Osteoporosis: Evaluation of Screening Patterns in a Primary-Care Group Practice

An estimated half of all women aged older than 50 yr will have an osteoporosis-related fracture in their lifetime. National osteoporosis clinical guidelines for screening recommend measurement of bone mineral density in average risk women beginning at age 65 yr. Little data are available regarding compliance with this recommendation. The objective of this study was to evaluate osteoporosis screening rates in a random sample of women, aged 66 yr or older, in a large multisite primary-care group practice. The study was conducted in a primary-care group practice serving over 180,000 patients in the Denver metropolitan area. Medical records of a random sample of 833 female patients aged 66 yr or older were reviewed retrospectively. Patients were seen at 1 of 13 practice locations, by 1 of 34 physicians, who practiced either family medicine or internal medicine. The frequency of osteoporosis screening was calculated. Accepted methods of screening include peripheral bone density measurement by ultrasound or dual-energy X-ray absorptiometry (DXA), or central DXA. The physician-specific osteoporosis screening rates varied widely, ranging from 19% to 97%. The practice-specific osteoporosis screening rates ranged from 26% to 91%. Overall, the mean rate of osteoporosis screening among all physicians was 56%. Despite improvements in osteoporosis screening, there continues to be a gap in the quality of care provided compared to national recommended guidelines. Policy changes, performance improvement measures, and interventions are needed to improve screening rates in primary-care practices.     

Customer Convergence

This article explores the interrelationships between three categories of service quality in healthcare delivery organizations: patient, employee, and physician satisfaction. Using the largest and most representative national databases available, the study compares the evaluations of hospital care by more than 2 million patients, 150,000 employees, and 40,000 physicians. The results confirm the relationship connecting employees' satisfaction and loyalty to their patients' satisfaction and loyalty. Patients' satisfaction and loyalty were also strongly associated with medical staff physicians' evaluations of overall satisfaction and loyalty to the hospital. Similarly, hospital employees' satisfaction and loyalty were related to the medical staff physicians' satisfaction with and loyalty to the hospital. Based upon the strength of the interrelationships, individual measures and subscales can serve as leverage points for improving linked outcomes. Patients, physicians, and employees, the three co—creators of health, agree on the evaluation of the quality of that service experience. The results demonstrate that promoting patient—centeredness, enhancing medical staff relations, and improving the satisfaction and loyalty of employees are not necessarily three separate activities in competition for hospital resources and marketing leadership attention.     

American Cancer Society Colorectal Cancer Survivorship Care Guidelines

Answer questions and earn CME/CNE Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer death in both men and women and second leading cause of cancer death when men and women are combined in the United States (US). Almost two‐thirds of CRC survivors are living 5 years after diagnosis. Considering the recent decline in both incidence and mortality, the prevalence of CRC survivors is likely to increase dramatically over the coming decades with the increase in rates of CRC screening, further advances in early detection and treatment and the aging and growth of the US population. Survivors are at risk for a CRC recurrence, a new primary CRC, other cancers, as well as both short‐term and long‐term adverse effects of the CRC and the modalities used to treat it. CRC survivors may also have psychological, reproductive, genetic, social, and employment concerns after treatment. Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long‐term care of CRC survivors. The guidelines in this article are intended to assist primary care clinicians in delivering risk‐based health care for CRC survivors who have completed active therapy. CA Cancer J Clin 2015;65:427–455 . © 2015 American Cancer Society.     

Rebalancing risk management—Part 1: The Process for Active Risk Control (PARC)

Risk assessment, by itself, does nothing to reduce risk or improve safety. It can only change outcomes by informing the design and management of effective risk control interventions. But current practice in healthcare risk management suffers from an almost complete lack of support for risk control. This first installment of a 2‐part series on rebalancing risk management describes a new framework to guide risk control practice: The Process for Active Risk Control.     

Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency,Causes, and Costs

OBJECTIVES: To examine the frequency and reasons for potentially avoidable hospitalizations of nursing home (NH) residents. DESIGN: Medical records were reviewed as a component of a project designed to develop and pilot test clinical practice tools for reducing potentially avoidable hospitalization. SETTING: NHs in Georgia. PARTICIPANTS: In 10 NHs with high and 10 with low hospitalization rates, 10 hospitalizations were randomly selected, including long‐ and short‐stay residents. MEASUREMENTS: Ratings using a structured review by expert NH clinicians. RESULTS: Of the 200 hospitalizations, 134 (67.0%) were rated as potentially avoidable. Panel members cited lack of on‐site availability of primary care clinicians, inability to obtain timely laboratory tests and intravenous fluids, problems with quality of care in assessing acute changes, and uncertain benefits of hospitalization as causes of these potentially avoidable hospitalizations. CONCLUSION: In this sample of NH residents, experienced long‐term care clinicians commonly rated hospitalizations as potentially avoidable. Support for NH infrastructure, clinical practice and communication tools for health professionals, increased attention to reducing the frequency of medically futile care, and financial and other incentives for NHs and their affiliated hospitals are needed to improve care, reduce avoidable hospitalizations, and avoid unnecessary healthcare expenditures in this population.     

Performance improvement,telemedicine, patient engagement,and comparative no-show rates

No-show patient visits should be considered risk events. No-shows impact the quality and continuity of patient care. Missed visits increase health care risks by deferred or missed diagnosis and treatment, and increases costs of care. This performance improvement project proactively implemented a telemedicine system of care during a public health emergency (PHE). The goal was to improve health care access and decrease health care disparities despite emergency management changes in organizational staffing and federal stay-at-home orders. Telemedicine visits also addressed known causes of historically high in-person no-show office rates—lack of transportation, childcare issues, mobility issues, and adverse weather conditions. Despite location in a Hospital Census Tract where 50% of our population is below the Federal Poverty Level, with less access to technology, telemedicine proved to be successful. The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines were the planning framework. The Model for Healthcare Improvement including Part 1 (AIM) and Part 2 (Plan-Do-Study-Act) was used to develop interventions, outcomes, and rationale for use. Data was collected from January 2020 thru March 2022, with 22,831 total scheduled visits (15,837 in-person, 6994 telemedicine). The average monthly no-show rate for in-person visits was 35% compared to 9% for telemedicine visits.     

Implementation of nursing services in community corrections: A community-academic partnership

Persons who are incarcerated (PWAI) suffer from a disproportionately higher number of physical and mental health conditions. While most jails and prisons provide onsite healthcare, community correctional centers often do not and accessing community healthcare is challenging due to insurance issues, inadequate health literacy, mistrust, and long waits for appointments. A registered nurse-led wellness clinic provides a viable solution to addressing the healthcare needs of PWAI in a community correctional setting. Through a community-academic partnership between a college of nursing and two community correctional transitional centers for men, a registered nurse (RN) faculty member and nursing students provide onsite healthcare. Services include, but are not limited to, acute and chronic disease management, case management, healthcare navigation, and health education. In the first 2 years of operation, there have been 587 new resident health assessments, 882 RN visits, and 152 group education sessions. RN visits have been primarily for: connection to resources (42.6%), medication management (15.6%), and acute conditions (12%). A RN-led wellness clinic is an innovative way to address health needs for PWAI. While this model of care focuses on an academic RN faculty practice at community correctional centers it could be replicated across community settings.