bibliography of resources that provide information about the structural determinants of poverty in the United States. The annotation for each reference listed in the bibliography provides a brief summary of the item’s contents. The bibliography contains listings of relevant books, research and technical reports, and scholarly literature. Given the large amount of literature on this topic, this bibliography provides only a purposeful sampling. In searching for materials to include in the bibliography, researchers carried out keyword searches of several major social science databases and of websites of federally funded poverty research centers in the U.S. The research centers examined included those housed at the University of California, Davis (UC Davis Center for Poverty Research); the University of Kansas (UK Center for Poverty Research), the University of Wisconsin (Institute for Research on Poverty); and Stanford University (Stanford Center on Poverty and Inequality). The search intentionally excluded materials published prior to the 1996 Welfare Reform ACT, as that landmark legislation clearly altered the structural landscape in this country.
Integrated behavioral health care is an emerging field with the potential to improve health outcomes for patients and health care delivery within practices. Integrated behavioral health care can systematically enhance a primary care practice’s ability to effectively address behavioral health issues that naturally emerge in the primary care, prevent fragmentation between behavioral health and medical care, and create effective relationships with mental health specialists outside the primary care setting.
As greater numbers of primary care practices and health systems begin to design and implement integrated behavioral health services, there is a growing need for quality measures that are rigorous and appropriate to the specific characteristics of different approaches to integration.
The Atlas of Integrated Behavioral Health Care Quality Measures (the IBHC Measures Atlas) aims to support the field of integrated behavioral health care measurement by:
Presenting a framework for understanding measurement of integrated care;Providing a list of existing measures relevant to integrated behavioral health care; andOrganizing the measures by the framework and by user goals to facilitate selection of measures.Intended Audience
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