A Step-by-Step Guide to Building a Complex Care Coordination Program in a Small Setting.

Children with medical complexity comprise a growing population that stresses existing models of pediatric care. This report will describe a care support project that delivered shared plans of care to providers and families of children with medical complexity. This program was built around carefully constructed care support teams where each member had clearly defined roles and responsibilities.

Role of Adverse Events in Unscheduled Hospitalizations Among Patients With Solid Tumors Who Receive Medical Oncology Treatment.

Purpose: The development of strategies to prevent or mitigate cancer treatment-related adverse events (AEs) is necessary to improve patient experience, safety, and cost containment. To develop a strategy to easily identify and mitigate AEs, we sought to understand the frequency and severity of those that resulted in hospitalizations.

Methods: We retrospectively characterized hospitalizations of ambulatory adult patients with solid tumor cancers within 30 days of chemotherapy administration using medical record data abstraction.

Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT-AF.

Background Chronic kidney disease ( CKD ) is a common comorbidity in patients with atrial fibrillation. The presence of CKD complicates drug selection for stroke prevention and rhythm control. Methods and Results Patients enrolled in ORBIT AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) with baseline renal function and follow-up data were included (N=9019).

Intimate Partner Violence Among Female Sex Workers and Their Noncommercial Male Partners in Mexico: A Mixed-Methods Study.

Utilizing mixed methods, we examined intimate partner violence (IPV) behaviors among 428 female sex workers (FSWs) who use drugs and their noncommercial male partners in Tijuana and Ciudad Juarez, Mexico. Half of all participants reported perpetrating and experiencing at least one type of IPV behavior in the past year. In interviews, drug use emerged as an important theme associated with IPV behaviors, and we found men and women differed in their motivations for engaging in IPV behaviors.

Nudging Healthier Choices in a Hospital Cafeteria: Results From a Field Study.

More than two thirds of adults and one third of children are overweight or obese in the United States. These trends have led to initiatives to provide information that supports informed choices. Traffic light labeling has been shown to increase consumer awareness and encourage healthy selections.

Physician Approaches to Conflict with Families Surrounding End-of-Life Decision-making in the Intensive Care Unit. A Qualitative Study.

Rationale: Families of critically ill patients are often asked to make difficult decisions to pursue, withhold, or withdraw aggressive care or resuscitative measures, exercising "substituted judgment" from the imagined standpoint of the patient. Conflict may arise between intensive care unit (ICU) physicians and family members regarding the optimal course of care.

Objectives: To characterize how ICU physicians approach and manage conflict with surrogates regarding end-of-life decision-making.

Results of a Regional Effort to Improve Warfarin Management.

Background: Improved anticoagulation control with warfarin reduces adverse events and represents a target for quality improvement. No previous study has described an effort to improve anticoagulation control across a health system.

Objective: To describe the results of an effort to improve anticoagulation control in the New England region of the Veterans Health Administration (VA).

An Epidemiological Study of Burglary Offenders: Trends and Predictors of Self-Reported Arrests for Burglary in the United States, 2002-2013.

Burglary is serious property crime with a relatively high incidence and has been shown to be variously associated with other forms of criminal behavior. Unfortunately, an epidemiological understanding of burglary and its correlates is largely missing from the literature. Using public-use data collected between 2002 and 2013 as part of the National Survey on Drug Use and Health (NSDUH), the current study compared those who self-reported burglary arrest in the prior 12 months with and without criminal history.

Risk Factors for Cognitive Impairment in Fragile X-Associated Tremor/Ataxia Syndrome.

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disease with motor, psychiatric, and cognitive manifestations that occurs in carriers of the fragile X mental retardation 1 ( FMR1) gene premutations. This was a retrospective chart review of 196 individuals (127 men and 69 women) with FXTAS. Forty-six (23%) participants were cognitively impaired, of whom 19 (10%) had dementia.

The Palliative Performance Scale Predicts Three- and Six-Month Survival in Older Adult Patients Admitted to the Hospital through the Emergency Department.

Background: There is often little information on long-term prognosis available for Emergency Medicine physicians when decisions on admission, treatment, or consultations are being made for patients. There is a new focus to understand if palliative support should be offered in the emergency department (ED) and the Palliative Performance Scale (PPS), a screening tool used in other settings in palliative care, has been little used in the ED.

Objective: The goal of this study was to assess the prognostic value of the PPS in predicting three- and six-month survival in patients admitted through the ED.

Nationwide Interdisciplinary E-Consultation on Transgender Care in the Veterans Health Administration.

Background: Veteran's Health Administration (VHA) requires the provision of quality transgender care for the relatively large number of transgender veterans using VHA services.

Introduction: The Office of Patient Care Services has taken a multimethod approach to improving provider knowledge and skill for transgender veteran care. However, unique patient-specific questions can arise.

A Systematic Review of Patient Safety Measures in Adult Primary Care.

Safety measure development has focused on inpatient care despite outpatient visits far outnumbering inpatient admissions. Some measures are clearly identified as outpatient safety measures when published, yet outcomes from quality improvement studies also may be useful measures. The authors conducted a systematic review of the literature to identify published articles detailing safety measures applicable to adult primary care.

Concussion Care Practices and Utilization of Evidence-Based Guidelines in the Evaluation and Management of Concussion: A Survey of New England Emergency Departments.

Evidence-based clinical practice guidelines can facilitate proper evaluation and management of concussions in the emergency department (ED), often the initial and primary point of contact for concussion care. There is no universally adopted set of guidelines for concussion management, and extant evidence suggests that there may be variability in concussion care practices and limited application of clinical practice guidelines in the ED. This study surveyed EDs throughout New England to examine current practices of concussion care and utilization of evidence-based clinical practice guidelines in the evaluation and management of concussions.

Clergy Views on a Good Versus a Poor Death: Ministry to the Terminally Ill.

Background: Clergy are often important sources of guidance for patients and family members making medical decisions at the end-of-life (EOL). Previous research revealed spiritual support by religious communities led to more aggressive care at the EOL, particularly among minority patients. Understanding this phenomenon is important to help address disparities in EOL care.