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BackgroundDespite widespread adoption of patient-centered medical home (PCMH), little is known about why practices pursue PCMH and what is needed to undergo transformation.ObjectiveExamine reasons practices obtained and maintained PCMH recognition and what resources were needed.DesignQualitative study of practice leader perspectives on PCMH transformation, based on a random sample of primary care practices engaged in PCMH transformation, stratified by US region, practice size, PCMH recognition history, and practice use of Consumer Assessment of Healthcare Providers and Systems (CAHPS®) PCMH survey.Participants105 practice leaders from 294 sampled practices (36% response rate).ApproachContent analysis of interviews with practice leaders to identify themes.ResultsMost practice leaders had local control of PCMH transformation decisions, even if practices adopted quality initiatives under the direction of an organization or network. Financial incentives, being in a statewide effort, and the intrinsic desire to improve care or experiences were the most common reasons practice leaders decided to obtain PCMH recognition and pursue associated care delivery changes. Leadership support and direction were highlighted as essential throughout PCMH transformation. Practice leaders reported needing specialized staff knowledge and significant resources to meet PCMH requirements, including staff knowledgeable about how to implement PCMH changes, track and monitor improvements, and navigate implementation of simultaneous changes, and staff with specific quality improvement (QI) expertise related to evaluating changes and scaling-up programs.ConclusionPCMH efforts necessitated support and assistance to frontline, on-site practice leaders leading care delivery changes. Such change efforts should include financial incentives (e.g., direct payment or additional reimbursement), leadership direction and support, and internal or external staff with experience with the PCMH application process, implementation changes, and QI expertise in monitoring process and outcome data. Policies that recognize and meet the needs of on-site practice leaders will better promote primary care practice transformation and move practices further toward their PCMH transformation goals.Electronic supplementary materialThe online version of this article (10.1007/s11606-020-06052-1) contains supplementary material, which is available to authorized users.KEY WORDS: practice transformation, quality improvement, leadership, primary care 相似文献
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Immunohistochemical localization of alphavbeta3 integrin receptor during experimental tooth movement. 总被引:3,自引:0,他引:3
Nabeel Talic Carla A Evans Jon C Daniel Anne George A Moneim Zaki 《American journal of orthodontics and dentofacial orthopedics》2004,125(2):178-184
During orthodontic treatment, multinucleated clast cells carry out the resorption of mineralized tissues. Adhesion of clast cells to the mineralized tissues is mediated by transmembrane cell-surface glycoproteins called integrins, specifically by the alphavbeta3 integrin, which plays an important role in the process of bone resorption. The role of the alphavbeta3 integrin in bone resorption leading to osteoporosis has been demonstrated, but its role in alveolar bone and root resorption during orthodontic tooth movement is unknown. This study examined the expression of the alphavbeta3 integrin during experimental tooth movement. Tooth movement was achieved in 16 male Sprague-Dawley rats (each weighing 120-200 g) with elastic bands between their maxillary first and second molars. The molar-bearing segments were dissected and processed for histologic and immunohistochemical examination. The expression of alphavbeta3 integrin was examined with 2 primary antibodies: a polyclonal anti-alphav integrin subunit antibody and a polyclonal anti-beta3 integrin subunit antibody. Negative controls were similarly processed but without incubation with primary antibodies. The alphavbeta3 integrin was expressed both by osteoclasts associated with alveolar bone resorption and by odontoclasts associated with root resorption during experimental tooth movement. Furthermore, the beta3 integrin subunit was expressed by the epithelial rests of Malassez in the periodontal ligament. Negative controls did not show immunolabeling. The alphavbeta3 integrin adhesion receptor is expressed during experimental tooth movement and might be involved in the process of mineralized tissue resorption and the functions of the epithelial rests of Malassez. 相似文献
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Tahir Yaqub Muhammad Nawaz Muhammad Z. Shabbir Muhammad A. Ali Imran Altaf Sohail Raza Muhammad A. B. Shabbir Muhammad A. Ashraf Syed Z. Aziz Sohail Q. Cheema Muhammad B. Shah Saira Rafique Sohail Hassan Nageen Sardar Adnan Mehmood Muhammad W. Aziz Sehar Fazal Nadir Hussain Muhammad T. Khan Muhammad M. Atique Ali Asif Muhammad Anwar Nabeel A. Awan Muhammad U. Younis Muhammad A. Bhattee Zarfishan Tahir Nadia Mukhtar Huda Sarwar Maaz S. Rana Omair Farooq 《Biomedical and environmental sciences : BES》2021,34(9):729-733
In 2019, the newly emerged SARS-CoV-2 virus caused pneumonia-like illness. The disease rapidly spread globally, leading to a worldwide outbreak referred to as the COVID-19 pandemic. The affected patients show symptoms of fever, dry cough, respiratory distress, myalgia, and gastrointestinal disturbance. As of April 5, 2021, 132,083,022 people worldwide were affected by COVID-19, while 2,868,454 people died due to the disease[1]. SARS-CoV-2-positive patients may remain asymptomatic or start showing symptoms in 2?14 days after exposure to the virus[2]. The viral infection can be diagnosed from nasopharyngeal, throat, alveolar lavage, lacrimal, blood, and stool samples. The patient starts shedding the virus in stool regardless of being symptomatic or asymptomatic, which makes sewage-based detection of the virus to be more beneficial in the early infection stage. 相似文献
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David R. Stukus Nabeel Farooqui Kasey Strothman Kelsey Ryan Songzhu Zhao Jack H. Stevens Daniel M. Cohen 《Annals of allergy, asthma & immunology》2018,120(4):395-400.e1
Background
Mobile health applications for asthma are increasingly being developed. However, there are no published randomized controlled trials evaluating efficacy in decreasing exacerbations.Objective
To evaluate the impact of a mobile asthma application for asthma-related urgent health care usage.Methods
We conducted a 6-month prospective randomized controlled trial for patients (6 months–21 years old) with persistent asthma presenting with an asthma exacerbation to the emergency department of a pediatric academic medical center. Participants were randomized to AsthmaCare (application providing medication and trigger reminders and treatment plan) or the control (online asthma information). Primary outcome measures were comparison of emergency department and urgent care visits and hospitalizations 6 months before and after randomization.Results
AsthmaCare participants (n?=?98) were slightly older (7.84 vs 6.24 years; P?=?.02) than controls (n?=?95) but similar for sex (55% vs 62% boys), race (83% vs 77% African American), and insurer (89% vs 98% Medicaid). The 2 groups were similar in having more than 2 comorbidities (34% vs 32%) and receiving National Heart, Lung, and Blood Institute step 3 treatment or higher (69% vs 57%). There was no significant decrease in emergency department or urgent care visits or hospitalizations between the intervention and control groups. AsthmaCare participants were more likely to report improvement in asthma management 6 months after study enrollment (79% vs 64%; P?=?.06).Conclusion
This randomized controlled trial did not demonstrate a significant decrease in asthma-related emergency department visits or hospitalizations among children who used a mobile health application.10.