Healthcare Delivery Practices Research Articles

Core values of employed general practitioners in Germany – a qualitative study

Background“Core values” help to guide practice of health care delivery. The core values of general practice are described in the European definition of general practice by WONCA, e.g. a holistic, comprehensive and continuous care. They may be associated with the idea that the general practitioner is the owner of the practice rather than an employee.ObjectivesThe objective was to examine the core values of employed GPs in their professional setting and their practical manifestation.MethodsFrom April to May 2021, we conducted 17 semi-structured telephone-interviews with employed GPs in two districts in Baden-Wuerttemberg, Germany. The data were analysed using qualitative content analysis.ResultsWe identified twelve core values, including values relevant to patient care and values relevant to the lives of employed GPs. Values with high relevance were job satisfaction, the professional distance from patients, collaboration and collegial exchange, comprehensive care, adequate consultation time and availability to patients. Values with heterogeneous relevance were continuity of care, waiting times and medical autonomy. The value “availability” of employed GPs to patients was associated with both patient care and personal life. The limited availability of employed GPs was accompanied by tensions between these two trends and other values.ConclusionThe values of employed GPs are partly consistent with the current WONCA definition of general practice. There were also indications of new values. The increase in the proportion of employed GPs implies a need to reflect on the core values of general practice, taking into account factors on the part of employed GPs, patients, and practice organisation.

Improving Health Training Institutions Status to Function As Tertiary: Challenges and the Way Forward in Ghana

The objective of this opinion article is to explain how to improve Health Training Institutions Status to Function as Tertiary. Health Training Institution (HTI) is a unit under Ministry of Health of Ghana which has as its principal object the conducting of courses of training in the theory and practice of health care delivery, including nursing, midwifery and allied health subjects. These and many other measures like being abreast with accreditation procedures, improving facilities such as library, ICT and skill laboratories, general infrastructure and proper and efficient governance system coupled with good leadership style to reflect on the contemporary tertiary education system.

Surgical waitlist management: Perspectives from surgeons on surgical prioritization at a paediatric hospital.

Globally exacerbated surgical waitlists have provided the opportunity to reflect on prioritization and resource allocation decisions. The unique circumstances of paediatric surgery and consequences of surgical delay prompted the study reported in this paper. As part of a larger project to attend to prioritization in our surgical waitlists, we conducted a Quality Improvement study, the purpose of which is to understand surgeon's perspectives regarding the ethical and practical realities of surgical prioritization at our institution. The study comprises semi-structured interviews with nine full-time paediatric surgeons from a variety of subspecialties conducted at our institution, which is a tertiary paediatric hospital with ten surgical subspecialties in a publicly funded healthcare system. Participants articulated how they prioritize their waitlists, and how they understand ethical prioritization. These findings resonate with the growing public concern for ethical practice in healthcare delivery and transparency in prioritization and resource allocation practices. Specifically, more transparency, consistency, and support is required in prioritization practices. This work highlights the importance of institutional dialogue regarding surgical case prioritization. Because quality improvement work is necessarily site-specific, concrete generalizations cannot be offered. However, the insights gleaned from these interviews and the process by which they were gleaned are a valuable knowledge-sharing resource for any institution that is interested in ongoing quality improvement work. The objectives here were to clarify the goals of prioritization within the institution, improve prioritization practices, and make them more ethical and transparent.

Impact of HPV testing in Opportunistic Cervical Screening: Support for Primary HPV Screening in the United States.

Human papillomavirus (HPV) testing for cervical screening increases diagnosis of precancer and reduces the incidence of cervical cancer more than cytology alone. However, real-world evidence from diverse practice settings is lacking for the United States (U.S.) to support clinician adoption of primary HPV screening. Using a population-based registry, which captured all cervical cytology (with or without HPV testing) and all cervical biopsies, we conducted a real-world evidence study of screening in women aged 30-64 years across the entire state of New Mexico. Negative cytology was used to distinguish co-tests from reflex HPV tests. A total of 264 198 cervical screening tests (with exclusions based on clinical history) were recorded as the first screening test between 2014-2017. Diagnoses of cervical intraepithelial neoplasia grades 2 or 3 or greater (CIN2+, CIN3+) from 2014-2019 were the main outcomes. Of cytology-negative screens, 165 595 (67.1%) were co-tests and 4.8% of these led to biopsy within 2 years vs 3.2% in the cytology-only group. Among cytology-negative, HPV tested women, 347 of 398 (87.2%) CIN2+ cases were diagnosed in HPV-positive women, as were 147 of 164 (89.6%) CIN3+ cases. Only 29/921 (3.2%) CIN3+ and 67/1964 (3.4%) CIN2+ cases were diagnosed in HPV-negative, cytology-positive women with biopsies. Under U.S. opportunistic screening, across a diversity of health care delivery practices, and in a population suffering multiple disparities, we show adding HPV testing to cytology substantially increased the yield of CIN2+ and CIN3+. CIN3+ was rarely diagnosed in HPV-negative women with abnormal cytology, supporting U.S. primary HPV-only screening. This article is protected by copyright. All rights reserved.

Effects of the COVID-19 pandemic on the approach to emergency surgery: a comparative study

Background & objective: Corona pandemic has had profound effects on the practice of healthcare delivery across the globe. The institutional practices and protocols had to be rewritten to cope up with the surge of corona patients and to save the staff and the non-corona patients. We evaluated the emergency surgery cases during the first wave of COVID-19 after the decision to stop elective surgeries, in regard to differences in terms of case distribution, patient profile, anesthesia methods used and the management, and compared with an equivalent period before the pandemic.
 Methodology: Patient files related to emergency surgery from October-November 2019 and April-May 2020, were retrospectively evaluated. Assessment parameters included age, gender, surgical discipline, ASA score, type of anesthesia, time to discharge, reoperation, laparoscopic or open surgery.
 Results: The most common surgical cases in both periods belonged to general surgery. While the number of patients in ASA-I decreased during the COVID period, those in ASA-II increased. We found that while general anesthesia was preferred in majority of the surgeries during the non-COVID period, spinal anesthesia gained popularity in the COVID period (p < 0.05).
 Conclusion: The decrease in the number of patients with ASA-I indicates a change in the surgeons’ priorities in emergency surgery cases. Although there is a worldwide approach to the use of laparoscopic surgery, the use of open surgical techniques increased in our hospital.
 Key words: Covid-19; Pandemic, Emergency surgery
 Citation: Akcaalan Y, Erkilic E, Gulec H, Gumus T, Ozturk L, Kayan G, Kanbak O, Celik N. Effects of the COVID-19 pandemic on the approach to emergency surgery: a comparative study. Anaesth. pain intensive care 2022;26(3):469-473; DOI: 10.35975/apic.v26i4.1949
 Received: Sep 29, 2021; Reviewed: Jan 10, 2022; Accepted: Mar 26, 2022

Status of Compassionate, Respectful, and Caring Health Service Delivery: Scoping Review.

BackgroundA compassionate, respectful, and caring (CRC) health professional is very important for human-centered care, serving clients ethically and with respect, adhering to the professional oath, and serving as a model for young professionals. As countries try to achieve universal health coverage (UHC), quality delivery of health services is crucial. CRC health care is an initiative around the need to provide quality care services to clients and patients. However, there is an evidence gap on the status of CRC health care service delivery.ObjectiveThis scoping review aimed to map global evidence on the status of CRC health service delivery practice.MethodsAn exhaustive literature review and Delphi technique were used to answer the 2 research questions: “What is the current status of CRC health care practices among health workers?” and “Is it possible for health professionals, health managers, administrators, and policy makers to incorporate it into their activity while designing strategies that could improve the humanistic and holistic approach to health care provision?” The studies were searched from the year 2014 to September 2020 using electronic databases such as MEDLINE (PubMed), Cochrane Library, Web of Science, Hinari, and the World Health Organization (WHO) library. Additionally, grey literature such as Google, Google Scholar, and WorldWideScience were scrutinized. Studies that applied any study design and data collection and analysis methods related to CRC care were included. Two authors extracted the data and compared the results. Discrepancies were resolved by discussion, or the third reviewer made the decision. Findings from the existing literature were presented using thematic analysis.ResultsA total of 1193 potentially relevant studies were generated from the initial search, and 20 studies were included in the final review. From this review, we identified 5 thematic areas: the status of CRC implementation, facilitators for CRC health care service delivery, barriers to CRC health care delivery, disrespectful and abusive care encountered by patients, and perspectives on CRC. The findings of this review indicated that improving the mechanisms for monitoring health facilities, improving accountability, and becoming aware of the consequences of maltreatment within facilities are critical steps to improving health care delivery practices.ConclusionsThis scoping review identified that there is limited CRC service provision. Lack of training, patient flow volume, and bed shortages were found to be the main contributors of CRC health care delivery. Therefore, the health care system should consider the components of CRC in health care delivery during in-service training, pre-service training, monitoring and evaluation, community engagement, workload division, and performance appraisal.

Impact of the Ebola Virus disease in Nigeria

The study, impact of Ebola Virus Disease in Nigeria, is intended to assess the prevention and control program implemented by the Nigerian government towards a successful containment of the outbreak of Ebola Virus Disease; determine the effectiveness of the program implemented in terms of public awareness, healthcare delivery practices and provision of resources; also determine the impact of the Ebola Virus Disease in terms of economic, social and psychological. The study utilized the descriptive research design and a self-structured questionnaire. A pre-test of the questionnaires was conducted to test their reliability. Data were analyzed using weighted and composite means, ranking, and Pearson Correlation. Findings showed that the Ebola Virus Disease prevention and Control Programs initiated by the government were highly implemented and effective with respect to public awareness, healthcare delivery practices, and provision of the resource. Finally, Ebola Virus Disease had a great negative impact on the economic, social, and psychological health status of Nigerians .

Quality and Safety Challenges in Inpatient Pediatric Care during the COVID‐19 Pandemic: A National Qualitative Study

Research ObjectiveThe COVID‐19 pandemic has necessitated rapid changes in healthcare delivery, including surge planning and modifying healthcare delivery environments and practices. Our objective was to identify the major resulting challenges for quality and safety of pediatric inpatient care.Study DesignWe conducted semi‐structured video interviews. Using constant comparative methods, we iteratively coded data to identify themes related to pediatric inpatient quality and safety challenges during the pandemic.Population StudiedWe purposefully sampled from community and children's hospitals serving pediatric patients in the 6 U.S. states with the highest COVID‐19 hospitalization rates at the onset of the pandemic (NY, NJ, DC, MA, CT, LA). We recruited 2 front‐line clinicians per site (mix of administrators, nurses, physicians).Principal FindingsTwenty‐four participants from 12 hospitals were interviewed. The most commonly encountered themes are detailed in Table 1. Changes in healthcare delivery practices potentially impacting quality and safety of inpatient pediatric care included: 1) limits on family and caregiver visitation, which may have hindered gathering important details for diagnosis and engaging in shared‐decision making about management; 2) personal protective equipment and isolation practices, which may have compromised effective communication with caregivers and interpreters; 3) changes in quality improvement (QI) infrastructure and activities, with potential decreases in monitoring and safety efforts; 4) difficulties defining and providing high‐quality care for children with COVID‐19 and multi‐system inflammatory syndrome in children, both novel diagnoses; and 5) potential increases in safety events due to decreased direct contact with patients and monitoring (e.g., wound infections, central line‐associated bloodstream infections and catheter‐associated urinary tract infections).TABLE 1 ThemeExemplary QuoteLimiting family or caregiver visitation“In challenging diagnoses, even if it wasn't COVID‐related, you couldn't have both parents there at the same time.”Experiencing personal protective equipment or isolation status as a barrier to communication“With non‐English speaking parents, we were trying to use an interpreter phone with an N9, an extra mask, the negative pressure circulator running in the background. Trying to get a good history and to provide quality care was really brutal.”Difficulty maintaining high‐quality care“These people would not have any care. They would be sitting in the ED in the hallway, one ED doc taking care of 50 patients. No, you were not qualified to take care of this patient, but this is a pandemic.”Changes in QI operations (staffing, data monitoring, QI activities)“Everything non‐essential stopped. Meetings canceled, research on hold, IRB halted, labs shut down. We have mandatory reporting on things like sepsis. There was too much else going on, we stopped measuring certain things.”Increasing healthcare‐associated safety events or harms“We had an uptake in our CLABSI, in every healthcare‐associated condition we were capable of tracking. After the fact, because that was not the priority.”ConclusionsThis national qualitative study of early COVID‐19 epicenters described changes in several domains of healthcare delivery affecting quality and safety of pediatric inpatient care.Implications for Policy or PracticeThe several potential areas of focus identified can help clinicians and hospital leaders plan for safe and high‐quality care for hospitalized children, during this ongoing crisis and for future pandemics.Primary Funding SourceAgency for Healthcare Research and Quality.

Online Healthcare Practices and Associated Stakeholders: Review of Literature for Future Research Agenda

The rise of online platforms for health information exchange is changing the traditional healthcare delivery practices. With Internet technologies, online healthcare practices are continuously growing through their diversified delivery functionalities with better and faster reachability. Participants use such forums for various purposes, for instance, to gather information, seek medical assistance, connect with other users, and purchase healthcare products or services. The need for a consolidated study, considering all key aspects of virtual healthcare, is crucial. We aim to examine the existing literature to study stakeholders of online healthcare and their behaviour dynamics, available functionalities and service delivery approaches during different phases. We have identified five key stakeholders who are vital for online healthcare deliveries and explored their contributions across life-cycle stages of online healthcare community (OHC) in India. The PRISMA reporting approach was used to select suitable literature for this study. About 78 articles were identified, which were shortlisted to 67 articles, keeping in mind the objectives of this study. Key findings from all these articles are segregated according to identified themes and systematically presented to enlarge the visibilities of associated functionalities. This study is one of the initial studies on India’s OHC that has defined associated stakeholders, functionalities and association dynamics during different life-cycle phases. People are proactively emerging towards OHC to acquire knowledge, share experience and decide their healthcare drives. Being operated virtually, information technology (IT) is the driving factor of OHC, and we have addressed the diversified IT aspects applicable in an OHC set-up. We also have accumulated all key attributes of OHC and produced a theoretical framework through this study, which academic researchers can use to understand the present approaches better and derive futuristic studies. Similarly, service providers can use the findings to evaluate their services, identify the present loopholes in the operational approaches and effectively manage the deliverables to meet end-user needs.

Partnership Forum: The Role of Research in the Transformation of Veterans Affairs Community Care.

Partnership Forum: The Role of Research in the Transformation of Veterans Affairs Community Care.

Intersectional invisibility experiences of low-income African-American women in healthcare encounters

ABSTRACT Background The disparities that Black/African-American women experience in health care are persistent and staggering. Findings from health outcomes research continue to demonstrate poorer outcomes for African-American women compared to women of other race/ethnicity in several conditions. These racial/ethnic and gender health disparities observed are complex, heavily nuanced and multi-factorial. To understand these, there is a need to apply an ‘intersectionality’ lens. Intersectionality refers to the experience of persons with multiple intersecting statuses. The objective of this exploratory study was to gain insight into the healthcare experiences of low-income African-American women. Methods In-depth one-on-one interviews were conducted with 22 women and 2 focus group discussions with community leaders and advocates. Investigators conducted a thematic analysis of the transcripts. Results The thematic analysis revealed four major themes, which tell the story of the intersectional invisibility experienced by low-income AA women in the healthcare system. These included (1) the perception of ‘not feeling heard’; (2) patient as ‘expert of her own body’; (3) disregard of patient preferences; and (4) the need for self-advocacy. Conclusions Black/African-American women, and particularly those with socioeconomic disadvantage, experience intersectional invisibility resulting from provider implicit bias, stereotypical assumptions, and systemic structures that enable discriminatory practices in healthcare delivery. Healthcare provider education that more explicitly addresses these biases and stereotypes should be complemented with system-level interventions that aim to dismantle the structural racism inherent in healthcare policies and practices.

“Seconds save lives – clean your hands”: the 5 May 2021 World Health Organization SAVE LIVES: Clean Your Hands campaign

To highlight the urgent need to save lives by implementing best practices in health care delivery, the slogan for 5 May 2021, world hand hygiene day, is “Seconds save lives – clean your hands”. The WHO campaign calls to action key stakeholders: health care workers, IPC practitioners, patients and families, facility managers, policy-makers, vaccinators, and the general public who can play critical roles in achieving optimal hand hygiene at the point of care, helping to strengthen society involvement.

Impact of geography and travel distance on outcomes in epithelial ovarian cancer: a national cancer database analysis

BackgroundAs ovarian cancer treatment shifts to provide more complex aspects of care at high-volume centers, almost a quarter of patients, many of whom reside in rural counties, will not have...

Knowledge creation practices at organizational boundaries: the role of ICT in sickle-cell care for tribal communities

PurposeThis paper aims to examine the role of information and communication technology (ICT) in the knowledge creation practices adopted by a health care organization. The organization is delivering care to patients of a genetic disorder, called the sickle cell, in tribal communities. The paper identifies how ICT intermediates knowledge creation practices across the organizational boundaries wherein tribal patients, front-line counselors and expert physicians interact, which then produces context-specific, evidence-based medicine (EBM).Design/methodology/approachThe knowledge-in-practice approach is adopted to conduct an ethnographic study of sickle cell care practices in a non-profit health care organization in Western India. The analysis focuses on ICT-mediated interactional practices among the physicians, front-line counselors, tribal patients and their families, for more than a year-long observation. These are supplemented with informal and formal interviews, archival records and vignettes based on several episodes to explicate the key knowledge creation practices.FindingsTechnology-mediated informative interactions at organizational boundaries can bridge socio-linguistic and interpretive barriers between actors, while also providing a generative structure that leads to the creation of longitudinal clinical evidence about a rare genetic disorder. Three specific ICT-entwined knowledge creation practices emerge, namely, knowing the community, increasing interactional engagement and constructing gradients of socio-clinical history. These practices generate organization-wide knowledge about the social and clinical dimensions of the genetic disorder. The findings are presented through vignettes and a novel conceptual framework.Research limitations/implicationsThis study identifies various useful knowledge creation practices in health care delivery for resource-constrained emerging economy contexts. Further, the study suggests that the involvement of local front-line actors and ICT can become important resources in the delivery of health care in these settings.Originality/valueA novel framework is developed which demonstrates knowledge creation at organizational boundaries wherein the actors use ICT-based practices for effective delivery of health care. The proposed framework may be used by health care organizations in similar contexts providing care to marginalized communities.

Perceived Challenges of Working Environment Among Emergency Department Nurses in Saudi Arabia

Background: Emergency room nurses are faced with many challenges related to the nature of complex practices and the environment. Research has approved a number of characteristics of emergency department nurses in order to fulfill the required role. Objectives: To determine the perception of nurses of the Emergency Department to the challenges associated with their working environment. Methods: A cross-sectional design was used in four selected governmental hospitals in Hail. Among one hundred and seventy-five of Emergency registered nurses; One Hundred and Fifty-Eight emergency registered nurses were recruited conveniently based on the inclusion criteria. A closed ended questionnaire sheet was marked out by all the selected nurses to determine their perception towards challenges associated with their working environment. Results: In this study among the total population of Emergency Room staffs, 90 % of staffs were included; ages ranged between 23-29 yrs were 77.8%. Majority of female nurses were 88.6% most of the sample 83.5% hold bachelor’s degree in nursing. Moreover, 48.7% practicing as a nurse about 1-4 yrs. The ER nurses ranged from 1- 4 yrs of experience were 75.9%. Majority of 79.7% were working as a staff Nurse. More than half of the Non-Saudi were working in ER was 54.4%. The variables under the quality of environment for professionals, most of them shows bad perception in working environment so far in comfort zone were 27.8%, nursing assistance and technician, hours of work shift have higher in bad perception overall level of 22.7%. In regards the Cleaning were 29.7%, Quality of materials were 37.9%, Physician were 36.7%, Number of calls per shift were 39.2%. In determining the perception of Emergency Department nurse towards challenges associated with their working environment shows higher perception level with the mean value of 32.03 and standard deviation was 5.6. Conclusion: From this study we concluded that, the healthcare policy makers may have concern about health care providers. The working condition of the Emergency Room nurses Perceived that they have somewhat discouragement in their working environment. Some changes in reimbursement and the practice of health care delivery required hospital to change the way they operate. These results will also propagate the managers to re-define a development plan for the Emergency Department working Environment of the selected Hospitals, in hail. Keywords : Nurse, Perception, Emergency Department, Challenges, Working Environment. DOI: 10.7176/JBAH/10-10-05 Publication date: May 31 st 2020

Exposing undergraduate medical students to inter-professionalism education in the competency-based curriculum

The field of medicine has been regarded as one of the most complex fields requiring inputs from a number of stakeholders for a favorable outcome of a patient. Acknowledging this, it is the need of the hour to expose the medical students to the concept of inter-professional education (IPE) right from the initial stages of their career. The context to initiate IPE usually results whenever there is a desire to ameliorate health outcomes of the patients or to improve the health care delivery practices. At the same time, the time allocated for the electives after the completion of third professional year can also be utilized to run a complete module or training on any inter-professional course. In conclusion, an approach of inter-professional education is a must to ensure the delivery of effective and efficient health care, including the domains of enhancing patient safety through optimal utilization of the skills of each professional.

A Process for Assessing Products for Infection Prevention in Health Care Settings: A Framework From the Healthcare Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention.

Infection control is a complex task that spans people, products, and practices in diverse settings. For years, the Healthcare Infection Control Practices Advisory Committee (HICPAC) has provided advice and guidance to the Centers for Disease Control and Prevention (CDC) on how best to prevent infections. These recommendations have focused largely on health care delivery practices and occasionally on general categories of products. With an influx of novel infection control products and growing use of these products by frontline clinicians, an efficient process for developing transparent, rigorous product recommendations that includes myriad data sources was necessary. To address this gap, the CDC asked HICPAC to develop a process that would help inform committees considering product-related recommendations. This article describes the process to develop this approach and provides an outline of how the tool may be used when products with infection control claims are recommended in guidelines or recommendations for infection prevention.

Perceptions and Experiences of Methadone Maintenance Treatment

Over the past 10 years, there has been a consistent increase in opioid use, which has resulted in an increase in methadone maintenance treatment (MMT). With retention in MMT being a key factor, to understand the process of retention, it is important to better understand individual perceptions and experiences. Little research in Ottawa, Ontario, has addressed the perspective of MMT from people enrolled in MMT; therefore, nursing-based research was undertaken. The objective was to understand the process and experiences associated with MMT from the perspective of persons who are enrolled in treatment. Twelve participants were engaged in semistructured interviews. These participants described that, although MMT can positively affect the people who use such a treatment option, multiple barriers, including social perceptions, physical environment, and healthcare delivery practices, continue to affect MMT initiation and delivery.

Experiences of HIV-infected adults and healthcare providers with healthcare delivery practices that influence engagement in US primary healthcare settings: a qualitative systematic review.

The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a major public health problem that has claimed the lives of more than 34 million people worldwide. The health of people living with HIV (PLWH) is optimized by ongoing engagement in HIV care, yet many people living with HIV either do not enter or fall out of care. Access to care and ongoing engagement in care for antiretroviral (ARV) medication adherence and psychoeducational support are critical to achieving the desired outcomes of reducing the risk of further HIV transmission and HIV related morbidity and mortality, and managing other commonly co-occurring health, social and behavioral conditions, thereby maximizing wellness. The objective of the review was to identify, evaluate and synthesize existing qualitative evidence on the experiences of HIV-infected adults with healthcare systems/practices/processes, and the experiences of healthcare providers with healthcare systems/practices/processes that impact engagement in primary healthcare settings in the United States (US). The review included studies reporting on the qualitative experiences of HIV-infected adults, aged 18-65 years, with healthcare systems, practices and processes and their healthcare providers (physicians, nurses and others providing care to these patients in the primary care healthcare setting). Qualitative studies including but not limited to designs such as phenomenology, ethnography, grounded theory, action research and qualitative descriptive were included. Studies published in languages other than English and conducted outside of the US were excluded. Using a three-step search strategy, databases of published and unpublished articles were searched from 1997 to 2017. All included studies were assessed by two independent reviewers for methodological quality, and data was extracted and pooled using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Findings were rated according to their level of credibility, categorized based on similarity in meaning and subjected to a meta-synthesis. A total of 1038 qualitative articles were identified of which 41 were included after critical appraisal. Meta-synthesis generated four synthesized findings: i) What I want from my provider: to be a respectful, empathetic and holistic partner in my care; ii) I cannot do it alone: the critical importance of actively guiding and assisting patients during transitions and securing the needed resources; iii) Help me to understand my illness and care needs; iv) One-stop care that is de-stigmatizing and welcoming to diverse cultures keeps clients in care. These synthesized findings were derived from 243 study findings that were subsequently aggregated into 19 categories. Of the 243 study findings, 240 were rated unequivocal and three were rated credible. The overall ConQual for each of the four synthesized findings was moderate due to common dependability issues across the included studies. A total of 1597 participants were included. Only two studies were included from 1997 to 2000. The majority of included studies were published from 2005 to 2017. The synthesized findings illustrate clear quality indicators for primary care practice, emphasizing the patient-provider-care team partnership and shared decision making that is holistic, takes into account a patient's whole life, responsibilities and stressors, and reframes HIV associated misperceptions/myths. The review also highlights the importance of helping patients navigate and interact with the healthcare system by offering one-stop services that assist with multiple medical care needs and "wraparound" services that provide the needed care coordination to assist with critical quality of life needs such as food, housing, transportation, and assistance with applying for health insurance and medication.

Insurance Carrier and Local Healthcare Delivery Practices Are Independent Predictors of Mortality Among Hospitalized Patients With Gastric Cancer

Insurance Carrier and Local Healthcare Delivery Practices Are Independent Predictors of Mortality Among Hospitalized Patients With Gastric Cancer