flexible grading policies
I'm especially attracted to the #ungrading work I've been watching from folks like Mary Klann and David Buck...and I know there are so many more people working with authentic and alternative assessment practices...
flexible grading policies
I'm especially attracted to the #ungrading work I've been watching from folks like Mary Klann and David Buck...and I know there are so many more people working with authentic and alternative assessment practices...
We as parents will always give more to our kids than they will give us,
This is likely true: parents give to their kids in ways we ourselves probably can't remember or truly know. Lately, however — and maybe this is because my kids have reached a certain age — I feel like I've been getting more from my kids than I'm giving, both in care and intellectually.
I wonder how I might teach differently if my expectation were always that I would be getting more from my students than they might get from me?
Twitter group DMs with international friends
For me too such international group conversations have been immensely sustaining during the pandemic, and a deep source of learning and laughter. Many of us don't even really know each other that well and have not ever met in person, but our guards are down, our empathy is up, and almost any topic elicits some thoughtful response, or at least acknowledgement.
Can you think of others?
In the USA especially, I feel like teachers would benefit from much more care from society in general and government at all levels. In the USA, we pay lip service to the sacrifice and nobility of teachers, but also under-fund and under-value teaching and education generally.
Crocker-Buque, T., Edelstein, M., & Mounier-Jack, S. (2017). Interventions to reduce inequalities in vaccine uptake in children and adolescents aged <19 years: A systematic review. Journal of Epidemiology and Community Health, 71(1), 87–97. https://doi.org/10.1136/jech-2016-207572
Howard, J., Huang, A., Li, Z., Tufekci, Z., Zdimal, V., Westhuizen, H.-M. van der, Delft, A. von, Price, A., Fridman, L., Tang, L.-H., Tang, V., Watson, G. L., Bax, C. E., Shaikh, R., Questier, F., Hernandez, D., Chu, L. F., Ramirez, C. M., & Rimoin, A. W. (2021). An evidence review of face masks against COVID-19. Proceedings of the National Academy of Sciences, 118(4). https://doi.org/10.1073/pnas.2014564118
Liverpool, C. W., Jessica Hamzelou, Adam Vaughan, Conrad Quilty-Harper and Layal. (n.d.). Covid-19 news: One in ten cases in England have been in health workers. New Scientist. Retrieved July 7, 2020, from https://www.newscientist.com/article/2237475-covid-19-news-one-in-ten-cases-in-england-have-been-in-health-workers/
Huebener, M., Waights, S., Spiess, C. K., Siegel, N. A., & Wagner, G. G. (2020). Parental Well-Being in Times of COVID-19 in Germany. IZA Discussion Paper, 13556.
Keystone-SDA/gw. (n.d.). Emergency care workers urge Swiss government to act as Covid cases soar. SWI Swissinfo.Ch. Retrieved 1 March 2021, from https://www.swissinfo.ch/eng/emergency-care-workers-urge-swiss-government-to-act-as-covid-cases-surge/46103186
Disabato, D., Aurora, P., Sidney, P. G., Taber, J. M., Thompson, C. A., & Coifman, K. (2021). Taking care with self-care during COVID-19: Affect-behavior associations during early stages of the pandemic. PsyArXiv. https://doi.org/10.31234/osf.io/eycmj
Merchant, A. (n.d.). Perspective | I work in a nursing home. Here’s why my colleagues are skipping the vaccine. Washington Post. Retrieved February 18, 2021, from https://www.washingtonpost.com/outlook/nursing-home-skip-vaccine/2021/02/12/4d31d17a-6bfa-11eb-9f80-3d7646ce1bc0_story.html
Ahuvia, I., Sung, J., Dobias, M., Nelson, B., Richmond, L., London, B., & Schleider, J. L. (2021, April 25). College student interest in teletherapy and self-guided mental health supports during the COVID-19 pandemic. https://doi.org/10.31234/osf.io/8unfx
Vaughan, Adam. ‘Covid-19 Vaccine Passports: Everything You Need to Know’. New Scientist. Accessed 17 April 2021. https://www.newscientist.com/article/2273080-covid-19-vaccine-passports-everything-you-need-to-know/.
I managed to do half the work. But that’s exactly it: It’s work. It’s designed that way. It requires a thankless amount of mental and emotional energy, just like some relationships.
This is a great example of how services like Facebook can be like the abusive significant other you can never leave.
I realized it was foolish of me to think the internet would ever pause just because I had. The internet is clever, but it’s not always smart. It’s personalized, but not personal. It lures you in with a timeline, then fucks with your concept of time. It doesn’t know or care whether you actually had a miscarriage, got married, moved out, or bought the sneakers. It takes those sneakers and runs with whatever signals you’ve given it, and good luck catching up.
Pinterest doesn’t know when the wedding never happens, or when the baby isn’t born. It doesn’t know you no longer need the nursery. Pinterest doesn’t even know if the vacation you created a collage for has ended. It’s not interested in your temporal experience.This problem was one of the top five complaints of Pinterest users.
Made with love an care.
Health, T. L. P. (2021). COVID-19 in France: Challenges and opportunities. The Lancet Public Health, 6(4), e192. https://doi.org/10.1016/S2468-2667(21)00054-2
Can we occupy technology with love?
An interesting re-framing of the social media problem. Similar to the IndieWeb philosophy, but a bit more pointed.
“Follow your blisters” implies something that you come back to so many times that you eventually move past the blister stage, into toughened skin. Eventually, the activity “marks you” through use and practice, and you develop a special competence. When you practice an activity a bit more obsessively than other people, you build unique character – you earn some wear and some healing that makes you idiosyncratic, and a little unbalanced.It is something that you don’t need to put on your to-do list, something you care enough about to return to repeatedly, even though it causes discomfort. Over time, you develop a layer of protection that enables you to do that something more easily.
Morris, C. (2020, May 23). “Baffling” observations from the front line. BBC News. https://www.bbc.com/news/52760992
New Covid-19 lockdown study shows drop in child health visits but resilience of HIV care systems in rural KZN. (2020, May 25). Africa Health Research Institute. https://www.ahri.org/new-covid-19-lockdown-study-shows-drop-in-child-health-visits-but-resilience-of-hiv-care-systems-in-rural-kzn/
Goodnough, A. (2020, December 1). Long-Term-Care Residents and Health Workers Should Get Vaccine First, C.D.C. Panel Says. The New York Times. https://www.nytimes.com/2020/12/01/health/covid-vaccine-distribution-cdc.html
David R Tomlinson 💙. (2021, March 5). Truth. 💙 @FreshAirNHS @theRCN @TheBMA @mancunianmedic @DrLindaDykes @Chakladar_A @KGadhok https://t.co/Ke2C84KuaT https://t.co/C469qvrSoK [Tweet]. @DRTomlinsonEP. https://twitter.com/DRTomlinsonEP/status/1367962251211202566
ReconfigBehSci. (2021, January 14). RT @jimtankersley: The Biden ‘American Rescue Plan’ goes big: $1.9T, incl almost every Dem stimulus priority under the sun: State/local… [Tweet]. @SciBeh. https://twitter.com/SciBeh/status/1349993219988328449
Farzan, A. N. (n.d.). Philadelphia let ‘college kids’ distribute vaccines. The result was a ‘disaster,’ volunteers say. Washington Post. Retrieved 26 February 2021, from https://www.washingtonpost.com/nation/2021/01/27/philly-fighting-covid-vaccine/
Tankersley, J., & Crowley, M. (2021, January 14). Biden Outlines $1.9 Trillion Spending Package to Combat Virus and Downturn. The New York Times. https://www.nytimes.com/2021/01/14/business/economy/biden-economy.html
the community is both endlessly creative and genuinely interested in solving big issues in meaningful ways. Whether it's their commitment to careful (and caring) community stewardship or their particular strain of techno-ethics, I have been consistently (and pleasantly) surprised at what I've seen during the last twelve months. I don't always see eye-to-eye with their decisions and I don't think that the community is perfect, but it's consistently (and deliberately) striving to be better, and that's a fairly rare thing, online or off.
Cosslett, R. L. (2021, February 3). ‘They were freaking out’: meet the people treating NHS workers for trauma. The Guardian. https://www.theguardian.com/world/2021/jan/23/meet-the-people-treating-nhs-workers-for-trauma
editor, Ian Sample Science. ‘Coronavirus: UK Scientists Identify Drugs That May Help Severe Cases’. The Guardian, 11 December 2020, sec. Science. https://www.theguardian.com/science/2020/dec/11/coronavirus-uk-scientists-identify-drugs-that-may-help-severe-cases.
Green, Andrew. ‘A Tribute to Some of the Doctors Who Died from COVID-19’. The Lancet 396, no. 10264 (28 November 2020): 1720–29. https://doi.org/10.1016/S0140-6736(20)32478-8.
In King County, pollution makes ZIP codes predictors of your health | Crosscut. (n.d.). Retrieved 5 March 2021, from https://crosscut.com/video/new-normal/king-county-pollution-makes-zip-codes-predictors-your-health
Will it also help accomplish another goal — communicating to my students that a classroom of learners is, in my mind, a sort of family?
I like the broader idea of a classroom itself being a community.
I do worry that without the appropriate follow up after the fact that this sort of statement, if put on as simple boilerplate, will eventually turn into the corporate message that companies put out about the office and the company being a tight knit family. It's easy to see what a lie this is when the corporation hits hard times and it's first reaction is to fire family members without any care or compassion.
<small><cite class='h-cite via'>ᔥ <span class='p-author h-card'>Remi Kalir</span> in Annotate Your Syllabus 3.0 (<time class='dt-published'>03/13/2021 14:18:33</time>)</cite></small>
Rietz, H. (2020, November 18). Intensivmedizin am Anschlag: Zertifizierte Betten sind belegt. Neue Zürcher Zeitung. https://www.nzz.ch/wissenschaft/intensivmedizin-am-anschlag-zertifizierte-betten-sind-belegt-ld.1587675
Holder, J., Stevis-Gridneff, M., & McCann, A. (2020, December 4). Europe’s Deadly Second Wave: How Did It Happen Again? The New York Times. https://www.nytimes.com/interactive/2020/12/04/world/europe/europe-covid-deaths.html
identity theft
Saw this while scrolling through quickly. Since I can't meta highlight another hypothesis annotation
identity theft
I hate this term. Banks use it to blame the victims for their failure to authenticate people properly. I wish we had another term. —via > mcr314 Aug 29, 2020 (Public) on "How to Destroy ‘Surveillance C…" (onezero.medium.com)
This is a fantastic observation and something that isn't often noticed. Victim blaming while simultaneously passing the buck is particularly harmful. Corporations should be held to a much higher standard of care. If corporations are treated as people in the legal system, then they should be held to the same standards.
Dr Phil Hammond 💙. (2020, December 6). In some parts of the country, 31% of care home staff come from the EU. Some areas already have a 26% vacancy rate. And on January 1, EU recruitment will plummet because workers earn less than the £26,500 threshold. A very predictable recruitment crisis on top of the Covid crisis. [Tweet]. @drphilhammond. https://twitter.com/drphilhammond/status/1335490431837200384
Mansfield, K. E., Mathur, R., Tazare, J., Henderson, A. D., Mulick, A., Carreira, H., Matthews, A. A., Bidulka, P., Gayle, A., Forbes, H., Cook, S., Wong, A. Y., Strongman, H., Wing, K., Warren-Gash, C., Cadogan, S. L., Smeeth, L., Hayes, J. F., Quint, J. K., … Langan, S. M. (2020). COVID-19 collateral: Indirect acute effects of the pandemic on physical and mental health in the UK. MedRxiv, 2020.10.29.20222174. https://doi.org/10.1101/2020.10.29.20222174
Buckley, M. (n.d.). Volunteering to give the vaccine: ‘One of the most therapeutic things’. Chicagotribune.Com. Retrieved 22 February 2021, from https://www.chicagotribune.com/coronavirus/ct-covid-vaccine-volunteers-20210212-4ar63uhar5cpzngp2lqaqqi2wy-story.html
Imperial projects global coronavirus trajectory with simulation tool | Imperial News | Imperial College London. (n.d.). Imperial News. Retrieved 19 February 2021, from https://www.imperial.ac.uk/news/210053/imperial-projects-coronavirus-trajectory-countries-with/
Covid eruption in Brazil’s largest state leaves health workers begging for help. (2021, January 14). The Guardian. http://www.theguardian.com/world/2021/jan/14/brazil-manaus-amazonas-covid-coronavirus
Anonymous. (2021, January 20). This is what it’s like to be an intensive care unit nurse right now. The Guardian. http://www.theguardian.com/commentisfree/2021/jan/20/intensive-care-nurse-eu-europeans-health-britain
Thomas Van Boeckel. (2020, November 30). Https://t.co/s7o808PE3U now shows the ‘ad-hoc’ bed capacity as well as the bed capacity certified by the Swiss Society of Intensive Care Medicine. Data from partners the Coordinated Sanitary Service of @vbs_ddps. Thanks @nico_criscuolo @ChengZhao20, PhDs at @ETH_en https://t.co/5XxTexVyy9 [Tweet]. @thvanboeckel. https://twitter.com/thvanboeckel/status/1333323133592408064
Groulx, T., Bagshawe, M., Giesbrecht, G., Tomfohr-Madsen, L., Hetherington, E., & Lebel, C. (2021). Prenatal care disruptions and associations with maternal mental health during the COVID-19 pandemic. PsyArXiv. https://doi.org/10.31234/osf.io/fc38j
These days I find myself away from broadcast tools and more in the insular channels of my friend groups. What I want from technology is to share life with my friends; to be given the opportunity, and the power, to share that life, and all it includes… showing them care, or sharing the bits of knowledge that seem important to us as a group.
Yes, you do face difficult choices (moral) but you don't care about it. All you care are the reputation bars. So... Let's kill this guy, who cares if he is innocent, but this faction needs it or I'm dead. Sounds great on paper but to be honest... you just sit there and do whatever for these reputation bars. If you won't, then you lose
Research, then, becomes a practice of correspondence.[7] It is through corresponding with things that we care for them
both words share the same etymological root (from the Latin, curar
Shipley, Rebecca J., David Brealey, Rashan Haniffa, Clare Elwell, Tim Baker, David A. Lomas, und Mervyn Singer. „Lessons and Risks of Medical Device Deployment in a Global Pandemic“. The Lancet Global Health 0, Nr. 0 (3. Februar 2021). https://doi.org/10.1016/S2214-109X(21)00028-0.
Özceylan, G., Toprak, D., & Esen, E. S. (2020). Vaccine rejection and hesitation in Turkey. Human Vaccines & Immunotherapeutics, 16(5), 1034–1039. https://doi.org/10.1080/21645515.2020.1717182
Fuchs-Schunder. N., Kuhn. M., Tertilt. M., (2020). The Short-Run Macro Implications of School and Child-Care Closures Institute of labor Economics. Retrieved from: https://covid-19.iza.org/publications/dp13353/
Despite some implementation challenges, patient portals have allowed millions of patients to access to their medical records, read physicians’ notes, message providers, and contribute valuable information and corrections.
I wonder if patients have edit - or at least, flag - information in their record?
Most users frankly don’t care how software is packaged. They don’t understand the difference between deb / rpm / flatpak / snap. They just want a button that installs Spotify so they can listen to their music.
Weiskittle, R. E., Mlinac, M., & Nicole Downing, L. (2020, August 25). Addressing COVID-19 Worry and Social Isolation in Home-Based Primary Care. https://doi.org/10.31234/osf.io/483zv
Ledford, H., Cyranoski, D., & Noorden, R. V. (2020). The UK has approved a COVID vaccine—Here’s what scientists now want to know. Nature, 588(7837), 205–206. https://doi.org/10.1038/d41586-020-03441-8
Svelte by itself is great, but doing a complete PWA (with service workers, etc) that runs and scales on multiple devices with high quality app-like UI controls quickly gets complex. Flutter just provides much better tooling for that out of the box IMO. You are not molding a website into an app, you are just building an app. If I was building a relatively simple web app that is only meant to run on the web, then I might still prefer Svelte in some cases.
Coronavirus excess fatalities: How pandemic is impacting the lives and deaths of those who don’t have COVID. (n.d.). Sky News. Retrieved October 15, 2020, from https://news.sky.com/story/coronavirus-excess-fatalities-how-pandemic-is-impacting-the-lives-and-deaths-of-those-who-dont-have-covid-12103141
Why, though, do we not romanticize our preservation? The same matter of chance, of the fleeting nature of fate exists on the other side of the coin. What would have happened if we were better rested, if our energy was better preserved, if we managed our time and said what we really mean? Rarely do we approach whether we get eight hours of sleep with the same guilt as we do whether or not we attended a party, even when, according to sleep expert Matthew Walker, sleep deprivation prevents the brain from remembering information, creating new memories, and sustaining emotional well-being.
A great observation!
IZA – Institute of Labor Economics. ‘COVID-19 and the Labor Market’. Accessed 6 October 2020. https://covid-19.iza.org/publications/dp13742/.
Thomas, K., & Rabin, R. C. (2020, October 4). Trump’s Treatment Suggests Severe Covid-19, Medical Experts Say. The New York Times. https://www.nytimes.com/2020/10/04/health/trump-covid-treatment.html
Mondelli, Mario U., Marta Colaneri, Elena M. Seminari, Fausto Baldanti, and Raffaele Bruno. ‘Low Risk of SARS-CoV-2 Transmission by Fomites in Real-Life Conditions’. The Lancet Infectious Diseases 0, no. 0 (29 September 2020). https://doi.org/10.1016/S1473-3099(20)30678-2.
The thing is this has been requested before though and they really don't seem to care :/
This dynamic is playing out during the pandemic among the many people who refuse to wear masks or practice social distancing.
Many people say they care for each other but when it comes to a pandemic that many think is a hoax, they don't care for the health of others. Even if it is a hoax, wouldn't you still be careful?
Commissioner, O. of the. (2020, September 23). Coronavirus (COVID-19) Update: FDA Authorizes First Point-of-Care Antibody Test for COVID-19. FDA; FDA. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-point-care-antibody-test-covid-19
Don’t really give much a hoot of “image” problems. We diagnose problems, device solutions, and then if that appeals, great, and if it doesn’t appeal, also great
Also Svelte is so great because developer do not need to worry about class names conflict, except of passing (global) classes to component (sic!).
You must: reference each element you are extending using refs or an id add code in your oncreate and ondestroy for each element you are extending, which could become quite a lot if you have a lot of elements needing extension (anchors, form inputs, etc.)
This is where hooks/behaviors are a good idea. They clean up your component code a lot. Also, it helps a ton since you don't get create/destroy events for elements that are inside {{#if}} and {{#each}}. That could become very burdensome to try and add/remove functionality with elements as they are added/removed within a component.
But some sort of official way to do that in the language would make this nicer - and would mean I would have to worry less about destroying components when their parent is destroyed, which I'm certainly not being vigilant about in my code.
HuffPost UK. ‘The Coronavirus Is Creating A Mental Health Crisis For Health Care Workers’, 21 September 2020. https://www.huffpost.com/entry/health-care-workers-covid-mental-health_n_5f625a6ac5b6c6317cfed815.
Most instructors will have the experience and knowledge of their students’ situation to make wise choices about activities that will work best.
Academic professors are acknowledging their students well-being which is important and shows care from both sides of the professor and student. This allows the student know that even though the professor is mainly involved with education, they still care.
Paudel, Dhirendra. ‘ABC Framework of Fear of COVID-19 for Psychotherapeutic Intervention in Nepal: A Review’. Preprint. PsyArXiv, 4 September 2020. https://doi.org/10.31234/osf.io/9sj4a.
Customers care more about the value our application adds to their lives than the programming language or framework the application is built with. Visible Technical Debt such as bugs and missing features and poor performance takes precedence over Hidden Technical Debt such as poor test code coverage, modularity or removing dead code
Smith, C. F., Drew, S., Ziebland, S., & Nicholson, B. D. (2020). Understanding the role of GPs’ gut feelings in diagnosing cancer in primary care: A systematic review and meta-analysis of existing evidence. British Journal of General Practice, 70(698), e612–e621. https://doi.org/10.3399/bjgp20X712301
Thornton, J. (2020). Covid-19: Care homes in Belgium and Spain had “alarming living conditions,” says MSF report. BMJ, 370. https://doi.org/10.1136/bmj.m3271
Covid-19 has decimated independent U.S. primary care practices—How should policymakers and payers respond? (2020, July 2). The BMJ. https://blogs.bmj.com/bmj/2020/07/02/covid-19-has-decimated-independent-u-s-primary-care-practices-how-should-policymakers-and-payers-respond/
Texas patient, 30, dies after attending ‘COVID party,’ doctor says. (n.d.). Usatoday. Retrieved 13 July 2020, from https://www.usatoday.com/story/news/nation/2020/07/11/texas-patient-30-dies-after-attending-covid-party-doctor-says/5422175002/
Crosby, S. S. (2020). My COVID-19. Annals of Internal Medicine. https://doi.org/10.7326/M20-5126
Balsari, S., Sange, M., & Udwadia, Z. (2020). COVID-19 care in India: The course to self-reliance. The Lancet Global Health, 0(0). https://doi.org/10.1016/S2214-109X(20)30384-3
Marijon, E., Karam, N., Jost, D., Perrot, D., Frattini, B., Derkenne, C., Sharifzadehgan, A., Waldmann, V., Beganton, F., Narayanan, K., Lafont, A., Bougouin, W., & Jouven, X. (2020). Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: A population-based, observational study. The Lancet Public Health, 5(8), e437–e443. https://doi.org/10.1016/S2468-2667(20)30117-1
Care homes or prisons? The coronavirus dilemma that won’t go away. (2020, July 19). Jackie Cassell. https://www.jackiecassell.com/care-homes-or-prisons-the-coronavirus-dilemma-that-wont-go-away/
Rodela, T. T., Tasnim, S., Mazumder, H., Faizah, F., Sultana, A., & Hossain, M. M. (2020). Economic Impacts of Coronavirus Disease (COVID-19) in Developing Countries [Preprint]. SocArXiv. https://doi.org/10.31235/osf.io/wygpk
die Notwendigkeit, neben der als typisch männlich betrachteten Gerechtigkeitsmoral ("voice of justice") auch die feminine Fürsorgemoral ("voice of care") anzuerkennen, die sich statt an formalen Gerechtigkeitsprinzipien eher an der Qualität der Beziehung orientiert und Gefühle sowie soziales Engagement in den Vordergrund der Betrachtung rückt.[3]
Ziedan, E., Simon, K. I., & Wing, C. (2020). Effects of State COVID-19 Closure Policy on NON-COVID-19 Health Care Utilization (Working Paper No. 27621; Working Paper Series). National Bureau of Economic Research. https://doi.org/10.3386/w27621
Dave, D. M., Friedson, A. I., Matsuzawa, K., McNichols, D., & Sabia, J. J. (2020). Did the Wisconsin Supreme Court Restart a COVID-19 Epidemic? Evidence from a Natural Experiment (Working Paper No. 27322; Working Paper Series). National Bureau of Economic Research. https://doi.org/10.3386/w27322
Gettys, T. (n.d.). ‘Listening to experts is elitist’: Idaho Republicans move to strip power from public health officials. Retrieved 12 August 2020, from https://www.rawstory.com/2020/08/listening-to-experts-is-elitist-idaho-republicans-move-to-strip-power-from-public-health-officials/
Jones, Callum J, Thomas Philippon, and Venky Venkateswaran. ‘Optimal Mitigation Policies in a Pandemic: Social Distancing and Working from Home’. Working Paper. Working Paper Series. National Bureau of Economic Research, April 2020. https://doi.org/10.3386/w26984.
Stock, James H. ‘Data Gaps and the Policy Response to the Novel Coronavirus’. Working Paper. Working Paper Series. National Bureau of Economic Research, March 2020. https://doi.org/10.3386/w26902.
Well-Being Services for Health Care Workers During the COVID-19 Pandemic. (2020, August 4). The Health Psychologist. https://div38healthpsychologist.com/2020/08/04/well-being-services-for-health-care-workers-during-the-covid-19-pandemic-program-highlights-from-the-department-of-psychiatry-university-of-colorado-school-of-medicine/
Chen, M. K., Chevalier, J. A., & Long, E. F. (2020). Nursing Home Staff Networks and COVID-19 (Working Paper No. 27608; Working Paper Series). National Bureau of Economic Research. https://doi.org/10.3386/w27608
The Impact of COVID-19 on the U.S. Child Care Market: Evidence from Stay-At-Home Orders. COVID-19 and the Labor Market. (n.d.). IZA – Institute of Labor Economics. Retrieved August 5, 2020, from https://covid-19.iza.org/publications/dp13261/
Exploring the Relationship between Care Homes and Excess Deaths in the COVID-19 Pandemic: Evidence from Italy. COVID-19 and the Labor Market. (n.d.). IZA – Institute of Labor Economics. Retrieved July 27, 2020, from https://covid-19.iza.org/publications/dp13492/
Quinn, A. E., Trachtenberg, A. J., McBrien, K. A., Ogundeji, Y., Souri, S., Manns, L., Rennert-May, E., Ronksley, P., Au, F., Arora, N., Hemmelgarn, B., Tonelli, M., & Manns, B. J. (2020). Impact of payment model on the behaviour of specialist physicians: A systematic review. Health Policy, 124(4), 345–358. https://doi.org/10.1016/j.healthpol.2020.02.007
Jul 30, J. C. · P., & July 31, 2020 1:50 PM ET | Last Updated: (2020, July 30). Black people and other people of colour make up 83% of reported COVID-19 cases in Toronto | CBC News. CBC. https://www.cbc.ca/news/canada/toronto/toronto-covid-19-data-1.5669091
Aksoy, C. G., Eichengreen, B., & Saka, O. (2020). The Political Scar of Epidemics (Working Paper No. 27401; Working Paper Series). National Bureau of Economic Research. https://doi.org/10.3386/w27401
Hall, R. E., Jones, C. I., & Klenow, P. J. (2020). Trading Off Consumption and COVID-19 Deaths (Working Paper No. 27340; Working Paper Series). National Bureau of Economic Research. https://doi.org/10.3386/w27340
Knittel, C. R., & Ozaltun, B. (2020). What Does and Does Not Correlate with COVID-19 Death Rates (Working Paper No. 27391; Working Paper Series). National Bureau of Economic Research. https://doi.org/10.3386/w27391
Gupta, S., Montenovo, L., Nguyen, T. D., Rojas, F. L., Schmutte, I. M., Simon, K. I., Weinberg, B. A., & Wing, C. (2020). Effects of Social Distancing Policy on Labor Market Outcomes (Working Paper No. 27280; Working Paper Series). National Bureau of Economic Research. https://doi.org/10.3386/w27280
Coronavirus (COVID-19): Daily data for Scotland—Gov.scot. (n.d.). Retrieved July 31, 2020, from https://www.gov.scot/publications/coronavirus-covid-19-daily-data-for-scotland/
However, social media websites don’t really care about defamation–they care about trademark use. T
Kalenkoski, C. M., & Pabilonia, S. W. (2020). Initial Impact of the COVID-19 Pandemic on the Employment and Hours of Self-Employed Coupled and Single Workers by Gender and Parental Status. IZA Discussion Paper, 13443.
Rampini, A. A. (2020). Sequential Lifting of COVID-19 Interventions with Population Heterogeneity (Working Paper No. 27063; Working Paper Series). National Bureau of Economic Research. https://doi.org/10.3386/w27063
Horton, Richard. ‘Offline: COVID-19 and the Dangers of Sinophobia’. The Lancet 396, no. 10245 (18 July 2020): 154. https://doi.org/10.1016/S0140-6736(20)31600-7.
Hossain, M. M., Mazumder, H., Tasnim, S., Nuzhath, T., & Sultana, A. (2020). Geriatric health in Bangladesh during COVID-19: Challenges and recommendations [Preprint]. SocArXiv. https://doi.org/10.31235/osf.io/x2b8w
correspondent, Robert Booth Social affairs. ‘Covid-19 Outbreaks up to 20 Times More Likely in Large Care Homes, Study Finds’. The Guardian, 14 July 2020, sec. World news. https://www.theguardian.com/world/2020/jul/14/covid-19-outbreaks-up-to-20-times-more-likely-in-large-care-homes-uk-study.
De La Vega, R., Barquin, R. R., Boros, S., & Szabo, A. (2020). The Impact of the Certainty of Information on COVID-19 Attitudes in Spanish University Teachers and Students [Preprint]. PsyArXiv. https://doi.org/10.31234/osf.io/6kytj
Meeting the psychological needs of people recovering from severe coronavirus. (2020, May 7). https://www.youtube.com/watch?v=6hAUUTdhHlc&feature=youtu.be
Meeting the Needs of People with Dementia Living in Care Homes during Covid-19. (2020, May 1). https://www.youtube.com/watch?v=blJjUwBhVpk&feature=youtu.be
Lancet, T. (2020). COVID-19: The worst may be yet to come. The Lancet, 396(10244), 71. https://doi.org/10.1016/S0140-6736(20)31517-8
Evamdrou, M., Falkingham, J., Qin, M., & Vlachantoni, A. (2020). Older and ‘staying at home’ during lockdown: Informal care receipt during the COVID-19 pandemic amongst people aged 70 and over in the UK [Preprint]. SocArXiv. https://doi.org/10.31235/osf.io/962dy
Leiserowitz, A., Maibach, E., Rosenthal, S. A., Kotcher, J., Bergquist, P., Ballew, M. T., Goldberg, M. H., Gustafson, A., & Wang, X. (2020). Climate change in the American Mind: April 2020 [Preprint]. PsyArXiv. https://doi.org/10.31234/osf.io/8439q
Lighter, J., Phillips, M., Hochman, S., Sterling, S., Johnson, D., Francois, F., & Stachel, A. (n.d.). Obesity in Patients Younger Than 60 Years Is a Risk Factor for COVID-19 Hospital Admission. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciaa415
Tijdink, J. K., Luykx, J. J., van Veen, S., Vinkers, C., & Veltman, E. (2020). Challenging COVID-19 times for older psychiatric patients: Potential implications and solutions [Preprint]. PsyArXiv. https://doi.org/10.31234/osf.io/z4puv
Henley, J. (2020, June 26). Swedes rapidly losing trust in Covid-19 strategy, poll finds. The Guardian. https://www.theguardian.com/world/2020/jun/26/swedes-rapidly-losing-trust-in-covid-19-strategy-poll-finds
Liverpool, C. W., Jessica Hamzelou, Adam Vaughan, Conrad Quilty-Harper and Layal. (n.d.). Covid-19 news: Almost 20,000 care home deaths in England and Wales. New Scientist. Retrieved July 6, 2020, from https://www.newscientist.com/article/2237475-covid-19-news-almost-20000-care-home-deaths-in-england-and-wales/
editor, D. C. H. policy. (2020, June 27). It’ll take four years for NHS to recover from Covid-19, health chiefs warn. The Observer. https://www.theguardian.com/society/2020/jun/27/itll-take-four-years-for-nhs-to-recover-from-covid-19-health-chiefs-warn
Goh, H.-H., & Bourne, P. E. (2020). Ten simple rules for researchers while in isolation from a pandemic. PLOS Computational Biology, 16(6), e1007946. https://doi.org/10.1371/journal.pcbi.1007946
Fiebig, J. H., Gould, E. R., Ming, S., & Watson, R. A. (2020). An Invitation to Act on the Value of Self-Care: Being a whole person in all that you do [Preprint]. PsyArXiv. https://doi.org/10.31234/osf.io/k72vd
Beachum, L., national, closeLateshia B. assignment reporter E. H. closeAlex H. assignment reporter covering, & newsEmailEmailBioBioFollowFollow, breaking. (n.d.). Is social isolation getting to you? Here’s how to know — and what experts say to do. Washington Post. Retrieved April 9, 2020, from https://www.washingtonpost.com/health/2020/04/04/social-isolation-mental-health-help/
Goldman, P. S., Ijzendoorn, M. H. van, Sonuga-Barke, E. J. S., Goldman, P. S., Ijzendoorn, M. H. van, Bakermans-Kranenburg, M. J., Bradford, B., Christopoulos, A., Cuthbert, C., Duchinsky, R., Fox, N. A., Grigoras, S., Gunnar, M. R., Ibrahim, R. W., Johnson, D., Kusumaningrum, S., Ken, P. L. A., Mwangangi, F. M., Nelson, C. A., … Sonuga-Barke, E. J. S. (2020). The implications of COVID-19 for the care of children living in residential institutions. The Lancet Child & Adolescent Health, 0(0). https://doi.org/10.1016/S2352-4642(20)30130-9
Twitter. (n.d.). Twitter. Retrieved June 16, 2020, from https://twitter.com/scibeh/status/1254678802158030849
Renault, M. (2020, May 5). ‘ICU Delirium’ Is Leaving COVID-19 Patients Scared and Confused. The Atlantic. https://www.theatlantic.com/science/archive/2020/05/coronavirus-icu-delirium/610546/
Townsend, M. (2020, June 6). Number of missing vulnerable children soars as safeguarding is cut during pandemic. The Observer. https://www.theguardian.com/society/2020/jun/06/alarming-rise-in-cases-of-missing-children-following-safeguarding-cuts
Andersson, L. (2020, June 08) COVID-19 i svensk intensivvård. Retrieved June 8, 2020, from https://www.icuregswe.org/data--resultat/covid-19-i-svensk-intensivvard/
Angner, E. (2020, May 11). "Terrific assessment of projections of demand for Swedish ICU beds. The first two panels are model-based projections by academics; the third is a simple extrapolation by the public-health authority; the fourth is the actual outcome /1." Twitter. https://twitter.com/SciBeh/status/1260121561861939200
Katie Mack RT Mark Richardson - Twitter
Horton, R. (2020). Offline: CoHERE—a call for a post-pandemic health strategy. The Lancet, 395(10232), 1242. https://doi.org/10.1016/S0140-6736(20)30895-3
David Murphy - BPS President en Twitter: “Within the framework below we’re prioritizing areas where there’s time urgency & BPS can make a sig. impact. ATM these are disease prevention, staff wellbeing, effect of confinement esp on vulnerable groups, psychol care of patients & relatives & adapting psychol services (2/2) https://t.co/C0sGT1FizG” / Twitter. (n.d.). Twitter. Retrieved April 21, 2020, from https://twitter.com/clinpsychdavid/status/1242891161951514629
It should be every elected official’s goal to help find ways to free employers from dictatorial rules that hinder their growth. ObamaCare does the opposite, and that’s why the self-insurance option needs to be preserved.
That’s why the escape hatch is so appealing. Self-insured companies can tailor their health benefits to meet the needs of their workers. They don’t have to pay for services their employees neither need nor want. And self-insured plans pay their own medical costs, without having to subsidize the health-care costs of other groups.
The administration and its allies fear that the more people gravitate toward the successful, free-market self-insurance approach, the worse their government-engineered health “reform” will look. We’re already seeing the beginning of this trend.
Meanwhile, ObamaCare penalties and onerous rules have forced many companies to lay off workers or cut hours to turn full-time employees into part-timers. Small-business owners should not have to make their hiring decisions based upon tens of thousands of pages of regulations in the Affordable Care Act.
Kosir, U., Loades, M. E., Wild, J., Wiedemann, M., Krajnc, A., Roškar, S., & Bowes, L. (2020, May 18). What was the impact of COVID-19 on Adolescent and Young Adult cancer care and their wellbeing? Results from a cross-sectional online survey conducted in the early stages of the pandemic. https://doi.org/10.31234/osf.io/kb6t5
Dr Muge Cevik on Twitter
Public Health England. Recommended PPE for primary, outpatient, community and social care by setting, NHS and independent sector. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/878750/T2_poster_Recommended_PPE_for_primary__outpatient__community_and_social_care_by_setting.pdf
Australian Government Department of Health (2020, April 1). Coronavirus (COVID-19) – Restrictions on entry into and visitors to aged care facilities [Text]. https://www.health.gov.au/resources/publications/coronavirus-covid-19-restrictions-on-entry-into-and-visitors-to-aged-care-facilities
PDF - Ministry of Health, New Zealand - Approach for testing
Health Psychology Exchange
Zahnd, W. E. (2020). The COVID‐19 Pandemic Illuminates Persistent and Emerging Disparities among Rural Black Populations. The Journal of Rural Health, jrh.12460. https://doi.org/10.1111/jrh.12460
Dachevych, A. (2020 May 04). How lockdown affects babies. BBC News. Retrieved May 11, 2020, from https://www.bbc.com/news/av/health-52507731/coronavirus-lockdown-how-does-it-affect-babies
Youngstrom, E. A., Ph.D., Hinshaw, S. P., Stefana, A., Chen, J., Michael, K., Van Meter, A., … Vieta, E. (2020, April 20). Working with Bipolar Disorder During the COVID-19 Pandemic: Both Crisis and Opportunity. https://doi.org/10.31234/osf.io/wg4bj
King, E. K., Harrell, A. R., & Richling, S. (2020, April 18). Best Practices: Caregiver Training Resources Derived from Remote Behavioral Service Delivery within the Foster Care System. https://doi.org/10.31234/osf.io/k56nq
Picturing Health. Films about coronavirus (COVID-19). picturinghealth.org/coronavirus-films/
Thornton, J. (2020). Clinicians are leading service reconfiguration to cope with covid-19. BMJ, m1444. https://doi.org/10.1136/bmj.m1444
Meyer, J. P., Franco-Paredes, C., Parmar, P., Yasin, F., & Gartland, M. (2020). COVID-19 and the coming epidemic in US immigration detention centres. The Lancet Infectious Diseases, 0(0). https://doi.org/10.1016/S1473-3099(20)30295-4
If immediate admission is not possible, start emergency treatment in primary care
1) lie flat
2) pilocarpine drops
3) acetazolamide 500 mg orally
p. 174-175
Ce livre, que vous m'avez vu tout à l'heure lire […] ce livre, comme vos yeux en se penchant vers lui ne pourraient déchiffrer son titre à vingt ans de distance, ma mémoire, dont la vue est plus appropriée à ce genre de perceptions, va vous dire quel il était […]
L'immersion du lecteur, entravé dans sa perception du support matériel (« ce livre »). Un éthos du care (de la sollicitude) produit par le narrateur qui vient au secours de l'instance du lecteur par la médiation d'un autre support, immatériel : sa mémoire.
Cette relation de care (entre le narrateur et le lecteur) se trouvait déjà fictionnalisée en p. 165 :
[…] cette opération, en apparence si simple, d'ouvrir ou de fermer ma croisée, je n'en venais jamais à bout sans le secours de quelqu'un de la maison […]
Ouvrir la fenêtre de la chambre et lire le titre d'un livre : deux opérations de lecture impliquant la matérialité des supports.
It needs to be fully repealed, because the first step out of the gate for Obamacare is a step in the wrong direction and that is for government control over every aspect of health care, so it’s hard to fix the system that they have put in place without ending that premise that government ought to be running and controlling health care.
CARE Framework
Thanks to @mkcow below for providing a direct link to the CARE Framework.
CARE framework
Getting a lot of attention in the CC community right now.
I wonder which privacy-related stuffs users must accept to agree to this.
At MONSAM Portable Sinks, get a wide range of portable sinks. They offer portable changing stations for baby, day care portable sinks and toddler sinks. Their range of child-friendly portable sinks that are perfectly suited for preschool, kindergarten and child care centers.
Partlyasaresult,premiumincreasesforthemostpopularplanswillriseanaverageof34%in2018andarelikelytorisefurtherafterthemandaterepealgoesintoeffect.
This is statistics of how they wanted to repeal it
ObamaCare, is the product of a Conservative Think-Tank. 60% of citizens get private insurance from their employers, 15% receive Medicare (65 and older), and the federal gov’t funds Medicaid for low-income families (the allocation to this fund has been declining).
Lucky, Trump removed that
United States and its Health care: The gov’t has some government-run programs and private insurance.
U.S. health care system
Health care spending was 12.4% of GDP in 2016. That is approximately $7,919.00 per person. There were 11.6% of people who skipped prescriptions because of cost.
Switzerland Health Care System
Mandate: The gov’t mandates that everyone buy health insurance, funding comes from payroll taxes.
3
Health care spending was 11% of GDP in 2016. Approximately $4,600.00 per person. 7.8% of patients skipped prescriptions because of cost. The life expectancy was 85.5 years in 2015.
France health care system
2-Tier: The gov’t pays two-thirds, and the private sector pays one-third.
2
Health Care spending was 10.6% of Canada’s GDP in 2016 and 10.5% of patients skipped prescriptions because of cost.
Canada health care system
Single-Payer: The gov’t taxes its citizens to pay for health care.
Single-Payer, 2-Tier, and Mandate systems.
three definitive models for Universal Health Care
a wealthy nation with unhealthy lifestyles, little interest in preventive medicine, and expectations of limitless, top-notch specialist care would empower its health-care system to accommodate these preferences
his very first patient shocked him by refusing the moderately expensive but effective treatment he prescribed for her cancer—a choice that turns out to be common among patients in Singapore, who like to pass the money in their government-mandated health-care savings accounts on to their children
“value-based care,” which rewards providers who keep costs down while achieving good outcomes, is not going well
John Robert, a microbiologist in New Mexico did an experiment on whether the beard contained bacteria. Results from the experiment that beards contain a lot of bacteria as dirty as a toilet. That’s a lot of bacteria and it’s a bit unsettling. He advised men with a beard should wash hands frequently and wash beard if they want to have a clean and healthy beard. Also, take care not to get food on your beard when you eating. If you exercise outside for a long time under the hot weather, there will be massive secretion of oil and have a lot of dust in your beard. If you haven’t clean your beard in the time it’s very easy to damage your sink. In particular, the bacteria on the surface of the face will take advantage of this, causes folliculitis and sebaceous adenitis, even cause swelling of the lips and face.
Is Growing A Beard Easy To Nourish Germ?
The HMO Act of 1973 changed that premise. It authorized for-profit IPA-HMOs in which HMOs may contract with independent practice associations (IPAs) that, in turn, contract with individual physicians for services and compensation. By the late 1990s, 80 percent of MCOs were for-profit organizations, and only 68 percent or less of insurance premiums went toward medical care.
The HMO Act of 1973 resulted in for profit health care.
Nixon signed into law, the Health Maintenance Organization Act of 1973, in which medical insurance agencies, hospitals, clinics and even doctors, could begin functioning as for-profit business entities instead of the service organizations they were intended to be.
In the 1970s health care was allowed to change from a non-profit to a for profit.
a group of teachers created a program through Baylor University Hospital where they would agree to pre-pay for future medical services (up to 21 days in advance). The resulting organization was not-for-profit and only covered hospital services. It was essentially the precursor to Blue Cross.
Baylor University's teacher's created one of the first "employee insurance companies" which turned into Blue Cross.
Since U.S. businesses were prohibited from offering higher salaries, they began looking for other ways to recruit new employees as well as incentivizing existing ones to stay. Their solution was the foundation of employer-sponsored health insurance as we know it today.
The result of the Stabilization Act of 1942 was for employers to provide health care benefits to employees.
Because health benefits could be considered part of compensation but did not count as income, workers did not have to pay income tax or payroll taxes on those benefits. Thus, by 1943, employers had an increased incentive to make health insurance arrangements for their workers, and the modern era of employer-sponsored health insurance began
After WWII companies started providing health insurance to employees. Somewhere along the way this translated into employers co-oping with private insurance companies to provide health insurance as opposed to paying the employees medical bills or providing their own doctors and clinics.
have the knowledge and skills to help navigate the hospital system, explain your diagnosis in detail, and explain potential outcomes. We are also here to help decipher the information from doctor visits, set up meetings with care teams, and organize home care, and medications
Using specialist in a field saves time, and ultimately saves lives.
Initial resistance to the hospitalist movement among physicians often focused on the unavoidable discontinuity in care created by the model and the potential loss of information across the hospital threshold.45,49-52 Effective hospitalist programs have created mechanisms to mitigate the impact of this discontinuity, including calling primary care physicians on admission and discharge, faxing daily progress notes, and encouraging primary care physicians to visit or call their hospitalized patients. Though some concerns about information transfer linger, 2 recent surveys suggest that most physicians now accept the hospitalist model. In a national telephone survey of 400 internists, 51% (204) thought hospitalists might provide better care and 46% (184) thought patients might get more cost-effective care. Although 73% were concerned about the impact of hospitalists on continuity, physicians with hospitalists in their community were more approving.10 In a survey of 524 California primary care physicians, physicians perceived hospitalists as increasing (41%) or not changing (44%) the overall quality of care and most (55%) thought that hospitalists increase inpatient efficiency.11 In both surveys, primary care physicians stated their belief that patients generally preferred to be cared for in the hospital by their regular physician. Surveys of both generalists and specialists at Park Nicollet showed high levels of physician satisfaction several years after the implementation of a hospitalist program.28
A major early concern was that patients accustomed to having their primary physician as their inpatient attending would not accept hospitalists.45 In general, however, surveys of patients who were cared for by hospitalists show high levels of satisfaction, no lower than that of similar patients cared for by their own primary physicians28,31,32 or by traditional academic ward attendings.18,21 We have postulated that patients may be willing to trade off the familiarity of their regular physician for the availability of the hospitalist.45
And while hospitalists have already moved into post-acute-care settings, Dr. Bessler says that will become an even bigger focus in the next 20 years of the specialty. “It’s not generally been the psyche of the hospitalist in the past to feel accountable beyond the walls of the hospital,” he says. “But between episodic care [and] bundled payments … you can’t just wash your hands of it. You have to understand your next site-of-care decision. You need to make sure care happens at the right location.”
Five years ago, it was accountable care organizations and value-based purchasing that SHM glommed on to as programs to be embraced as heralding the future. Now it’s the Bundled Payments for Care Improvement initiative (BCPI), introduced by the Center for Medicare & Medicaid Innovation (CMMI) at the Centers for Medicare & Medicaid Services (CMS) back in 2011 and now compiling its first data sets for the next frontier of payments for episodic care. BCPI was mandated by the Patient Protection and Affordable Care Act (ACA) of 2009, which included a provision that the government establish a five-year pilot program by 2013 that bundled payments for inpatient care, according to the American Hospital Association. BCPI now has more than 650 participating organizations, not including thousands of physicians who then partner with those groups, over four models. The initiative covers 48 defined episodes of care, both medical and surgical, that could begin three days prior to admission and stretch 30, 60, or 90 days post-discharge. <img class="file media-element file-medstat-image-flush-right" height="220" width="220" alt="Dr. Weiner" typeof="foaf:Image" src="https://www.the-hospitalist.org/sites/default/files/styles/medium/public/images/weinerweb.jpg" title="" />Dr. Weiner “The reason this is so special is that it is one of the few CMS programs that allows providers to be in the driver’s seat,” says Kerry Weiner, MD, chief medical officer of acute and post-acute services at TeamHealth-IPC. “They have the opportunity to be accountable and to actually be the designers of reengineering care. The other programs that you just mentioned, like value-based purchasing, largely originate from health systems or the federal government and dictate the principles and the metrics that as a provider you’re going to be evaluated upon. “The bundled model [BCPI] gives us the flexibility, scale, and brackets of risk that we want to accept and thereby gives us a lot more control over what physicians and physician groups can manage successfully.”
“If we can’t build what I think of as a pyramid of care with one doctor and many, many other people supporting a broad group of patients, I don’t think we’re going to be able to find the scale to take care of the aging population that’s coming at us,” she says. Caring for patients once they are discharged means including home nurses, pharmacists, physical therapists, dietitians, hired caregivers, and others in the process, Dr. Gorman says. But that doesn’t mean overburdening the wrong people with the wrong tasks. The same way no one would think to allow a social worker to prescribe medication is the same way that a hospitalist shouldn’t be the one checking up on a patient to make sure there is food in that person’s fridge. And while the hospitalist can work in concert with others and run many things from the hospital, maybe hospital-based physicians aren’t always the best physicians for the task. “There are certain things that only the doctor can do, of course, but there are a lot more things that somebody else can do,” Dr. Gorman says, adding, “some of the times, you’re going to need the physician, it’s going to be escalated to a medication change, but sometimes maybe you need to escalate to a dietary visit or you need to escalate to three physical therapy visits. “The nitty-gritty of taking care of people outside of the hospital is so complex and problematic, and most of the solutions are not really medical, but you need the medical part of the dynamic. So rather [than a hospitalist running cases], it’s a super-talented social worker, nurse, or physical therapist. I don’t know, but somebody who can make sure that all of that works and it’s a process that can be leveraged.” Whoever it is, the gravitation beyond the walls of the hospital has been tied to a growing sea change in how healthcare will compensate providers. Medicare has been migrating from fee-for-service to payments based on the totality of care for decades. The names change, of course. In the early 1980s, it was an “inpatient prospective payment system.”
Hospitalists are often referred to as the quarterbacks of the hospital. But even the best QB needs a good team to succeed. For HMGs, that roster increasingly includes nurse practitioners (NPs) and physician assistants (PAs).
“The day is upon us where we need to strongly consider nurse practitioners and physician assistants as equal in the field,” he says. “We’re going to find a much better continuity of care for all our patients at various institutions with hospital medicine and … a nurse practitioner who is at the top of their license.”
Hospitalists as QB should play leadership role in integrating all members of care team
“The role of the hospitalist often is to take recommendations from a lot of different specialties and come up with the best plan for the patient,” says Tejal Gandhi, MD, MPH, CPPS, president and CEO of the National Patient Safety Foundation. “They’re the true patient advocate who is getting the cardiologist’s opinion, the rheumatologist’s opinion, and the surgeon’s opinion, and they come up with the best plan for the patient.”
Despite the hospitalist field’s unprecedented growth, there have been challenges. The model is based on the premise that the benefits of inpatient specializa-tion and full-time hospital pres-ence outweigh the disadvantages of a purposeful discontinuity of care. Although hospitalists have been leaders in developing sys-tems (e.g., handoff protocols and post-discharge phone calls to pa-tients) to mitigate harm from dis-continuity, it remains the model’s Achilles’ heel.
Finally, financial penalties for readmis-sions have led many hospitalists to staff post–acute care facilities to improve coordination with col-leagues at acute care hospitals.
Conversely, some traditional programs may develophospitalist tracks that emphasize acquisition of theskills most relevant to inpatient practice. If suchtracks are developed, it will be important not to re-duce training in ambulatory care too aggressively,since the competent hospitalist will need a full un-derstanding of what can — and cannot — be donein the outpatient setting
As with anymajor transition, the medical community must con-tinually reevaluate the new approach to ensure thatany possible discontinuity in care is outweighed byimproved clinical outcomes, lower costs, better edu-cation for physicians, and greater satisfaction on thepart of patients.
Equally pressing is the question of value, definedas the quality of care divided by its cost.10
Two of the principles underlying generalism,whether in the form of internal medicine, pediatrics,or family medicine, have been comprehensivenessand continuity.7,8 Ideally, the primary care physicianwould provide all aspects of care, ranging from pre-ventive care to the care of critically ill hospitalizedpatients. This approach, argued the purists, wouldresult in medical care that was more holistic, less frag-mented, and less expensive.9 To its proponents, thenotion was so attractive — the general internist ad-mits the patient to the hospital, directs the inpatientworkup, and arranges for a seamless transition backto the outpatient setting — that questioning it wouldhave seemed sacrilegious merely a few years ago
Polls show that doctors are trusted by the public more than politicians, which means it’s hard for public policy to shape the healthcare system unless medical associations sign off on it.
“It’s about embracing the inscrutable nature of human interactions,” says Chang. Evidence-based medicine was a massive improvement over intuition-based medicine, he says, but it only covers traditionally quantifiable data, or those things that are easy to measure. But we’re now quantifying information that was considered qualitative a generation ago.
Biggest challenges to redesigning the health care system in a way that would work better for patients and improve health
“Our biggest opportunity is leaning into that. It’s either embracing the qualitative nature of that and designing systems that can act just on the qualitative nature of their experience, or figuring how to quantitate some of those qualitative measures,” says Chang. “That’ll get us much further, because the real value in health care systems is in the human interactions. My relationship with you as a doctor and a patient is far more valuable than the evidence that some trial suggests.”
Biggest challenges to redesigning the health care system in a way that would work better for patients and improve health
Duffy points to the increase in health care interactions online and adds that he would like to see a pervasive culture of in-person care as last resort. “If every organizational decision, technology decision, process decision — assuming all the payment stuff, that’s kind of ticket of entry, transpires — if you view in-person as last resort, that will help pull systems across the country to a more consumer-forward Uber-like experience,” he says
Biggest challenges to redesigning the health care system in a way that would work better for patients and improve health
As with other forms of value-based health care, patient-centered care requires a shift in the way provider practices and health systems are designed, managed, and reimbursed. In keeping with the tenets of patient-centeredness, this shift neither happens in a vacuum, it driven by traditional hierarchies in which providers or clinicians are the lone authority. Everyone, from the parking valet and environmental services staff to c-suite members, are engaged in the process, which impacts hiring, training, leadership style, and organizational culture. Patient-centered care also represents a shift in the traditional roles of patients and their families from one of passive “order taker” to one of active “team member.” One of the country’s leading proponents of patient-centered care, Dr. James Rickert, has stated that one of the basic tenets of patient-centered care is that “patients know best how well their health providers are meeting their needs.” To that end, many providers are implementing patient satisfaction surveys, patient and family advisory councils, and focus groups, and using the resulting information to continuously improve the way health care facilities and provider practices are designed, managed, and maintained from both a physical and operational perspective so they become centered more on the individual person than on a checklist of services provided. As the popularity of patient- and family-centered health care increases, it is expected that patients will become more engaged and satisfied with the delivery of their care, and evidence of its clinical efficacy should continue to mount.
Cultural shift to patient-centered care
The concept of patient-centered care extends to the treatments and therapies clinicians provide. Not only are care plans customized, but medications are often customized as well. A patient’s individual genetics, metabolism, biomarkers, immune system, and other “signatures” can now be harnessed in many disease states — especially cancer — to create personalized medications and therapies, as well as companion diagnostics that help clinicians better predict the best drug for each patient.
Patient-centered care via personalized medicine
Strict visiting hours and visitor restrictions are a thing of the past in a patient-centered care model. Patients are given the authority to identify who can visit and when. Family members (as defined by the patient and not limited to blood relations) are invited to visit during rounding and shift changes so they can be part of the care team, participating in discussions and care decisions. When not in the room with the patient, they are kept informed of their loved one’s progress through direct and timely updates. A patient-centered care hospital’s infrastructure encourages family collaboration through a home-like environment that not only meets the needs of the patient, but also meets the needs of family members. For example, maternity wards are being redesigned with family-friendly postpartum rooms that can accommodate the mom, new baby, and family members, who are encouraged to spend up to 24 hours a day together in the room to foster family bonding.
Patient-centered care in the hospital
The primary goal and benefit of patient-centered care is to improve individual health outcomes, not just population health outcomes, although population outcomes may also improve. Not only do patients benefit, but providers and health care systems benefit as well, through: Improved satisfaction scores among patients and their families. Enhanced reputation of providers among health care consumers. Better morale and productivity among clinicians and ancillary staff. Improved resource allocation. Reduced expenses and increased financial margins throughout the continuum of care.
Benefits of patient-centered care