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News Article | May 9, 2017
Site: www.prnewswire.com

The move to enterprise telemedicine is also reflected in additional survey findings. Survey respondents identified telemedicine platform features that are most valuable to their organizations. Three of the top six platform features are related to telemedicine data and analytics: clinical documentation, ability to send documentation to/from the EMR, and ability to analyze consult data. All of these were rated as critical or valuable by nearly 80% of respondents. "We saw a high degree of value placed on platform features related to data and analytics, EMR integration and support for off-the-shelf endpoints such as laptops and tablets.  These features and capabilities tend to have a greater impact on the organization as a whole more than individual departments because they are integral to maximizing the value of investments in equipment and software," said McGraw. "Conversely, features that tend to have more of an impact on individual departments, such as support for proprietary devices, are less frequently noted as critical or valuable." For the second year in a row, the top three telemedicine objectives are all patient-oriented: improving patient outcomes, improving patient convenience and increasing patient engagement. Survey respondents also identified their primary contributors to return on investment (ROI) for their telemedicine programs. The most frequently cited ROI driver was improved patient satisfaction, which ranked above all forms of government and private payor reimbursement. Four hundred thirty-six healthcare executives, physicians, nurses and other professionals participated in the third annual survey, which covered a wide variety of telemedicine topics including priorities, program maturity, EMR-related challenges and more. Complimentary copies of the full survey report may be downloaded at: https://reachhealth.com/resources/telemedicine-industry-survey/. About REACH Health REACH Health is the leading enterprise telemedicine software company, providing solutions for multiple specialties and settings of care, all supported on one software platform. Designed by physicians and software engineers, these solutions are recognized for fostering collaboration between bedside clinicians and remote specialists through shared clinical workflows. Today, many of the nation's most successful telemedicine programs use REACH to achieve measurable improvements in their clinical, operational and financial performance. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/enterprise-telemedicine-deployments-on-the-rise-in-us-hospitals-300453889.html

Ladin K.,Health in Reach | Zhang G.,Health in Reach | Hanto D.W.,Vanderbilt University
American Journal of Transplantation | Year: 2017

Recently, a redistricting proposal intended to equalize Model for End-stage Liver Disease score at transplant recommended expanding liver sharing to mitigate geographic variation in liver transplantation. Yet, it is unclear whether variation in liver availability is arbitrary and a disparity requiring rectification or reflects differences in access to care. We evaluate the proposal's claim that organ supply is an "accident of geography" by examining the relationship between local organ supply and the uneven landscape of social determinants and policies that contribute to differential death rates across the United States. We show that higher mortality leading to greater availability of organs may in part result from disproportionate risks incurred at the local level. Disparities in public safety laws, health care infrastructure, and public funding may influence the risk of death and subsequent availability of deceased donors. These risk factors are disproportionately prevalent in regions with high organ supply. Policies calling for organ redistribution from high-supply to low-supply regions may exacerbate existing social and health inequalities by redistributing the single benefit (greater organ availability) of greater exposure to environmental and contextual risks (e.g. violent death, healthcare scarcity). Variation in liver availability may not be an "accident of geography" but rather a byproduct of disadvantage. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

Abiiro G.A.,University of Heidelberg | Abiiro G.A.,University for Development Studies | Mbera G.B.,Health in Reach | De Allegri M.,University of Heidelberg
BMC Health Services Research | Year: 2014

Background: In sub-Saharan Africa, universal health coverage (UHC) reforms have often adopted a technocratic top-down approach, with little attention being paid to the rural communities' perspective in identifying context specific gaps to inform the design of such reforms. This approach might shape reforms that are not sufficiently responsive to local needs. Our study explored how rural communities experience and define gaps in universal health coverage in Malawi, a country which endorses free access to an Essential Health Package (EHP) as a means towards universal health coverage. Methods. We conducted a qualitative cross-sectional study in six rural communities in Malawi. Data was collected from 12 Focus Group Discussions with community residents and triangulated with 8 key informant interviews with health care providers. All respondents were selected through stratified purposive sampling. The material was tape-recorded, fully transcribed, and coded by three independent researchers. Results: The results showed that the EHP has created a universal sense of entitlements to free health care at the point of use. However, respondents reported uneven distribution of health facilities and poor implementation of public-private service level agreements, which have led to geographical inequities in population coverage and financial protection. Most respondents reported affordability of medical costs at private facilities and transport costs as the main barriers to universal financial protection. From the perspective of rural Malawians, gaps in financial protection are mainly triggered by supply-side access-related barriers in the public health sector such as: shortages of medicines, emergency services, shortage of health personnel and facilities, poor health workers' attitudes, distance and transportation difficulties, and perceived poor quality of health services. Conclusions: Moving towards UHC in Malawi, therefore, implies the introduction of appropriate interventions to fill the financial protection gaps in the private sector and the access-related gaps in the public sector and/or an effective public-private partnership that completely integrates both sectors. Current universal health coverage reforms need to address context specific gaps and be carefully crafted to avoid creating a sense of universal entitlements in principle, which may not be effectively received by beneficiaries due to contextual and operational bottlenecks. © 2014 Abiiro et al.; licensee BioMed Central Ltd.

Allen J.O.,University of Michigan | Griffith D.M.,University of Michigan | Gaines H.C.,Health in Reach
Health Psychology | Year: 2013

Objective: Women play a critical role in men's dietary health, but how men think about the nature and mechanisms of their wives' influence on their eating behavior is not well understood. This study examined how African American men described the roles their wives played in shaping their eating behavior. Methods: Thematic content analysis was used to analyze data from nine exploratory focus groups conducted with a convenience sample of 83 African American men who were middle aged or older and lived in southeast Michigan. Results: Men perceived having more freedom to choose what they ate while eating out, even when accompanied by their wives, compared with at home. The men indicated their wives influenced what they ate at home more than their own preferences. They described traditional gendered food roles at home and were satisfied that their wives played a dominant role in household food preparation and decision making. Men had mixed feelings about wives' efforts to prepare healthier meals. While they appreciated that their wives cared about their health, the men felt they were rarely consulted on how meals could be healthier and often disliked the healthy changes their wives made. The men prioritized keeping their wives happy, preserving spousal division of roles, and maintaining marital harmony over participating in food decision making or expressing their personal food preferences. Conclusions: Interventions to improve married African American men's eating behaviors need to explicitly consider that men may prioritize marital harmony and the preservation of spousal food roles over their tastes, preferences, and desired food decision making roles. © 2012 American Psychological Association.

Turner B.J.,Health in Reach
European Journal of Gastroenterology and Hepatology | Year: 2016

OBJECTIVES: Noninvasive measures are widely used to assess fibrosis and may be used to prioritize hepatitis C virus (HCV) treatment. We examined risks for likely fibrosis in patients with chronic HCV infection using fibrosis-4 (FIB-4) and imaging. PATIENTS AND METHODS: A HCV screening program diagnosed chronic HCV in patients born from 1945 to 1965 admitted in a safety net hospital. Likely fibrosis was based on FIB-4 (≥1.45) alone or combined with imaging interpreted as fibrosis or cirrhosis. Logistic regression was used to calculate adjusted odds ratios (AORs) for demographic, clinical, and insurance factors associated with each outcome. Using multiple linear regression among patients with likely fibrosis, we examined associations with higher Model for End-Stage Liver Disease (MELD) scores. RESULTS: Using FIB-4 alone, 57% (83/146) of patients had likely fibrosis versus 43% (63/148) using FIB-4 plus imaging. Obesity/overweight and Hispanic ethnicity had over three-fold to four-fold higher AORs for fibrosis, respectively, based on FIB-4 plus imaging, but both AORs were only two-fold greater with FIB-4 alone. Being uninsured was significantly associated with fibrosis based on FIB-4 alone [AOR=2.40 (95% confidence interval 1.01–5.70)] but not with imaging. Heavy alcohol use and older age were associated with higher AORs of fibrosis with both measures (all P<0.004). MELD scores were ∼3 points higher for uninsured patients, regardless of measure (both P<0.05). CONCLUSIONS: Using FIB-4 plus imaging to identify fibrosis in chronic HCV, higher risks are seen for Hispanics and overweight/obese individuals than using FIB-4 alone. Higher MELD scores at diagnosis for the uninsured indicate delayed access to care. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Downe S.,Health in Reach
The Cochrane database of systematic reviews | Year: 2013

Vaginal examinations have become a routine intervention in labour as a means of assessing labour progress. Used at regular intervals, either alone or as a component of the partogram (a pre-printed form providing a pictorial overview of the progress of labour), the aim is to assess if labour is progressing physiologically, and to provide an early warning of slow progress. Abnormally slow progress can be a sign of labour dystocia, which is associated with maternal and fetal morbidity and mortality, particularly in low-income countries where appropriate examinations with routine rectal examinations to assess the progress of labour, we identified no difference in neonatal infections requiring antibiotics (risk ratio (RR) 0.33, 95% confidence interval (CI) 0.01 to 8.07, one study, 307 infants). There were no data on the other primary outcomes of length of labour, maternal infections requiring antibiotics and women's overall views of labour. The study did show that significantly fewer women reported that vaginal examination was very uncomfortable compared with rectal examinations (RR 0.42, 95% CI 0.25 to 0.70, one study, 303 women). We identified no difference in the secondary outcomes of augmentation, caesarean section, spontaneous vaginal birth, operative vaginal birth, perinatal mortality and admission to neonatal intensive care.Comparing two-hourly vaginal examinations with four-hourly vaginal examinations in labour, we found no difference in length of labour (mean difference in minutes (MD) -6.00, 95% CI -88.70 to 76.70, one study, 109 women). There were no data on the other primary outcomes of maternal or neonatal infections requiring antibiotics, and women's overall views of labour. We identified no difference in the secondary outcomes of augmentation, epidural for pain relief, caesarean section, spontaneous vaginal birth and operative vaginal birth. On the basis of women's preferences, vaginal examination seems to be preferred to rectal examination. For all other outcomes, we found no evidence to support or reject the use of routine vaginal examinations in labour to improve outcomes for women and babies. The two studies included in the review were both small, and carried out in high-income countries in the 1990s.  It is surprising that there is such a widespread use of this intervention without good evidence of effectiveness, particularly considering the sensitivity of the procedure for the women receiving it, and the potential for adverse consequences in some settings.The effectiveness of the use and timing of routine vaginal examinations in labour, and other ways of assessing progress in labour, including maternal behavioural cues, should be the focus of new research as a matter of urgency. Women's views of ways of assessing labour progress should be given high priority in any future research in this area.

Golub M.,Health in Reach
Progress in community health partnerships : research, education, and action | Year: 2011

People of color suffer worse health outcomes than their White counterparts due, in part, to limited access to high-quality specialty care. This article describes the events that led to the Bronx Health REACH coalition's decision to file a civil rights complaint with the New York State Office of the Attorney General alleging that three academic medical centers in New York City discriminated on the basis of payer status and race in violation of Title VI of the Civil Rights Act of 1964, the Hill-Burton Act, New York State regulations, and New York City Human Rights Law. Key Points: Although the problem has not yet been resolved, the related community mobilization efforts have raised public awareness about the impact of disparate care, strengthened the coalition's commitment to achieve health equality, and garnered support among many city and state legislators. Community groups and professionals with relevant expertise can tackle complex systemic problems, but they must be prepared for a long and difficult fight.

ATLANTA--(BUSINESS WIRE)--REACH Health, the leading provider of enterprise telemedicine software solutions, today released the results from the 2015 U.S. Telemedicine Industry Benchmark Survey. Key findings from the study include: Two hundred thirty-three healthcare executives, physicians, nurses and other professionals participated in the comprehensive industry survey, providing detailed information related to their priorities, objectives and challenges; telemedicine program models and management structures; service lines and settings of care; and their telemedicine platforms. “Our first annual telemedicine industry survey exposed a variety of interesting findings, some anticipated and many that are surprising,” said Steve McGraw, President and CEO of REACH Health. “One interesting result that emerged: the degree of focus of the telemedicine program manager had a stronger correlation with success than did executive support or adequacy of funding.” Overall, the report indicates a maturing industry, evolving rapidly from specialty to mainstream status - nearly 60 percent of survey participants noted telemedicine as their top priority or one of their highest priorities. The study also revealed evolving perspectives on the business cases for telemedicine. “Surprisingly, at the top of the list of ROI drivers is ‘Improved Reputation,’ which is generally regarded as a soft driver for financial performance compared to hard drivers such as reimbursement,” continued McGraw. “The underlying details of these and other findings documented in the report will help providers benchmark their programs with those of their peers to identify opportunities for growth and improvement.” Copies of the survey report will be available at the REACH Health booth #2310 at the 20th annual American Telemedicine Association conference, May 3 – 5, 2015 in Los Angeles. To receive a copy of the Executive Summary now and the full survey report when it is published, please register here: http://reachhealth.com/telemedicine-industry-survey. REACH Health is the leading enterprise telemedicine software company, providing solutions supporting multiple service lines and settings of care, all on one common software platform. These solutions combine real-time audio and video with vital patient data, clinical workflow and documentation to recreate the bedside experience for both the doctors and the patient. Clinical and performance data is utilized within reporting and analytics to monitor key telemedicine program metrics and enable continuous benchmarking and improvement. Combined, these advanced capabilities are proven to result in improved patient outcomes and more effective, sustainable telemedicine programs. Many of the nation’s most powerful telemedicine programs run on the REACH Health solution. REACH Health pioneered one of the nation’s first telestroke programs and continues to be the innovation leader, providing the most advanced clinical solutions to improve patient access and drive measurable improvements in outcomes. Physicians and clinicians embrace the ease of use of a single, intuitive platform tailored to multiple specialties including neurology, telestroke, cardiology, ICU, psychiatry, pulmonology and others. For more information, visit www.reachhealth.com.

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