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HealthDay News — The US Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient for assessing the balance of benefits and harms of screening and preventive interventions for [...]

K Health reported a new collaboration with Mayo Clinic's digital healthcare initiative, Mayo Clinic Platform, which harnesses new knowledge, solutions and technologies to improve patients' lives. According to a media [...]

Additionally early full remission can reduce the indirect costs associated with depression. However, evidence also demonstrates that primary care clinicians are not optimising timely treatments for their clients that experience [...]

Primary care clinicians diagnose and manage most of the approximately 13 million Americans affected by major depression each year (Kessler, Merikangas, and Wang 2007). Improving the process of depression care [...], Objective. To advance research on depression communication and treatment by comparing assessments of communication about depression from patient report, clinician report, and chart review to assessments from transcripts. Data. One hundred sixty-four primary care visits from seven health care systems (2010-2011). Study Design. Presence or absence of discussion about depressive symptoms, treatment recommendations, and follow-up was measured using patient and clinician post-visit questionnaires, chart review, and coding of audio transcripts. Sensitivity and specificity of indirect measures compared to transcripts were calculated. Principal Findings. Patient report was sensitive for mood (83 percent) and sleep (83 percent) but not suicide (55 percent). Patient report was specific for suicide (86 percent) but not for other symptoms (44-75 percent). Clinician report was sensitive for all symptoms (83-98 percent) and specific for sleep, memory, and suicide (80-87 percent), but not for other symptoms (45-48 percent). Chart review was not sensitive for symptoms (50-73 percent), but it was specific for sleep, memory, and suicide (88-96 percent). All indirect measures had low sensitivity for treatment recommendations (patient report: 24-42 percent, clinician report 38-50 percent, chart review 49-67 percent) but high specificity (89-96 percent). For definite follow-up plans, all three indirect measures were sensitive (82-96 percent) but not specific (40-57 percent). Conclusions. Clinician report and chart review generally had the most favorable sensitivity and specificity for measuring discussion of depressive symptoms and treatment recommendations, respectively. Key Words. Patient-clinician communication, depression, primary care, quality

A growing number of Americans are living with chronic medical conditions and often require medical care that bridges multiple delivery sites, such as hospitals and primary care clinics (Partnership for [...], Objective. To examine whether primary care team cohesion changes the association between using an integrated outpatient-inpatient electronic health record (EHR) and clinician-rated care coordination across delivery sites. Study Design. Self-administered surveys of primary care clinicians in a large integrated delivery system, collected in 2005 (N= 565), 2006 (N= 678), and 2008 (N = 626) during the staggered implementation of an integrated EHR (2005-2010), including validated questions on team cohesion. Using multivariable regression, we examined the combined effect of EHR use and team cohesion on three dimensions of care coordination across delivery sites: access to timely and complete information, treatment agreement, and responsibility agreement. Principal Findings. Among clinicians working in teams with higher cohesion, EHR use was associated with significant improvements in reported access to timely and complete information (53.5 percent with EHR vs. 37.6 percent without integrated-EHR), agreement on treatment goals (64.3 percent vs. 50.6 percent), and agreement on responsibilities (63.9 percent vs. 55.2 percent, all p < .05). We found no statistically significant association between use of the integrated-EHR and reported care coordination in less cohesive teams. Conclusion. The association between EHR use and reported care coordination varied by level of team cohesion. EHRs may not improve care coordination in less cohesive teams. Key Words. Electronic health records, care coordination, primary care, teams, team cohesion

Objective. To investigate whether different risk-adjustment methodologies and economic profiling or "practice efficiency" metrics produce differences in practice efficiency rankings for a set of primary care physicians (PCPs). Data Source. Twelve months of claims records (inpatient, outpatient, professional, and pharmacy) for an independent practice association HMO. Study Design. Patient risk scores obtained with six profiling risk-adjustment methodologies were used in conjunction with claims cost tabulations to measure practice efficiency of all primary care physicians who managed 25 or more members of an HMO. Data, Collection. For each of the risk-adjustment methodologies, two measures of "efficiency" were constructed: the standardized cost difference between total observed (standardized actual) and total expected costs for patients managed by each PCP, and the ratio of the PCP&apos;s total observed to total expected costs (O/E ratio). Primary care physicians were ranked from most to least efficient according to each risk-adjusted measure, and level of agreement among measures was tested using weighted kappa. Separate rankings were constructed for pediatricians and for other primary care physicians. Findings. Moderate to high levels of agreement were observed among the six risk-adjusted measures of practice efficiency. Agreement was greater among pediatrician rankings than among adult primary care physician rankings, and, with the standardized difference measure, greater for identifying the least efficient than the most efficient physicians. The O/E ratio was shown to be a biased measure of physician practice efficiency, disproportionately targeting smaller sized panels as outliers. Conclusions. Although we observed moderate consistency among different risk-adjusted PCP rankings, consistency of measures does not prove that practice efficiency rankings are valid, and health plans should be careful in how they use practice efficiency information. Indicators of practice efficiency should be based on the standardized cost difference, which controls for number of patients in a panel, instead of O/E ratio, which does not. Key Words. Physician profiling, economic profiling, practice efficiency, risk-adjustment, observed-to-expected ratio, standardized cost difference, Managed care plans in the United States are increasingly using paid claims records to monitor and judge the physicians who provide services to plan members. The motivation for economic, or [...]

* While Academic Nurse-Managed Centers (ANMCs) are often established with a mission to provide access to care for underserved populations and to provide clinical experiences for students, their need to improve operational efficiencies for fiscal stability has grow more important in the face of increasing cost pressure. * Funding sources and financial performance measures among six ANMCs are reported. * Centers with carefully negotiated capitated contracts and commercial contracts that credentialed APNs had more stable income streams than those serving Medicaid, Medicare, and uninsured patients. * Solid business plans and solid business practices around coding, billing, collections, and accounting also contributed to stronger performance. * Inconsistent business practices contribute to the instability of individual centers as well as hinder more global efforts to set standards of best practice. * Unfortunately, the current payer systems do not recognize the unique nature of APN care that emphasizes health promotion, further complicating the pursuit of performance standards., NURSE-MANAGED CENTERS (NMCs) play an important role in the health services delivery system by offering populations a unique approach to primary care that emphasizes health promotion and disease prevention with [...]

Information obtained from a quantitative and qualitative investigation undertaken in autumn 1991-spring 1992 gives a useful insight into the range and type of collaboration between general practice-based community and practice nurses. There seems to be good support and communications between practice nurses, district nurses and health visitors, but the full potential of the nurses' skills can be restricted by the clear division of labour within general practice. Working patterns will have to be changed before all the skills of the primary health care team can be fully used.

Success of primary nursing as an organisational tool depends on those using the system. Efficiently implemented primary nursing increases nurse and patient autonomy with a consequent improvement in health care. However, misunderstanding may occur over leadership, workload, nurse/patient relationships and patient autonomy. Uncritical adoption of primary nursing techniques will not automatically solve all problems.

Data from NT public hospitals are used to analyze the rates of avoidable hospitalization in Aboriginal and non-Aboriginal people in the Northern territory (NT) from 1998-99 to 2005-06, and to understand their implications for primary care interventions. Findings reveal that substantially higher rates of avoidable hospitalization occur in NT Aboriginal people, highlighting the presence of obstacles which hinder their access to effective primary care.

One in five primary care nurses feel awkward or embarrassed discussing obesity with patients, a study suggests. Researchers from the Sheffield Hallam University surveyed just under 400 practice nurses, health [...]

Studies reveal that ensuring that primary care nurses can address the health needs of babies, children and young people is critically important. Thus a self-assessment tool to identify skills and competencies is launched and a brief overview of the 'Getting it Right for Children and Young People: A Self-assessment Tool for Practice Nurses' tool is presented.

An evaluation at Group Health Cooperative demonstrates measurable benefit to patients and staff when a primary care practice adopts a patient-centered medical home model. At one year, patients at the [...]

UK health professionals should offer encouragement and support to up to 1,000 nurses who have taken the chance to become part of an innovative new health care delivery system. Primary care groups consist of a wide range of nursing skills, offering patients the very best care which is nurse-led. Each primary care group is responsible for up to 180,000 people, with the emphasis on providing the best care possible. The new care groups will not succeed without support from the rest of the medical profession.