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[PMID]:28459496
[Au] Autor:Park CS; Kang KH; Yun SN
[Ti] Título:Growth Trajectories and Detrended Intraindividual Variability to Assess Case Managers' Competency in Continuing Education.
[So] Source:J Contin Educ Nurs;48(5):230-238, 2017 May 01.
[Is] ISSN:1938-2472
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Tracking the effectiveness of CE over time beyond simply confirming its efficacy in continuing education (CE) in nursing is crucial. However, research evidence on the analysis of change of the effectiveness of CE over time is limited, particularly in the context of case management. This methodological study aimed to introduce both a growth curve modeling and an intra-individual variability index and demonstrate step-by-step procedures and interpretations of those analyses to assess case manager competency over time, using secondary data analysis. Data were collected from 22 case managers affiliated with the Korean National Health Insurance Corporation who attended three series of CE to improve their competency between May 2008 and August 2009. Unexpected results revealed a negative fixed effect of education level in the overall estimation of case managers' competency trajectory and a negative correlation between education level and case managers' intra-individual competency inconsistency over time. J Contin Nurs Educ. 2017;48(5):230-238.
[Mh] Termos MeSH primário: Administração de Caso/normas
Gerentes de Casos/educação
Educação Continuada/estatística & dados numéricos
Educação Continuada/normas
Avaliação Educacional/métodos
Competência Profissional/estatística & dados numéricos
Competência Profissional/normas
[Mh] Termos MeSH secundário: Adulto
Administração de Caso/estatística & dados numéricos
Gerentes de Casos/estatística & dados numéricos
Feminino
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.3928/00220124-20170418-08


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[PMID]:29206955
[Au] Autor:Rizzo VM; Rowe JM; Shier Kricke G; Krajci K; Golden R
[Ad] Endereço:Department of Social Work, Binghamton University, PO Box 6000, Binghamton, NY 13902; Department of Social Work, University of Wisconsin-Whitewater. Center for Health Care Studies, Northwestern University, Chicago. Health and Aging, Rush University Medical Center, Chicago.
[Ti] Título:AIMS: A Care Coordination Model to Improve Patient Health Outcomes.
[So] Source:Health Soc Work;41(3):191-195, 2016 Aug 01.
[Is] ISSN:0360-7283
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Assistência Centrada no Paciente/organização & administração
Serviço Social
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Administração de Caso/organização & administração
Comportamento Cooperativo
Feminino
Seres Humanos
Masculino
Meia-Idade
Equipe de Assistência ao Paciente/organização & administração
Satisfação do Paciente
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1093/hsw/hlw029


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[PMID]:28468663
[Au] Autor:Plucinski MM; Ferreira M; Ferreira CM; Burns J; Gaparayi P; João L; da Costa O; Gill P; Samutondo C; Quivinja J; Mbounga E; de León GP; Halsey ES; Dimbu PR; Fortes F
[Ad] Endereço:Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA. mplucinski@cdc.gov.
[Ti] Título:Evaluating malaria case management at public health facilities in two provinces in Angola.
[So] Source:Malar J;16(1):186, 2017 05 03.
[Is] ISSN:1475-2875
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Malaria accounts for the largest portion of healthcare demand in Angola. A pillar of malaria control in Angola is the appropriate management of malaria illness, including testing of suspect cases with rapid diagnostic tests (RDTs) and treatment of confirmed cases with artemisinin-based combination therapy (ACT). Periodic systematic evaluations of malaria case management are recommended to measure health facility readiness and adherence to national case management guidelines. METHODS: Cross-sectional health facility surveys were performed in low-transmission Huambo and high-transmission Uíge Provinces in early 2016. In each province, 45 health facilities were randomly selected from among all public health facilities stratified by level of care. Survey teams performed inventories of malaria commodities and conducted exit interviews and re-examinations, including RDT testing, of a random selection of all patients completing outpatient consultations. Key health facility readiness and case management indicators were calculated adjusting for the cluster sampling design and utilization. RESULTS: Availability of RDTs or microscopy on the day of the survey was 71% (54-83) in Huambo and 85% (67-94) in Uíge. At least one unit dose pack of one formulation of an ACT (usually artemether-lumefantrine) was available in 83% (66-92) of health facilities in Huambo and 79% (61-90) of health facilities in Uíge. Testing rates of suspect malaria cases in Huambo were 30% (23-38) versus 69% (53-81) in Uíge. Overall, 28% (13-49) of patients with uncomplicated malaria, as determined during the re-examination, were appropriately treated with an ACT with the correct dose in Huambo, compared to 60% (42-75) in Uíge. Incorrect case management of suspect malaria cases was associated with lack of healthcare worker training in Huambo and ACT stock-outs in Uíge. CONCLUSIONS: The results reveal important differences between provinces. Despite similar availability of testing and ACT, testing and treatment rates were lower in Huambo compared to Uíge. A majority of true malaria cases seeking care in health facilities in Huambo were not appropriately treated with anti-malarials, highlighting the importance of continued training and supervision of healthcare workers in malaria case management, particularly in areas with decreased malaria transmission.
[Mh] Termos MeSH primário: Administração de Caso/estatística & dados numéricos
Instalações de Saúde/estatística & dados numéricos
Malária/prevenção & controle
Setor Público
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Angola
Criança
Pré-Escolar
Estudos Transversais
Feminino
Pessoal de Saúde/estatística & dados numéricos
Seres Humanos
Lactente
Recém-Nascido
Malária/parasitologia
Masculino
Meia-Idade
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1186/s12936-017-1843-7


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[PMID]:28464945
[Au] Autor:Phok S; Phanalasy S; Thein ST; Likhitsup A; ACTwatch Group
[Ad] Endereço:Population Services Khmer, 29 334 St, Boeung Keng Kang, P. O. Box 258, Phnom Penh, Cambodia.
[Ti] Título:Private sector opportunities and threats to achieving malaria elimination in the Greater Mekong Subregion: results from malaria outlet surveys in Cambodia, the Lao PDR, Myanmar, and Thailand.
[So] Source:Malar J;16(1):180, 2017 05 02.
[Is] ISSN:1475-2875
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The aim of this paper is to review multi-country evidence of private sector adherence to national regulations, guidelines, and quality-assurance standards for malaria case management and to document current coverage of private sector engagement and support through ACTwatch outlet surveys implemented in 2015 and 2016. RESULTS: Over 76,168 outlets were screened, and approximately 6500 interviews were conducted (Cambodia, N = 1303; the Lao People's Democratic Republic (PDR), N = 724; Myanmar, N = 4395; and Thailand, N = 74). There was diversity in the types of private sector outlets providing malaria treatment across countries, and the extent to which they were authorized to test and treat for malaria differed. Among outlets stocking at least one anti-malarial, public sector availability of the first-line treatment for uncomplicated Plasmodium falciparum or Plasmodium vivax malaria was >75%. In the anti-malarial stocking private sector, first-line treatment availability was variable (Cambodia, 70.9%; the Lao PDR, 40.8%; Myanmar P. falciparum = 42.7%, P. vivax = 19.6%; Thailand P. falciparum = 19.6%, P. vivax = 73.3%), as was availability of second-line treatment (the Lao PDR, 74.9%; Thailand, 39.1%; Myanmar, 19.8%; and Cambodia, 0.7%). Treatment not in the National Treatment Guidelines (NTGs) was most common in Myanmar (35.8%) and Cambodia (34.0%), and was typically stocked by the informal sector. The majority of anti-malarials distributed in Cambodia and Myanmar were first-line P. falciparum or P. vivax treatments (90.3% and 77.1%, respectively), however, 8.8% of the market share in Cambodia was treatment not in the NTGs (namely chloroquine) and 17.6% in Myanmar (namely oral artemisinin monotherapy). In the Lao PDR, approximately 9 in 10 anti-malarials distributed in the private sector were second-line treatments-typically locally manufactured chloroquine. In Cambodia, 90% of anti-malarials were distributed through outlets that had confirmatory testing available. Over half of all anti-malarial distribution was by outlets that did not have confirmatory testing available in the Lao PDR (54%) and Myanmar (59%). Availability of quality-assured rapid diagnostic tests (RDT) amongst the RDT-stocking public sector ranged from 99.3% in the Lao PDR to 80.1% in Cambodia. In Cambodia, the Lao PDR, and Myanmar, less than 50% of the private sector reportedly received engagement (access to subsidized commodities, supervision, training or caseload reporting), which was most common among private health facilities and pharmacies. CONCLUSIONS: Findings from this multi-country study suggest that Cambodia, the Lao PDR, Myanmar, and Thailand are generally in alignment with national regulations, treatment guidelines, and quality-assurance standards. However, important gaps persist in the private sector which pose a threat to national malaria control and elimination goals. Several options are discussed to help align the private sector anti-malarial market with national elimination strategies.
[Mh] Termos MeSH primário: Administração de Caso/estatística & dados numéricos
Regulamentação Governamental
Fidelidade a Diretrizes/estatística & dados numéricos
Malária/prevenção & controle
Setor Privado/estatística & dados numéricos
Garantia da Qualidade dos Cuidados de Saúde/normas
[Mh] Termos MeSH secundário: Ásia Sudeste
Administração de Caso/normas
Seres Humanos
Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1186/s12936-017-1800-5


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[PMID]:28464890
[Au] Autor:Buregyeya E; Rutebemberwa E; LaRussa P; Lal S; Clarke SE; Hansen KS; Magnussen P; Mbonye AK
[Ad] Endereço:Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda. eburegyeya@musph.ac.ug.
[Ti] Título:Comparison of the capacity between public and private health facilities to manage under-five children with febrile illnesses in Uganda.
[So] Source:Malar J;16(1):183, 2017 05 02.
[Is] ISSN:1475-2875
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Public health facilities are usually the first to receive interventions compared to private facilities, yet majority of health seeking care is first done with the latter. This study compared the capacity to manage acute febrile illnesses in children below 5 years in private vs public health facilities in order to design interventions to improve quality of care. METHODS: A survey was conducted within 57 geographical areas (parishes), from August to October 2014 in Mukono district, central Uganda. The survey comprised both facility and health worker assessment. Data were collected on drug stocks, availability of treatment guidelines, diagnostic equipment, and knowledge in management of malaria, pneumonia and diarrhoea, using a structured questionnaire. RESULTS: A total of 53 public and 241 private health facilities participated in the study. While similar proportions of private and public health facilities stocked Coartem, the first-line anti-malarial drug, (98 vs 95%, p = 0.22), significantly more private than public health facilities stocked quinine (85 vs 53%, p < 0.01). Stocks of obsolete anti-malarial drugs, such as chloroquine, were reported in few public and private facilities (3.7 vs 12.5%, p = 0.06). Stocks of antibiotics-amoxycillin and gentamycin were similar in both sectors (≥90% for amoxicillin; ≥50 for gentamycin). Training in malaria was reported by 65% of public health facilities vs 56% in the private sector, p = 0.25), while, only 21% in the public facility and 12% in the private facilities, p = 0.11, reported receiving training in pneumonia. Only 55% of public facilities had microscopes. Malaria treatment guidelines were significantly lacking in the private sector, p = 0.01. Knowledge about first-line management of uncomplicated malaria, pneumonia and diarrhoea was significantly better in the public facilities compared to the private ones, though still sub-optimal. CONCLUSION: Deficiencies of equipment, supplies and training exist even in public health facilities. In order to significantly improve the capacity to handle acute febrile illness among children under five, training in proper case management, availability of supplies and diagnostics need to be addressed in both sectors.
[Mh] Termos MeSH primário: Administração de Caso/estatística & dados numéricos
Febre/terapia
Instalações de Saúde/estatística & dados numéricos
Malária/terapia
Setor Privado/estatística & dados numéricos
Setor Público/estatística & dados numéricos
[Mh] Termos MeSH secundário: Pré-Escolar
Feminino
Pessoal de Saúde/estatística & dados numéricos
Seres Humanos
Lactente
Recém-Nascido
Masculino
Uganda
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1186/s12936-017-1842-8


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[PMID]:29360311
[Au] Autor:Raduege TJ; Thomson Reuters Accelus..
[Ti] Título:Benefits and Services.
[So] Source:Issue Brief Health Policy Track Serv;2017:1-59, 2017 Dec 26.
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Benefícios do Seguro
Medicaid/organização & administração
[Mh] Termos MeSH secundário: Orçamentos
Administração de Caso
Criança
Serviços de Saúde da Criança
Serviços de Saúde Comunitária
Serviços de Saúde Bucal
Serviços de Planejamento Familiar
Governo Federal
Infecções por HIV
Serviços de Assistência Domiciliar
Seres Humanos
Cobertura do Seguro
Seguro de Serviços Farmacêuticos
Assistência de Longa Duração
Serviços de Saúde Materna
Serviços de Saúde Mental
Terapia Ocupacional
Patient Protection and Affordable Care Act
Modalidades de Fisioterapia
Governo Estadual
Telemedicina
Abandono do Uso de Tabaco
Transporte de Pacientes
Estados Unidos
Transtornos da Visão/terapia
Serviços de Saúde da Mulher
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:180124
[St] Status:MEDLINE


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[PMID]:29304039
[Au] Autor:Raftery P; Condell O; Wasunna C; Kpaka J; Zwizwai R; Nuha M; Fallah M; Freeman M; Harris V; Miller M; Baller A; Massaquoi M; Katawera V; Saindon J; Bemah P; Hamblion E; Castle E; Williams D; Gasasira A; Nyenswah T
[Ad] Endereço:EVD Response Team, World Health Organization, Monrovia, Montserrado, Liberia.
[Ti] Título:Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening.
[So] Source:PLoS Negl Trop Dis;12(1):e0006135, 2018 01.
[Is] ISSN:1935-2735
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The 2014-16 Ebola Virus Disease (EVD) outbreak in West Africa highlighted the necessity for readily available, accurate and rapid diagnostics. The magnitude of the outbreak and the re-emergence of clusters of EVD cases following the declaration of interrupted transmission in Liberia, reinforced the need for sustained diagnostics to support surveillance and emergency preparedness. We describe implementation of the Xpert Ebola Assay, a rapid molecular diagnostic test run on the GeneXpert platform, at a mobile laboratory in Liberia and the subsequent impact on EVD outbreak response, case management and laboratory system strengthening. During the period of operation, site coordination, management and operational capacity was supported through a successful collaboration between Ministry of Health (MoH), World Health Organization (WHO) and international partners. A team of Liberian laboratory technicians were trained to conduct EVD diagnostics and the laboratory had capacity to test 64-100 blood specimens per day. Establishment of the laboratory significantly increased the daily testing capacity for EVD in Liberia, from 180 to 250 specimens at a time when the effectiveness of the surveillance system was threatened by insufficient diagnostic capacity. During the 18 months of operation, the laboratory tested a total of 9,063 blood specimens, including 21 EVD positives from six confirmed cases during two outbreaks. Following clearance of the significant backlog of untested EVD specimens in November 2015, a new cluster of EVD cases was detected at the laboratory. Collaboration between surveillance and laboratory coordination teams during this and a later outbreak in March 2016, facilitated timely and targeted response interventions. Specimens taken from cases during both outbreaks were analysed at the laboratory with results informing clinical management of patients and discharge decisions. The GeneXpert platform is easy to use, has relatively low running costs and can be integrated into other national diagnostic algorithms. The technology has on average a 2-hour sample-to-result time and allows for single specimen testing to overcome potential delays of batching. This model of a mobile laboratory equipped with Xpert Ebola test, staffed by local laboratory technicians, could serve to strengthen outbreak preparedness and response for future outbreaks of EVD in Liberia and the region.
[Mh] Termos MeSH primário: Surtos de Doenças/prevenção & controle
Monitoramento Epidemiológico
Doença pelo Vírus Ebola/diagnóstico
Doença pelo Vírus Ebola/epidemiologia
Unidades Móveis de Saúde
[Mh] Termos MeSH secundário: Administração de Caso
Ebolavirus/isolamento & purificação
Doença pelo Vírus Ebola/virologia
Seres Humanos
Libéria/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180210
[Lr] Data última revisão:
180210
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180106
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pntd.0006135


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[PMID]:29235781
[Au] Autor:Machledt D
[Ad] Endereço:National Health Law Program (NHeLP).
[Ti] Título:Addressing the Social Determinants of Health Through Medicaid Managed Care.
[So] Source:Issue Brief (Commonw Fund);2017:1-9, 2017 Nov 01.
[Is] ISSN:1558-6847
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Issue: With its emphasis on coordinated care and prevention, managed care should be tailor-made to tackle social determinants of health. But various challenges discourage Medicaid health plans and providers from assisting beneficiaries with nonmedical concerns such as housing insecurity or parenting skills that are integral to improving health outcomes and lowering costs. To better address these social factors, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid managed care rule in early 2016. Goal: To explore the impact of several provisions of the new regulation that influence states' ability to address social determinants of health through managed care. Findings and Conclusions: Several provisions in the new Medicaid managed care rule signal CMS's intent to increase access to high-value nonmedical interventions. For instance, the regulation financially incentivizes health plans to address these needs by allowing certain nonclinical services to be included as covered services when calculating the capitated rate and medical loss ratios. In addition, the regulation encourages states to improve care coordination, adopt alternative payment models, and provide long-term services and supports in the home and community for beneficiaries with functional limitations.
[Mh] Termos MeSH primário: Programas de Assistência Gerenciada/organização & administração
Medicaid/organização & administração
Determinantes Sociais da Saúde
Apoio Social
[Mh] Termos MeSH secundário: Administração de Caso
Serviços de Saúde Comunitária
Enfermagem Domiciliar
Seres Humanos
Assistência de Longa Duração
Saúde da População
Mecanismo de Reembolso
Reembolso de Incentivo
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:28456130
[Au] Autor:Miller IW; Camargo CA; Arias SA; Sullivan AF; Allen MH; Goldstein AB; Manton AP; Espinola JA; Jones R; Hasegawa K; Boudreaux ED; ED-SAFE Investigators
[Ad] Endereço:Department of Psychiatry and Human Behavior, Brown University, Butler Hospital, Providence, Rhode Island.
[Ti] Título:Suicide Prevention in an Emergency Department Population: The ED-SAFE Study.
[So] Source:JAMA Psychiatry;74(6):563-570, 2017 Jun 01.
[Is] ISSN:2168-6238
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Suicide is a leading cause of deaths in the United States. Although the emergency department (ED) is an opportune setting for initiating suicide prevention efforts, ED-initiated suicide prevention interventions remain underdeveloped. Objective: To determine whether an ED-initiated intervention reduces subsequent suicidal behavior. Design, Setting, and Participants: This multicenter study of 8 EDs in the United States enrolled adults with a recent suicide attempt or ideation and was composed of 3 sequential phases: (1) a treatment as usual (TAU) phase from August 2010 to December 2011, (2) a universal screening (screening) phase from September 2011 to December 2012, and (3) a universal screening plus intervention (intervention) phase from July 2012 to November 2013. Interventions: Screening consisted of universal suicide risk screening. The intervention phase consisted of universal screening plus an intervention, which included secondary suicide risk screening by the ED physician, discharge resources, and post-ED telephone calls focused on reducing suicide risk. Main Outcomes and Measures: The primary outcome was suicide attempts (nonfatal and fatal) over the 52-week follow-up period. The proportion and total number of attempts were analyzed. Results: A total of 1376 participants were recruited, including 769 females (55.9%) with a median (interquartile range) age of 37 (26-47) years. A total of 288 participants (20.9%) made at least 1 suicide attempt, and there were 548 total suicide attempts among participants. There were no significant differences in risk reduction between the TAU and screening phases (23% vs 22%, respectively). However, compared with the TAU phase, patients in the intervention phase showed a 5% absolute reduction in suicide attempt risk (23% vs 18%), with a relative risk reduction of 20%. Participants in the intervention phase had 30% fewer total suicide attempts than participants in the TAU phase. Negative binomial regression analysis indicated that the participants in the intervention phase had significantly fewer total suicide attempts than participants in the TAU phase (incidence rate ratio, 0.72; 95% CI, 0.52-1.00; P = .05) but no differences between the TAU and screening phases (incidence rate ratio, 1.00; 95% CI, 0.71-1.41; P = .99). Conclusions and Relevance: Among at-risk patients in the ED, a combination of brief interventions administered both during and after the ED visit decreased post-ED suicidal behavior.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência
Ideação Suicida
Suicídio/prevenção & controle
[Mh] Termos MeSH secundário: Adulto
Administração de Caso
Terapia Combinada
Serviço Hospitalar de Emergência/estatística & dados numéricos
Serviços de Emergência Psiquiátrica/estatística & dados numéricos
Feminino
Seguimentos
Linhas Diretas
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Programas de Rastreamento
Meia-Idade
Psicoterapia
Rhode Island
Medição de Risco
Prevenção Secundária
Suicídio/estatística & dados numéricos
Tentativa de Suicídio/prevenção & controle
Tentativa de Suicídio/estatística & dados numéricos
[Pt] Tipo de publicação:CLINICAL TRIAL; COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1706
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1001/jamapsychiatry.2017.0678


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[PMID]:29192004
[Au] Autor:Simon TD; Whitlock KB; Haaland W; Wright DR; Zhou C; Neff J; Howard W; Cartin B; Mangione-Smith R
[Ad] Endereço:Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and tamara.simon@seattlechildrens.org.
[Ti] Título:Effectiveness of a Comprehensive Case Management Service for Children With Medical Complexity.
[So] Source:Pediatrics;140(6), 2017 Dec.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To assess whether children with medical complexity (CMC) exposed to a hospital-based comprehensive case management service (CCMS) experience improved health care quality, improved functional status, reduced hospital-based utilization, and/or reduced overall health care costs. METHODS: Eligible CMC at Seattle Children's Hospital were enrolled in a cluster randomized controlled trial between December 1, 2010, and September 29, 2014. Participating primary care providers (PCPs) were randomly assigned, and CMC either had access to an outpatient hospital-based CCMS or usual care directed by their PCP. The CCMS included visits to a multidisciplinary clinic ≥ every 6 months for 1.5 years, an individualized shared care plan, and access to CCMS providers. Differences between control and intervention groups in change from baseline to 12 months and baseline to 18 months (difference of differences) were tested. RESULTS: Two hundred PCPs caring for 331 CMC were randomly assigned. Intervention group ( = 181) parents reported more improvement in the Consumer Assessment of Healthcare Providers and Systems version 4.0 Child Health Plan Survey global health care quality ratings than control group parents (6.7 [95% confidence interval (CI): 3.5-9.8] vs 1.3 [95% CI: 1.9-4.6] at 12 months). We did not detect significant differences in child functional status and most hospital-based utilization between groups. The difference in change of overall health care costs was higher in the intervention group (+$8233 [95% CI: $1701-$16 937]) at 18 months). CCMS clinic costs averaged $3847 per child-year. CONCLUSIONS: Access to a CCMS generally improved health care quality, but was not associated with changes in child functional status or hospital-based utilization, and increased overall health care costs among CMC.
[Mh] Termos MeSH primário: Administração de Caso/normas
Pesquisas sobre Serviços de Saúde/métodos
Pessoal de Saúde/normas
Hospitais Pediátricos
Transtornos do Neurodesenvolvimento/terapia
Atenção Primária à Saúde/normas
Melhoria de Qualidade
[Mh] Termos MeSH secundário: Criança
Feminino
Seres Humanos
Masculino
Qualidade de Vida
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE



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