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Utilization, financial outcomes and stakeholder perspectives of a re-organized adult sickle cell program.

重新组织的成人镰状细胞计划的利用、财务结果和利益相关者观点。

  • 影响因子:3.02
  • DOI:10.1371/journal.pone.0236360
  • 作者列表:"Rousseau R","Weisberg DF","Gorero J","Parwani V","Bozzo J","Kenyon K","Smith C","Cole J","Curtis S","Forray A","Roberts JD
  • 发表时间:2020-07-24
Abstract

:In 2011 Yale New Haven Hospital, in response to high utilization of acute care services and widespread patient and health care personnel dissatisfaction, set out to improve its care of adults living with sickle cell disease. Re-organization components included recruitment of additional personnel; re-locating inpatients to a single nursing unit; reducing the number of involved providers; personalized care plans for pain management; setting limits upon access to parenteral opioids; and an emphasis upon clinic visits focused upon home management of pain as well as specialty and primary care. Outcomes included dramatic reductions in inpatient days (79%), emergency department visits (63%), and hospitalizations (53%); an increase in outpatient visits (31%); and a decrease in costs (49%). Providers and nurses viewed the re-organization and outcomes positively. Most patients reported improvements in pain control and life style; many patients thought the re-organization process was unfair. Their primary complaint was a lack of shared decision-making. We attribute the contrast in these perspectives to the inherent difficulties of managing recurrent acute and chronic pain with opioids, especially within the context of the imbalance in wellness, power, and privilege between persons living with sickle cell disease, predominantly persons of color and poor socio-economic status, and health care organizations and their personnel.

摘要

: 在2011耶鲁纽黑文医院,为了应对急性护理服务的高利用率和广泛的患者和医疗保健人员的不满,着手改善其对患有镰状细胞病的成年人的护理。重组部分包括招聘额外人员; 将住院患者重新安置到一个护理单元; 减少相关提供者的数量; 疼痛管理的个性化护理计划; 设定胃肠外阿片类药物的使用限制; 重点是门诊就诊,重点是疼痛的家庭管理以及专科和初级保健。结果包括住院天数显著减少 (79%),急诊就诊 (63%) 和住院 (53%); 门诊就诊增加 (31%); 费用减少 (49%)。提供者和护士积极看待重组和结果。大多数患者报告疼痛控制和生活方式有所改善; 许多患者认为重组过程是不公平的。他们的主要抱怨是缺乏共同决策。我们将这些观点的对比归因于阿片类药物治疗复发性急性和慢性疼痛的固有困难,特别是在镰状细胞病患者 (主要是有色人种和社会经济地位差的人) 之间的健康、权力和特权失衡的背景下,和卫生保健组织及其人员。

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发表时间:2020-02-01
DOI:10.1016/j.ajog.2019.07.044
作者列表:["Yang J","Peng CF","Qi Y","Rao XQ","Guo F","Hou Y","He W","Wu J","Chen YY","Zhao X","Wang YN","Peng H","Wang D","Du L","Luo MY","Huang QF","Liu HL","Yin A"]

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影响因子:1.74
发表时间:2020-02-01
DOI:10.1177/1049909119868657
作者列表:["Suarez ML","Schlaeger JM","Angulo V","Shuey DA","Carrasco J","Roach KL","Ezenwa MO","Yao Y","Wang ZJ","Molokie RE","Wilkie DJ"]

METHODS:OBJECTIVES:Sickle cell disease (SCD) is a serious illness with disabling acute and chronic pain that needs better therapies, but insufficient patient participation in research is a major impediment to advancing SCD pain management. The purpose of this article is to discuss the challenges of conducting an SCD study and approaches to successfully overcoming those challenges. DESIGN:In a repeated-measures, longitudinal study designed to characterize SCD pain phenotypes, we recruited 311 adults of African ancestry. Adults with SCD completed 4 study visits 6 months apart, and age- and gender-matched healthy controls completed 1 visit. RESULTS:We recruited and completed measures on 186 patients with SCD and 125 healthy controls. We retained 151 patients with SCD with data at 4 time points over 18 months and 125 healthy controls (1 time point) but encountered many challenges in recruitment and study visit completion. Enrollment delays often arose from patients' difficulty in taking time from their complicated lives and frequent pain episodes. Once scheduled, participants with SCD cancelled 49% of visits often because of pain; controls canceled 30% of their scheduled visits. To facilitate recruitment and retention, we implemented a number of strategies that were invaluable in our success. CONCLUSION:Patients' struggles with illness, chronic pain, and their life situations resulted in many challenges to recruitment and completion of study visits. Important to overcoming challenges was gaining the trust of patients with SCD and a participant-centered approach. Early identification of potential problems allowed strategies to be instituted proactively, leading to success.

影响因子:2.13
发表时间:2020-01-01
DOI:10.1093/ajcp/aqz108
作者列表:["Mukherjee MB","Colah RB","Mehta PR","Shinde N","Jain D","Desai S","Dave K","Italia Y","Raicha B","Serrao E"]

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