Reducing avoidable emergency department (ED) visits is an important health system goal. This is a retrospective cohort study of the impact of a primary care intervention including an in-hospital, free, adult clinic for poor uninsured patients on ED visit rates and emergency severity at a nonprofit hospital. We studied adult ED visits during August 16, 2009-August 15, 2011 (preintervention) and August 16, 2011-August 15, 2014 (postintervention). We compared pre- versus post-mean annual visit rates and discharge emergency severity index (ESI; triage and resource use–based, calculated Agency for Healthcare Research and Quality categories) among high-users (≥3 ED visits in 12 months) and occasional users. Annual adult ED visit volumes were 16 372 preintervention (47.5% by high-users), versus 18 496 postintervention. High-users’ mean annual visit rates were 5.43 (top quartile) and 0.94 (bottom quartile) preintervention, versus 3.21 and 1.11, respectively, for returning high-users, postintervention (all P < .001). Postintervention, the visit rates of new high-users were lower (lowest and top quartile rates, 0.6 and 3.23) than preintervention high-users’ rates in the preintervention period. Visit rates of the top quartile of occasional users also declined. Subgroup analysis of medically uninsured high-users showed similar results. Upon classifying preintervention high-users by emergency severity, postintervention mean ESI increased 24.5% among the lowest ESI quartile, and decreased 12.2% among the top quartile. Pre- and post-intervention sample demographics and comorbidities were similar. The observed reductions in overall ED visit rates, particularly low-severity visits; highest reductions observed among high-users and the top quartile of occasional users; and the pattern of changes in emergency severity support a positive impact of the primary care intervention.
Despite the evidence indicating that decision aids (DA) improve informed treatment decision making for prostate cancer (PCa), physicians do not routinely recommend DAs to their patients. We conducted semi-structured interviews with urologists (n = 11), radiation oncologists (n = 12) and primary care physicians (n = 10) about their methods of educating low-risk PCa patients regarding the treatment decision, their concerns about recommending DAs, and the essential content and format considerations that need to be addressed. Physicians stressed the need for providing comprehensive patient education before the treatment decision is made and expressed concern about the current unevaluated information available on the Internet. They made recommendations for a DA that is brief, applicable to diverse populations, and that fully discloses all treatment options (including active surveillance) and their potential side effects. Echoing previous studies showing that low-risk PCa patients are making rapid and potentially uninformed treatment decisions, these results highlight the importance of providing patient education early in the decision-making process. This need may be fulfilled by a treatment DA, should physicians systematically recommend DAs to their patients. Physicians' recommendations for the inclusion of particular content and presentation methods will be important for designing a high quality DA that will be used in clinical practice.
In our Engineering Communication Skills classrooms we aim to provide a meaningful setting in which students move from the classroom sphere to the professional sphere of writing. In this paper, we report on how we can use community service learning (CSL) IntroductionThe -Communication Skills for Engineering Students‖ courses we offer at Carleton University are designed to teach students to adapt their communication skills to new contexts and audiences (beyond the classroom), and thus ultimately be able to communicate successfully as professional engineers. Description of CSL Community Service Learning DefinedCSL is a unique form of experiential learning. The underlying difference between CSL opportunities and other experiential approaches to learning is that CSL opportunities benefit both the student and the recipient of the service; a service is provided while at the same time learning is occurring [2]. Furthermore, CSL programs, unlike volunteer programs, must have some type of academic context [3]. The key to CSL is that the learning experiences are wellconnected with the course material in a way that the engagement with the course material aids in more successful and effective comprehension of the content matter being taught [4]. Benefits of Community Service Learning on Post-Secondary StudiesThere is a growing body of literature which documents the benefits of CSL during undergraduate studies [5][6] [7]. Four benefits discussed here are 1) more effective learning, 2) student engagement and retention, 3) creation of a bridge between university and workplace writing, and 4) development of stronger writing skills. More effective learningCSL projects lead to more successful learning, given the belief that learning occurs through coparticipation in a process [8].-Experience in and of itself is not educative unless it is ...linked with efforts to move beyond individual experience to consideration of larger social processes‖ [9,p. 78]. Learning is social and happens when communication occurs while working towards a practical goal.[10]. Student engagement and retentionCSL has been found to lead to increased student engagement, improved academic outcomes and ultimately, to increased rates of retention [11] Creation of a bridge between university and professional writingLearning to write for and in university is very different from learning to write in the workplace. In the university, students are taught to write. In the workplace, on the other hand, learning to write is incidental, as learners act in a community of practice (COP) [15] to achieve a goal [8]. The genre features are a manifestation of the knowledge which an organization possesses which allows it to function as a group [16]. The genres reflect the routines / habitual practices of the group. As newcomers are socialized into the COP, they acquire the genre of that COP. [8,p.113].‖ Potential readers are many and often indeterminate, and these readers will have different purposes for reading these texts. In the university, on the other hand, a...
Community-based writing classrooms are on the rise, but the "movement as a whole remains largely unstudied" (Deans 14). In their book Writing the Community, Linda Adler-Kassner, Robert Crooks and Ann Waters call community-based initiatives a micro revolution because, despite the growing number
The Perspectives on Writing series addresses writing studies in a broad sense. Consistent with the wide ranging approaches characteristic of teaching and scholarship in writing across the curriculum, the series presents works that take divergent perspectives on working as a writer, teaching writing, administering writing programs, and studying writing in its various forms.The WAC Clearinghouse and Parlor Press are collaborating so that these books will be widely available through free digital distribution and low-cost print editions. The publishers and the Series editor are teachers and researchers of writing, committed to the principle that knowledge should freely circulate. We see the opportunities that new technologies have for further democratizing knowledge. And we see that to share the power of writing is to share the means for all to articulate their needs, interest, and learning into the great experiment of literacy.
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