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Here's a common hospital discharge scenario: the patient is ready to be discharged home, and the hospital has a discharge planner or case manager who is prepared to call the patient's primary care physician (PCP) to discuss the patient's post-discharge care. But who does the discharge planner call? And will anyone respond to the call?
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A health care model that seeks to improve quality while reducing costs is attracting more attention lately as the health care reform has made it a priority for pilot project funds.
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In quality improvement circles, certain states have gained a reputation for excellence, and recent statistics out of Pennsylvania seem to indicate that this particular state's reputation is well deserved. A new report issued by the Pennsylvania Department of Health (DOH) shows a decline of 12.5% for overall health care-associated infection (HAI) rates at the state's acute care hospitals in 2009.
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Infection preventionists must seize an extraordinary moment in health care, when divergent forces are aligning to redesign a system that has failed to contain costs and protect the lives to which it has been entrusted, Atul Gawande, MD, MPH, said recently in New Orleans in the keynote address at the 37th annual educational conference of the Association for Professionals in Infection Control and Epidemiology (APIC).
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Alarming public health officials, a highly drug-resistant gram negative bacterial strain that is emerging rapidly in hospitals in India has been detected in patients in three U.S. states.
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While there are uncomplicated patient cases where physician-patient communication is fairly straightforward, such communication also can range to the other end of the continuum involving end-of-life care and related decision-making.
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Internet research has been an issue for institutional review boards since its roots in the 1990s, and the challenges ethics boards face in reviewing such studies are in pioneer territory.
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"The paternalistic model assumes that there are shared objective criteria for determining what is best. Hence the physician can discern what is in the patient's best interest with limited patient participation . . . the physician acts as the patient's guardian, articulating and implementing what is best for the patient...The conception of patient autonomy is patient assent, either at the time or later, to the physician's determinations of what is best.""Four Models of the Physician-Patient Relationship." JAMA. April 22/29, 1992 Vol 267, No. 16.