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Collections of articles and abstracts printed in The Permanente Journal are available as PDF downloads. Also available are PDF collections of abstracts with links to relevant articles previously published in The Permanente Journal.


The Permanente Journal, The Permanente Press, Kaiser Permanente The Permanente Journal, The Permanente Press, Kaiser Permanente The Permanente Journal, The Permanente Press, Kaiser Permanente

The Permanente Journal, The Permanente Press, Kaiser Permanente The Permanente Journal, The Permanente Press, Kaiser Permanente The Permanente Journal, The Permanente Press, Kaiser Permanente

The Permanente Journal, The Permanente Press, Kaiser Permanente

Kaiser Permanente Authors

Kaiser Permanente Authors published in peer-reviewed journals.

2015

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2014

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2013

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2012

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2011

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2010

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2009

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2008

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IHI

The Institute for Healthcare Improvement Annual National Forum on Quality Improvement in Health Care: The Permanente Journal "Service Quality" Poster Awards


2015

Spring 2015 - Volume 19 Number 2

Changing Medicine and Building Community: Maine's Adverse Childhood Experiences Momentum
Leslie Forstadt, PhD; Sally Cooper, MD; Sue Mackey Andrews
Physicians are instrumental in community education, prevention, and intervention for adverse childhood experiences. In Maine, a statewide effort is focusing on education about adverse childhood experiences and ways that communities and physicians can approach childhood adversity. This article describes how education about adversity and resilience can positively change the practice of medicine and related fields. It exemplifies the collective impact model by increasing community knowledge, affecting medical practice, and improving lives.

Workplace Violence in the Emergency Department: Giving Staff the Tools and Support to Report
Julie Stene, MHA, MSN, RN; Erin Larson, MSN, RN; Maria Levy, RN; Michon Dohlman, MSN, RN
Workplace violence is increasing across the nation's Emergency Departments, and nurses often perceive it as part of their job. Reporting processes were inconsistent, and nurses often did not know what acts constitute violence and underreported it. A staff nurse-led workgroup developed an initial survey and a reporting tool, and education was provided. A posteducation survey documented the reporting of violent acts has increased, and staff perceived the Emergency Department to be a safer environment.

Fall 2015 - Volume 19 Number 4

Caring Science: Transforming the Ethic of Caring-Healing Practice, Environment, and Culture within an Integrated Care Delivery System
Anne Foss Durant, RN, MSN, NP, NEA-BC; Shawna McDermott, MBA; Gwendolyn Kinney, RN, MSN; Trudy Triner
The intent of this article is two-fold: 1) to provide context and background on how a professional practice framework was used to transform the ethics of a caring-healing practice, environment, and culture across multiple hospitals within an integrated delivery system; and 2) to provide evidence on how integration of Caring Science across administrative, operational, and clinical areas appears to contribute to meaningful patient quality and health outcomes.

2014

Winter 2014 - Volume 18 Number 1

Televisitation: Virtual Transportation of Family
Bonnie Nicholas, RN, CNCC(C), CPTC
Televisitation is the virtual transportation of a patient's family to the bedside, regardless of the patient's location within an acute care setting. In Thunder Bay, Ontario, Canada, the health system embraces patient- and family-centered care. The important relationship between health outcomes and the psychosocial needs of patients and families has been recognized more recently. First Nations renal patients with family in remote communities were some of the earliest users of videoconferencing technology for this purpose.

2013

Winter 2013 - Volume 17 Number 1

Televisitation: Virtual Transportation of Family
Bonnie Nicholas, RN, CNCC(C), CPTC
Televisitation is the virtual transportation of a patient's family to the bedside, regardless of the patient's location within an acute care setting. In Thunder Bay, Ontario, Canada, the health system embraces patient- and family-centered care. The important relationship between health outcomes and the psychosocial needs of patients and families has been recognized more recently. First Nations renal patients with family in remote communities were some of the earliest users of videoconferencing technology for this purpose.

Summer 2013 - Volume 17 Number 3

Mental Health Practice and Attitudes of Family Physicians Can Be Changed
Dan MacCarthy, MB, BCh, BAO; Rivian Weinerman, MD, FRCPC; Liza Kallstrom, MSc; Helena Kadlec, MA, PhD; Marcus J Hollander, MA, MSc, PhD; Scott Patten, MD, FRCPC, PhD
The British Columbia Practice Support Program delivered an adult mental health module to enhance family physician skills, comfort, and confidence in diagnosing and treating mental health patients using the lens of depression. More than 1400 of the province's 3300 full-service family physicians have completed or started training, and reported high to very high success implementing self-management tools with an overall positive impact on patients.

Identification of Internal and External Stressors in Parents of Newborns in Intensive Care
Cindy Grosik, MSN, RNC, CNL; Denise Snyder, MSN, NNP-BC; Gerard M Cleary, DO; Diane M Breckenridge, PhD, RN; Barbara Tidwell
To identify parents' self-reported stressors, 119 parents of neonatal infants, 24 weeks to full term, were surveyed in a 28-bed level 3 NICU of an 665-bed acute care hospital. Parents deal with fear and uncertainty, are unprepared, and so feel overwhelmed, hopeless, and despair. Highest stressors include: "seeing my baby stop breathing," "being separated from my baby," "being discharged from the hospital before my baby," and "seeing my baby suddenly change color." Establishing strong, trusting, therapeutic relationships is essential.

Training Patient and Family Storytellers and Patient and Family Faculty
Lisa Morrise, MArts; Katy Jo Stevens, MSW, LCSW
Narrative medicine has become a prominent method of developing more empathetic relationships between medical clinician and patient on the basis of a deeper understanding of the patient experience. Patient and family storytelling is a key component of the collaboration that is ideal. Providing patients and families with training will make the narratives they share more powerful. This article provides instruction for teaching patients and families how to tell stories with purpose and offers advice about how to support patients, families, and clinicians participating in this effort.

Fall 2013 - Volume 17 Number 4

Challenges in Evaluating All-Cause Hospital Readmission Measures for Use as National Consensus Standards
Alexis Morgan, MPH; Adeela Khan, MPH; Taroon Amin, MA, MPH, PhD(c)
Through the evaluation of measures for endorsement, several overarching issues in measuring all-cause readmissions were identified, including statistical modeling and the usability of the measures for quality improvement and accountability. Additionally, it was decided that, for the first time, quality monitoring and accountability of readmissions will take place at the health plan level. Measuring at various levels of accountability reinforces the idea that multiple stakeholders have a responsibility and a role to reduce readmissions. These measures can help reduce the substantial financial and emotional stress that readmissions place on the health care system.

How Asking Patients a Simple Question Enhances Care at the Bedside: Medical Students as Agents of Quality Improvement
Hope Olivia Ward; Sarah Kibble; Gney Mehta; Marc Franklin; Joshua Kovoor; Aled Jones, BN (Hons), PhD; Sukhmeet Panesar, BSc (Hons), MBBS; Andrew Carson-Stevens, MBBCh, MPhil
Medical students have traditionally played a passive role in the delivery of health care. Using the Model for Improvement to adapt the Ask One Question concept for local use, medical students at Cardiff University (United Kingdom) asked 120 patients one question. On a simple but effective level, Ask One Question reflects good manners and is a demonstrable competency of patient-centered practice. It is a vehicle for enabling students to seek improvements in health care and initiate relevant actions to improve the patient experience at the bedside.

Establishing a Portfolio of Quality-Improvement Projects in Pediatric Surgery through Advanced Improvement Leadership Systems
Betsy T Gerrein, DNP, CPNP; Christina E Williams, MS; Daniel von Allmen, MD
Formal quality-improvement (QI) projects require that participants are educated in QI methods. However, orchestrating a portfolio of projects that addresses the strategic mission of the institution requires an extension of basic QI training to provide the division or business unit with the capacity to successfully develop and manage the portfolio. Advanced Improvement Leadership Systems is a program to help units create a meaningful portfolio.

2012

Winter 2012 - Volume 16 Number 1

How Do Adolescents Access Health Information? And Do They Ask Their Physicians?
George Ettel, III; Ian Nathanson, MD; Donna Ettel, PhD; Christine Wilson, PhD, ARNP; Paul Meola
Using a cross-sectional design, the authors administered an anonymous survey to high school students in grades 9 to 12. Surveys were completed by 497 of 705 students. All students were comfortable using the Internet, >90% used it at home and in school, a significant proportion reported trusting online information, and 22% modified their behavior. Topics included skin, nutrition, birth control, and sexually transmitted diseases. A significant number of students reported conducting e-mail conversations on health topics with their teachers versus only 5% with physicians.

Peer Review: Innovating Change
Antonio Salud II, MD; David Shapiro, MD; Tom Rampulla, MSMI; Karen Reddin, RN, MSN
Medicine has traditionally focused on specialty and subspecialty expertise, which subsequently leads to fragmentation, inefficiencies, and lack of accountability. The Institute methodology fosters accountability rather than blame, focuses on system failures rather than on individual ones, and results in a peer-review process built on strong interdisciplinary relationships.

Fall 2012 - Volume 16 Number 4

Patient Experience and Physician Productivity: Debunking the Mythical Divide at HealthPartners Clinics
Troy J Boffeli, DPM, FACFAS; Kerri L Thongvanh, MBA; Sarah J Horst Evans, MA; Clay R Ahrens, MHA
It is a common presumption that higher productivity must entail a sacrifice in patient satisfaction or vice versa. For a large multispecialty medical and surgical practice, an observational study found discrete sets of common characteristics for physicians and staff in four quadrants of high/low productivity and high/low satisfaction. There are many physicians who excel in both high areas simultaneously.

Anesthesiology Leadership Rounding: Identifying Opportunities for Improvement
Dietrich Gravenstein, MD; Susan Ford, RN; F Kayser Enneking, MD
Rounding that includes participation of individuals with authority to implement changes is important to the transformation of an institution into a high-quality and safe organization. The Chief of Anesthesiology, a quality coordinator, up to four residents, the ward charge nurse, and patient nurses participated in rounds at bedsides. The introduction of leadership rounding by an anesthesiology service can identify opportunities for improving quality that are not captured by conventional efforts.

2011

Winter 2011 - Volume 15 Number 1

Practice Leaders Programme: Entrusting and Enabling General Practitioners to Lead Change to Improve Patient Experience
Marion Lynch, PDHSc, MSc,PgCMed Ed, PgCStComm RGN RMN; Nigel McFetridge, MB, BCh, MRCGP, DFPHM
Oxford Deanery, England
In a region of social deprivation and quality underperformance in the United Kingdom, 19 new and experienced general practitioners entered a yearlong, narrative and complex systems program to: support change in leadership thinking and practice, facilitate practice-led service improvement, support career development, and contribute to extended GP specialty training. Statistically significant increases occurred in leadership competencies, services and care, confidence and changed culture.

Implementation Study­­­ —Vohs National Quality Award
Community Implementation and Translation of Kaiser Permanente's Cardiovascular Disease Risk-Reduction Strategy
Winston Wong, MD, MS; Marc Jaffe, MD; Michelle Wong, MPH, MPP; R James Dudl, MD
Kaiser Permanente San Diego, California
Forty-six clinics at community health centers and in public hospital/health systems in California initiated Kaiser Permanente's (KP) cardiovascular disease (CVD) risk-reduction program. Success included: 2245 patients received at least 1 of the 3 cardiovascular medications within 18 months, demonstrating successful translation of the strategy to the non-KP community. This may be a model for spread of CVD prevention measures, and prevention programs for other diseases, to all populations throughout the US.

Maintaining Optimal Oxygen Saturation in Premature Infants (Web Only)
Yoke Yen Lau, RN, BHSN; Yih Yann Tay, RN, BHSN; Varsha Atul Shah, MD, MBBS, MRCP; Pisun Chang, RN; Khuan Tai Loh, PEN
Singapore General Hospital
Advances in technology have resulted in increasing survival rates for premature infants. Oxygen therapy is commonly used in neonatal units as part of respiratory support. The number of premature infants in our institution surviving with severe (stage ≥3) retinopathy of prematurity (ROP) prompted a review of oxygen therapy as a contributing factor. Prolonged exposure to high concentrations of oxygen may cause irreversible damage to the eyes of very-low-birth-weight preterm infants and is a potential cause of blindness.

Spring 2011 - Volume 15 Number 2

Birth Outcomes Among Low-Income Women - Documented and Undocumented
Bich Ngoc Dang, MD; Louise Van Dessel, BS, MBA; June Hanke, RN, MSN, MPH; Margo A Hilliard, MD, MPH
In January 2007, Texas expanded the Children's Health Insurance Program (CHIP) to include perinatal care for the unborn children of undocumented low-income women. In a retrospective cohort study of 10,763 pregnant women (CHIP) and 4614 (Medicaid) who delivered between January 1 and August 31, 2008, Hispanic women had the lowest preterm and low-birth-weight rates (6.6% and 5.8%), and non-Hispanic black women had the highest (11.3% and 12.4%).

Reducing Antipsychotic Polypharmacy Among Psychogeriatric and Adult Patients with Chronic Schizophrenia
Yen-Li Goh, MD; Kok Han Seng, MD; Alex Su Hsin Chuan, MD; Hong Choon Chua, MD
In phase 1 of a project conducted with inpatients with chronic schizophrenia, the average chlorpromazine-equivalent dose per day in psychogeriatric patients was reduced from 375 mg to 170 mg. In phase 2 with adult patients, there was a reduction in both the average number of antipsychotics from 2.9 to 2.27, and an average chlorpromazine-equivalent dose per day from 1523 mg to 1246 mg, with no documented relapse within six months of implementation of both the projects.

Summer 2011 - Volume 15 Number 3

Building a System of Care: Integration across the Heart Failure Care Continuum
Jackie Cawley, DO; Cassandra Cote Grantham, MA
Disparate heart failure (HF) services existed across MaineHealth until an interdisciplinary joint HF workgroup was convened and created a comprehensive set of strategies that better linked HF activities and care settings across the health system, which resulted in: better communication, coordination, reliability, and standardization of HF care; improved readmission rates for Medicaid/Medicare (18.5% to 12.7%); increased prescribed ACE inhibitors (77% to 96%); smoking cessation counseling (77% to 97%); and completed discharge instructions (65% to 87%).

Optimizing Treatment of Intra-amniotic Infection and Early-Onset Postpartum Endometritis: Advantages of Single-Agent Therapy
Norma Stiglich, MD; Meredith Alston, MD; Simone vanSwam, MD
Intra-amniotic infection and early-onset postpartum endometritis occur in 9% of delivering patients at Denver Health Medical Center, the safety-net hospital for the city and county. In this retrospective study of 337 patients, 185 received the standard multi-agent antibiotic regimen and 152 received a single-agent (ampicillin/sulbactam). The results support the use of a single-agent. These patients collectively received 558 fewer medication doses.

Virtual Visitation in the Neonatal Intensive Care: Experience with the Use of Internet and Telemedicine in a Tertiary Neonatal Unit
CL Yeo, MD; Selina KY Ho, MD; KC Khong, RN, BHSN; YY Lau, RN, BHSN
Families of newborns requiring prolonged neonatal intensive care faced emotional and financial difficulties. To evaluate Internet-based telemedicine, eligible newborns were identified and written consent was obtained before a Web camera was installed by the baby's cot. Using the child specific, confidential password, families viewed real-time video images of their newborns through a secure portal via an Internet browser or third-generation (3G) phone. Virtual visitation was well accepted by families.

2009

Fall 2009 - Volume 13 Number 4

Reducing Collusion Between Family Members and Clinicians of Patients Referred to the Palliative Care Team
James Alvin Low, MBBS, FRCP; Sim Lai Kiow, SRN; Norhisham Main, MBBS, MRCP; Koh Kim Luan, SRN; Pang Weng Sun, MBBS, FRCP; May Lim, SRN
Alexandra Hospital, Singapore
The deeply entrenched Asian cultural practice of collusion—a secret agreement made between clinicians and family members to hide the diagnosis of a serious or life-threatening illness from a patient—was studied by the Palliative Care Team. Between December 2004 and June 2008, 655 patients with advanced-stage cancers were referred to the team. Beginning in February 2005, with the implementation of awareness measures, the team was able to maintain an average awareness rate of 80% of patients.

Decreasing Adverse Events through Night Talks: An Interdisciplinary, Hospital-Based Quality Improvement Project
Christine White, MD, MAT; Javier Gonzalez del Rey, MD, MEd
Cincinnati Children's Hospital
The majority of medical adverse events are secondary to errors in communication. Review of nonoperative adverse events at Cincinnati Children's Hospital Medical Center in 2007 found that 57% were related to failure to recognize abnormal vital signs and to communicate or to address parents' or nurses' concerns. The initiation of Night Talks—a late-evening review of patients' status by physicians and nurses—reduced near misses in neurosurgical patients to zero in 201 days, a 5360% change.

Staff Solutions for Noise Reduction in the Workplace
Alison Connor, RN, BSN, NE-BC; Elizabeth Ortiz, RN
St Luke's Hospital and Health Network, Pennsylvania
A comprehensive noise-reduction project was initiated in response to low patient-satisfaction scores on an inpatient neuroscience unit. Before project initiation, decibel readings (dB) were as high as 78.1 dB (standard recommended levels are 40 dB). Postproject satisfaction scores rose to the 95th percentile by July 2008.

Developing a Unit-Based Family Advocacy Board on a Pediatric Intensive Care Unit
Christine McMullan, MPA; Margaret Parker, MD, FCCM; Jeralyn Sigwart, RN, MS, PNP
Stony Brook University Hospital, New York
A pediatric intensive care unit developed a family advocacy board to assist staff in providing patient- and family-centered care. Questions asked pediatric critical care staff related to patients and families as advisors showed a statistically significant improvement postimplementation. Staff perception of the level of family involvement during and after anesthesia induction increased from 42% to 78%, and during resuscitation increased from 28% to 90%.

2008

Fall 2008 - Volume 12 Number 4

Early Discharge Study for Premature Infants: Singapore General Hospital
By Yeo Cheo Lian, MD; Selina Ho Kah Ying, MD; Cheong Chiu Peng, RN; Tay Yih Yann, RN
At Singapore General Hospital, premature infants had a median birth weight of 1210 g. Discharge traditionally occurred when infants were medically fit and weighed 2000 g. The length of hospital stay was reduced 59.8%, primarily by improved discharge planning, revised guidelines (mean discharge at 1915 g), and nurses' active preparation of parents psychologically and mentally for care of their babies at home.

Counseling and Wellness Services Integrated with Primary Care: A Delivery System That Works
By Ken Van Beek, LMSW; Steve Duchemin, PA-C; Geniene Gersh, MA, LLP; Susanne Pettigrew, PA-C; Pamela Silva; Barb Luskin
Grand Valley Health, Michigan
By colocating behavioral health counselors and nutritionists alongside primary care physicians. Grand Valley Health Plan established the national benchmark for patients using ambulatory services for mental health, and ranked first in Michigan on all six HEDIS "effectiveness of care" measures for behavioral health. One result was a 54% decrease in mental health hospitalization. Up to 70% of primary care visits are driven by psychosocial factors, with 25% of patients having a diagnosable mental disorder, and comorbidity occurring in up to 80% of patients.

NAPH Member Articles

The National Association of Public Hospitals and Health Systems (NAPH) Member Articles

2011

Spring 2011 - Volume 15 Number 2

Birth Outcomes Among Low Income Women – Documented and Undocumented
Bich Dang, MD, Margo A Hilliard, MD, June Hanke, Louise Van Dessel
Harris County Hospital District, Houston
http://www.thepermanentejournal.org/files/Spring2011/BirthOutcomes.pdf
In January 2007, Texas expanded the Children's Health Insurance Program (CHIP) to include perinatal care for the unborn children of undocumented low-income women. In a retrospective cohort study of 10,763 pregnant women (CHIP) and 4614 (Medicaid) who delivered between January 1 and August 31, 2008, Latina women had the lowest preterm and low-birth-weight rates (6.6% and 5.8%,), and non-Latina black women has the highest (11.3% and 12.4%).

Unconscious (Implicit) Bias and Health Disparities: Where Do We Go from Here?
John F Steiner, MD, MPH; Edward P Havranek, MD
Denver Health
http://www.thepermanentejournal.org/files/Spring2011/HealthDisparities.pdf
Disparities in health care are of great concern, with much attention focused on the potential for unconscious (implicit) bias to play a role in this problem. This article provides a research roadmap that spans investigations of the presence of implicit bias in health care settings, identification of mechanisms through which implicit bias operates, and interventions that may prevent or ameliorate its effects. Concrete suggestions are offered for indi­viduals in different roles.

Winter 2011 - Volume 15 Number 1

Community Implementation and Translation of Kaiser Permanente's Cardiovascular Disease Risk-Reduction Strategy
Winston Wong, MD, MS; Marc Jaffe, MD; Michelle Wong, MPH, MPP; R James Dudl, MD
University of California San Diego Medical Center
http://www.thepermanentejournal.org/files/Winter2011PDFS/cardiodiseaseriskreduction.pdf
Forty-six clinics at community health centers and in public hospital/health systems in California initiated Kaiser Permanente's (KP) cardiovascular disease (CVD) risk-reduction program. Success included: 2245 patients received at least 1 of the 3 cardiovascular medications within 18 months, demonstrating successful translation of the strategy to the non-KP community. This may be a model for spread of CVD prevention measures, and prevention programs for other diseases, to all populations throughout the US.

Innovation in Our Nation's Public Hospitals: Three-Year Follow-Up Interview with Five CEOs and Medical Directors—Part 1
Tom Janisse, MD
Truman Medical Centers, San Francisco General Hospital and Trauma Center, Cooper Green Mercy Hospital, New York City Health and Hospitals Corporation
http://www.thepermanentejournal.org/files/Winter2011PDFS/ceointerviews.pdf
Revisiting leaders from four hospitals systems, this interview includes comments on community interventions (a health fair that offered testing for prostate cancer); the relationship between community clinics and the hospital (a medical respite and mobile video translation conferencing); system integration (wellness programs for people who frequent the system and a nurse practitioner-staffed "bridge clinic"); and integration of people in the system (primary care-specialty care referrals, and multidisciplinary teams).

2010

Fall 2010 - Volume 14 Number 3

An Alternate Model for Medical Education: Longitudinal Medical Education Within an Integrated Health Care Organization—A Vision of a Model for the Future?
Quentin Eichbaum, MD, PhD, MPH, MFA, FCAP; Tim Grennan, MD, FACP; Howard Young, MD; Myra Hurt, PhD
University of California Davis Medical Center
http://www.thepermanentejournal.org/files/Fall2010PDFS/MedicalEducation.pdf
If one accepts that large health care systems are to remain part of the medical landscape, can their strengths be used in seeking solutions to the country's health care dilemmas. The authors suggest that situating modular and longitudinal medical education within a progressive integrated health care system such as a large, multispecialty group model, nonprofit health maintenance organization might provide a valid alternate stream of education and training for physicians.

Overview of Emerging Concepts in Metabolic Surgery
Michel Murr, MD, FACS; Arash Rafiei, MD; Habib Ajami, MD; Tannous K Fakhry, MD
Tampa General Hospital
http://www.thepermanentejournal.org/files/Fall2010PDFS/MetabolicSurgery.pdf
Obesity is a worldwide health epidemic, and about two-thirds of US adults are overweight or obese. The link between diabetes and obesity is because of induction of insulin resistance by excess adipose tissue and generalized low chronic inflammation. Metabolic or bariatric surgery induces durable and sustainable weight loss, and its role is well established. This review includes: the types of metabolic surgery, preoperative evaluation, postoperative care, follow-up, and the future of metabolic surgery.

2009

Fall 2009 - Volume 13 Number 4

Developing a Unit-Based Family Advocacy Board on a Pediatric Intensive Care Unit
Christine McMullan, MPA; Margaret Parker, MD, FCCM; Jeralyn Sigwart, RN, MS, PNP
Stony Brook University Hospital, New York
http://www.thepermanentejournal.org/files/Fall2009PDFS/DevelopingUnit-BasedFamilyAdvocacyBoardPediatricIntensiveCareUnit.pdf
A pediatric intensive care unit developed a family advocacy board to assist staff in providing patient- and family-centered care. Questions asked pediatric critical care staff related to patients and families as advisors showed a statistically significant improvement postimplementation. Staff perception of the level of family involvement during and after anesthesia induction increased from 42% to 78%, and during resuscitation increased from 28% to 90%.

2008

Winter 2008 - Volume 12 Number 1

Puentes Clinic: An Integrated Model for the Primary Care of Vulnerable Populations
Lawrence Kwan, MD; Cheryl J Ho, MD; Charles Preston, PhD; Viet Le, MD, PhD
Santa Clara Valley Health and Hospital System
http://www.thepermanentejournal.org/files/Winter2008PDFS/Puentes_clinic.pdf
This integrated model to address the needs of a medically vulnerable population of homeless and injection-drug users emphasizes open access, outreach, groups, and a team approach to care. Emergency Department and urgent care visit rates decreased, simultaneous with increased primary care visits.

Innovation in Our Nation's Public Hospitals: Interview with Five CEOs and Medical Directors
Tom Janisse, MD; Winston F Wong, MD
New York City Health and Hospitals Corporation, Truman Medical Centers, Cooper Green Mercy Hospital, San Francisco General Hospital
http://www.thepermanentejournal.org/files/Winter2008PDFS/innovation.pdf
Prominent leaders talk about: developing an integrated system with community clinics and neighborhoods; and, for an ever larger, diverse, and immigrant population, a new simultaneous translation system; and training future doctors by involving them in the hospital's quality improvement committees and clinical projects.

Spring 2008 - Volume 12 Number 2

Introducing the "Teamlet": Initiating a Primary Care Innovation at San Francisco General Hospital
Brian Yoshio Laing; Lisa Ward, MD, MScPH, MS; Thomas Yeh; Ellen Chen, MD; Thomas Bodenheimer, MD
http://www.thepermanentejournal.org/files/Spring2008PDFS/teamlet.pdf
The 15-minute visit cannot meet the health care needs of patients in primary care. In the Family Health Center, the "Teamlet" practice innovation--a clinician and a health coach--was implemented to expand the traditional medical visit into previsit, visit, postvisit, and between-visit care.

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