Preparing for an Era of Episode-Based Care in Total Joint Arthroplasty

With a history of steadily rising healthcare costs, the United States faces an unprecedented set of health and financial challenges. The COVID-19 pandemic will only exacerbate these challenges, and it is of paramount importance to reform and refine health systems to maximize the value of care delivered to the patient. Recent developments related to value improvement in total joint arthroplasty suggest that episode-based payment is likely to become standard practice given the current healthcare environment. Consequently, developing episode-based care models for total joint arthroplasty is in the best interests of surgeons, health systems, and patients. In this article, we review important developments related to value-based care in total joint arthroplasty and present an episode-based framework for delivering high-value, patient-centric care. We examine each phase of a total joint arthroplasty episode—preoperative, acute, post-acute, and follow up—and present several ideas with developing bodies of evidence that can improve the value of care delivered to the patient.     

Care of the critically ill patient

In this article we aim to describe some of the key principles of this relatively new speciality. Intensive care medicine has become an essential and integral part of hospital medicine which uses a system-based approach to the care of a patient, underpinned by detailed understanding of physiology and pharmacology. Modern critical care embraces multi disciplinary team work in all aspects of patient care from admission through to discharge (including end-of-life care and organ donation).     

The Structural Landscape of the Health Care System for Breast Cancer Care: Results from The Los Angeles Women's Health Study

Abstract:  The structure of health care has been rapidly evolving in response to financial pressures and demands to improve quality. Little work has documented the structure of care and its impact in the context of breast cancer care. We conducted a survey to characterize Los Angeles physicians caring for breast cancer patients and the structural landscape of the healthcare system in which they practice. Cross-sectional survey of physicians who treated a population-based cohort of breast cancer patients. We surveyed 477 physicians, targeting all Los Angeles County medical oncologists, radiation oncologists, and surgeons reported by patients participating in the Los Angeles Women's Health Study (77% response rate). Specialty-specific questionnaires were developed. Items were based on the structure and quality of care literature, cognitive interviews with cancer care specialists, and existing physician survey instruments. Breast cancer care providers in Los Angeles are diverse, with one-third non-white and 46% speaking a non-English language. Group practice is most common, (37% single specialty, 16% group-model HMO, 8% multi-specialty group). Minimal teaching involvement predominates. Mean new breast cancer patient volumes are relatively high (8 per month overall; six for surgeons), representing 46% of new cancer patients. Physicians reported high career satisfaction levels (83–92%). Physicians were least satisfied with the amount of time spent with patients (82%). Data from this study represent important building blocks for further analyses to determine the impact of structural characteristics on the quality of care that breast cancer patient's experience.     

一体化护理模式在围产期保健中的作用研究

为探讨一体化护理模式在围产期保健中的作用,采用产前健康教育,产时呼吸训练,疼痛缓解（音乐,暗示疗法）,美学渗透,Ｄｏｕｌａ式－家庭化分娩等良性护理介入以及协同式护理,产后社区随访,帮助产妇完成“接受－认知－参与－自觉行为”过程。结果增加了产妇的产前认识,缩短了产程,减少了新生儿窒息及产后出血的发生率,提高了产妇的自护能力,伤口愈合良好,子宫复旧,恶露时间缩短,母婴产褥期患病率下降,新生儿生理性体重     

Care of the critically ill patient

Modern intensive care medicine requires a multidisciplinary approach to look after critically ill patients. Dedicated critical care units offer a variety of facilities to monitor and support organ functions, allowing diagnosis and treatment of life-threatening conditions in a controlled environment. This article describes the main principles of intensive care medicine, giving an overview of a systematic approach to assessment and treatment of organ dysfunction, and highlights some of the complex ethical and organizational challenges.