February 2019, Volume XXXII, No 11
Change management
Improving outcomes in health care
In health care, where change management is often viewed with dread rather than enthusiasm, this might seem like a surprising way to begin. Change management is most often defined as the process, tools, and techniques required to achieve a certain business outcome. This includes supporting people to make changes.
February 2019, Volume XXXII, No 11
interview
Shaping our health and well-being
John R. Finnegan Jr., PhD, University of Minnesota School of Public Health
cover story One
Change management: Improving outcomes in health care
By Claire S. Neely, MD, FAAP; and Sarah Horst, MA
In health care, where change management is often viewed with dread rather than enthusiasm, this might seem like a surprising way to begin. Change management is most often defined as the process, tools, and techniques required to achieve a certain business outcome. This includes supporting people to make changes.
cover story two
Evidence synthesis: Improving outcomes, avoiding waste
By Timothy Wilt, MD, MPH; Wei (Denise) Duan-Porter, MD, PhD; and Nancy Greer, PhD
The amount of information available to make health care decisions is enormous and changing rapidly. Clinicians, health systems, policy makers, researchers, and patients often find it difficult to identify the “right information” about the effects of health care interventions. These medical information “end-users” increasingly rely on systematic reviews and corresponding
Pain Management
Dialing down opioid use: Alternative treatments
By David Schultz, MD
The opioid crisis currently gripping the U.S. presents significant challenges for the treatment of chronic pain. For much of the 2000s, opioids were liberally prescribed to treat pain, but in recent years, it has become clear that prescription opioids may lead to abuse, addiction, and overdose death in a certain population of chronic pain patients.
Behavioral Health
Play therapy: Helping medically complex pediatric patients
By Monica Oberg, MSW, LICSW
Six-year-old Hannah has required around-the-clock care for spina bifida and other complex medical conditions her entire life. A trach tube, feeding tube, and wheelchair are indicators of her numerous days and nights spent in a hospital or clinic awaiting another test or surgery—experiences that have
PROFESSIONAL UPDATE: Cardiology
Acute aortic dissection: Timely recognition and multidisciplinary care
By Jasmine Curry, BS; Matt Pavlovec, RN, BSN; and Kevin M. Harris, MD
An acute aortic dissection (AD) occurs when there is a tear in the intima, the inner layer of the aorta, allowing blood to travel through a separate channel (false lumen), often leading to complications which may include cardiac tamponade, aortic regurgitation, ischemia of the branch vessels, and, ultimately, aortic rupture. The patient’s symptoms depend on the path of the dissection and which organs are malperfused. Most commonly, patients with AD have symptoms of chest or back pain
Behavioral Health
Adolescent medicine: Meeting unique needs
By Andrea Westby, MD; Michelle D. Sherman, PhD, LP, ABPP; and James Smith, MD, MPH
Adolescence. For many parents, educators, and health care providers, this word elicits some combination of terror, uncertainty, and excitement. Adolescence (defined by the World Health Organization as ages 10–19) is a time of tremendous change across physical, social, relational, and spiritual domains, as youth transition from
Medicine and the Law
“Stark” legislation and regulation: Updating the updates
By Antonio “Tony” Fricano, JD
On June 20, 2018, the Centers for Medicare & Medicaid Services (CMS) announced that there will be what CMS called a “Regulatory Sprint” to revamp the Physician Self-Referral Law (commonly referred to as the “Stark Law,” named for its original sponsor, California Congressman Pete Stark). CMS is seeking recommendations and input from the public on how to address any undue impact and burden of the Stark Law
Cardiovascular Disease
The “Million Hearts” initiative: Addressing heart attacks and strokes
By Stanton Shanedling, PhD, MPH
Preventing one million heart attacks and strokes over five years is a powerful call to action—one that was taken on in 2012 by the U.S. Department of Health and Human Services, and co-led by the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS) under the Million Hearts initiative.
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