The Experts below are selected from a list of 176556 Experts worldwide ranked by ideXlab platform
Dinny H De Bakker - One of the best experts on this subject based on the ideXlab platform.
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What part of the total Care consumed by type 2 diabetes patients is directly related to diabetes? Implications for disease management programs
International journal of integrated care, 2011Co-Authors: Christel E. Van Dijk, Robert A. Verheij, Ilse C.s. Swinkels, Mieke Rijken, François G. Schellevis, Peter P. Groenewegen, Dinny H De BakkerAbstract:Background: Disease management programs (DMP) aim at improving coordination and quality of Care and reducing healthCare costs for specific chronic diseases. This paper investigates to what extent total healthCare utilization of type 2 diabetes patients is actually related to diabetes and its implications for diabetes management programs. Research design and methods: HealthCare utilization for diabetes patients was analyzed using 2008 self-reported data (n=316) and data from electronic medical records (EMR) (n=9023), and divided whether or not Care was described in the Dutch type 2 diabetes multidisciplinary healthCare standard. Results: On average 4.3 different disciplines of healthCare providers were involved in the Care for diabetes patients. Ninety-six percent contacted a GP-practice and 63% an ophthalmologist, 24% an internist, 32% a physiotherapist and 23% a dietician. Diabetes patients had on average 9.3 contacts with GP-practice of which 53% were included in the healthCare standard. Only a limited part of total healthCare utilization of diabetes patients was included in the healthCare standard and therefore theoretically included in DMPs. Conclusion: Organizing the Care for diabetics in a DMP might harm the coordination and quality of all healthCare for diabetics. DMPs should be integrated in the overall Organization of Care.
Elizabeth M. Yano - One of the best experts on this subject based on the ideXlab platform.
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Organization of Care and diagnosed depression among women veterans.
The American journal of managed care, 2010Co-Authors: Usha Sambamoorthi, Bevanne Bean-mayberry, Patricia A. Findley, Elizabeth M. Yano, Ranjana BanerjeaAbstract:OBJECTIVE To analyze the association between the Organizational features of integration of physical and mental healthCare in womens health clinics and the diagnosis of depression among women veterans with or at risk for cardiovascular conditions (ie, diabetes mellitus, heart disease, or hypertension). STUDY DESIGN Retrospective and observational secondary data analyses. METHODS We studied 27,972 women veterans from 118 facilities with diagnosed cardiovascular conditions in fiscal year 2001 (FY2001) using merged MediCare claims and Veterans Health Administration (VHA) data merged with the 1999 VHA Survey of Primary Care Practices and the 2001 VHA Survey of Women Veterans Health Programs and Practices. The dependent variable was a binary indicator for diagnosed depression during FY2001 at the individual level. We used a multilevel logistic regression model to control for clustering of women veterans within facilities. Individual-level independent variables included demographics, socioeconomic characteristics, and chronic physical conditions. RESULTS Overall, 27% of women veterans using the VHA were diagnosed as having depression in FY2001. Across facilities, rates of diagnosed depression varied from 13% to 41%. After controlling for individual-level and facility-level independent variables, women veterans who were served in separate women's health clinics with integrated physical and mental healthCare were more likely to have diagnosed depression. The adjusted odds ratio was 1.12 (95% confidence interval, 1.01-1.25). CONCLUSIONS Existing women-specific VHA Organizational features with integration of primary Care and mental health seem effective in diagnosing depression. Emerging patient-centered medical home models may facilitate diagnosis and treatment of mental health issues among women with complex chronic conditions.
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the Organization and delivery of women s health Care in department of veterans affairs medical center
Womens Health Issues, 2003Co-Authors: Elizabeth M. Yano, Donna L Washington, Caroline Goldzweig, Cynthia D Caffrey, Carole TurnerAbstract:Congressional eligibility reforms have profoundly changed the array of services to be made available to women veterans in Department of Veterans Affairs (VA) health Care facilities. These include access not only to primary and specialty Care services already afforded VA users, but also to a full spectrum of gender-specific services, including prenatal, obstetric, and infertility services never before provided in VA settings. The implications of this legislative mandate for delivering Care to women veterans are poorly understood, as little or no information has been available about how Care for women veterans is organized. This article reports on the first national assessment of variations in the Organization of Care for women veterans.
Anne Frølich - One of the best experts on this subject based on the ideXlab platform.
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Organization of Care for people with multimorbidity: a systematic review of randomized controlled trials
International Journal of Integrated Care, 2021Co-Authors: Christian Ulrich Eriksen, Hanne Birke, Sofie A L Helding, John Andersen, Anne FrølichAbstract:Introduction: Multimorbidity is associated with increased mortality, reduced physical functioning and quality of life, and increased healthCare utilization. Organizational models for providing integrated Care in multimorbidity exist, but evidence on the effectiveness of specific interventions is limited. Previous systematic reviews have only considered interventions in the primary Care sector. We examined the effectiveness of interventions with an Organizational or patient-oriented focus designed to improve outcomes for people with multimorbidity in general practices, communities, and hospitals. Multimorbidity was defined according to the WHO definition of two or more chronic conditions in the same individual. Methods: We systematically searched PubMed, Embase, and CENTRAL in November 2018, supplementing two earlier systematic reviews in terms of time periods and data-bases. We also searched for interventions in the hospital sector. We included randomized controlled trials reporting outcomes of Organizational and/or patient-oriented interventions with the purpose of supporting clinical Care provision for patients with multimorbidity. We applied the risk of bias criteria developed by the Cochrane group, Effective Practice and Organization of Care. We extracted data on study participants; duration, and follow-up; intervention elements; primary outcome(s); and results. Finally, we undertook a narrative synthesis, grouping findings by sector and primary outcome measure(s). (PROSPERO registration number: CRD42019119490.) Results: Forty articles were included, covering a total study population of 11,713 participants. Thirteen studies took place in general practice settings, 19 in community settings, and eight in hospital settings. The overall risk of bias was acceptable, with the studies in general practice and hospital settings generally having a lower risk than the community-based studies. Findings are inconsistent, and the outcomes assessed are too heterogeneous to draw clear conclusions. However, some tendencies emerge from our synthesis. In general practice settings, Organizational interventions could potentially improve outcomes for mental health, selected clinical parameters, and mortality, while patient-oriented interventions could potentially improve outcomes for mental health. In community settings, Organizational interventions appear effective in improving mental health outcomes, and patient-oriented interventions could potentially improve health-related quality of life and reduce mortality. Organizational interventions based in hospital settings could potentially reduce mortality, and improve mental health, selected clinical parameters, and treatment. Overall, the potentially effective intervention elements in the Organizational interventions are team-based Care, Care managers, and telemedicine, while it in the patient-oriented interventions is to target the self-management capacities of patients. Discussions/Limitations: Interventions targeting multimorbidity hold promise in improving various outcome measures. By including the hospital sector, we have provided a comprehensive overview of the evidence-base existing on interventions for multimorbidity. However, the inconsistency in the outcome measures used makes it difficult to draw firm conclusions, and the complexity of the interventions does not allow for isolation of the effective components. Conclusions/Lessons learned: We see potentially clinically relevant effects of patient-oriented and, especially, Organizational interventions. Also, we identified promising results of interventions taking place in hospital settings. Suggestions for future research: To streamline the outcome measures used, future research should apply the core outcome set developed for interventions targeting multimorbidity.
Jean-francois Richard - One of the best experts on this subject based on the ideXlab platform.
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Assessing the Effect of Quality-Improvement Strategies for Organization of Care in Type 2 Diabetes Outcomes in Adults: Aim-Strait
Canadian journal of diabetes, 2020Co-Authors: Alice Y.y. Cheng, Harpreet S. Bajaj, Maureen Clement, Diana Sherifali, Doron Eisen, Olaf Heisel, Paul Keown, Jean-francois RichardAbstract:Abstract Objectives To observe the effect of an Organization-of-Care improvement process on the achievement of therapeutic goals for people with type 2 diabetes mellitus (T2DM). Methods This single-arm cohort study analyzed the electronic medical records of patients with T2DM in 5 primary Care practices in Ontario, Canada, before and 2 years after implementation of an individualized quality-improvement program. The primary outcome was the change in glycated hemoglobin (A1C) between baseline and follow up, with secondary analyses including change in other metabolic parameters, medication patterns and clinic visits. Pre specified subgroup analysis of patients with baseline values above guideline therapeutic targets was performed. Results In the overall population of 1,886 patients, A1C improved from 7.1% (baseline) to 7.0% (follow up) (p Conclusions The implementation of an Organization-of-Care improvement program in primary Care was associated with improved metabolic control, which was most pronounced in patients with baseline levels above guideline-recommended therapeutic targets.
Romain Bourcier - One of the best experts on this subject based on the ideXlab platform.
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Stroke Transfer and its Organizational Paradigm
Clinical Neuroradiology, 2018Co-Authors: Lili Detraz, Marielle Ernst, Romain BourcierAbstract:Since the clinical recognition of endovascular therapy (EVT) for stroke treatment is recent (2015), some Organizational issues, such as the “drip and ship (DS) versus mothership (MS)” access to EVT remain unanswered. There is growing pressure to guarantee immediate access to EVT with limited human resources and infrastructures. As results from prospective studies are missing, a review of the existing literature dealing with clinical retrospective studies was carried out. Most of the studies did not report a significant difference with respect to the adverse effects for patients treated by EVT according to the Organizational paradigm of Care. Several studies did not report a significant difference concerning the 3 months functional outcomes regarding the Organizational paradigm. Only two studies built theoretical models of the best outcomes and observed a superiority of the DS only if the door to needle time was less than 30 min. Waiting for the results of ongoing randomized controlled trials, this review of articles presenting patients treated with either MS or DS provides an overview but does not emphasize a superiority of a given paradigm; however, it highlights the inequalities of access to EVT according to the Organization of Care in different areas.
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stroke transfer and its Organizational paradigm review of Organizational paradigms and the impact on outcome
Clinical Neuroradiology-klinische Neuroradiologie, 2018Co-Authors: Lili Detraz, Marielle Ernst, Romain BourcierAbstract:Since the clinical recognition of endovascular therapy (EVT) for stroke treatment is recent (2015), some Organizational issues, such as the "drip and ship (DS) versus mothership (MS)" access to EVT remain unanswered. There is growing pressure to guarantee immediate access to EVT with limited human resources and infrastructures. As results from prospective studies are missing, a review of the existing literature dealing with clinical retrospective studies was carried out. Most of the studies did not report a significant difference with respect to the adverse effects for patients treated by EVT according to the Organizational paradigm of Care. Several studies did not report a significant difference concerning the 3 months functional outcomes regarding the Organizational paradigm. Only two studies built theoretical models of the best outcomes and observed a superiority of the DS only if the door to needle time was less than 30 min. Waiting for the results of ongoing randomized controlled trials, this review of articles presenting patients treated with either MS or DS provides an overview but does not emphasize a superiority of a given paradigm; however, it highlights the inequalities of access to EVT according to the Organization of Care in different areas.