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Roughly one in ten adult Americans find their walking slowed by progressive chronic conditions like arthritis, back problems, heart and lung diseases, and diabetes. In this passionate and deeply informed book, Lisa I. Iezzoni describes the personal experiences of and societal responses to adults whose mobility makes it difficult for them to live as they wish-partly because of physical and emotional conditions and partly because of persisting societal and environmental barriers. Basing her conclusions on personal experience, a wealth of survey data, and extensive interviews with dozens of people from a wide social spectrum, Iezzoni explains who has mobility problems and why; how mobility difficulties affect people's physical comfort, attitudes, daily activities, and relationships with family and friends throughout their communities; strategies for improving mobility; and how the health care system addresses mobility difficulties, providing and financing services and assistive technologies. Iezzoni claims that, although strategies exist to improve mobility, many people do not know where to turn for advice. She addresses the need to inform policymakers about areas where changes will better accommodate people with difficulty walking. This straightforward and engaging narrative clearly demonstrates that improving people's ability to move freely and independently will enhance overall health and quality of life, not only for these persons, but also for society as a whole.

Public Policy --- Movement Disorders --- Gait --- Chronic Disease --- Chronic diseases --- Movement disorders. --- Diseases, Chronic --- NCDs (Noncommunicable diseases) --- Non-communicable diseases --- Non-infectious diseases --- Noncommunicable diseases --- Diseases --- Dyskinesia --- Dyskinesias --- Motor disorders --- Disabilities --- Nervous system --- Movement Disorder Syndromes --- Dyskinesia Syndromes --- Etat Marbre --- Status Marmoratus --- Dyskinesia Syndrome --- Movement Disorder --- Movement Disorder Syndrome --- Psychomotor Disorders --- Chronically Ill --- Chronic Illness --- Chronic Diseases --- Chronic Illnesses --- Disease, Chronic --- Illness, Chronic --- Illnesses, Chronic --- Pain Management --- Gaits --- Locomotion --- Walking --- Affirmative Action --- Migration Policy --- Population Policy --- Social Protection --- Social Policy --- Action, Affirmative --- Migration Policies --- Policies, Migration --- Policies, Population --- Policies, Public --- Policies, Social --- Policy, Migration --- Policy, Population --- Policy, Public --- Policy, Social --- Population Policies --- Protection, Social --- Public Policies --- Social Policies --- Policy Making --- Social Control, Formal --- psychology --- Complications. --- american adults. --- arthritis. --- back problems. --- chronic conditions. --- chronic health conditions. --- diabetes. --- disabling conditions. --- emotional conditions. --- health care system. --- health policy. --- healthy society. --- heart disease. --- improve mobility. --- lung disease. --- medicine. --- mobility difficulties. --- mobility problems. --- nonfiction. --- personal experiences. --- physical disabilities. --- policymakers. --- public health. --- quality of life. --- social relationships. --- societal issues. --- textbooks. --- walking.

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Health risk assessment. --- Outcome assessment (Medical care) --- Outcome Assessment, Health Care --- Risk Adjustment --- Decision Support Techniques. --- Delivery of Health Care --- Models, Statistical. --- Risk Factors. --- Population at Risk --- Populations at Risk --- Health Correlates --- Risk Factor Scores --- Risk Scores --- Correlates, Health --- Factor, Risk --- Risk Factor --- Risk Factor Score --- Risk Score --- Score, Risk --- Score, Risk Factor --- Organs at Risk --- Model, Statistical --- Models, Binomial --- Models, Polynomial --- Statistical Model --- Probabilistic Models --- Statistical Models --- Two-Parameter Models --- Binomial Model --- Binomial Models --- Model, Binomial --- Model, Polynomial --- Model, Probabilistic --- Model, Two-Parameter --- Models, Probabilistic --- Models, Two-Parameter --- Polynomial Model --- Polynomial Models --- Probabilistic Model --- Two Parameter Models --- Two-Parameter Model --- Statistics as Topic --- Analysis, Decision --- Decision Aids --- Decision Support Technics --- Decision Analysis --- Decision Modeling --- Models, Decision Support --- Aid, Decision --- Aids, Decision --- Analyses, Decision --- Decision Aid --- Decision Analyses --- Decision Support Model --- Decision Support Models --- Decision Support Technic --- Decision Support Technique --- Model, Decision Support --- Modeling, Decision --- Technic, Decision Support --- Technics, Decision Support --- Technique, Decision Support --- Techniques, Decision Support --- Clinical Decision-Making --- Decision Making --- Decision Making, Organizational --- Assessment of outcome (Medical care) --- Outcome evaluation (Medical care) --- Outcome measures (Medical care) --- Outcomes assessment (Medical care) --- Outcomes measurement (Medical care) --- Outcomes research (Medical care) --- Patient outcome assessment --- Medical care --- Assessment, Health risk --- Health hazard appraisal --- Health hazard assessment --- Health risk appraisal --- HRA (Public health) --- Human risk assessment --- Medicine, Preventive --- Public health --- Risk assessment --- Environmental health --- methods. --- organization & administration. --- Evaluation --- Social Risk Factors --- Factor, Social Risk --- Factors, Social Risk --- Risk Factor, Social --- Risk Factors, Social --- Social Risk Factor

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BACKGROUND: Persons who are dually eligible for Medicare and Medicaid generate disproportionately high costs. Individuals younger than 65 years of age who qualify for Medicare because of disability are especially costly, as they require expensive long-term services and supports (LTSS) needs. To explore efficient health care delivery models for these beneficiaries, the Centers for Medicare & Medicaid Services (CMS) initiated demonstration programs for dually eligible individuals. The Massachusetts One Care program is CMS's only demonstration program nationwide that targets younger beneficiaries: individuals aged 21 to 64 years. As CMS and Massachusetts Medicaid designed One Care, which involves dually capitated payments to plans and covers all services including LTSS, local disability advocates voiced concerns about threats to care quality. They argued that persons with disability should be the ones leading efforts to assess One Care quality, highlighting fears related to independent living in communities. OBJECTIVES: This study aimed to test the comparative effectiveness for improving patient-reported health care experiences of 2 informational interventions in a 12-month period: (1) the "YES Health: Your Experience, Speak up for better health care" initiative, in which disability advocates developed brief topical surveys and gathered information from One Care enrollees with significant physical disability or serious mental illness; and (2) the Persons With Disability Quality Survey (PDQ-S), developed collaboratively with persons with disability. METHODS: We focused on English- and Spanish-speaking One Care members with either serious mental illness or significant physical disability. This cluster randomized controlled trial randomly assigned 27 primary care practices with ≥50 One Care members meeting these specifications to 3 study arms differing by information provided to practice directors and primary care providers (PCPs): (1) quarterly YES Health reports plus results from baseline administration of PDQ-S to 720 enrollees before YES Health implementation; (2) PDQ-S results only; and (3) no study information. We administered PDQ-S again 1 year later and used difference-in-differences analyses of results across the 2 years to assess intervention outcomes. After YES Health concluded, we surveyed the 221 PCPs listed as serving sample members at the 27 practices. RESULTS: Led by individuals with significant physical disability or serious mental illness, YES Health engaged 45 persons--with disabilities from the 9 randomly assigned practices--in surveys evaluating their One Care quality. Topics selected for the quarterly YES Health quality surveys were One Care plans and care teams, communication with clinicians, LTSS, and transportation. However, PCPs at the 9 study arm 1 practices did not engage with the disability advocates, despite repeated outreach. With minimal exceptions, we found no differences across the 3 study arms in PDQ-S member-reported outcomes. Of the 110 eligible PCPs who responded to the survey (54.4%), few reported knowing about YES Health or baseline PDQ-S results. CONCLUSIONS: Individuals with disability successfully designed and implemented YES Health. Nonetheless, the inability to engage PCPs in collaborative interactions likely contributed to YES Health having no effect. Future research should consider approaches toward developing effective patient-physician partnerships to improve care. LIMITATIONS AND SUBPOPULATION CONSIDERATIONS: This study may have limited generalizability beyond the context of dually eligible individuals aged <65 years in integrated care delivery systems with dually capitated reimbursement.

People with disabilities --- Medical care.

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Over the past forty years, the health humanities, previously called the medical humanities, has emerged as one of the most exciting fields for interdisciplinary scholarship, advancing humanistic inquiry into bioethics, human rights, health care, and the uses of technology. It has also helped inspire medical practitioners to engage in deeper reflection about the human elements of their practice. In Health Humanities Reader, editors Therese Jones, Delese Wear, and Lester D. Friedman have assembled fifty-four leading scholars, educators, artists, and clinicians to survey the rich body of work that has already emerged from the field—and to imagine fresh approaches to the health humanities in these original essays. The collection’s contributors reflect the extraordinary diversity of the field, including scholars from the disciplines of disability studies, history, literature, nursing, religion, narrative medicine, philosophy, bioethics, medicine, and the social sciences. With warmth and humor, critical acumen and ethical insight, Health Humanities Reader truly humanizes the field of medicine. Its accessible language and broad scope offers something for everyone from the experienced medical professional to a reader interested in health and illness.

Philosophy, Medical. --- Medical education. --- Medicine and the humanities. --- Humanities and medicine --- Humanities --- Medical personnel --- Professional education --- Education --- Medicine --- Communication in medicine. --- Médecine --- Médecine et sciences humaines --- Communication en médecine --- Enseignement médical --- Philosophy. --- Philosophie --- Medical Philosophy --- narrative medicine.