Journal of general internal medicine
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COVID-19 symptom reports describe varying levels of disease severity with differing periods of recovery and symptom trajectories. Thus, there are a multitude of disease and symptom characteristics clinicians must navigate and interpret to guide care. ⋯ Health services clinic data from a large integrated health system offers insights into the post-COVID symptoms associated with care seeking for sequelae that are not adequately managed by usual care pathways (self-management and primary care clinic visits). These findings can inform machine learning algorithms, primary care management, and selection of patients for earlier COVID-19 recovery referral.
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There are approximately 25.6 million individuals with limited English proficiency (LEP) in the USA, and this number is increasing. ⋯ Adults with LEP had consistently worse access to care than adults without LEP. System-level interventions, such as expanding access to health insurance coverage, providing language services, improving provider training in cultural competence, and increasing diversity in the medical workforce may minimize barriers and improve equity in access to care.
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Editorial
A Roadmap for Modifying Clinician Behavior to Improve the Detection of Cognitive Impairment.
A staggering number of individuals live with cognitive decline. Primary care providers are ideally situated to detect the first signs of cognitive decline, but many persons remain undiagnosed. ⋯ There is a great need for interventions to address this problem. This article applies an implementation science framework, the Behavioral Change Wheel, to evaluate the factors that influence detection of cognitive impairment in primary care and proposes candidate interventions for future study.
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Observational Study
Interdisciplinary Team Meetings in Practice: an Observational Study of IDTs, Sensemaking Around Care Transitions, and Readmission Rates.
Interdisciplinary teams (IDTs) have been implemented to improve collaboration in hospital care, but their impact on patient outcomes, including readmissions, has been mixed. These mixed results might be rooted in differences in organization of IDT meetings between hospitals, as well as variation in IDT characteristics and function. We hypothesize that relationships between IDT members are an important team characteristic, influencing IDT function in terms of how members make sense of what is happening with patients, a process called sensemaking OBJECTIVE: (1) To describe how IDT meetings are organized in practice, (2) assess differences in IDT member relationships and sensemaking during patient discussions, and (3) explore their potential association with risk-stratified readmission rates (RSRRs). ⋯ IDTs vary not only in how they are organized, but also in team relationships and sensemaking. Though our design does not allow for inferences of causation, these differences may be associated with hospital readmission rates.
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Healthcare workers, especially female employees, have historically been at an increased risk for occupational stress. During the early stages of the COVID-19 pandemic, many healthcare workers shifted to a telework model of care and started working from home (WFH). It is unclear how WFH impacted female healthcare employees' job satisfaction and stress levels. ⋯ Employees at this VA medical center who had the ability to work from home during the COVID-19 pandemic, particularly younger women, reported less stress, less burnout, and more satisfaction, while maintaining work efficiency and team cohesion. Providing permission to WFH may decrease the added burden that female healthcare workers often experience as they strive to overcome gender gaps and inequalities in the workplace.