Specific Medical Services Research Articles

Process indicators outshine outcome measures: assessing hospital quality of care in breast cancer treatment in China

Reporting the results of quality indicators can narrow the gap in the quality of care between hospitals. While most studies rely on outcome indicators, they may not accurately measure the quality of care. Process indicators are not only strongly associated with treatment outcomes, but are also more sensitive to whether patients are treated accurately, enabling timely intervention. Our study aims to investigate whether process indicators provide a more reasonable assessment of hospital quality of care compared to outcome indicators. Data were sourced from the Specific Disease Medical Service Quality Management and Control System in China. A total of 113,942 patients with breast cancer treated in 298 hospitals between January 2019 and April 2023 were included in this retrospective study. The rankability of 11 process indicators was calculated and used as a weight to create a new composite indicator. The composite indicators and outcome measures were compared using the O/E ratio categories. Finally, in order to determine the impact of different years on the results, a sensitivity analysis was conducted using bootstrap sampling. The rankability (ρ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rho$$\\end{document}) values of the eleven process indicators showed significant differences, with the highest ρ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rho$$\\end{document} value for preoperative cytological or histological examination before surgery (0.919). The ρ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rho$$\\end{document} value for the outcome indicator was 0.011. The rankability-weighting method yielded a comprehensive score (ρ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\rho$$\\end{document} = 0.883). The comparison with categorical results of the outcome indicator has different performance classifications for 113 hospitals (37.92%) for composite scores and 140 (46.98%) for preoperative cytological or histological examinationbefore surgery. Process indicators are more suitable than outcome indicators for assessing the quality of breast cancer care in hospitals. Healthcare providers can use process indicators to identify specific areas for improvement, thereby driving continuous quality improvement efforts.

Carolife – Life Caring Solutions

In times of medical emergencies, individuals always face difficulties in finding the most suitable hospital for necessary treatment. They may navigate from one healthcare facility to another, medications, and blood supply. Hospital finder will solve these problems. This application is designed to help individuals to find the best medical care for their needs in a convenient way. It uses GPS-Global Positioning System in smart phones to find the nearest hospitals that offer the desired medical specialities, such as cardiology, neurology etc. It also shows the routes from the current location to the selected hospital through Google Maps, saving time and reducing stress for the users. Moreover, it supplies information about the hospitals, such as their facilities, doctors, blood banks, laboratories, and appointment schedules. Users can search for hospitals based on their requirements. They can also access their earlier medical history through the application by logging in to keep the privacy of the users. This application aims to reduce the hassle of searching for specific medical services and improve the health outcomes of the users/patients by providing them with reliable and relevant information. Key Words: GPS, Google Maps, Blood Bank, Appointment Schedules, Privacy

Pharmacy practice in hospital settings in GCC countries: Pharmacists’ medication therapy monitoring activities

PurposeOur study aims to provide an overview of medication therapy monitoring practices carried out by pharmacists in hospitals across the Gulf Cooperation Council (GCC) countries. MethodsThis is a cross-sectional questionnaire-based study of hospitals located in the GCC. Questions were adopted from the American Society of Health-System Pharmacists (ASHP) national survey. Frequency analyses were used to examine the number and percentages of specific responses to the survey questions. ResultsA total of 64 hospitals participated in this survey, reflecting an overall response rate of 52.0%. Almost half of participating hospitals (48.4%) were from Saudi Arabia. Among the 64 participating hospitals, 54.7% monitored their patients daily, 40.6% assigned pharmacists to patient care units for at least eight hours per day, and 42.2% held pharmacists accountable for medication-related outcomes. Moreover, the criteria used to identify patients requiring monitoring, 35.9% relied on the list of high-risk medications, 26.5% relied on specific medical services, 21.9% relied on directions from the hospital committee, and 17.2% relied on lab abnormalities. The most frequently utilized method for monitoring adverse drug events (ADEs) was through notifications from nurses or physicians, observed in 60.9% of participating hospitals. ConclusionThe survey emphasizes the need for hospitals in the GCC to promote increased pharmacist accountability for medication-related outcomes, explore technological solutions to enhance monitoring efficiency and extend the presence of pharmacists in patient care units beyond the current level.

Sex differences in the age of childhood autism diagnosis and the impact of co-occurring conditions.

Sex differences in the age of autism diagnosis during childhood have been documented consistently but remain poorly understood. In this study, we used electronic health records data from a diverse, academic medical center to quantify differences in the age of autism diagnosis between boys and girls and identify associations between the age of diagnosis and co-occurring neurodevelopmental, psychiatric, and medical conditions. An established computable phenotype was used to identify all autism diagnoses within the Duke University Health System between 2014 and 2021. Co-occurring neurodevelopmental and psychiatric diagnoses as well as visits to specific medical and supportive services were identified in the 2 years prior to the autism diagnosis. Cox proportional hazards models were fitted to quantify associations between diagnosis age and sex with and without controlling for the presence of each co-occurring diagnosis and visit type. Records from 1438 individuals (1142 boys and 296 girls) were included. Girls were more likely to be diagnosed either before age 3 ( = 497.720, p < 0.001) or after age 11 ( = 4.014, p = 0.047), whereas boys were more likely to be diagnosed between ages 3 and 11 ( = 5.532, p = 0.019). Visits for anxiety ( = 4.200, p = 0.040) and mood disorders ( = 7.033, p = 0.008) were more common in girls and associated with later autism diagnosis (HR = 0.615, p < 0.001; and HR = 0.493, p < 0.001). Visits for otolaryngology were more common in boys and associated with an earlier autism diagnosis (HR = 1.691, p < 0.001). After controlling for these conditions, associations between sex and diagnosis age were reduced and not statistically significant. These results show that the age of autism diagnosis differs in girls compared to boys, but these differences were neutralized when controlling for co-occurring neurodevelopmental and psychiatric conditions prior to autism diagnosis. Understanding sex differences and the possible mediating role of other diagnoses may suggest targets for intervention to promote earlier and more equitable diagnosis.

Learner's Stop the Bleed Outcomes Between Lay Instructor and Emergency Medical Services (EMS)-Trained Instructor Groups.

One of the most utilized Stop the Bleed courses, the "Bleeding Control Basic (BCon) course v. 1.0," requires instructors to have a specific healthcare license or pre-hospital credential (e.g., physician or paramedic) or specific emergency medical services (EMS) instructor certification and have completed the BCon provider course. This requirement provides a level of expertise in instructorsbutlimits the potential workforce for sharing life-saving knowledge and skills. Other Stop the Bleedcourses, such as the American Red Cross First Aid for Severe Trauma (FAST) course, do not have this requirement. This raises questions pertaining to the learners' outcomes between those facilitated by instructors with and without healthcare licenses or credentials. Learners' outcomes for applying a tourniquet (skill), knowledge (cognitive), and Intention to Aid (attitude for behavior) were compared between those taught by lay instructors and EMS-trained (emergency medical technician or paramedic) instructors. All were trained as new instructors in the FASTprogram. For the study's primary outcome, all of the learners (n=135) properly applied a tourniquet to a simulated leg injury at the end of the training based on video evidence (skill). Learners in the EMS-trained instructor groups (n=84, mean age 25.5 years, 68% female), who were olderandhad more education, scored significantly higher on knowledge of tourniquet use on the Stop the Bleed Educational Assessment Tool (SBEAT) (mean=90.0 vs. 83.9 on a scale of 0-100, p=0.001) with a small effect size than the lay instructor group (n=51, mean age 16.6 years, 88% female).There was no statistical difference in attitude toward helping behaviors in a bleeding emergency between the two groups on the Intention to Aid (I2A) survey. Lay instructors andEMS-trained instructors performed comparably in facilitating a widely available Red Cross Stop the Bleed course. Lay experience with tourniquets should not disqualify individuals from being a Stop the Bleed instructor. Using a standard curriculum with instructor development offers a way for people with and without an EMS background to teach life-saving competencies effectively.

경계영역 보건의료제품의 안전관리에 관한 행정법적 쟁점

The COVID-19 infectious disease health crisis, which has recently spread worldwide, has provided an opportunity to increase the number of products which using advanced convergence-technologies in the health and medical field. As of the increasing demand for various products for diagnosis, prevention, as well as treatment of diseases, there are some cases that cannot be managed by classifying them into specific regulatory types currently set. Accordingly, in order to prepare an appropriate management system, a theoretical review of the law is required to prepare a plan to reasonably manage emerging new-atypical cases. In particular, various types of health care products applying advanced technology or convergence technology are being released as the technology that utilizes drugs, medical devices, and health care products changes and develops.&#x0D; To address these issues, administrative authorities regulating the health and medical product sector sometimes prepare ‘borderline guidance’ so as to ensure consistency in law enforcement. This article examines how to classify and approach products that across the boundary areas, such as food/pharmaceuticals, health functional foods/pharmaceuticals, pharmaceuticals/ medical devices, quasi-drugs/hygiene products, and health products/industrial products, and how to establish classification standards.&#x0D; Borderline health and medical products have the characteristics of invasiveness in the human body and irreversibility of effects due to the inherent characteristics of the product. For this reason, the management system for boundary health products should consider the following: It is assumed that convergent helath products which sold in the consumer goods market might have information asymmetry between producers and consumers when new technologies are applied, and measures are sought to protect consumers. The legal system governing convergence health products may have similarities with the legal system in the field of product safety law. However, it is necessary to consider the specificity of the health care field. In addition, a management system applicable to each regulatory area of the boundary product was developed by the dual management system that of the health-medical product market centered on the regulation of consumer information and that of the specific medical service delivering system where used health care products as a medium of medical service. It is desirable to establish product classification criteria based on sound legal theory so as to guarantee institutional consistency and predictability.

The Impact of Prior Authorization in Allergy/Immunology: A Position Statement of the AAAAI

Prior authorizations (PA) are used by insurers to control health care costs by requiring providers to obtain approval before specific pharmaceuticals and/or medical services can be used. This process is often used for expensive therapies and limits plan members' access with the goal to reduce health expenditures. Although initially used to promote lower-cost, but equally effective alternatives, it has become overused to the point where it is now a burdensome and time-consuming task, which diverts resources away from direct patient care to administrative duties.

Identifying need for spay and neuter services: A GIS-based analysis

Abstract This study provides a method for assessing the need for spay and neuter services in Massachusetts by creating a composite index that accounts for spatial accessibility and social vulnerability. An accessibility index (AI) of existing low-cost spay/neuter (S/N) facilities was created using the two-step floating catchment area (2SFCA) method which was then combined with the social vulnerability index (SVI) from the Centers for Disease Control and Prevention to create a need index (NI). Two methods for selecting the final target areas from the NI results were examined and used to make recommendations for S/N funding allocation. The construction of the NI (i.e. factors included or weights applied to factors) had a significant impact on the results. The NI displayed statistically significant spatial autocorrelation, and hot spot analysis revealed statistically significant clusters of comparatively high- and low-need regions in the state. The target areas identified were strongly influenced by high levels of social vulnerability in urban areas and low spatial accessibility of low-cost S/N facilities in more rural western Massachusetts. The results of this project demonstrate the utility of geographic information systems (GIS)-based analysis in veterinary and shelter medicine, as well as the potential for the use of non-veterinary specific data, such as the CDC SVI, when planning the equitable distribution of limited resources. One Health impact statement Providing spay and neuter (S/N) services to owned and free-roaming cats, dogs and other companion animal species is integral to the health and well-being of the animals themselves. Their human companions also reap the physical and mental health benefits of the human–animal bond, in addition to the environmental and public health impact of limiting free-roaming dog and cat populations. By recognizing the relationships between human and animal populations, existing gaps in need can be addressed through the use of human data to inform decisions on animal health when relevant animal health service data are lacking. A composite index of factors accounting for the social vulnerability was combined with the spatial accessibility of existing S/N resources to create a final index of need for S/N resources. This transdisciplinary approach takes methodologies from public health, acknowledges the impact of the vulnerability of human populations on surrounding companion animal populations, and applies a practical method of identifying the need for specific veterinary medical services.

Occurrence of pharmaceuticals in the wastewater of a Greek hospital: Combining consumption data collection and LC-QTOF-MS analysis

In this article we applied drug consumption approach and chemical analysis in parallel to investigate the concentrations of a large number of pharmaceuticals in different streams of a General Hospital. Drugs consumption data was collected during two periods (Period 1, 2) and the predicted environmental concentrations (PECs) were estimated for the wastewater of a building housing specific medical services (Point A) and for the entire hospital (Point B). Hospital wastewater samples (HWW) samples were also collected from these points and periods and the measured environmental concentrations (MEC) were determined using UHPLC-ESI-QTOF-MS/MS. According to consumption data, the highest number of drugs was consumed in the departments of Hematology, Intensive Care Unit, Cardiology, Internal Medicine, and Oncology, while the number of active substances used in the hospital was 413 (Period 1) and 362 (Period 2). For most substances, much higher PEC and MEC values were found at the HWW of Point A indicating that on-site treatment of this stream could be examined in the future. The application of wide-scope target analysis allowed the quantification of 122 compounds, while 21 additional substances were identified using suspect screening. The highest mean concentrations in Period 1 were found for acetaminophen (1100 μg/L) and rifaximin (723 μg/L), while in Period 2 for iopromide (458 μg/L) and acyclovir (408 μg/L). Among the detected compounds, 19 metabolites were determined. Atenolol acid, 1-hydroxy-midazolam and clopidogrel carboxylic acid were quantified at concentrations much higher than parent compounds indicating the importance of metabolites' monitoring in HWW. Calculation of PEC/MEC ratio for 36 pharmaceuticals showed sufficient correlation of these values for 19 % to 33 % of the substances depending on the examined period and sampling point. The parallel collection of drugs consumption data and chemical analysis give a thorough picture of the substances present in HWW and their main sources, facilitating decision-making for their better management.

Evenly Is Even Better? Digital Competitiveness and the Quality of Medical Research

The combination of rapid advances in digital technology and the COVID-19 pandemic has increased the importance of knowledge sharing and balanced advances in medical research. This study explored how digital competitiveness influences the diverse quality of medical research in vital areas. Based on our synthesized framework of research quality, we found that digital competitiveness benefits medical research broadly but not evenly. While digital competitiveness was positively associated with impactful research across all four fields in vital areas, the relationship between digital competitiveness and science-based and explorative research varied depending on the field. By focusing on the quality of medical research rather than a specific medical service, our study offers meaningful implications for knowledge sharing and collaborative research, which are key conditions for the sustainable development of medicine.

The comparative analysis of SARIMA, Facebook Prophet, and LSTM for road traffic injury prediction in Northeast China

ObjectiveThis cross-sectional research aims to develop reliable predictive short-term prediction models to predict the number of RTIs in Northeast China through comparative studies.MethodologySeasonal auto-regressive integrated moving average (SARIMA), Long Short-Term Memory (LSTM), and Facebook Prophet (Prophet) models were used for time series prediction of the number of RTIs inpatients. The three models were trained using data from 2015 to 2019, and their prediction accuracy was compared using data from 2020 as a test set. The parameters of the SARIMA model were determined using the autocorrelation function (ACF) and the partial autocorrelation function (PACF). The LSTM uses linear as the activation function, the mean square error (MSE) as the loss function and the Adam optimizer to construct the model, while the Prophet model is built on the Python platform. The root mean squared error (RMSE), mean absolute error (MAE) and Mean Absolute Percentage Error (MAPE) are used to measure the predictive performance of the model.FindingsIn this research, the LSTM model had the highest prediction accuracy, followed by the Prophet model, and the SARIMA model had the lowest prediction accuracy. The trend in medical expenditure of RTIs inpatients overlapped highly with the number of RTIs inpatients.ConclusionBy adjusting the activation function and optimizer, the LSTM predicts the number of RTIs inpatients more accurately and robustly than other models. Compared with other models, LSTM models still show excellent prediction performance in the face of data with seasonal and drastic changes. The LSTM can provide a better basis for planning and management in healthcare administration.ImplicationThe results of this research show that it is feasible to accurately forecast the demand for healthcare resources with seasonal distribution using a suitable forecasting model. The prediction of specific medical service volumes will be an important basis for medical management to allocate medical and health resources.

Utilization and Costs of Gender-Affirming Care in a Commercially Insured Transgender Population.

Many transgender people need specific medical services to affirm their gender. Gender-affirming health care services may include mental health support, hormone therapy, and reconstructive surgeries. Scant information is available about the utilization or costs of these services among transgender people, which hinders the ability of insurance regulators, health plans, and other health care organizations to plan and budget for the health care needs of this population and to ensure that transgender people can access medically necessary gender-affirming care. This study used almost three decades of commercial insurance claims from a proprietary database containing data on more than 200 million people to identify temporal trends in the provision of gender-affirming hormone therapy and surgeries and to quantify the costs of these services.

Design and Build a Web-Based Service Information System at the Sejahtera Medika Clinic in Rangkasbitung

Clinic is a health service facility that provides individual health services providing basic or specific medical services, organized by more than one type of health and led by medical personnel. The service activities carried out are in the form of public services. So far, the service system at the Sejahtera Medika Clinic starts from patient registration, input patient data, diagnoses and prescribes, payments and reports data that still uses the manual method, namely bookkeeping using a ledger. This causes several obstacles that often hinder the clinical management, especially in obtaining data related to patient service information. For this reason, it is necessary to develop a system that utilizes computer technology with a guaranteed security system, then the data is stored in a database and stored automatically. The development method used in this research is the Waterfall method, where there are 5 stages, namely: Analysis, Design, Implementation, Testing and Maintenance. In the implementation using UML (Unified Modeling Language) tools including Use Case Diagrams, Activity Diagrams, Class Diagrams and Sequence Diagrams

Pioneering a Value-Based Purchasing Initiative for Ambulatory Surgery Centers in TRICARE West.

Pioneering a Value-Based Purchasing Initiative for Ambulatory Surgery Centers in TRICARE West.

Patterns of Health Services Use Before Age 1 in Children Later Diagnosed With ADHD

Background: Children with ADHD have 2 to 3 times increased health care utilization and annual costs once diagnosed, but little is known about utilization patterns early in life, prior to diagnosis. Quantifying early health services use among children later diagnosed with ADHD could help us understand the early life impact of the disorder and uncover health care utilization patterns associated with higher ADHD risk. Methods: Electronic health record (EHR) data from the Duke University Health System (DUHS) was analyzed for patients born October 1, 2006–October 1, 2016. Those with at least two well-child visits before age 1 were grouped as ADHD or not ADHD based on retrospective billing codes. Adjusted odds ratios (AORs) for hospital admissions, procedures, emergency department (ED) visits, and outpatient clinic encounters before age 1 were compared between groups via logistic regression controlling for sex, race, and ethnicity. Results: ADHD diagnoses were identified in 1,315 (4.4%) of 29,929 patients meeting criteria. Before age 1, individuals with ADHD had 60% increased odds of hospital admission, 58% increased odds of visiting the emergency department, and 41% increased odds of procedures (p < .0001), including 4.7-fold increased odds of blood transfusion (p < .0001). They also had more outpatient clinic visits (μ = 14.7 vs. μ = 12.5, p < .0001), including 52% increased odds of visiting a medical specialist, 38% increased odds of visiting a surgical specialist, 70% increased odds of visiting a neonatologist, and 71% increased odds of visiting an ophthalmologist (p < .0001 for all AORs). In addition, individuals with ADHD had 6-fold increased odds of visits related to child abuse and neglect (p = .0010). Conclusions: Children later diagnosed with ADHD were more likely to be admitted to the hospital, visit the ED, and visit specific medical and surgical services before age 1. Future work will identify patterns of health interactions unique to ADHD to stratify ADHD risk.

Developing a Robust and Flexible Web Service Framework for Medical Care

The rapid growth of Internet technologies and availability of web tools created an opportunity to develop a robust and user-friendly web service model for medical care, and it demands urgent solutions as the uncertainty of disease spread threaten humanity. With changing Quality of Service principles, many existing web services need to offer specific medical services that suit practical needs. The provision of an effective service selection and recommendation features that best meet the user's requirements will be able to improve the quality of web service model. The Quality of Service metrics should be calculated and analyzed before optimizing a recommendation technique. Evaluation therefore forms an important part of the process for designing and implementing recommendation systems. Further, predicting Quality of Service indicators accurately from historical background dataset under complex scenarios and combination of conditions is useful. In this perspective, lots of web service methods are studied, and this paper presents our comprehensive analysis mainly focusing on the development of better web service based framework for medical applications.

HEALTHCARE POLICY OF GEORGIA AND ACTIVE ENGAGEMENT OF SOCIETY

HEALTHCARE POLICY OF GEORGIA AND ACTIVE ENGAGEMENT OF SOCIETY

Litigation to Access Health Services: Ally or Enemy of Global Public Health?

Background:Some scholars and global health advocates argue that litigation is a strategy to advance public health care, especially in those countries that do not have specific legislation to guarantee access to basic health care services. However, strategic litigation has another side, known as judicialization of the right to health, particularly present in the Latin American region where most countries incorporate the right to health into their constitutions, but their citizens still struggle with health disparities.Objectives:Considering these two perspectives on litigation in health care, this paper examines the phenomenon of litigation in health care and its impact on public health in Brazil, where there is an ambiguous process of litigation in health care.Methods:Comparing the literature of both the use of strategic litigation for advancing public health and the judicialization of the right to health, this paper develops an ethical analysis of the impacts of strategic litigation for individuals and societies, using Brazil’s public health care system and its policies as case-study of the impact of court decisions on the management of the system.Findings:Supporters of strategic litigation present experiences in African countries using this strategy to access a specific medical service led to enforce the creation of health-related policies by authorities and policymakers. However, in Brazil, a country with the right to health guaranteed by its Constitution, strategic litigation creates access to health care for some individuals, but also results in complex sociomedical challenges with significant impact for public administration and distributive justice.Conclusions:Strategic litigation can lead to ambiguous results, which will depend on the local context and the existence or not of public health services and health-related policies. When this strategy is considered, ethical analysis helps to understand how litigation can both benefit and damage individuals’ health and the public health system in the complex context and diverse reality of Brazil. As a result, strategic litigation must be considered from an ethical perspective of prudence and discernment in a close interaction with the local reality, its particular circumstances, culture, policies, and laws.

Bicriteria Vehicle Routing Problem with Preferences and Timing Constraints in Home Health Care Services

Home Healthcare (HHC) is an emerging and fast-expanding service sector that gives rise to challenging vehicle routing and scheduling problems. Each day, HHC structures must schedule the visits of caregivers to patients requiring specific medical and paramedical services at home. These operations have the potential to be unsuitable if the visits are not planned correctly, leading hence to high logistics costs and/or deteriorated service level. In this article, this issue is modeled as a vehicle routing problem where a set of routes has to be built to visit patients asking for one or more specific service within a given time window and during a fixed service time. Each patient has a preference value associated with each available caregiver. The problem addressed in this paper considers two objectives to optimize simultaneously: minimize the caregivers’ travel costs and maximize the patients’ preferences. In this paper, different methods based on the bi-objective non-dominated sorting algorithm are proposed to solve the vehicle routing problem with time windows, preferences, and timing constraints. Numerical results are presented for instances with up to 73 clients. Metrics such as the distance measure, hyper-volume, and the number of non-dominated solutions in the Pareto front are used to assess the quality of the proposed approaches.

The combined care clinic: a strategy in improving quality and efficiency related to essential patient reviews in the UK

BackgroundStandardised delivery of patient care remains an essential facet of the NHS. In 2004, the general practice contract for delivering specific primary medical services incorporated a financial payment: Quality Outcomes Framework (QOF). In majority of practices, these reviews are completed by the practice nursing healthcare team.AimTo understand if the combined care (CC) clinic improves the efficiency in delivering patient reviews.MethodThe CC clinic was designed in 2015 inviting patients with diabetes; who may also have other long-term conditions, to be addressed in a ‘one stop’ approach. It is implemented by healthcare assistants (HCAs) supported by apprentices, who perform standard checks such as blood pressures, urine dipstick checks, smoking data, and health promotion that are protocolled. Where there are abnormalities noted, the HCA is able to escalate to the practice nurses who are supported by a GP lead.ResultsQOF diabetes data were reviewed from 2015–2016 (636 patients on register) and 2016–2017 (649 patients on register). Results showed a marked percentage increase between years in the following indicators: DM003 (last blood pressure measurement ≤140/80 mmHg) 7.29%; DM006 (proteinuria/microalbuminuria) 6.20%; and DM009 (foot exam) 3.21%. All other diabetic indicators apart from two showed a percentage increase. The proportion of patients seen between April–October also increased in the subsequent year.ConclusionThe CC clinic provides a method of patient review in an efficient process, without the need for multiple visits, thereby increasing practice capacity to focus on other aspects of patient care and work streams.