Assessing the implementation of a patient navigation intervention for colonoscopy screening.

Background: A recent study demonstrated the effectiveness of the New Hampshire Colorectal Cancer Screening Program's (NHCRCSP) patient navigation (PN) program. The PN intervention was delivered by telephone with navigators following a rigorous, six-topic protocol to support low-income patients to complete colonoscopy screening. We applied the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework to examine implementation processes and consider potential scalability of this intervention.

Cost-effectiveness of a patient navigation intervention to increase colonoscopy screening among low-income adults in New Hampshire.

Background: Colonoscopy is the most widely used colorectal cancer (CRC) screening test in the United States. Through the detection and removal of potentially precancerous polyps, it can prevent CRC. However, CRC screening remains low among adults who are recommended for screening.

Increasing colonoscopy screening in disparate populations: Results from an evaluation of patient navigation in the New Hampshire Colorectal Cancer Screening Program.

Background: To investigate uniformly successful results from a statewide program of patient navigation (PN) for colonoscopy, this comparison study evaluated the effectiveness of the PN intervention by comparing outcomes for navigated versus non-navigated patients in one of the community health clinics included in the statewide program. Outcomes measured included screening completion, adequacy of bowel preparation, missed appointments and cancellations, communication of test results, and consistency of follow-up recommendations with clinical guidelines.

Methods: The authors compared a subset of 131 patients who were navigated to a screening or surveillance colonoscopy with a similar subset of 75 non-navigated patients at one endoscopy clinic.

Chief nursing officer to chief executive officer: lessons learned.

As health care in the United States continues to evolve, more chief nursing officers are moving to the role of chief executive officer. This article describes lessons learned from a chief nursing officer who is currently serving as a chief executive officer of an academic medical center. Eight lessons are described followed by reflective questions encouraging the reader to reflect and begin to internalize the experiences of the past role of a chief nursing officer and their applicability to the potential future role of a chief executive officer.

Analysis of means used to compare providers' referral patterns.

Objectives: The objective of this study was to demonstrate through a case study how an analysis of means (ANOM) chart can be used to compare groups and to advocate the usefulness of this method in improvement work.

Methods: The ANOM technique was used to compare referral rates among providers at the Dartmouth-Hitchcock Medical Center's Spine Center. The purpose was to see whether there were any differences across providers in referral rates to Behavioral Medicine services for patients who scored low on their mental health score and whether referral rates were any different among the patient characteristics.

Nursing care issues in autologous bone marrow transplantation.

The significant growth in annual numbers of autologous bone marrow transplant (ABMT) procedures can be attributed to early promising results and improvements in supportive care. Expert nursing care is an important component of the care provided by the multidisciplinary transplant team. Nurses are challenged by the developing and rapidly changing nature of ABMT indications, the complexity of the therapy regimen, and the management of acute and long-term effects and toxicities.

Diagnosis and management of infantile marfan syndrome.

Marfan syndrome is infrequently diagnosed early in infancy. The experience of the authors with 22 severely affected infants diagnosed as having Marfan syndrome in the first 3 months of life is described and the literature on 32 additional infants with Marfan syndrome is reviewed. It was found that serious cardiac pathology (82% of the patients described in the article, 94% of those described in the literature) may be present at birth, and that congenital contractures (64% of our cases, 47% of literature cases) are often an associated finding.

How to maintain control over the work of accounts receivable service firms.

Healthcare organizations that enter agreements with accounts receivable consulting firms should insist on various contractual safeguards. These controls allow a hospital to reject any recommendation without incurring extra costs; approve the format of bills sent to potential payers and review copies of bills later produced; insist that consultants identify themselves to payers as hospital representatives, not employees; and protect their interests in other ways.

Risk sharing: health care's latest challenge.

With pressure building to reduce healthcare costs, relations between providers and insurers in the years ahead increasingly will focus on risk sharing and utilization controls. Fixed price agreements and managed care plans are two approaches expected to come into wider use. To cope with coming utilization reviews and efforts to manage outpatient care, hospitals will need information systems allowing them to evaluate patient mixes and service intensities.

Identifying psychosocial obstacles to breastfeeding success.

Breastfeeding is an intimate process that requires psychosocial adjustment as well as technical skill. This article reviews research on the relationships of personality, family and social environments, attitudes, and emotional states to breastfeeding outcomes. Risk factors for breastfeeding difficulties are discussed, alternative feeding plans are outlined, and interventions to address psychosocial needs are described.