Journal of general internal medicine
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Accounting for approximately 1 in 4 community-dwelling adults in the United States (US), people with disabilities (PWD) experience significant disparities in health care quality, access, and outcomes. At the same time, US physicians have reported feeling unprepared to care for PWD and have revealed significant negative bias about this population. ⋯ Medical education may perpetuate negative bias about disability through a hidden curriculum. Insufficient support from institutional and licensing authorities has stymied efforts to expand and improve disability-related training such that disability is not included in existing curricula focused on mitigating health care disparities - despite known vulnerabilities for PWD. Without improvements to disability-related curricular content, physicians will remain ill-equipped to care for the nation's largest minority group.
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There is limited evidence on interventions to address the health needs of vulnerable patients in permanent supportive housing (PSH). ⋯ An onsite primary care delivery model led to increases in primary care engagement for high-acuity PSH tenants.
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On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) announced new staffing mandates for long-term care (LTC) facilities in an effort to improve care quality in nursing homes (NHs). The guidelines require a minimum of 3.48 h of daily care per resident, including 0.55 h provided by registered nurses (RNs), 2.45 h by nurse aides (NAs), and an additional 0.48 h by other care staff. These requirements, including a 24/7 RN presence, aim to address chronic understaffing that has been linked to poor outcomes such as increased emergency visits and lower compliance with quality standards. ⋯ Despite these challenges, workforce shortages may be alleviated by the CMS initiatives, which include a $75 million national campaign to grow the NH workforce. This commentary discusses the implications of the CMS staffing rule, the legal challenges it faces, and the potential to improve RN work conditions and resident care. The paper concludes with recommendations for expanding workforce capacity and enhancing compliance through financial investment and policy reform.
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Medicine sub-internships aim to prepare students for residency. However, the traditional sub-internship structure, with multiple learners at varied levels, poses obstacles to providing the clinical exposure, learning environment, and direct observation and feedback necessary to develop essential skills. ⋯ Our model demonstrates that a CCSI can cultivate the skills and mindset to prepare students for internship. This coaching model can benefit students in other settings.
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Previous reports suggest patient and caregiver lack of awareness of dementia. Little is known about how this varies by ethnicity and how informal (family) caregiver burden is associated with knowing a dementia diagnosis. ⋯ Dementia diagnosis unawareness was very high in this community. MAPs are more likely to be unaware of a diagnosis than NHWPs. Lack of access to primary care and caregiver burden were not associated with dementia diagnosis unawareness.