Medical care
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Multicenter Study
How 3 rural safety net clinics integrate care for patients: a qualitative case study.
Integrated care focuses on care coordination and patient centeredness. Integrated care supports continuity of care over time, with care that is coordinated within and between settings and is responsive to patients' needs. Currently, little is known about care integration for rural patients. ⋯ Care integration was supported by 2 fundamental changes to organize and deliver care to patients-(1) empanelment with a designated group of patients being cared for by a provider; and (2) a multidisciplinary team able to address rural issues. New funding and organizational initiatives of the Affordable Care Act may help to further improve care integration, although additional solutions may be necessary to address particular needs of rural communities.
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Randomized Controlled Trial Multicenter Study Comparative Study
Use of interactive voice response to improve colorectal cancer screening.
Only 63% of the US population aged 50-75 years is adherent with recommended colorectal cancer (CRC) screening guidelines. Efforts are needed to increase screening for CRC. ⋯ Our analysis provides "real-world" evidence that IVR is effective when delivered by a commercial health plan, and may be a useful tool for increasing adherence to screening guidelines among patients outside an integrated care practice.
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Multicenter Study
Inpatient rehabilitation volume and functional outcomes in stroke, lower extremity fracture, and lower extremity joint replacement.
It is unclear if volume-outcome relationships exist in inpatient rehabilitation. ⋯ Outcome-specific volume effects ranged from small (functional status) to none (home discharge) in all 3 diagnostic groups. Patients with these conditions can be treated locally rather than at higher volume regional centers. Further regionalization of inpatient rehabilitation services is not needed for these conditions.
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Multicenter Study Comparative Study
Agreement between electronic medical record-based and self-administered pain numeric rating scale: clinical and research implications.
Pain screening may improve the quality of care by identifying patients in need of further assessment and management. Many health care systems use the numeric rating scale (NRS) for pain screening, and record the score in the patients' electronic medical record (EMR). ⋯ The underestimation of pain using EMR data, especially clinically actionable levels of pain, has important clinical and research implications. Improving the quality of pain care may require better screening.
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Multicenter Study
Evaluating patient access to Electronic Health Records: results from a survey of veterans.
Personal Health Records (PHRs) tethered to an Electronic Health Record (EHR) offer patients unprecedented access to their personal health information. At the Department of Veteran Affairs (VA), the My HealtheVet Pilot Program was an early PHR prototype enabling patients to import 18 types of information, including clinical notes and laboratory test results, from the VA EHR into a secure PHR portal. The goal of this study was to explore Veteran perceptions about this access to their medical records, including perceived value and effect on satisfaction, self-care, and communication. ⋯ Veterans' primary motivation for use of the pilot Web site was the ability to access their own personal health information from the EHR. With patients viewing such access as beneficial to their health and care, PHRs with access to EHR data are positioned to improve health care quality. Making additional information accessible to patients is crucial to meet their needs and preferences.