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Abstrac Background Treatment of acute pain is an essential element of pre-hospital care for injured and critically ill patients. Clinical studies indicate the need for improvement in the prehospital analgesia. Objective The aim of this study is to assess the current situation in out of hospital pain management in Germany regarding the substances, indications, dosage and the delegation of the use of analgesics to emergency medical service (EMS) staff. Material and methods A standardized survey of the medical directors of the emergency services (MDES) in Germany was carried out using an online questionnaire. The anonymous results were evaluated using the statistical software SPSS (Chi-squared test, Mann-Whitney-U test). Results Seventy-seven MDES responsible for 989 rescue stations and 397 EMS- physician bases in 15 federal states took part in this survey. Morphine (98.7%), Fentanyl (85.7%), Piritramide (61%), Sufentanil (18.2%) and Nalbuphine (14,3%) are provided as opioid analgesics. The non-opioid analgesics (NOA) including Ketamine/Esketamine (98,7%), Metamizole (88.3%), Paracetamol (66,2%), Ibuprofen (24,7%) and COX-2-inhibitors (7,8%) are most commonly available. The antispasmodic Butylscopolamine is available (81,8%) to most rescue stations. Fentanyl is the most commonly provided opioid analgesic for treatment of a traumatic pain (70.1%) and back pain (46.8%), Morphine for visceral colic-like (33.8%) and non-colic pain (53.2%). In cases of acute coronary syndrome is Morphine (85.7%) the leading analgesic substance. Among the non-opioid analgesics is Ketamine/Esketamine (90.9%) most frequently provided to treat traumatic pain, Metamizole for visceral colic-like (70.1%) and non-colic (68.6%) as well as back pain (41.6%). Butylscopolamine is the second most frequently provided medication after Metamizole for “visceral colic-like pain” (55.8%). EMS staff (with or without a request for presence of the EMS physician on site) are permitted to use the following: Morphine (16.9%), Piritramide (13.0%) and Nalbuphine (10.4%), and of NOAs for (Es)Ketamine (74.1%), Paracetamol (53.3%) and Metamizole (35.1%). The dosages of the most important and commonly provided analgesic substances permitted to independent treatment by the paramedics are often below the recommended range for adults (RDE). The majority of medical directors (78.4%) of the emergency services consider the independent application of analgesics by paramedics sensible. The reason for the relatively rare authorization of opioids for use by paramedics is mainly due to legal (in)certainty (53.2%). Conclusion Effective analgesics are available for EMS staff in Germany, the approach to improvement lies in the area of application. For this purpose, the adaptations of the legal framework as well as the creation of a guideline for prehospital analgesia are useful.

Abstrac: Background: Treatment of acute pain is an essential element of pre-hospital care for injured and critically ill patients. Clinical studies indicate the need for improvement in the prehospital analgesia. Objective: The aim of this study is to assess the current situation in out of hospital pain management in Germany regarding the substances, indications, dosage and the delegation of the use of analgesics to emergency medical service (EMS) staff. Material and methods: A standardized survey of the medical directors of the emergency services (MDES) in Germany was carried out using an online questionnaire. The anonymous results were evaluated using the statistical software SPSS (Chi-squared test, Mann-Whitney-U test). Results: Seventy-seven MDES responsible for 989 rescue stations and 397 EMS- physician bases in 15 federal states took part in this survey. Morphine (98.7%), Fentanyl (85.7%), Piritramide (61%), Sufentanil (18.2%) and Nalbuphine (14,3%) are provided as opioid analgesics. The non-opioid analgesics (NOA) including Ketamine/Esketamine (98,7%), Metamizole (88.3%), Paracetamol (66,2%), Ibuprofen (24,7%) and COX-2-inhibitors (7,8%) are most commonly available. The antispasmodic Butylscopolamine is available (81,8%) to most rescue stations. Fentanyl is the most commonly provided opioid analgesic for treatment of a traumatic pain (70.1%) and back pain (46.8%), Morphine for visceral colic-like (33.8%) and non-colic pain (53.2%). In cases of acute coronary syndrome is Morphine (85.7%) the leading analgesic substance. Among the non-opioid analgesics is Ketamine/Esketamine (90.9%) most frequently provided to treat traumatic pain, Metamizole for visceral colic-like (70.1%) and non-colic (68.6%) as well as back pain (41.6%). Butylscopolamine is the second most frequently provided medication after Metamizole for "visceral colic-like pain" (55.8%). EMS staff (with or without a request for presence of the EMS physician on site) are permitted to use the following: Morphine (16.9%), Piritramide (13.0%) and Nalbuphine (10.4%), and of NOAs for (Es)Ketamine (74.1%), Paracetamol (53.3%) and Metamizole (35.1%). The dosages of the most important and commonly provided analgesic substances permitted to independent treatment by the paramedics are often below the recommended range for adults (RDE). The majority of medical directors (78.4%) of the emergency services consider the independent application of analgesics by paramedics sensible. The reason for the relatively rare authorization of opioids for use by paramedics is mainly due to legal (in)certainty (53.2%). Conclusion: Effective analgesics are available for EMS staff in Germany, the approach to improvement lies in the area of application. For this purpose, the adaptations of the legal framework as well as the creation of a guideline for prehospital analgesia are useful. [ABSTRACT FROM AUTHOR]

Background: Ambulatory training is an integral component of internal medicine residency programs, yet details regarding operational processes in resident continuity clinics remain limited. Methods: We surveyed a convenience sample of medical directors of residency practices between 2015 and 2019 (n = 222) to describe and share operational and scheduling processes in internal medicine resident continuity clinics in the US. Results: Among residency practices, support for the medical director role ranged substantially, but was most commonly reported at 11%-20% full-time-equivalent support. By the end of the survey period, the majority of programs (65.1%) reported obtaining patient-centered medical home (PCMH) certification (level 1-3). For new patient appointments, 34.9% of programs reported a 1-7 day wait and 25.8% reported an 8-14 day wait. Wait times for new appointments were generally shorter for PCMH certified practices (P = 0.029). No-show rates were most commonly 26%-50% for new patients and 11%-25% for established patients. Most programs reported that interns see 3-4 patients per ½-day and senior residents see 5-6 patients per ½-day. Most interns and residents maintain a panel size of 51-120 patients. Discussion: Creating high-performing residency clinics requires a focus on core building blocks and operational processes. Based on the survey results and consensus opinion, we provide five summary recommendations related to (1) support for the medical director leadership role, (2) patient-centered and coordinated models of care, (3) support for patient scheduling, (4) recommended visit lengths, and (5) ancillary support, such as social work. [ABSTRACT FROM AUTHOR]

PurposeThere are a few qualitative studies on the psychological resilience of COVID-19 medical directors upon outbreaks of pandemics. Psychological resilience is essential to providing quality care through the pandemic.Materials and MethodsWe conducted narrative interviews with 14 out of 21 medical directors of COVID-19 divisions in Israeli public hospitals upon the outbreak of the pandemic and through its first wave. We adopted the Salutogenic paradigm to identify personal and organizational resources that both deterred and promoted resilience of front-line medical directors. Thematic analysis was performed based on the Sense of coherence construct, an anchor of Salutogenics.ResultsLow comprehensibility was compensated by ethical boundaries and managerial experience. A few organizational and personal resources promoted manageability. The hospital management both deterred and promoted resilience. In contrast to Salutogenics theory, meaningfulness was driven by the occupational calling rather than by comprehensibility and manageability. Gaps in personal resources inhibited resilience.ConclusionsOur study adds to the scant qualitative research performed upon the outbreak of the pandemic and extends the Salutogenic paradigm suggesting that the three axes of sense of coherence are multi-layered, intertwined, and evolving. We introduce the dynamic spheres model that we adopted from Physics to illustrate the findings. We propose interventions to build resilience in front-line medical directors.

The current American Society of Transplantation (AST) accredited transplant fellowship programs in the United States provide no structured formal training in leadership and administration which is essential for successfully running a transplant program. We conducted a survey of medical directors of active adult kidney and kidney‐pancreas transplant programs in the United States about their demographics, training pathways, and roles and responsibilities. The survey was emailed to 183 medical directors, and 123 (67.2%) completed the survey. A majority of respondents were older than 50 years (61%), males (80%), and holding that position for more than 10 years (47%). Only 51% of current medical directors had taken that position after completing a one‐year transplant fellowship, and 58% took on the role with no prior administrative or leadership experience. The medical directors reported spending a median 50%–75% of time in clinical responsibilities, 25%–50% of time in administration, and 0%–25% time in research. The survey also captured various administrative roles of medical directors vis‐à‐vis other transplant leaders. The study, designed to be the starting point of an improvement initiative of the AST, provided important insight into the demographics, training pathways, roles and responsibilities, job satisfaction, education needs, and training gaps of current medical directors. [ABSTRACT FROM AUTHOR]

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Background: The effectiveness of intravenous (IV) antibiotics for the treatment of sepsis in UK prehospital emergency care is not fully understood. In addition, the views of the key clinical decision-makers in ambulance services have not been documented. Aims: This study aimed to provide contemporary, primary data on the opinions of medical directors from across the UK on the use of IV antibiotics to treat sepsis in prehospital emergency care. Methods: A qualitative methodology was used. During semi-structured telephone interviews, participants were encouraged to share their personal and professional views on the use of IV antibiotics to treat sepsis in ambulance services. The interviews were recorded and transcribed, and a thematic content analysis using the principles of grounded theory was carried out. Findings: Five themes emerged: barriers and enablers; early sepsis recognition; accurate and consistent National Early Warning Score (NEWS) scoring; the need for primary evidence; and standardisation of equipment and protocols. A range of opinions were suggested, with an emphasis on rapid transfers and the need for further evidence. Conclusion: There is a drive for early sepsis diagnosis and pre-alerting the receiving hospital. However, there are potential barriers to standardising the approach if paramedics were to collect blood samples and administer IV antibiotics. Additionally, in the absence of UK data on the effectiveness of this treatment, many key decision-makers are reluctant to consider it as a standard approach. Despite this, there is some strong support for using benzylpenicillin for the treatment of suspected sepsis. [ABSTRACT FROM AUTHOR]

Medical leadership remains integral to the health system amidst a growing burden of ill health and disease, rising patient expectations and medical and technological advancements. The study objectives were to (a) provide a perspective through a rapid review of medical director roles and responsibilities in public and private hospital settings across several Organisation for Economic Co-operation and Development (OECD) and Non-Organisation for Economic Co-operation and Development countries, and (b) provide recommendations on how health system performance could be strengthened. A rapid review of Medical Director job descriptions in public and private hospitals was carried out. Medical Directors are influential leaders in organisational decision-making and quality improvement; however, their role has shifted from clinical oversight to several managerial and leadership roles. We report some variation in their role and responsibilities, in the 'intensity of job requirements' and 'complexity of managing resources' dimensions. The changing expectations of medical directors and the variation in their roles and responsibiliteis may contribute to inefficiencies and misalignment within health systems. There may be a need to pursue reform to assure alignment with health system objectives, albeit reform may require different approaches to meet the needs of different health systems. Further research is needed to explore how reform of medical directors' roles and responsibilities can be quantified to demonstrate improvement within health systems., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

In the UK secondary care setting, the case for physician associates is based on the cover and stability they might offer to medical teams. We assessed the extent of their adoption and deployment – that is, their current usage and the factors supporting or inhibiting their inclusion in medical teams – using an electronic, self-report survey of medical directors of acute and mental health NHS trusts in England. Physician associates – employed in small numbers, in a range of specialties, in 20 of the responding trusts – were reported to have been employed to fill gaps in medical staffing and support medical specialty trainees. Inhibiting factors were commonly a shortage of physician associates to recruit and lack of authority to prescribe, as well as a lack of evidence and colleague resistance. Our data suggest there is an appetite for employment of physician associates while practical and attitudinal barriers are yet to be fully overcome. [ABSTRACT FROM AUTHOR]

Critical illness insurance was introduced 40 years ago. Medical directors continue to be challenged and frustrated with the complexities that critical illness claims offer. This article provides insights into the continued issues and possible solutions., (Copyright © 2023 Journal of Insurance Medicine.)

Nursing homes must provide sophisticated medical and personal care to a broad spectrum of residents and patients. Medications are an increasingly important part of that care. The risks and benefits of medications are widely published, but not necessarily recognized in the care of individual patients. Decisions about medications must be made in the proper context of the patient. Medications are often indicated for various illnesses, symptoms, and risk factors, but clinically significant adverse consequences of medications are common and typically mimic common syndromes. Timely recognition and management of adverse consequences requires vigilance and a high index of suspicion. Many factors influence medication prescribing and use in the nursing home. Newly updated OBRA surveyor guidance emphasizes the importance of following the full care process in implementing, dosing, monitoring, and adjusting medications. Physicians and consultant pharmacists have prominent, complementary roles in addressing medications in the nursing home. The purpose of this article is to clarify these roles, identify their basis (primarily, the care process), and discuss how physicians and consultant pharmacists can collaborate effectively to optimize medication use and minimize preventable adverse consequences. [Copyright &y& Elsevier]

Objectives: To derive and confirm scales measuring medical director's attitudes about hospitalization of nursing home residents. Method: The authors surveyed nursing facility medical directors about the necessity of hospitalizing residents for eight clinical conditions and compared the ratings to those obtained from an expert panel to derive a relative hospitalization score. They also asked about factors that might influence hospitalization decisions. They performed a factor analysis to derive scales that measure attitudinal determinants of hospitalization and used the relative hospitalization score to confirm the scales. Results: The survey had a 79% response rate. The relative hospitalization score demonstrated that medical directors were slightly less likely to recommend hospitalization than expert panel physicians. Factor analyses yielded 10 scales focusing on nursing home functioning, economics. resident specific considerations, and physician attitudes. Eight of the 10 scales had significant bivariable associations with the relative hospitalization score, and 6 had significant multivariable associations. Discussion: Medical directors identify multiple determinants of hospitalization for nursing facility residents across several domains. Hospitalization decisions for nursing facility residents are complex and involve clinical and nonclinical factors. [ABSTRACT FROM AUTHOR]

The medical director (MD) is a key member of the senior management team within a Trust and is expected to contribute at a strategic and policy level as well as being the main management conduit to the medical workforce. While little formal training for MDs was available in the past, more latterly there has been considerable emphasis on training in leadership and management. However, the question as to whether the skills gained during medical directorship are subsequently utilised after MDs have stood down from their post has not been addressed. We undertook a small study to determine the impact of this on individuals and their organisations. The major finding was that the considerable skill and expertise gained by those who had undertaken the MD role, albeit in this instance self-taught, were not utilised by the organisation or the wider NHS once the incumbent had stepped down. The role of the MD is pivotal in bridging the clinician-manager divide and further research of the issues raised would be of value. [ABSTRACT FROM AUTHOR]

Objective. To characterize and follow the variability present in statewide emergency medical services (EMS) medication formularies across the United States over a ten-year period.Methods. Investigators contacted the lead EMS agencies in all 50 states during three years (1992, 1997, and 2002). Using a standardized form, the investigators collected information about each state's prehospital medication policies, including whether a statewide EMS medication formulary existed, the authority of local medical directors to modify it, and what medications it contained. The investigators then sorted states into categories based on the regulatory intent of their EMS medication policies and compared medication listings across years.Results. Responses were obtained from all 50 states ( n = 50, 100%) during each of the survey periods. There appeared to be a trend toward stricter state control and toward less variation between statewide formularies. State regulations in seven states stopped allowing local medical directors to retain full control of their systems' formularies, and eight states implemented mandatory statewide formularies. There was a trend toward more consistency between states, with more “most commonly” listed medications (6.9% in 1992 versus 22.1% in 2002) and fewer “least commonly” listed medications (58.3% in 1992 versus 42.3% in 2002). Controversial medications such as neuromuscular blockers and thrombolytics appeared in a small but increasing number of statewide formularies.Conclusions. Considerable variation was found among statewide EMS medication formularies, both in how they were established and in their contents. Although several states continued to rely solely on local medical direction, there seemed to be a trend toward more uniformity and stricter state control over prehospital medication formularies during the study period.Key words: emergency medical services; legislation, medical; medical directors; clinical practice variation; formularies; medication. [ABSTRACT FROM AUTHOR]

This study examines which issues public psychiatrists perceive as having most impacted their careers over the past five years and whether this impact was experienced differently by psychiatrists in varying regions of the country. The author sent a questionnaire to all members of the American Association of Community Psychiatrists in clinical practice for at least five years. Seventy-one percent (344 of 482) responded. As expected, respondents were generally negative about how economic factors have impacted their professional lives. This impact, however, was experienced very differently depending on which region of the country the psychiatrist was working. [ABSTRACT FROM AUTHOR]

This study examines which issues public psychiatrists perceive as having most impacted their careers over the past five years and whether this impact was differentially experienced by staff psychiatrists and medical directors. The authors sent a questionnaire to all members of the American Association of Community Psychiatrists (AACP) in clinical practice for at least 5 years. Surprisingly, public psychiatrists report that the impact of recent changes have been primarily positive, except in the domain of economic developments. Both program and agency medical directors report experiencing about the same amount of change, though significantly more positive overall impact, compared to staff psychiatrists. This finding should encourage psychiatrists to become program medical directors, a feasible next step for many staff psychiatrists. [ABSTRACT FROM AUTHOR]

The medical director is an important member of the healthcare team in a nursing home, and is responsible for overall coordination of care and for implementation of policies related to care of the residents in a nursing home. The residents in nursing homes are frail, medically complex, and have multiple disabilities. The medical director has an important leadership role in assisting nursing home administration in providing quality care that is consistent with current standards of care. This article provides an overview of roles and functions of the medical director, and suggests ways the medical director can be instrumental in achieving excellent care in today's nursing facilities. [ABSTRACT FROM AUTHOR]

Purpose: There are a few qualitative studies on the psychological resilience of COVID-19 medical directors upon outbreaks of pandemics. Psychological resilience is essential to providing quality care through the pandemic., Materials and Methods: We conducted narrative interviews with 14 out of 21 medical directors of COVID-19 divisions in Israeli public hospitals upon the outbreak of the pandemic and through its first wave. We adopted the Salutogenic paradigm to identify personal and organizational resources that both deterred and promoted resilience of front-line medical directors. Thematic analysis was performed based on the Sense of coherence construct, an anchor of Salutogenics., Results: Low comprehensibility was compensated by ethical boundaries and managerial experience. A few organizational and personal resources promoted manageability. The hospital management both deterred and promoted resilience. In contrast to Salutogenics theory, meaningfulness was driven by the occupational calling rather than by comprehensibility and manageability. Gaps in personal resources inhibited resilience., Conclusions: Our study adds to the scant qualitative research performed upon the outbreak of the pandemic and extends the Salutogenic paradigm suggesting that the three axes of sense of coherence are multi-layered, intertwined, and evolving. We introduce the dynamic spheres model that we adopted from Physics to illustrate the findings. We propose interventions to build resilience in front-line medical directors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Gillie, Naamati-Schneider and Pikkel.)

Palliative care generates considerable stress in hospice medical directors and matrons. In this survey, increased time working in the hospice correlates with suicidal thoughts in medical directors and a fear of burnout in matrons. Major sources of stress include management committees, administrative duties, relatives and the relationship between the medical director and matron. [ABSTRACT FROM PUBLISHER]

In August of 2007, the author testified as the medical expert witness on behalf of the State of Louisiana in the St. Rita's Nursing Home criminal case. Thirty-five residents drowned as floodwaters swept over the nursing home during Hurricane Katrina. For nursing home owners, administrators, and medical staff leadership, there are additional lessons to be learned from this catastrophe. [Copyright &y& Elsevier]

Background Sepsis is a medical emergency that requires prompt recognition and treatment. Multiple Emergency Medical Services (EMS) agencies across the United States have implemented sepsis protocols. In 2016, Maryland instituted its own state-wide EMS sepsis protocol which includes fluid resuscitation, vasopressor administration, and requires alerting the hospital of an incoming sepsis patient. Objective The purpose of this study was to quantify the perspectives of EMS medical directors in Maryland regarding prehospital sepsis care and to identify challenges encountered during the implementation of the statewide sepsis protocol. Methods A 17-question survey was sent to all 24 jurisdictional medical directors in the state of Maryland. Results A total of 14 (58%) medical directors responded, representing four of the five EMS regions in the state. More than half (57%) stated sepsis alerting was a priority in their jurisdiction; however, in a listing of eight initiatives, sepsis was the least prioritized. Most (64%) respondents believed their clinicians had adequate training on sepsis. A majority (79%) of medical directors surveyed felt that core measures of sepsis management would be beneficial. The potentially most helpful core measures were the volume of IV fluid administration (92%), true positive sepsis alerts (83%), and cases of failure to activate a sepsis alert (75%). Engagement of field personnel was rated as the biggest challenge for the implementation of a sepsis protocol in general, and lack of a thermometer on EMS units (50%) was the largest hurdle specifically in the 2016 statewide sepsis protocol. Surveyed medical directors (86%) believe the most difficult obstacle to overcome for EMS clinicians in the treatment of sepsis are nonspecific signs and symptoms. Conclusions Prehospital sepsis care was viewed to be important amongst the medical directors surveyed. However, significant challenges to implementation of a sepsis protocol and delivery of prehospital sepsis care are perceived by jurisdictional medical directors. Additional investment and dedication to sepsis care will advance prehospital sepsis treatment in Maryland., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Garfinkel et al.)

Background: A competent medical leadership and management workforce is key to the effectiveness and efficiency of health service provision and to leading and managing the health system reform agenda in China. However, the traditional recruitment and promotion approach of relying on clinical performance and seniority provides limited incentive for competency development and improvement. Methods: A three-component survey including the use of a validated management competency assessment tool was conducted with Directors of Medical Services ( n = 143) and Deputy Directors of Medical Services ( n = 152) from three categories of hospital in Jinan, Shandong Province, China. Results: The survey identified the inadequacy of formal and informal management training received by hospital medical leaders before commencing their management positions and confirms that the low self-perceived competency level across two medical management level and three hospitals was beyond acceptable. The study also indicates that the informal and formal education provided to Chinese medical leaders have not been effective in developing the required management competencies. Conclusions: The study suggests two system level approaches (health and higher education systems) and one organization level approach to formulate overall medical leadership and management workforce development strategies to encourages continuous management competency development and self-improvement among clinical leaders in China.

Since its foundation in 1915, the Children's Hospital Glanzing has had many innovative medical directors, whose careers and scientific activities are described here in chronological order. Leopold Moll established substantial socio-pediatric initiatives such as "Kriegspatenschaften" ("war sponsorship organizations") and vacations for poor children, as well as counseling centers for mothers in Vienna. August Reuss founded baby care wards and pediatrics departments. He established his own training for pediatricians. Alfred Rosenkranz established in 1974 the first Neonatal Intensive Care Unit in Austria.In 1992, Andreas Lischka successfully introduced quality management (QM) to the Children's Hospital Glanzing, one of the first hospitals in Europe, involving all hospital staff. The Children's Hospital Glanzing was the second European center to participate in the Vermont Oxford Neonatal Network (VONN) for the quality assurance of neonatal care. In 2000 in Wilhelminen Hospital, the first "baby hatch" was established for the anonymous abandonment of newborns without legal prosecution in order to give these unwanted babies a chance of survival (in addition to the possibility of an anonymous birth).Since 1999, music therapy has been offered at the neonatal intensive care unit in cooperation with the University of Music and Performing Arts, Vienna (mdw).Publications on the toxicity of the plasticizer diethylhexyl phthalate (DEHP) in polyvinyl chloride (PVC)-containing medical products constituted the opportunity to establish a PVC-free neonatal intensive care unit. Promotion of breast-feeding especially for premature born babies has always been a particular concern of the Children's Hospital Glanzing. Pollution with polychlorinated biphenyls (PCBs), dioxins, and furan in breast milk cannot be avoided; only a legal ban would lead to a reduction in these pollutants.To reduce the fear of hospitals in children, in 1994 the Children's Hospital Glanzing established a yearly summer children's festival before the end of the school term, with more than 2,500 parents and children attending in 2007. Great importance was attached to the comprehensive education of prospective pediatricians in all areas of our specialty, which could be taught by rotation in our own department with many focal points.The current situation of the Covid-19 pandemic indicates the great importance not only of intensive care beds but also the training of sufficient medical and supporting staff., (© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2020.)

Introduction: Cultural tailoring of evidence-based diabetes prevention program (DPP) interventions is needed to effectively address obesity and its related chronic diseases among Latinos in primary care. This article describes the patient-centered process used to adapt the DPP and reports cultural adaptations., Methods: We used a 2-stage formative research process to culturally adapt an evidence-based DPP intervention in the context of primary care. The first stage involved 5 focus groups of Latino patients and interviews with 5 stakeholders (3 with primary care physicians and 2 with medical directors) to inform a first round of adaptations. The second stage included pretesting the stage I-adapted intervention with a Latino patient advisory board to complete a second round of adaptations., Results: Key stakeholders involved in this 2-stage adaptation process included 34 Latino patients who participated in 5 focus groups and 5 physicians and medical directors who participated in key informant interviews during stage I and 11 patients who attended the 16 advisory board meetings and their family members who attended 1 of the meetings during stage II. Using this patient-centered stakeholder-engaged approach, we found the original intervention was largely congruent with the cultural values of the study population. To further strengthen the cultural relevance of the intervention, salient cultural values emphasized by patients and stakeholders underscored the importance of family and community support for behavior change. Accordingly, key adaptations were made to (1) invite family members to the orientation session and at 2 other key timepoints to facilitate family support, (2) provide participants support from the coach and each other via smartphone applications, and (3) provide healthy, easy, low-cost culturally appropriate meals at each group session., Conclusions: The 2-stage approach actively engaging patients, family members, providers, and health care system leaders reinforced the cultural congruence of the existing intervention while further strengthening it with adaptations promoting Latino family and community support., Competing Interests: Conflict of interest: none declared., (© Copyright 2018 by the American Board of Family Medicine.)