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Background. Patient-centered care models allow for the ability to tailor treatment to outcomes of importance to patients. Objective. The purposes of this study were to (1) define patient subgroups based on outcomes of importance; (2) determine whether patient subgroups based on outcomes of importance differed in demographic, clinical, and psychological measures; and (3) determine whether outcome domain subgroups differed in treatment responses. Design. This was a prospective, longitudinal observational study. Methods. This was a secondary analysis of the Optimal Screening for Prediction of Referral and Outcome study. Patients in the development phase completed the Patient Centered Outcome Questionnaire (PCOQ) and questionnaires related to negative mood, fear avoidance, and positive coping, as well as region-specific questionnaires. Patients in the validation cohort completed the PCOQ, measures of treatment satisfaction and region-specific questionnaires at 4 weeks, 6 months, and 1 year. A hierarchical agglomerative cluster analysis identified profiles based on importance outcomes as determined by the PCOQ. Analysis of variance and chi-squared assessed baseline subgroup differences in demographics, psychological factors, and clinical outcomes. Repeated-measure analysis of variance considered subgroup differences in outcomes longitudinally. Results. Cluster analysis identified 3 subgroups: (1) 'Multiple Outcome Domains Important' subgroup characterized by high importance attached to improvement in all domains, (2) 'Pain and Function Outcomes Important' subgroup characterized by high importance attached to improvement in pain and interference, and (3) 'Pain Important' subgroup characterized by greatest importance attached to improvement in pain. Limitations. Our sample included patients from outpatient physical therapy and may not be representative of patients in other settings. Concl USJOn. Patients can be characterized by the importance attached to improvement in outcome domains. The identified subgroups differed in baseline measures as well as response to treatment., Nearly one-third of individuals in the United States develop chronic pain, (1,2) with annual costs exceeding those of cancer, heart disease, and diabetes. (3) Despite advances in medical technology, the [...]

A business plan was developed as the foundation for implementing a sustainable nurse-led community clinic in an academic setting located in an area that hosts an underserved population. The benefits [...]

Physician disengagement and related concepts such as burnout are prevalent, have wide-reaching implications, and therefore have received widespread national attention. Published approaches have focused primarily on burnout, with fewer focusing on engagement. In addition, most approaches thus far have focused on physicians rather than a mixed group of physicians and allied health professionals. An integrated safety-net institution in Massachusetts developed a provider-organization collaborative model focusing on communication and relationship building to improve provider engagement., PHYSICIAN ENGAGEMENT IS THE EXTENT TO which physicians are willing to go above and beyond for the organization, are loyal and committed, and ask what they can do for the [...]

Objectives: To identify consumers' preferences over care settings, such as physicians' offices, emergency rooms (ERs), urgent care centers, retail clinics, and virtual physicians on smartphones, for minor illnesses. Data Sources: A survey conducted between 9/27/16 and 12/7/16 emailed to all University of California, Irvine employees. Study Design: Participants were presented with 10 clinical scenarios and asked to choose the setting in which they wanted to receive care. We estimated multinomial conditional logit regression models, conditioning the choice on out-of-pocket costs, wait time, travel time, and chooser characteristics. Data Collection: 5451 out of 21 037 employees responded. Principal Findings: Out-of-pocket costs and wait time had minimal impact on patient's preference for site of care. Choices were driven primarily by the clinical scenario and patient characteristics. For chronic conditions and children's well-visits, the doctor's office was the preferred choice by a strong majority, but for most acute conditions, either the ER (for high severity) or urgent care clinics (for lower severity) were preferred to the office setting, particularly among younger patients and those with less education. Conclusions: Patients have several alternatives to traditional physicians' offices and ERs. The low impact of out-of-pocket costs suggests that insurers interested in encouraging increased utilization of alternatives would need to consider substantial changes to benefit structure. KEYWORDS ambulatory care settings, choice models, retail clinics, urgent care, virtual physicians, 1 | INTRODUCTION Recent decades have seen several innovations in the way acute, and primary care for minor ailments and injuries is provided. Physician offices and emergency rooms (ERs) are [...]

Distractions threaten patient safety and quality of care. The purpose of this study was to explore hospital nurses' perceptions about distractions to the delivery of patient-centered care. Staffing issues, telephone ringing, computer issues, and multitasking were the four highest-rated distractors., Because nurses play a critical role in delivery of safe, high-quality, patient-centered care, they must be focused and engaged fully. Nurses have numerous responsibilities and deal with many distractions during [...]

Reducing the length of stay (LOS) is a well-recognized best place for hospital leaders to transform their organizations' operations to reduce costs effectively. A focus on redesigning clinical and financial [...]

Nurses value patient--and family-centered care as one of the most important elements of nursing, and as such, these foundations are embedded into nursing practice and theory. Patient engagement in health research, as an evolution of patient--and family-centered care, has emerged as a critical new way of doing research over the last several years. However, the benefit, value, and exploration of ways in which patient partnerships can be built within the context of nephrology nursing research are still relatively new. This article describes patient-centered outcomes research, discusses how patients can be involved throughout the research process, and provides examples for effective partnerships in nephrology nursing research. Key Words: Patient engagement, patient--and family-centered care, patient-centered outcomes research, patient-oriented research, nephrology nursing research, patient partner., Patient--and family-centered care is one of the most important elements of nursing practice as an essential component to fostering a therapeutic relationship between patients, their families, and their health care [...]

The Institute of Medicine (IOM) (2011) report, 'The Future of Nursing: Leading Change, Advancing Health,' was inspired by a vision to strengthen nursing leadership to help transform health care. Paralleling the IOM report, a core belief of the American Nephrology Nurses Association is to provide nurses with leadership opportunities, and encourage nurses to seize opportunities to develop and polish their leadership skills. This article discusses 'The Leadership Challenge' as one model for leadership development that can propel individuals, including nurses, toward exemplary leadership. The article presents the Five Practices of Exemplary Leadership within 'The Leadership Challenge' as an effective evidence-based path to achieving the extraordinary. Key Words: Leadership, nurse leaders, future of nursing., At some point in time, every nurse realizes there are better ways to provide patient care, better policies to drive care, and better ways to organize and lead care. These [...]

Objective: Drug and alcohol (DA)-related emergency department (ED) visits represent an increasing fraction the head-injured population seen in the ED. Such patients present a challenge to the evaluation of head injury and determination of need for computed tomographic (CT) scan and further clinical path. This effort examined whether an electroencephalogram (EEG)-based biomarker could aid in reducing unnecessary CT scans in the intoxicated ED population. Method: This is a retrospective secondary study of an independent prospective US Food and Drug Administration validation trial that demonstrated the efficacy of (1) an automatic Structural Injury Classifier for the likelihood of injury visible on a CT (CT+) and (2) an EEG-based Brain Function Index to assess functional impairment in minimally impaired, head-injured adults presenting within 3 days of injury. Impact on the biomarker performance in patients who presented with or without DA was studied. Results: Structural Injury Classifier sensitivity was not significantly impacted by the presence of DA. Although specificity decreased, it remained several times higher than obtained using standard CT decision rules. Furthermore, the potential to reduce the number of unnecessary scans by approximately 30% was demonstrated when the Structural Injury Classifier was integrated into CT clinical triage. The Brain Function Index was demonstrated to be independent of the presence of DA. Conclusion: This EEG-based assessment technology used to identify the likelihood of structural or functional brain injury in mildly head-injured patients represents an objective way to aid in triage patients with DA on presentation, with the potential to decrease overscanning while not sacrificing sensitivity to injuries visible on CT. Keywords: brain electrical activity, brain function index, drug and alcohol intoxication, EEG, quantitative electrophysiological measures, structural brain injury, structural injury classifier, traumatic brain injury, TBI, The ability to achieve rapid, objective, and accurate identification of traumatic brain injury (TBI) is key to enabling rapid triage of head-injured patients in an emergency department (ED) or urgent [...]

Objectives: To estimate rates and national trends of initiation of new psychotropic medications without a psychiatric diagnosis and to identify demographic and clinical correlates independently associated with such use among US adults in outpatient settings.Data Source: Data were gathered from the 2006-2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based U.S. outpatient care. The sample was limited to adults aged 18 or older who received a new psychotropic drug prescription (n = 8618 unweighted).Study Design: Using a repeated cross-sectional design with survey sampling techniques, we estimated prescription initiation rates and national trends. Multivariable-adjusted logistic regression analysis was used to identify correlates independently associated with initiation of new psychotropic prescriptions without a psychiatric diagnosis.Data Collection/Extraction Methods: Data were publicly available, and we extracted them from the Centers for Disease Control and Prevention website.Principal Findings: Altogether, at 60.4% of visits at which a new psychotropic prescription was initiated, no psychiatric diagnosis was recorded for the visit. Overall, the rate increased from 59.1% in 2006-2007 to 67.7% in 2008-2009 and then decreased to 52.0% in 2014-2015. Visits to psychiatrists were associated with very low odds of having no psychiatric diagnosis when compared to primary care visits (OR = 0.02; 95% CI, 0.01-0.04). Visits to non-psychiatric specialists showed 6.90 times greater odds of not having a psychiatric diagnosis when compared to primary care visits (95% CI, 5.38-8.86).Conclusion: New psychotropic medications are commonly initiated without any psychiatric diagnosis, especially by non-psychiatrist physicians. Non-psychiatrists should document relevant diagnoses more vigilantly to prevent potentially inappropriate use or misuse.KEYWORDSprescribing patterns, prescription, psychiatric diagnosis, psychotropic, 1 | INTRODUCTIONThe use of prescription psychotropic medications has increased steadily over the past two decades, (1-4) driven, in large part, by the increased prescribing of these medications by non-psychiatrists. [...]

Patient and family advisors can have a large and meaningful impact on a hospital system. The Children's Mercy Hospital is showcased here as both an early adopter of the use of Patient and Family Advisers (PFAs) and other varied forms of family engagement. In 1999, the first Teen Advisory Board was formed. In 2003, a Family Advisory Board was instituted to partner with high-level hospital administrators to focus on improving the quality, safety, and experience of care on a system-wide level. Family Advisory Board members also began volunteering on hospital committees to provide patient and family perspectives regarding the planning and delivery of care. This article is authored by two mothers of hospital patients, who were hired in 2008 as 'parents on staff,' creating a Family-Centered Care Department, which recently merged with the Patient Experience Department to form a new Patient and Family Engagement Department. Roles for parents in the hospital system have expanded over time, including the hiring of three more 'parents on staff,' the formation of 15 Patient Family Advisory Councils organized around varied populations and diagnoses, and PFA participation on the varied Hospital-Acquired Condition committees, providing key end user input into quality and safety decisions. Key Words: Patient- and family-centered care, patient and family engagement, PFAC, PFA, advisors., No parent chooses to have a sick child. When a child is born, our hopes and dreams include images of a happy childhood, playdates with friends, first day of school [...]

Shared decision making (SDM) is a collaborative approach between clinicians and patients, where the best available evidence is integrated with patients' values and preferences for managing their health problems. Shared decision making may enhance patient-centered care and increase patients' satisfaction, engagement, adherence, and ability to self-manage their conditions. Despite its potential benefits, SDM is underutilized by physical therapists, and frequent mismatches between patients' and therapists' rehabilitation goals have been reported. Physical therapists can use evidence-based strategies, tools, and techniques to address these problems. This paper presents a model for SDM and explains its association with improved patient outcomes and relevance to situations commonly encountered in physical therapy. It describes freely available resources, including health literacy universal precautions, teach-back, motivational interviewing, decision aids, and patient-reported outcome measures that can help physical therapists integrate SDM into their clinical practices. This paper also explains SDM facilitators and barriers, suggests a theoretical framework to address them, and highlights the need for SDM promotion within physical therapy practice, education, administration, and research., Patients, payers, and regulators are requiring improved patient-centered care and increased patient engagement in health decisions. (1) By contrast, health care providers are driven to achieve positive medical outcomes that [...]

Objective. To examine the association between medical home enrollment and receipt of recommended care for Medicaid beneficiaries with multiple chronic conditions (MCC).Data Sources/Study Setting. Secondary claims data from fiscal years 2008-2010. The sample included nonelderly Medicaid beneficiaries with at least two of eight target conditions (asthma, chronic obstructive pulmonary disease, diabetes, hypertension, hyperlipidemia, seizure disorder, major depressive disorder, and schizophrenia).Study Design. We used linear probability models with person- and year-level fixed effects to examine the association between patient-centered medical home (PCMH) enrollment and nine disease-specific quality-of-care metrics, controlling for selection bias and time-invariant differences between enrollees.Data Collection Methods. This study uses a dataset that links Medicaid claims with other administrative data sources.Principal Findings. Patient-centered medical home enrollment was associated with an increased likelihood of receiving eight recommended mental and physical health services, including A1C testing for persons with diabetes, lipid profiles for persons with diabetes and/or hyperlipidemia, and psychotherapy for persons with major depression and persons with schizophrenia. PCMH enrollment was associated with overuse of short-acting [beta]-agonists among beneficiaries with asthma.Conclusions. The PCMH model can improve quality of care for patients with multiple chronic conditions.Key Words. Medical homes, quality, multimorbidity, chronic conditions, Caring for patients with multiple chronic conditions (MCC) is a priority for the US health care system. Half (51.70 percent) of all Americans have at least one chronic condition, and [...]

Background. The Short Musculoskeletal Function Assessment (SMFA) is a widely used patient-reported outcome measure, originally having 2 elements of outcome: the function index and the bother index. In multiple studies, it has been argued that the SMFA should be scored using 3, 4, or 6 subscales instead. Therefore, there is inconsistency with the number of underlying dimensions of the SMFA. Objective. The aim of this study was to evaluate the structural validity of the various proposed subscale configurations of the SMFA in a broad range of Dutch patients with injuries. Design. This study used a prospective cohort design. Methods. Participants with injuries were asked to complete the Dutch SMFA (SMFA-NL) at 5 to 8 weeks postinjury. The structural validity of the 6 different factor structures that have been proposed in other studies was evaluated using confirmatory factor analyses. Internal consistency was analyzed using Cronbach alpha. Results. A total of 491 patients participated (response rate = 74%). A 4-factor structure showed an acceptable fit (root-mean-square error of approximation [RMSEA] = 0.070, comparative fit index = 0.973, Tucker-Lewis index = 0.971). Other models, including the original 2-index structure, showed insufficient structural validity in Dutch patients with injuries. The 4-factor structure showed sufficient discriminant validity and good internal consistency (Cronbach alpha [greater than or equal to] 0.83). Limitations. It is unclear whether conclusions are generalizable across different countries, people who are elderly, and people without injuries. Conclusion. In a broad range of patients with injuries, the SMFA-NL may be best scored and interpreted using a 4-factor structure. Other factor structures showed insufficient structural validity., Injuries are a large contributor to the international burden of disease. (1-3) In the treatment of patients with injuries, traditional outcome measures such as x-ray recordings and range of motion [...]

Background. Existing variation has been identified in the rehabilitation programs for patients following cardiac surgery. Sternal precautions are believed to be overly restrictive and detrimental to patient recovery both physically and psychologically. Objective. The objective of this study was to determine the deformation of sternal skin during shoulder movements and upper extremity activities using a noncontact approach. Design. This was a cross-sectional, nonexperimental observational study. Methods. Two black dots were marked on participants' skin overlying sternoclavicular joints using an erasable marker. The coordinates of the dots were recorded using a digital camera and obtained using Image J, a public domain image processing program. Skin deformation between the 2 dots was quantified as biomechanical strain. Results. The sternal skin strain was -15.3% (SD = 5.6) and -12.0% (SD = 7.0) at 90 and 180 degrees of flexion; 0.0% (SD = 0.0) and -12.8% (SD = 5.8) at 90 and 180 degrees of abduction; and -6.4% (SD = 2.8), -8.9% (SD = 3.8), and -9.8% (SD = 4.6) when lifting the 0-, 5-, and 10-lb weights, respectively. The sternal skin strain was 7.9% (SD = 3.9) for extension to the end range and -2.5% (SD = 5.8) for pushing up from a chair. There is a trend of strain magnitude decrease with the increase of rhomboid strength, but no statistically significant association was found between them (R = 0.12). Limitations. Limitations included convenience sampling, small sample size, and using skin deformation as a proxy for mechanical loading of the bony structures. Conclusions. The data do not support the restriction on most of the shoulder movements and upper extremity activities following cardiac surgery. The approach has the advantage of measuring skin deformation in the entire sternal region., Unwarranted variation in clinical practice is considered to be the greatest challenge to recognizing the value of physical therapy services. (1) Existing variation has been identified in the rehabilitation programs [...]

As the world population ages, we can expect to care for an increasing number of older cancer patients. Prostate cancer is inherently a condition that affects patients of advanced age. In caring for these patients who have advanced prostate cancer, it is important to first assess the health status of the patient and his goals of care. As this is established, likely through a geriatric assessment, this will inform how to modify or mold the treatment plan to fit a patient's needs and vulnerabilities. These vulnerabilities may surface as patients undergo treatment such as androgen deprivation therapy--the backbone of systemic therapy for advanced disease. Androgen deprivation therapy leads to long-term adverse effects; therefore, providers should carefully consider its use and proactively manage toxicity. It is important to assess patients before starting treatment and to adjust the choice of therapy, or supportive services, in order to maximize benefit and minimize potential harms., IntroductionProstate cancer is predominantly a disease of the elderly, with peak incidence occurring at just over 70 years old. [1] Given the breadth of prostate cancer and its therapies, this [...]

ABSTRACT Throughout the past 50 years, the role of the neuroscience nurse has become more specialized as we continue to keep pace with new innovations and improvement in care for [...]

As optometry grows at an impressive rate--new grads outpace retirees every year-it becomes more difficult to stand out from the crowd. If yours is a typical practice, what draws patients [...]

In January 2018, the American Nephrology Nurses Association and Nephrology News & Issues conducted a national study, The Health and Safety of Nephrology Nurses and the Environments in Which They Work. This article presents initial qualitative results from that study--in the words of nephrology nurses. Based on responses of participants, themes and subthemes were identified: staffing nursing practice (time to provide nursing care, nursing work hours, level of practice, nurses responsibility for the practice of others), work environment conditions (physical environments, psychological environments, civility/ incivility, environmental health, and work spaces), respect, recognition, interprofessional collaboration and support, and career and job satisfaction. Results of the study provide insight into what it is like to work on the frontlines of nephrology nursing. Key Words: Health, safety, nurses, nephrology, work environment, research., The health and safety of nephrology nurses and the environments in which they work can impact, positively or negatively, nephrology nurses as individuals, the patients they care for, and the [...]

* Nurse bullying is a persistent problem within nursing and has many negative effects on the workplace environment. * In this sample of nurses, 40% reported they were bullied in the past 6 months. * Nurses want to be empowered to make changes to optimize care and obtain the best outcomes for their patients. However, in many workplace cultures this doesn't happen. * Administrators need to understand how their workplace culture impacts nursing care and retention. * Investments should be made to improve the work culture and train staff on proper communication with role play opportunities to learn how to handle disruptive communication., WORKPLACE BULLYING IS common in the nursing profession. The obvious impact of bullying is to the victim who may experience mental or psychological distress and increased levels of stress (Einarsen [...]

* Big data for nursing research is complex and requires collaboration from multiple organizations. * The Nursing Value Workgroup (NVW), formed from the Big Data Science initiative in 2014, plans to measure nursing value and develop new real-time metrics to monitor costs, quality, and effectiveness of nursing care through understanding the individual contribution of a nurse to a patient. * The vision of the NVW is to create a warehouse that hosts data from multiple disparate data sources within multiple organizations for use in research to discover, explore, and test questions related to nursing value. * Business and managerial acumen is necessary to take on governance and board development work. * The collective open minds of several diverse partners including academia, practice, and industry allowed for robust discussion, freethinking, and led to development of an innovative governance structure for a nursing value research data warehouse., Big data used for nursing research can provide greater precision and granularity for measuring care quality, patient outcomes, and cost of nursing care. However, big data for nursing research is [...]

The ACC/AHA's lower BP goals are supported by previously unavailable evidence, the strongest of which is for patients with CVD. But others can benefit, too. For more than a century, [...]

Blue light has its pros and cons. Here's how to help your patients manage it for the best systemic and ocular outcomes. There is no arguing that today's patients are [...]

Inaccurate body temperature measurements impact clinical decision-making and patient safety. Nurses in our large free-standing children's hospital and clinics questioned the accuracy of certain thermometer devices. Our clinical practice policy on temperatures allowed nurses to use their clinical judgment about which device and route of thermometry should be used for their patients. An audit of our hospital and clinic thermometer purchases from January to May 2014 revealed seven different devices. The purpose of this evidence-based practice (EBP) project was to select the most precise and accurate temperature-taking routes and measurement methods to set as the standard for our hospital system. The evidence-based project began with the intent to conduct a systematic review of the literature on the accuracy of non-core thermometer devices. While developing evidence tables, it became clear that the results and conclusions of the studies were so inconsistent that we could not select the most accurate thermometer devices for our hospital system. We realized only studies comparing core vs. non-core were appropriate, and a meta-analysis was required to summarize data from core vs. non-core temperatures. Evidence shows that oral and rectal electronic thermometers provided the most accurate approximation of core body temperatures. Our findings resulted in a revision of the temperature policy. One year after the policy change, unit-by-unit observations of devices showed significant usage of approved devices. This successful practice and policy change improved clinical decision-making based on more accurate and consistent body temperatures., Rapid improvements in the technology of measuring body temperature and the search for more non-invasive methods have resulted in numerous devices designed for pediatric patients. In our 464-bed, free-standing children's [...]

Tofil, N.M., Schier, S., Benningfield, B., Cooper, A., Sloane, P.A., Zinkan, L.,... Rutledge, C. (2018). Tracheostomy education for parents utilizing simulation: A new paradigm in parental education. Pediatric Nursing, 44(3), 111-115. Easing the transition from hospital to home after a tracheostomy with discharge planning is a goal of family-centered patient care in pediatric settings. Proper tracheal tube maintenance and emergency management improves outcomes and reduces re-admissions. We hypothesized that family members caring for children with new tracheostomies will report greater knowledge, confidence, and preparedness after simulated training with high-fidelity mannequins. Parents (N=29) of children pending discharge with new tracheostomies were offered simulation training after didactic and hands-on bedside training was complete. Simulation-enhanced training consisted of four scenarios escalating in difficulty of session (training exercises and didactics) with a high-fidelity simulator most closely matching their own child's age. Post-training surveys were collected from January 2014 to January 2016. Caregivers agreed strongly with nine of 10 statements regarding preparedness, confidence, and emergency management, and 97% would recommend simulation training to other parents before discharge. Responses to open-ended questions were varied. First, describing what participants appreciated and learned, 28% noted simulation experience itself, 24% noted general tracheostomy care, and 7% noted emergency management. Second, 76% offered no topics for greater focus and improvement, and 24% suggested specific improvements. Third, general comments about training were positive (80%). Overall, caregivers favorably reported greater preparedness, confidence, and knowledge of emergency management. For unknown reasons, caregivers endorsed simulation training for other parents without consensus on additional training for themselves. Key Words: Simulation, parental education, pediatrics, tracheostomy., The number of families caring for children with tracheostomies at home increases each year as clinical indications shift from acute infection to chronic disease (Lawrason & Kavanagh, 2013). Approximately 5,000 [...]

The advent of high-throughput gene sequencing has revolutionized our understanding of the genetic mutations that drive myeloid malignancies. While these mutations are of interest pathobiologically, they are increasingly being recognized as clinically meaningful in providing diagnostic, prognostic, and therapeutic information to guide patient care. In this first part of our two-part review, we introduce mutation profiling as a relevant clinical tool for hematologists treating patients with myeloid malignancies. Next, we discuss the diagnostic and prognostic role of mutation profiling in myelodysplastic syndrome and acute myeloid leukemia. Finally, we detail the therapeutic implications of specific mutations in myelodysplastic syndrome and acute myeloid leukemia. In Part 2, we will discuss similar clinical approaches using mutation profiling in myeloproliferative neoplasms and other myeloid malignancies., Introduction Enormous strides have been made in recent years that have furthered our understanding of the underlying genetic alterations driving myeloid malignancies. High-throughput gene sequencing, the technological innovation behind these [...]

Leading health systems are demonstrating how venture investing can extend an organization's reach and effectiveness by helping it to improve the quality of care, diversify revenue streams, and create a [...]

Objective. To find clinically relevant combinations of chronic conditions among patients with diabetes and to examine their relationships with six diabetes quality metrics. Data Sources/Study Setting. Twenty-nine thousand five hundred and sixty-two adult patients with diabetes seen at eight Midwestern U.S. health systems during 2010-2011. Study Design. We retrospectively evaluated the relationship between six diabetes quality metrics and patients' combinations of chronic conditions. We analyzed 12 conditions that were concordant with diabetes care to define five mutually exclusive combinations of conditions ('classes') based on condition co-occurrence. We used logistic regression to quantify the relationship between condition classes and quality metrics, adjusted for patient demographics and utilization. Data Collection. We extracted electronic health record data using a standardized algorithm. Principal Findings. We found the following condition classes: severe cardiac, cardiac, noncardiac vascular, risk factors, and no concordant comorbidities. Adjusted odds ratios and 95 percent confidence intervals for glycemic control were, respectively, 1.95 (1.7-2.2), 1.6 (1.4-1.9), 1.3 (1.2-1.5), and 1.3 (1.2-1.4) compared to the class with no comorbidities. Results showed similar patterns for other metrics. Conclusions. Patients had distinct quality metric achievement by condition class, and those in less severe classes were less likely to achieve diabetes metrics. Key Words. Diabetes, quality, multiple chronic conditions, multimorbidity, public reporting, Diabetes care quality, as measured by achievement of quality metrics that were derived from clinical care guidelines, is suboptimal (American Diabetes Association 2016a). Many factors can and likely do influence [...]

Review's 2017 Office Design Contest had a slew of fantastic entries. With this year's winners, 'wow' starts long before the office visit. State-of-the-art equipment and high-tech exam lanes are testing [...]

When did you last care for a patient as a result of a disaster? One definition of a disaster is: A serious disruption of the functioning of a community or [...]

Having worked at Leichhardt Women's Community Health Centre in Sydney with patients who were largely disadvantaged and from culturally and linguistically diverse backgrounds, Jo was determined to provide the best [...]