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Content ArticlePrimary care providers (PCPs) serve as most people’s first point of contact with the healthcare system. These clinicians build relationships with their patients over time and help coordinate care delivered by other health care providers. Evidence shows that a strong foundation of primary care yields better health outcomes overall, greater equity in health care access and outcomes, and lower per capita health costs. But in the United States, decades of underinvestment and a low provider supply, among other problems, have limited access to effective primary care. This Commonwealth Fund brief highlights gaps in the US primary care system by comparing its performance to systems in 10 other high-income countries.
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Content ArticleThis article in The Journal of Post-Acute and Long-Term Care Medicine looks at the issue of systemic racism in long-term services and supports (LTSS) including nursing homes and home- and community-based care in the USA. The authors highlight segregation and disparities, with Black, Indigenous, and persons of colour (BIPOC) users having less access to quality care and reporting poorer quality of life. The authors make a number of policy recommendations to address these health inequalities in LTSS: Targeted increases to Medicaid reimbursement tied to direct care, and targeted enhanced Medicare and/or Medicaid reimbursement to LTSS providers that serve a disproportionate share of Medicaid or underserved older adults. Pay for performance incentives should focus on improving care among LTSS providers who serve individuals with disadvantaged status because of systemic racism and that operate above and beyond a person's clinical severity and comorbidity. The Centers for Medicare & Medicaid Services (CMS) should develop an overall health equity measure which would help capture how well providers meet the needs of diverse populations. Care Compare quality scores by race and ethnicity should be used internally and shared with states to develop culturally appropriate policies. Race and ethnicity-specific quality measures should be included on state-level report cards to incentivise action among states and tailor solutions to the local context. Promote culture change in nursing homes, with an ultimate goal of creating a person-centred, homelike model of care. Expand access to Medicaid-waivered home- and community-based services. Ensure that home- and community-based services are culturally appropriate. Promote integrated home- and community-based programs that can be targeted to BIPOC users to address existing disparities in outcomes.
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Content ArticleThis article in the journal JAMA Network Open aimed to determine if the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use, an educational initiative to establish antibiotic stewardship programs focusing on patient safety, is associated with reductions in antibiotic use in long term care settings. The authors looked at 439 long term care settings and found that participation in training on antibiotic stewardship from AHRQ was associated with a reduction in antibiotic use and urine culture collection. Fluoroquinolones, an antibiotic class targeted by the AHRQ safety program, had the greatest decrease.
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Content ArticleLanguage barriers, reduced self-advocacy, lower health literacy and biased care may hinder the diagnostic process. This US study in BMJ Quality & Safety looks at patient-reported diagnostic errors, what contributes to them and the impact they have, and examines the differences between respondents with limited English-language health literacy or disadvantaged socioeconomic position, and their counterparts. The authors conclude that: interpreter access should be viewed as a diagnostic safety imperative. social determinants affecting care access and affordability should be routinely addressed as part of the diagnostic process. patients and their families should be encouraged to access and update their medical records.
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In this blog, Clare Rayner, an occupational physician, describes how an international collaboration to help understand Long Covid was established by harnessing the power of technology and social media. This collective, between a group of UK doctors experiencing prolonged health problems after Covid-19 infection and a globally renowned rehabilitation clinic at Mount Sinai Hospital in New York, aims to help both patients and healthcare professionals by disseminating learning about Long Covid from both sides of the Atlantic. -
Content ArticleThe impermanent nature of a waiver flexibility and intensified staffing shortages leave health systems that have not yet moved forward with "hospital-at-home" programs in a policy-driven, wait-and-see limbo. The centricity of the home during pandemic life brought renewed attention to the "hospital-at- home" model, but the model dates to the mid-1990s, when it was developed by Bruce Leff, MD, a geriatrician and health services researcher at Johns Hopkins University in Baltimore. His expertise has been even more widely sought since March 2020, as hospitals looked to move care outside of their walls to meet the demands of COVID-19's earliest surges.
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Content ArticleThis report presents maternal mortality rates in the USA for 2020 based on data from the National Vital Statistics System. Maternal mortality rates, which are the number of maternal deaths per 100,000 live births, are shown in this report by age group and race and Hispanic origin. In 2020, 861 women were identified as having died of maternal causes in the United States, compared with 754 in 2019. The maternal mortality rate for 2020 was 23.8 deaths per 100,000 live births compared with a rate of 20.1 in 2019. In 2020, the maternal mortality rate for non-Hispanic Black women was 55.3 deaths per 100,000 live births, 2.9 times the rate for non-Hispanic White women (19.1). Rates for non-Hispanic Black women were significantly higher than rates for non-Hispanic White and Hispanic women. The increases from 2019 to 2020 for non-Hispanic Black and Hispanic women were significant. The observed increase from 2019 to 2020 for non-Hispanic White women was not significant.
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Content ArticleThis article in Studies in Health Technology and Informatics looks at how patient-peer support can be a valuable resource for patients in the context of hospital safety. Hospitalised patients often lack access to safety systems and face difficulties in having a proactive role in their safety. The authors of this study conducted semi-structured interviews with 30 patients and caregivers at a paediatric and an adult hospital. They highlight the potential benefits of incorporating patient-peer support into patient-facing technologies and argue that helping patients access such support can help them engage with and improve the quality and safety of their hospital care.
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Content ArticleIn this interview with Dr. Robert Mentz, Editor-in-Chief and Dr. Anu Lala, Deputy Editor at the Journal of Cardiac Failure, Kristin and Will Flanary (AKA Lady and Dr. Glaucomflecken) share their experience as co-patient and patient. Will suffered a cardiac arrest in May 2020 and the experience of discovering her husband, having to perform CPR and waiting in isolation for news left his wife Kristin with significant trauma. The interview explores the experience of those involved in medical trauma who are not the patient themselves, the 'co-patient', and the ways in which healthcare professionals can support them to process their experience.
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Content ArticleIn his account in the Journal of Cardiac Failure, Kristin Flanary describes her experience of discovering her husband having a cardiac arrest, giving him CPR and the subsequent wait for information on his condition. She then describes the trauma she experienced in the weeks and months following the incident. She highlights that healthcare providers can play an important role in helping relatives or non-patients who have been part of a medical emergency process their experiences.
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Content ArticleThis dissertation from Ivan Pupulidy, Tilburg University, introduces a network of practices that transformed the United States Department of Agriculture (USDA) Forest Service accident investigation. This dissertation uses case studies to show the interweaving of organisational and individual journeys, each of which began with the strength to inquire and to challenge assumptions. The case studies show how constructed realities, including my own, were challenged through inquiry and how four practices emerged that supported sense making at both the field and organisational leadership levels of the organisation.
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Content ArticleMany devices in current use were marketed before the US Food and Drug Administration (FDA) began regulating devices in 1976. Thus, manufacturers of these devices were not required to demonstrate safety and effectiveness, which presents both clinical and ethical problem for patients, especially for women, as some of the most dangerous devices—such as implanted contraceptive devices— are used only in women. This article from Madris Kinard and Rita F. Redberg investigates whether and to what extent devices for women receive less rigorous scrutiny than devices for men. This article also suggests how the FDA Center for Devices and Radiological Health could more effectively ensure safety and effectiveness of devices that were marketed prior to 1976.
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Content ArticleThe Center for Outcomes and Patient Safety in Surgery (COMPASS) in the USA combines clinical collaboration and data to ensure, amongst all surgical and procedural colleagues, the safest, most appropriate and effective and highest quality procedure for every patient, every time. It aims to continuously strengthen the care that our patients receive through the measurement and analysis of surgical outcomes and data. COMPASS is composed of clinicians representing all Massachusetts General Hospital surgical specialties.
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Content ArticleIn this interview for Patient Safety & Quality Healthcare, Andrea Truex, chief nursing officer of Englewood Community Hospital, Florida, talks about how focusing on communication can enhance patient safety.
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Content ArticleLaura Chapman is a law student in Chicago, USA, where she’s studying to become a lawyer. She has lymphoedema, a condition that causes painful swelling in her foot that worsens throughout the day. She needs custom garments to control that swelling, but her Medicaid plan doesn’t cover them. Here’s her story in her own words. Sick Note is a regular newsletter about America's healthcare system.
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Content ArticleThe composition and background of members of state medical boards, including public or citizen members, can impact the functionality and public perception of medical boards in the United States. This study from Doug Wojcieszak analysed the number of public members on each state medical board and their professional backgrounds or expertise to regulate the medical profession. The findings show that for nearly half of state medical boards public members comprise at least a quarter of their voting members; however, more than half of public members for all state medical boards have no measurable medical experience or background, including in patient safety. The need for public members to have medical expertise or background – especially in patient safety -- is discussed along with potential policy recommendations.
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Content ArticleThe direction of hospital design is taking a turn for the practical as a surge of institutions are updating their infrastructure and responding to demands for more outpatient facilities. Beyond aesthetics, hospitals are seeking architectural updates that improve safety, patient and staff satisfaction, and friendliness to the environment. Infection control, lighting conditions, noise level, air quality, and patient room design are just some of the factors that are considered.
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Content ArticleWhen SynergyHealth, St. Joseph’s Hospital of West Bend, Wisconsin, USA, decided to relocate and build an 82-bed acute care facility, there was an opportunity to design a hospital that focused on patient safety. Hospital leaders believed if a facility design process was “engineered properly,” it would enhance patient safety and create a patient safe culture; however, they found little information to give the direction. To help plan the new facility, a national learning lab was conducted, drawing from patient safety in the available literature; inviting experts from the healthcare profession and other fields, including transportation, spacecraft design, and systems engineering; and involving the hospital's board members, staff, physicians, and facility design team. In this case study, John G. Reiling describes the process used by St. Joseph to design a new hospital around patient safety, and identify and discuss safety design principles, providing examples of their application at St. Joseph’s new facility. Finally, recommendations are made for the design of all health care systems, including new facilities, remodeling, and additions.
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Content ArticleThe Joint Commission implemented medication management titration standards in 2017, with revisions in 2020. Researchers surveyed critical care nurses about their experiences with medication titration, use of clinical judgment when titrating, nurses’ scope and autonomy, and their moral distress. Of 781 respondents, 80% perceived the titration standards caused delays in patient care and 68% reported suboptimal care, both of which significantly and strongly predicted moral distress.
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Content ArticleThis article from the book 'Patient Safety and Quality: An Evidence-Based Handbook for Nurses' looks at the impact of the architectural design of a hospital facility on patient safety. This includes considering the design of hospital technology and equipment. The authors highlight the ways in which physical design can make healthcare systems and processes safer for patients and staff. They also identify indirect benefits of system design that may contribute to this, including improved staff wellbeing and making patients feel safer while in care environments.
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Content ArticleAs a growing number of hospitals pressed for resources due to the COVID-19 surge suspend elective surgeries, some healthcare professionals want the public to know exactly how important an "elective" procedure can be. The term "elective surgery" does not describe the acuity of the medical condition or necessity of the procedure. Rather, the use of "elective" distinguishes these surgeries that are scheduled in advance from emergency surgeries, such as trauma cases. As Americans learn of elective surgeries once again being postponed, physicians are taking to the web to debunk what can be a misnomer.
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Content ArticleThis study in the International Journal of Radiation Oncology, Biology and Physics assesses the impact of the early Covid-19 pandemic on incident learning through evaluation of events reported to the Radiation Oncology Incident Learning System® (RO-ILS) in the USA. The authors conclude that reporting to RO-ILS declined during the early Covid-19 pandemic, especially in hotspot areas, suggesting that resources and time were diverted away from incident reporting to address other critical needs. However, three of the five top reporting practices that stopped reporting during early Covid have since reported events after the analysis timeframe, suggesting the decline may be temporary.
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Content ArticleQuotes from US doctors on the impact the pandemic has had on their hospitals and the care they are providing.
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Content ArticleSoojin Jun, a pharmacist and a patient advocate, discusses three ways in which pharmacists can help solve the health crisis in the US."The first and foremost value of recognizing pharmacists as providers is that we can help deprescribing medications and guide patients to healthier lives for many chronic illnesses. Many insurance and government sponsored programs are wasting money by “restricting” how pharmacists should practice under their laws and regulations when they can better use the time and money by “guiding” how pharmacists could practice as providers."
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Content ArticleIn this blog for CNN health, Blake Ellis and Melanie Hicken discuss the exponential increase in the prescription of the drug Nuedexta to care home residents with dementia in the US. A CNN investigation found that the number of Nuedexta pills dispensed to care home facilities increased by nearly 400% in four years, prompting concerns that it is being inappropriately prescribed. The drug is designed to treat a rare disorder called pseudobulbar affect (PBA) which occurs in only 5% patients with dementia. State regulators have found doctors inappropriately diagnosing nursing home residents with PBA to justify using Nuedexta to treat patients whose confusion and agitation make them difficult to manage. Analysis by CNN also found that nearly half the Nuedexta claims filed with Medicare in 2015 came from doctors who had received money or other perks from the manufacturer.
