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Quinn M.T.,University of Chicago | Gunter K.E.,University of Chicago | Nocon R.S.,University of Chicago | Lewis S.E.,University of North Carolina | And 9 more authors.
Ethnicity and Disease | Year: 2013

Objectives: Safety net health centers (SNHCs), which include federally qualified health centers (FQHCs) provide primary care for underserved, minority and low income patients. SNHCs across the country are in the process of adopting the patient centered medical home (PCMH) model, based on promising early implementation data from demonstration projects. However, previous demonstration projects have not focused on the safety net and we know little about PCMH transformation in SNHCs. Design: This qualitative study characterizes early PCMH adoption experiences at SNHCs. Setting and Participants: We interviewed 98 staff (administrators, providers, and clinical staff) at 20 of 65 SNHCs, from five states, who were participating in the first of a five-year PCMH collaborative, the Safety Net Medical Home Initiative. Main Measures: We conducted 30-45 minute, semi-structured telephone interviews. Interview questions addressed benefits anticipated, obstacles encountered, and lessons learned in transition to PCMH. Results: Anticipated benefits for participating in the PCMH included improved staff satisfaction and patient care and outcomes. Obstacles included staff resistance and lack of financial support for PCMH functions. Lessons learned included involving a range of staff, anticipating resistance, and using data as frequent feedback. Conclusions: SNHCs encounter unique challenges to PCMH implementation, including staff turnover and providing care for patients with complex needs. Staff resistance and turnover may be ameliorated through improved health care delivery strategies associated with the PCMH. Creating predictable and continuous funding streams may be more fundamental challenges to PCMH transformation. (Ethn Dis. 2013;23[3]:356-362). Source


Li X.,University of Tennessee at Knoxville | Nukala S.,Nielsen Company | Mohebbi S.,University of Tennessee at Knoxville
International Journal of Advanced Manufacturing Technology | Year: 2013

This paper examines the influence of competition among supply chain partners on product demand. A power law demand function that depends on product pricing and shelf-space allocation (SSA) is used. The exponents in the power law are given by the elasticities of demand. In order to achieve the optimal pricing and SSA strategies in the presence of competition, game-theory-based methodologies-Cournot and Stackelberg games-are employed. For each type of game, a Nash equilibrium is achieved by optimizing the profit as a function of demand and price. A case study is presented to demonstrate the potential of this methodology. The results of this study indicate (1) how to achieve optimal pricing and SSA strategies, (2) how manufacturers can influence demand for a product, (3) that both prices and profits decrease using the Stackelberg game as compared with the Cournot game, and (4) that coordination beyond simple knowledge of price would be beneficial for improving overall profits. © 2013 Springer-Verlag London. Source


Hutton I.,University of Auckland | Gamble G.,University of Auckland | McLean G.,Sport and Recreation New Zealand | Butcher H.,Nielsen Company | And 2 more authors.
Internal Medicine Journal | Year: 2010

Background: Many adults with arthritis do not achieve physical activity levels recommended for good health. This study aimed to identify factors associated with physical activity participation in people with arthritis. Methods: 1106 out of 8163 adults with self-reported arthritis were identified from the 2003 Obstacles to Action study. Participants were classified as active if they reported 30 min of moderate activity ≥5 days a week or 20 min of vigorous activity ≥3 days a week (n = 613), or insufficiently active if they did not (n = 438). Sociodemographic factors, attitudes, self-efficacy, motivators and barriers to being active were analysed. Results: Active people with arthritis had a lower burden of chronic disease than insufficiently active people (18% with three or more chronic medical conditions vs 33%, P < 0.0001). Active participants believed more strongly in the benefits of physical activity, reported higher levels of encouragement from others and had greater overall levels of self-efficacy when compared with the less active participants (P for all <0.0001). Arthritis, fatigue and discomfort were ranked by both groups as the top three barriers. However, the active participants reported lower impact scores for these barriers than the inactive group (P for all <0.0001). These findings persisted after adjusting for occupational status, body mass index and comorbidities. Conclusion: Active adults with arthritis have lower levels of chronic disease, greater self-efficacy and fewer psychosocial barriers. Recognition of such barriers and motivators may be useful when designing intervention programmes to help people with arthritis initiate or intensify physical activity participation. © 2010 Royal Australasian College of Physicians. Source


McDonald J.S.,Rochester College | McDonald R.J.,Rochester College | Fan J.,Nielsen Company | Lanzino G.,Rochester College | And 2 more authors.
Journal of Stroke and Cerebrovascular Diseases | Year: 2015

Background We sought to measure the impact of the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) findings on clinical practice by studying trends in carotid artery stenting (CAS) and carotid endarterectomy (CEA) utilization before and after publication of CREST in a large US multihospital database. Methods The Premier Perspective Database was used to identify inpatient CEA and CAS procedures performed from January 2006 to March 2013. Patients were subclassified by age (<70/≥70 years) and presentation (symptomatic/asymptomatic). CEA and CAS volumes were compared before and after the publication of CREST (July 2010) using an interrupted time series model. Results A total of 121,157 CEA and 18,503 CAS procedures performed at 445 medical centers were identified. There was no significant change observed in the overall number of CEA procedures performed after CREST publication relative to the pre-existing trend (P =.08); however, there was a significant increase in the overall number of CAS procedures performed (delta of 40 cases, P =.0179) in patients aged younger than 70 years (delta of 24 cases, P =.0008), 70 years or older (delta of 25 cases, P =.0047), and asymptomatic patients (delta of 39 cases, P =.0159). The overall percentage of CEA procedures performed in relation to all revascularization procedures was significantly lower after CREST publication overall (delta, -1.5%; P =.041) for patients aged younger than 70 years (delta, -2.4%; P <.0001) and asymptomatic patients (delta, -1.5%; P =.035). Conclusions In this large sample of US hospitals, performance of CAS significantly increased after the publication of the CREST study. © 2015 National Stroke Association. Source


Peek M.E.,University of Chicago | Wilkes A.E.,University of Chicago | Roberson T.S.,University of Chicago | Goddu A.P.,University of Chicago | And 6 more authors.
Health Affairs | Year: 2012

Interventions to improve health outcomes among patients with diabetes, especially racial or ethnic minorities, must address the multiple factors that make this disease so pernicious. We describe an intervention on the South Side of Chicago-a largely lowincome, African American community-that integrates the strengths of health systems, patients, and communities to reduce disparities in diabetes care and outcomes. We report preliminary findings, such as improved diabetes care and diabetes control, and we discuss lessons learned to date. Our initiative neatly aligns with, and can inform the implementation of, the accountable care organization-a delivery system reform in which groups of providers take responsibility for improving the health of a defined population. © 2011 Project HOPE-The People-to-People Health Foundation, Inc. Source

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