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BackgroundApproximately 24 million Americans are living with diabetes. Patient activation among individuals with diabetes is critical to successful diabetes management. The Patient Centered Medical Home (PCMH) model holds promise for increasing patient activation in managing their health. However, what is not well understood is the extent to which individual components of the PCMH model, such as the quality of physician-patient interactions and organizational features of care, contribute to patient activation. This study’s objective is to determine the relative importance of the PCMH constructs or domains to patient activation among individuals living with diabetes.MethodsThis study is a cross-sectional analysis of 1253 primary care patients surveyed with type II diabetes. The dependent variable, patient activation, was assessed using the Patient Activation Measure (PAM). Independent variables included 7 PCMH domains- organizational access, integration of care, comprehensive knowledge, office staff helpfulness, communication, interpersonal treatment and trust. Ordered logistic regression was performed to determine whether each PCMH domain was independently associated with patient activation, followed by a final ordered logistic regression that included all the PCMH domains in a single adjusted model.ResultsUsing the full adjusted model, the odds of patients reporting higher activation scores (PAM) were found to be significant in the domains that represented organizational access (OR 1.56, 95% CI 1.31–1.85) and comprehensive knowledge (OR 1.44, 95% CI 1.13–1.85).ConclusionsMany practices have struggled with the challenge to develop fully functional patient-centered medical homes. In an effort to become more patient-centered, this study aimed to address what factors activated diabetic patients to adhere to diabetes management plan. Understanding these factors can help identify PCMH attributes that practices can prioritize and improve upon to assist their patients in improving health outcomes.Trial registrationStudy was not a clinical trial; therefore it was not registered.

The novel coronavirus disease 2019 (COVID-19) continues to be a major public health concern. The aim of this study was to describe the presenting characteristics, epidemiology and predictors of outcomes among confirmed COVID-19 cases seen at a large community healthcare system which serves the epicenter and diverse region of Florida. We conducted a retrospective analysis of individuals with lab-confirmed SARS-CoV-2 infection who were seen, from March 2, 2020 to May 31, 2020, at Memorial Healthcare System in South Florida. Data was extracted from a COVID-19 registry of patients with lab-confirmed SARS-CoV-2 infection. Univariate and backward stepwise multivariate logistic regression models were used to determine predictors of key study outcomes. There were a total of 1692 confirmed COVID-19 patients included in this study. Increasing age was found to be a significant predictor of hospitalization, 30-day readmission and death. Having a temperature of 38 °C or more and increasing comorbidity score were also associated with an increased risk of hospitalization. Significant predictors of ICU admission included having a saturated oxygen level less than 90%, hypertension, dementia, rheumatologic disease, having a respiratory rate greater than 24 breaths per minute. Being of Hispanic ethnicity and immunosuppressant utilization greatly increased the risk of 30-day readmission. Having an oxygen saturation less than 90% and an underlying neurological disorder were associated with an increased likelihood of death. Results show that a patient’s demographic, underlying condition and vitals at triage may increase or reduce their risk of hospitalization, ICU admission, 30-day readmission or death.

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Communication skills are paramount for a successful veterinary curriculum. Technological advances have improved communication processes, and the way instruction is delivered. Yet, with these advances come challenges such as email overload, increased interruptions, and miscommunications. Time is a valuable commodity at any high caseload veterinary teaching hospital. When increasingly more time is spent sending and receiving emails, text messages, pages, and calls in lieu of more focused clinical teaching, then the modes of communication and traditional learning theories need to be evaluated. An effective mode of communication is needed to reduce information overload and miscommunication. This article describes lessons learned from a pilot study to determine if a team-based messaging application could improve a surgical team’s communication by having all forms of transmitted media directly related to their scope of work accessible to everyone on the team in one real-time digital platform (Slack). Fifteen members of a university-based surgical team were enrolled into the study and provided with surveys at specific time points to evaluate the efficacy of an internet-based team communication tool during a 3-month period. Results of our study showed an overall perception of improved communication among team members when using a team-based communication platform. Recommendations are provided to address team member’s underutilization of the platform, which resulted in duplicate messages and miscommunication. We conclude an initial adoption by staff members is essential when implementing significant shifts in communication platforms.

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