Comparative Health Systems Research among Kaiser Permanente and Other Integrated Delivery Systems: A Systematic Literature Review

ObjectiveTo evaluate postpartum MRI activity in patients with MS and a completed pregnancy and to compare these results to an age-matched untreated nonpregnant MS cohort.MethodsPatient with MS from a tertiary care MS center between 2006 and 2015, with prepartum and postpartum neurologic follow-ups and MRI scans were analyzed. Clinical activity and inflammatory brain MRI activity (new T2-hyperintense or gadolinium-enhancing [Gd+] lesions) were assessed peripartum. The results were compared with untreated reproductive-age patients with MS from the placebo arm of the clinical trials.ResultsA total of 123 pregnancies in 123 women (median Expanded Disability Status Scale 1.0) were analyzed. Approximately 7.2% relapsed during pregnancy and 48.7% relapsed postpartum. Of pregnancies with prepartum and postpartum gadolinium (Gd)-enhanced MRI (n = 112), 8% had Gd+ lesions prepartum and 33% had new Gd+ lesions postpartum. Overall, 54.4% had either new T2 or Gd+ lesions postpartum. Seventy-nine percent of subjects with postpartum relapse had new MRI activity compared with 37.1% without relapse (p < 0.001). Twenty-five percent had both clinical and radiographic activity and only 24.9% maintained no evidence of disease activity status postpartum. There was no association between postpartum MRI activity and disease-modifying treatments (DMTs) (p > 0.5). MRI and clinical outcomes were also assessed for 126 nonpregnant untreated female patients with MS. Comparing pregnancy and no pregnancy groups, there was no difference in MRI activity at follow-up.ConclusionsThere was a high level of inflammatory radiographic disease activity which was related to relapses in postpartum patients with MS. Further studies are needed to determine whether hormonal fluctuations vs extended time off DMTs may be the underlying cause of our observations.

show abstract

“…These differences may make direct comparisons of outcomes across studies more challenging to interpret. 27 …”

Section: Discussionmentioning

confidence: 99%

MRI activity in MS and completed pregnancy

Houtchens

Bove

Healy

et al. 2020

Neurol Neuroimmunol Neuroinflamm

View full text Add to dashboard Cite

show abstract

“…They include primary and specialty outpatient care, as well as community and tertiary hospital services. The effective use of HIT is a key attribute of successful integrated delivery systems [ 37 , 38 ]. For example, in the case of Kaiser Permanente or the Veterans Affairs systems, the same longitudinal EHR is accessible and shared by both primary care physicians and specialists, thus facilitating the tracking of patients across the continuum [ 38 ].…”

Section: Resultsmentioning

confidence: 99%

Meaningful Use of Electronic Health Records: Experiences From the Field and Future Opportunities

et al. 2015

View full text Add to dashboard Cite

BackgroundWith the aim of improving health care processes through health information technology (HIT), the US government has promulgated requirements for “meaningful use” (MU) of electronic health records (EHRs) as a condition for providers receiving financial incentives for the adoption and use of these systems. Considerable uncertainty remains about the impact of these requirements on the effective application of EHR systems.ObjectiveThe Agency for Healthcare Research and Quality (AHRQ)-sponsored Centers for Education and Research in Therapeutics (CERTs) critically examined the impact of the MU policy relating to the use of medications and jointly developed recommendations to help inform future HIT policy.MethodsWe gathered perspectives from a wide range of stakeholders (N=35) who had experience with MU requirements, including academicians, practitioners, and policy makers from different health care organizations including and beyond the CERTs. Specific issues and recommendations were discussed and agreed on as a group.ResultsStakeholders’ knowledge and experiences from implementing MU requirements fell into 6 domains: (1) accuracy of medication lists and medication reconciliation, (2) problem list accuracy and the shift in HIT priorities, (3) accuracy of allergy lists and allergy-related standards development, (4) support of safer and effective prescribing for children, (5) considerations for rural communities, and (6) general issues with achieving MU. Standards are needed to better facilitate the exchange of data elements between health care settings. Several organizations felt that their preoccupation with fulfilling MU requirements stifled innovation. Greater emphasis should be placed on local HIT configurations that better address population health care needs.ConclusionsAlthough MU has stimulated adoption of EHRs, its effects on quality and safety remain uncertain. Stakeholders felt that MU requirements should be more flexible and recognize that integrated models may achieve information-sharing goals in alternate ways. Future certification rules and requirements should enhance EHR functionalities critical for safer prescribing of medications in children.

show abstract

“…Trabajo Social Global -Global Social Work, Vol 10, nº 18, enero-junio 2020, 94-115 predictivos en el marco de esta estrategia -como por ejemplo el modelo de Káiser Permanente (Maeda, Lee & Horberg, 2014;Nuño, 2015) o el Chronic Care Model (Coleman, Austin, Brach & Wagner, 2009) busca reconocer subpoblaciones mediante la identificación de pacientes en situación de cronicidad que precisen de un nivel de necesidad concreto y puedan beneficiarse de programas ajustados a sus características (Nuño, Contel, Orueta y García, 2013;Viguera, 2013). Se busca así, ofrecer una atención singularizada que pueda resultar más ágil y proactiva.…”

Section: La Analogía Con El Sistema Sanitariounclassified

La cronicidad en el marco de los servicios sociales: aportaciones para su discusión

2020

View full text Add to dashboard Cite

En este artículo partimos de un trabajo de investigación realizado en los servicios sociales municipales del Ayuntamiento de Lleida sobre población en situación de cronicidad. A partir de él, nos permitimos efectuar un conjunto de aportaciones sobre este fenómeno y el contexto en el cual se produce. En primer lugar, apuntamos la conveniencia de realizar un esfuerzo teórico para dotar de contenido el término cronicidad, dado que resulta un concepto demasiado vacío dentro de la esfera social, y, por tanto, de escaso valor técnico. Como hipótesis, planteamos su uso a modo de categoría conceptual, con el fin que en ella se puedan integrar las diversas manifestaciones y tipologías asociadas al fenómeno. Seguidamente, tomamos en consideración el tratamiento de la cronicidad en el ámbito de la salud, y subrayamos el interés por ciertas líneas de trabajo de carácter proactivo, cuyas orientaciones pueden resultar significativas para el ámbito social. Finalmente, sostenemos la necesidad de profundizar en la base científica de las intervenciones que se llevan a cabo desde los servicios sociales -en este caso con el fenómeno de la cronicidad- como una vía estratégica que contribuya a superar las lógicas de actuación reactivas dominantes.

show abstract

Comparative Health Systems Research among Kaiser Permanente and Other Integrated Delivery Systems: A Systematic Literature Review

Cited by 14 publications

References 64 publications

MRI activity in MS and completed pregnancy

MRI activity in MS and completed pregnancy

Meaningful Use of Electronic Health Records: Experiences From the Field and Future Opportunities

La cronicidad en el marco de los servicios sociales: aportaciones para su discusión

Contact Info

Product

Resources

About