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[PMID]:29382656
[Au] Autor:Pollock AM; Roderick P
[Ad] Endereço:Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK allyson.pollock@newcastle.ac.uk.
[Ti] Título:Why we should be concerned about accountable care organisations in England's NHS.
[So] Source:BMJ;360:k343, 2018 01 30.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Organizações de Assistência Responsáveis/legislação & jurisprudência
Assistência à Saúde/organização & administração
Medicina Estatal/organização & administração
[Mh] Termos MeSH secundário: Organizações de Assistência Responsáveis/ética
Tomada de Decisões Gerenciais
Assistência à Saúde/economia
Prestação Integrada de Cuidados de Saúde/organização & administração
Inglaterra/epidemiologia
Seres Humanos
Qualidade da Assistência à Saúde
Medicina Estatal/normas
[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:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k343


  2 / 10428 MEDLINE  
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[PMID]:28459901
[Au] Autor:Wilson G; Barkley K; Slicker K; Kowal R; Pope B; Michel J
[Ad] Endereço:Department of Internal Medicine, Scott and White Memorial Hospital, Temple, TX.
[Ti] Título:Overuse of Troponin? A Comprehensive Evaluation of Testing in a Large Hospital System.
[So] Source:J Hosp Med;12(5):329-331, 2017 May.
[Is] ISSN:1553-5606
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Troponin assays are integral to the diagnosis of acute myocardial infarction (AMI), but there is concern that testing is over utilized and may not conform to published guidelines. We reviewed all testing performed at 14 hospitals over 12 months and associated troponin values with the primary and secondary diagnoses for each visit. Troponin was determined to be negative, indeterminate or elevated based on reference ranges. The majority of troponin measurements were single, not serial (64%). The rate of AMI was low, with only 3.5% of tested patients having a primary or secondary diagnosis of AMI. Sensitivity, specificity and negative predictive value were excellent, exceeding 90%. However, positive predictive value was low, suggesting testing of populations with diseases known to be associated with elevated troponin levels in the absence of AMI. The majority (79%) of elevated troponin values were associated with primary diagnoses other than AMI. Only 28% of elevated troponins were associated with a primary or secondary diagnosis of AMI. These data suggest possible overuse of troponin testing in our healthcare system. Journal of Hospital Medicine 2017;12:329-331.
[Mh] Termos MeSH primário: Prestação Integrada de Cuidados de Saúde/normas
Infarto do Miocárdio/sangue
Infarto do Miocárdio/diagnóstico
Troponina/sangue
[Mh] Termos MeSH secundário: Biomarcadores/sangue
Seres Humanos
Estudos Retrospectivos
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Troponin)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.12788/jhm.2732


  3 / 10428 MEDLINE  
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[PMID]:29412565
[Au] Autor:Williams PAH
[Ti] Título:Standards for Safety, Security, and Interoperability of Medical Devices in an Integrated Health Information Environment.
[So] Source:J AHIMA;88(4):32-4, 2017 04.
[Is] ISSN:1060-5487
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Segurança Computacional/normas
Prestação Integrada de Cuidados de Saúde
Segurança de Equipamentos/normas
Equipamentos e Provisões/normas
Troca de Informação em Saúde/normas
Integração de Sistemas
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:180208
[St] Status:MEDLINE


  4 / 10428 MEDLINE  
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[PMID]:29351295
[Au] Autor:Spoorenberg SLW; Wynia K; Uittenbroek RJ; Kremer HPH; Reijneveld SA
[Ad] Endereço:University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, Groningen, The Netherlands.
[Ti] Título:Effects of a population-based, person-centred and integrated care service on health, wellbeing and self-management of community-living older adults: A randomised controlled trial on Embrace.
[So] Source:PLoS One;13(1):e0190751, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the effects of the population-based, person-centred and integrated care service 'Embrace' at twelve months on three domains comprising health, wellbeing and self-management among community-living older people. METHODS: Embrace supports older adults to age in place. A multidisciplinary team provides care and support, with intensity depending on the older adults' risk profile. A randomised controlled trial was conducted in fifteen general practices in the Netherlands. Older adults (≥75 years) were included and stratified into three risk profiles: Robust, Frail and Complex care needs, and randomised to Embrace or care as usual (CAU). Outcomes were recorded in three domains. The EuroQol-5D-3L and visual analogue scale, INTERMED for the Elderly Self-Assessment, Groningen Frailty Indicator and Katz-15 were used for the domain 'Health.' The Groningen Well-being Indicator and two quality of life questions measured 'Wellbeing.' The Self-Management Ability Scale and Partners in Health scale for older adults (PIH-OA) were used for 'Self-management.' Primary and secondary outcome measurements differed per risk profile. Data were analysed with multilevel mixed-model techniques using intention-to-treat and complete case analyses, for the whole sample and per risk profile. RESULTS: 1456 eligible older adults participated (49%) and were randomized to Embrace (n(T0) = 747, n(T1) = 570, mean age 80.6 years (SD 4.5), 54.2% female) and CAU (n(T0) = 709, n(T1) = 561, mean age 80.8 years (SD 4.7), 55.6% female). Embrace participants showed a greater-but clinically irrelevant-improvement in self-management (PIH-OA Knowledge subscale effect size [ES] = 0.14), and a greater-but clinically relevant-deterioration in health (ADL ES = 0.10; physical ADL ES = 0.13) compared to CAU. No differences in change in wellbeing were observed. This picture was also found in the risk profiles. Complete case analyses showed comparable results. CONCLUSIONS: This study found no clear benefits to receiving person-centred and integrated care for twelve months for the domains of health, wellbeing and self-management in community-living older adults.
[Mh] Termos MeSH primário: Prestação Integrada de Cuidados de Saúde/organização & administração
Vida Independente
Assistência Centrada no Paciente
Qualidade de Vida
Autocuidado
[Mh] Termos MeSH secundário: Atividades Cotidianas
Idoso
Idoso de 80 Anos ou mais
Feminino
Idoso Fragilizado
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180120
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190751


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[PMID]:29359902
[Au] Autor:Raduege TJ; Thomson Reuters Accelus.
[Ti] Título:Healthcare facilities.
[So] Source:Issue Brief Health Policy Track Serv;2017:1-61, 2017 Dec 26.
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Instalações de Saúde
Administração de Instituições de Saúde
Administração Hospitalar
Hospitais
[Mh] Termos MeSH secundário: Organizações de Assistência Responsáveis
Prestação Integrada de Cuidados de Saúde
Governo Federal
Reforma dos Serviços de Saúde
Seres Humanos
Reembolso de Seguro de Saúde
Medicaid
Medicare
Administração dos Cuidados ao Paciente
Equipe de Assistência ao Paciente
Patient Protection and Affordable Care Act
Atenção Primária à Saúde
Qualidade da Assistência à Saúde
Reembolso de Incentivo
Serviços de Saúde Rural
Governo Estadual
Estados Unidos
[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]:28463714
[Au] Autor:She S; Deng Y; Chen Y; Wu C; Yi W; Lu X; Chen X; Li J; Li R; Zhang J; Xiao D; Wu H; Ning Y; Zheng Y
[Ad] Endereço:Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou 510370, China.
[Ti] Título:Two-stage integrated care versus antipsychotic medication alone on outcomes of schizophrenia: One-year randomized controlled trial and follow-up.
[So] Source:Psychiatry Res;254:164-172, 2017 Aug.
[Is] ISSN:1872-7123
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:Integrated care can reduce rate of relapse and improve personal and social functions in patients with schizophrenia. We established and evaluated a new model of "intensive-consolidation" two-stage integrated care (IC) for inpatients with schizophrenia. Data were collected between 2012 and 2015. Chinese inpatients with schizophrenia (n=170) diagnosed according to DSM-IV were randomly assigned to antipsychotic medication-alone (n=84) or two-stage IC (n=86) and followed up for 12 months. The IC model included intensive treatments (antipsychotics plus the cognitive behavior therapy and rehabilitation treatment) during hospitalization and 3-time consolidation treatments with 3-month intervals at clinics. Outcome measures included the rate of relapse, psychiatric symptoms and social functioning. Compared with medication-alone group, the rate of relapse were significantly lower in IC group (p=0.012); the Mixed-Effects Model for Repeated-Measures analyses showed that the IC group significantly improved in positive symptoms over time; greater improvement in self-care and less aggressive behaviors were observed over time in IC group (all p<0.008). The findings support the feasibility and effectiveness of the new two-stage model of integrated care as an intervention for middle-acute-phase inpatients with schizophrenia. The model is particularly informative to countries where medical resources are mainly distributed in developed regions.
[Mh] Termos MeSH primário: Antipsicóticos/uso terapêutico
Terapia Cognitiva/métodos
Prestação Integrada de Cuidados de Saúde/métodos
Esquizofrenia/terapia
Psicologia do Esquizofrênico
[Mh] Termos MeSH secundário: Adulto
Doença Crônica
Terapia Cognitiva/tendências
Prestação Integrada de Cuidados de Saúde/tendências
Feminino
Seguimentos
Hospitalização/tendências
Seres Humanos
Masculino
Esquizofrenia/diagnóstico
Autocuidado/métodos
Autocuidado/tendências
Ajustamento Social
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antipsychotic Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180206
[Lr] Data última revisão:
180206
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


  7 / 10428 MEDLINE  
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[PMID]:29172981
[Au] Autor:Peterson J; Budlong H; Affeldt T; Skiermont K; Kyllo G; Heaton A
[Ad] Endereço:1 Fairview Pharmacy Services, Minneapolis, Minnesota.
[Ti] Título:Biosimilar Products in the Modern U.S. Health Care and Regulatory Landscape.
[So] Source:J Manag Care Spec Pharm;23(12):1255-1259, 2017 Dec.
[Is] ISSN:2376-1032
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Biosimilars have the potential to greatly reduce medication costs in the United States. As of July 1, 2017, 5 biosimilars have been approved by the FDA, but only 2 are available for purchase. This commentary outlines the efforts of an integrated health system to ensure biosimilar accessibility and discusses the current challenges and future implications. We highlight the implementation of a health plan policy and how a health system's formulary committee can encourage use while considering provider perceptions and operational challenges. In addition, we provide our perspective on potential implications for pricing, site of care, and pharmacy dispensing practices based on our experience with regulatory hurdles and market trends. Overall, we believe biosimilars are a good thing for the health care system, but their expected benefit may not be realized for years to come. DISCLOSURES: No outside funding supported this work. Affeldt reports advisory board membership with Janssen, and Skiermont reports membership with Amgen and McKesson. The other authors have nothing to disclose. Peterson and Budlong contributed the study concept and design and wrote the manuscript. Affeldt, Skiermont, Kyllo, and Heaton reviewed and revised the manuscript.
[Mh] Termos MeSH primário: Medicamentos Biossimilares/administração & dosagem
Prestação Integrada de Cuidados de Saúde/organização & administração
Aprovação de Drogas
[Mh] Termos MeSH secundário: Medicamentos Biossimilares/economia
Prestação Integrada de Cuidados de Saúde/economia
Custos de Medicamentos
Formulários Farmacêuticos como Assunto
Acesso aos Serviços de Saúde
Seres Humanos
Assistência Farmacêutica/organização & administração
Comitê de Farmácia e Terapêutica
Estados Unidos
United States Food and Drug Administration
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biosimilar Pharmaceuticals)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.18553/jmcp.2017.23.12.1255


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[PMID]:28455426
[Au] Autor:Settipani CA; Cleverley K; Hawke LD; Rice M; Henderson JL
[Ad] Endereço:Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
[Ti] Título:Essential components of integrated care for youth with mental health and addiction needs: protocol for a scoping review.
[So] Source:BMJ Open;7(4):e015454, 2017 04 28.
[Is] ISSN:2044-6055
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Efforts to move towards integrated care have been met with increased interest and enthusiasm in recent years given the potential to improve care and population health while containing costs. However, there is a need to better understand community-based integrated care approaches for youth with mental health and/or addiction concerns to guide future implementation efforts and develop a set of standards for key components. The objectives of this scoping review are to: (1) identify the populations, settings, service providers, interventions, infrastructure and care coordination methods that have been included in integrated care for youth with mental health and/or addiction needs and (2) identify constructs that have been measured and evaluated (eg, outcomes, engagement) in the context of youth integrated care. METHODS AND ANALYSIS: Seven electronic databases and several grey literature sources will be searched for material from 2001 to 2016. Inclusion criteria will be broad with respect to type of work, as we will include all types of research studies as well as non-research studies that provide information relevant to characteristics and constructs measured in the context of integrated care for youth mental health. Titles and abstracts will be independently screened for eligibility by two raters using inclusion criteria. Full-text articles will then be accessed and independently screened for inclusion. A formal data extraction method will be employed, enabling synthesis of results in quantitative and qualitative formats. ETHICS AND DISSEMINATION: Results will be widely disseminated to various stakeholders to inform implementation and research efforts. Findings will also launch a Delphi method study leading to the development of an assessment tool for youth mental health services integration. This review does not require ethics approval.
[Mh] Termos MeSH primário: Comportamento Aditivo/terapia
Prestação Integrada de Cuidados de Saúde/métodos
Serviços de Saúde Mental
[Mh] Termos MeSH secundário: Adolescente
Seres Humanos
Saúde Mental
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1136/bmjopen-2016-015454


  9 / 10428 MEDLINE  
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[PMID]:29320140
[Au] Autor:Amarashingham R; Xie B; Karam A; Nguyen N; Kapoor B
[Ad] Endereço:Pieces Technology, Inc.
[Ti] Título:Using Community Partnerships to Integrate Health and Social Services for High-Need, High-Cost Patients.
[So] Source:Issue Brief (Commonw Fund);2018:1-11, 2018 Jan 01.
[Is] ISSN:1558-6847
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Issue: Our health care and social services delivery systems are not well-equipped to effectively manage patients with multiple chronic diseases and complex social needs such as food, housing, or substance abuse services. Community-level efforts have emerged across the nation to integrate the activities of disparate social service organizations with local health care delivery systems. Evidence on the experiences and outcomes of these programs is emerging, and there is much to learn about their approaches and challenges. Goal: Profile and classify burgeoning initiatives, understand common challenges, and surface solutions to address those challenges. Methods: Mixed-methods approach, including literature search, surveys, semistructured interviews with program leaders, and consultation with expert panels. Findings and Conclusions: We categorized cross-sector community partnerships in four dimensions. We also identified five common challenges: inadequate strategies to sustain cost-savings, improvement, and funding; lack of accurate and timely measurement of return on investment; lack of mechanisms to share potential savings between health care and social services providers; lack of expertise to integrate multiple data sources during health care or social services provision; and lack of a cross-sector workflow evidence base.
[Mh] Termos MeSH primário: Serviços de Saúde Comunitária
Relações Comunidade-Instituição
Prestação Integrada de Cuidados de Saúde
Múltiplas Afecções Crônicas/terapia
Apoio Social
[Mh] Termos MeSH secundário: Redes Comunitárias
Necessidades e Demandas de Serviços de Saúde
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180122
[Lr] Data última revisão:
180122
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE


  10 / 10428 MEDLINE  
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[PMID]:29267288
[Au] Autor:Busetto L; Luijkx K; Calciolari S; González Ortiz LG; Vrijhoef HJM
[Ad] Endereço:Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
[Ti] Título:Exploration of workforce changes in integrated chronic care: Findings from an interactive and emergent research design.
[So] Source:PLoS One;12(12):e0187468, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Integrated care interventions introduced in response to the increased demand for long-term care entail profound changes to the health workforce. This exploratory study aims to provide an overview of the workforce changes implemented as part of integrated chronic care interventions. METHODS: An interactive and emergent research design was used consisting of a literature review, qualitative expert questionnaires and case reports. We defined integrated care as interventions targeting at least two of the six Chronic Care Model components. Workforce changes were defined as those changes experienced by clinical and non-clinical staff responsible for public and individual health intervention. RESULTS: Seven workforce changes were identified: (1) nurse involvement, (2) multidisciplinary staff, (3) multidisciplinary protocols/pathways, (4) provider training, (5) case manager/care coordinator, (6) team meetings, and (7) new positions. Most interventions included more than one of these workforce changes. CONCLUSION: The results of this study provide detailed insights into the current implementation of workforce changes in integrated care interventions and thereby pave the way for further investigations into the relative effectiveness of different workforce changes within the scope of complex interventions. Advancing knowledge in this area is essential for fostering health systems' capacity to cope with the challenges related to the current demographic and epidemiological trends.
[Mh] Termos MeSH primário: Prestação Integrada de Cuidados de Saúde/organização & administração
Pessoal de Saúde
[Mh] Termos MeSH secundário: Doença Crônica
Seres Humanos
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0187468



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