Journal of general internal medicine
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Randomized Controlled Trial
Long-term Effects of a Collaborative Care Model on Metabolic Outcomes and Depressive Symptoms: 36-Month Outcomes from the INDEPENDENT Intervention.
Collaborative care (CC) is a multicomponent team-based approach to providing mental health care with systematic integration into outpatient medical settings. The 12-month INDEPENDENT CC intervention improved joint disease control measures in patients with both depression and diabetes at 12 and 24 months following randomization. ⋯ While improvements since baseline in patient outcomes did not differ between the collaborative care and usual care groups at 36 months, patients who received CC were more likely to maintain improvements in depressive symptoms and glucose levels at 36 months if they had achieved these improvements at the end of active intervention.
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Reducing hospital readmissions is a federal policy priority, and predictive models of hospital readmissions have proliferated in recent years; however, most such models tend to focus on the 30-day readmission time horizon and do not consider readmission over shorter (or longer) windows. ⋯ It is more difficult to predict distant readmissions than proximal readmissions, and the more information the model uses, the better the predictions. Inclusion of utilization-based risk factors add substantially to the discriminative ability of the model, much more than any other included risk factor domain. Our best-performing models perform well relative to other published readmission prediction models. It is possible that these predictions could have operational utility in targeting readmission prevention interventions among high-risk individuals.
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The sobering realization that little has changed in the scope of inpatient harm makes it plain that efforts intent on improving patient safety must be redoubled if the status quo is to be reversed. Living up to the recommendations of the iconic Institute of Medicine (IOM) Report (To Err Is Human: Building a Safer Health System) must remain top of mind. Much can and must be done to assure to the degree possible the safety of the inpatient population.
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Patient agency in contraceptive decision-making is an essential component of reproductive autonomy. ⋯ The Contraceptive Agency Scale can be used in research and clinical care to reinforce non-coercive service provision as a standard of care.