Developing and Testing the Agency for Healthcare Research and Quality's National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards (NEATS) Instrument.

In 2011, the Institute of Medicine (IOM) (now the National Academy of Medicine) published standards for trustworthy guidelines and recommended that the National Guideline Clearinghouse (NGC) of the Agency for Healthcare Research and Quality clearly indicate the extent to which guidelines adhere to these standards. To accomplish this, the authors developed and tested the NGC Extent of Adherence to Trustworthy Standards (NEATS) instrument. The standards were operationalized as an instrument containing 15 items that cover disclosure of the funding source; disclosure and management of conflicts of interest; multidisciplinary input; incorporation of patient perspectives; rigorous systematic review; recommendations accompanied by rationale, assessment of benefits and harms, clear linkage to the evidence, and assessment of strength of evidence and strength of recommendation; clear articulation of recommendations; external review by diverse stakeholders; and plans for updating.

Dissemination and Implementation of Cognitive Behavioral Therapy for Depression in the Kaiser Permanente Health Care System: Evaluation of Initial Training and Clinical Outcomes.

Notwithstanding its empirical status and strong recommendation in clinical practice guidelines, cognitive behavioral therapy (CBT) continues to be delivered infrequently and with low fidelity on the clinical front lines. Recently, organized efforts and policies within the public sector to disseminate and implement CBT and other evidence-based psychotherapies have yielded encouraging results and provided optimism for bridging the research-to-practice-gap. Following from these efforts, the current article examines the initial impact and experience of the implementation of an individualized approach to CBT training and treatment within the Kaiser Permanente health care system.

What Do Clinicians Who Deliver Maternity Services Think Patient-Centered Care Is and How Is That Different for Vulnerable Women? A Qualitative Study.

Background: Patient-centered care is said to have a myriad of benefits; however, there is a lack of agreement on what exactly it consists of and how clinicians should deliver it for the benefit of their patients. In the context of maternity services and in particular for vulnerable women, we explored how clinicians describe patient-centered care and how the concept is understood in their practice.

Methods: We undertook a qualitative study using interviews and a focus group, based on an interview guide developed from various patient surveys focused around the following questions: (i) How do clinicians describe patient-centered care? (ii) How does being patient-centered affect how care is delivered? (iii) Is this different for vulnerable populations? And if so, how? We sampled obstetricians and gynecologists, midwives, primary care physicians, and physician assistants from a health management organization and fee for service clinician providers from two states in the US covering insured and Medicaid populations.

Perceptions and Experience of Patients, Staff, and Clinicians with Social Needs Assessment.

Context: Assessment of social needs is expanding at Kaiser Permanente (KP), but little is known about how members and clinicians experience the incorporation of social needs into health care.

Objective: To assess how KP members and clinicians experience social needs assessments incorporated into care.

Design: Qualitative and descriptive analysis of data from member and clinician focus groups, interviews, and surveys among 68 members and family caregivers who had participated in social needs assessment programs and 90 clinicians and staff in the KP Colorado, Georgia, Northern California, Northwest, and Southern California Regions.

One In Five Fewer Heart Attacks: Impact, Savings, And Sustainability In San Diego County Collaborative.

Before 2011 rates of hospitalization for heart attacks were about the same in San Diego County as they were in the rest of California. In 2011 a multistakeholder population health collaborative consisting of partners at the federal, state, and local levels launched Be There San Diego. The collaborative's goal was to reduce cardiovascular events through the spread of best practices aimed at improving control of hypertension, lipid levels, and blood sugar and through patient and medical community activation.

Single screen of citations with excluded terms: an approach to citation screening in systematic reviews.

Citation screening during the systematic review process can be time-consuming due to the exponentially increasing amount of research. This letter describes an approach to expediting the process by single screening citations that include terms in the abstract and/or keywords related to the exclusion criteria of the systematic review to quickly reject studies with a high likelihood of being excluded from the systematic review. This method can potentially improve the efficiency of the citation screening process while maintaining the quality of the systematic review; however, future research is needed to further validate this approach.

Using the PDQ-39 in routine care for Parkinson's disease.

Introduction: Using the 39-item Parkinson's Disease Questionnaire (PDQ-39) in routine care could efficiently identify symptoms that are most important to patients, but little evidence documents its use for this purpose.

Methods: A quality improvement pilot project using interviews with patients, caregivers, and providers.

Results: PDQ administration and scoring were successfully integrated into clinic workflows, and results were available for discussions during outpatient visits.

Evidence of a gap in understanding obesity among physicians.

Background: Experience suggests that some physicians view obesity as a purely lifestyle condition rather than a chronic metabolic disease. Physicians may not be aware of the role of biological factors in causing weight regain after an initial weight loss.

Methods: A questionnaire was administered at continuing medical education conferences, both primary care and obesity-specific.

Isocapnic buffering phase: a useful indicator of exercise endurance in patients with coronary artery disease.

Objectives: The significance of the isocapnic buffering (IB) phase - the period between the first ventilatory threshold (1 VT) and respiratory compensation point (RCP) - has not been adequately established in patients. This study aimed to determine the clinical significance of the IB phase in patients with coronary artery disease (CAD).

Methods: This retrospective study included data of sixty-two CAD patients after coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) performed in a single medical center between 2010 - 2014.

Can All Doctors Be Like This? Seven Stories of Communication Transformation Told by Physicians Rated Highest by Patients.

Introduction: The top predictors of patient satisfaction with clinical visits are the quality of the physician-patient relationship and the communications contributing to their relationship. How do physicians improve their communication, and what effect does it have on them? This article presents the verbatim stories of seven high-performing physicians describing their transformative change in the areas of communication, connection, and well-being.

Methods: Data for this study are based on interviews from a previous study in which a 6-question set was posed, in semistructured 60-minute interviews, to 77 of the highest-performing Permanente Medical Group physicians in 4 Regions on the "Art of Medicine" patient survey.

State of the art conference on weight management in VA: Policy and research recommendations for advancing behavioral interventions.

This article summarizes outcomes of the behavioral interventions work group for the Veterans Health Administration (VHA) State of the Art Conference (SOTA) for Weight Management. Sixteen VHA and non-VHA subject matter experts, representing clinical care delivery, research, and policy arenas, participated. The work group reviewed current evidence of efficacy, effectiveness, and implementation of behavioral interventions for weight management, participated in phone- and online-based consensus processes, generated key questions to address gaps, and attended an in-person conference in March 2016.

A System-Level Approach to Overweight and Obesity in the Veterans Health Administration.

Healthcare systems are challenged by steady increases in the number of patients who are overweight and obese. Large-scale, evidence-based behavioral approaches for addressing overweight and obesity have been successfully implemented in systems such as the Veterans Health Administration (VHA). These population-based interventions target reduction in risk for obesity-associated conditions through lifestyle change and weight loss, and are associated with modest weight loss.

Investing in Obesity Treatment: Kaiser Permanente's Approach to Chronic Disease Management.

Kaiser Permanente, an integrated health care delivery system in the USA, takes a "whole systems" approach to the chronic disease of obesity that begins with efforts to prevent it by modifying the environment in communities and schools. Aggressive case-finding and substantial investment in intensive lifestyle modification programs target individuals at high risk of diabetes and other weight-related conditions. Kaiser Permanente regions are increasingly standardizing their approach when patients with obesity require treatment intensification using medically supervised diets, prescription medication to treat obesity, or weight loss surgery.

Maternal Depression and Childhood Overweight in the CHAMACOS Study of Mexican-American Children.

Objective Although previous studies have examined the impact of maternal depression on child overweight and obesity, little is known about the relationship in Latino families, who suffer from high risks of depression and obesity. We prospectively investigated the association between depressive symptoms in women with young children and child overweight and obesity (overweight/obesity) at age 7 years among Latino families. Methods Participants included 332 singletons with anthropometric measures obtained at 7 years from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) study, a birth cohort study.

Screening for and Diagnosis of Depression Among Adolescents in a Large Health Maintenance Organization.

Objective: The aim of this analysis was to determine changes in patterns of depression screening and diagnosis over three years in primary and specialty mental health care in a large health maintenance organization (HMO) as part of a project to develop quality measures for adolescent depression treatment.

Methods: Two series of aggregate data (2010-2012) were gathered from the electronic health records of the HMO for 44,342 unique adolescents (ages 12 to 21) who had visits in primary and mental health care. Chi square tests assessed the significance of changes in frequency and departmental location of Patient Health Questionnaire-9 (PHQ-9) administration, incidence of depression symptoms, and depression diagnoses.

Population Care Management and Team-Based Approach to Reduce Racial Disparities among African Americans/Blacks with Hypertension.

Objectives: At Kaiser Permanente, national Equitable Care Health Outcomes (ECHO) Reports with a baseline measurement of 16 Healthcare Effectiveness Data and Information Set measures stratified by race and ethnicity showed a disparity of 8.1 percentage points in blood pressure (BP) control rates between African- American/black (black) and white members. The aims of this study were to describe a population care management team-based approach to improve BP control for large populations and to explain how a culturally tailored, patient-centered approach can address this racial disparity.

Study protocol for "Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET)": a pragmatic trial comparing implementation strategies.

Background: Little research has directly compared the effectiveness of implementation strategies in any setting, and we know of no prior trials directly comparing how effectively different combinations of strategies support implementation in community health centers. This paper outlines the protocol of the Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET), a trial designed to compare the effectiveness of several common strategies for supporting implementation of an intervention and explore contextual factors that impact the strategies' effectiveness in the community health center setting.

Methods/design: This cluster-randomized trial compares how three increasingly hands-on implementation strategies support adoption of an evidence-based diabetes quality improvement intervention in 29 community health centers, managed by 12 healthcare organizations.

Analysis of effectiveness and safety of a three-part triage system for the access to dermatology specialist health care.

Background: Accessibility and waiting times pose a general problem in public financed health care systems. In Italy a three-part triage system (urgent, priority and deferrable with a corresponding maximum time target before treatment of 1, 8 and 60 days respectively) to gain faster treatment for urgent and emergent cases of dermatology outpatients has been introduced.

Methods: From February 2011 to August 2013, samples of 1526 outpatient electronic medical record cases were randomly retrieved.

Self-Rated Health Among Patients with Coronary Artery Disease Enrolled in a Cardiovascular Risk Reduction Service.

Little is known about the use of the single self-rated health (SRH) status item measuring health-related quality of life among people with coronary artery disease (CAD). The objective of this study was to assess relationships between SRH and recurrent coronary events, mortality, health care utilization, and intermediate clinical outcomes and to assess predictors of fair/poor SRH. A total of 5573 patients enrolled in a comprehensive cardiac risk reduction service managed by clinical pharmacy specialists were evaluated over a 2-year period.

2014 Hypertension Guideline: Recommendation for a Change in Goal Systolic Blood Pressure.

The 2014 Kaiser Permanente Care Management Institute National Hypertension Guideline was developed to assist primary care physicians and other health care professionals in the outpatient treatment of uncomplicated hypertension in adult men and nonpregnant women aged 18 years and older. A major practice change is the recommendation for goal systolic blood pressure less than 150 mmHg in patients aged 60 years and older who are treated for hypertension in the absence of diabetes or chronic kidney disease. This article describes the reasons for, evidence for, and consequences of the change, and includes the guideline.

Tackling 30-Day, All-Cause Readmissions with a Patient-Centered Transitional Care Bundle.

In 2008, Kaiser Permanente Northwest identified the transition from hospital to home as a pivotal quality improvement opportunity and used multiple patient-centered data collection methods to identify unmet needs contributing to preventable readmissions. A transitional care bundle that crosses care settings and organizational functions was developed to meet needs expressed by patients. It comprises 5 elements: risk stratification, a specialized phone number for discharged patients, timely postdischarge follow-up, standardized patient discharge instructions and same-day discharge summaries, and pharmacist-supported medication reconciliation.