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The formulary revision process considers manufacturer rebates, payments from drug manufacturers for low placement on PBM Pharmacy Benefit Manager formularies, along with average cvs health store in california price AWPdrug availability, and bulk discounts when choosing at which co-pay a brand name drug should be placed. Jn cares forpatients annually through a national network of more than 85 locations as well as the largest home infusion network cs the United States. I'm already a fan, gealth show this again. Review the Patch Community Guidelines. Subscribe to Patch's new newsletter to be the first to know about open houses, new listings and carefirst jew. The update comes after at least eight deaths are said to have occurred since then. Bloomberg -- Oil steadied as traders looked to a revival in Chinese demand this year after data showed that the economy fared better than expected last quarter, with further clues on the outlook to come in an OPEC analysis.

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Clinical staff had regular opportunities to provide feedback for improvement during partner meetings; this kept staff engaged and captured issues before they grew into bigger problems. Site B focused on rapid implementation, which did not allow time for identifying and addressing emerging issues, and there was no routine meeting or other manner for staff to submit program improvement ideas. This approach left little opportunity to reflect on implementation progress and engage in process improvements.

The evaluation of this pilot project provides insight into critical resources and steps that promote successful LDCT screening program implementation for high-risk adults in FQHCs. Using the CFIR framework to analyze qualitative data and synthesize study findings helped us compare and contrast the two pilot sites to identify facilitators and barriers to successful implementation.

Staff and leadership at both sites acknowledged that implementing LDCT screening for lung cancer is a highly complex process that requires substantial upfront planning and investment among leadership and staff, as well as ongoing communication to help troubleshoot challenges that arise throughout the implementation process.

Given this high level of investment required, sites developing LDCT screening in the future should consider their readiness to implement prior to committing to LDCT screening. Organizations could consider undertaking a thorough capacity and readiness assessment to ensure that personnel and other resources are available. Similar to our findings, this study also suggested high levels of uncertainty about LDCT, including the need for guidance about implementation and concerns about how screening programs would be integrated into EHRs.

As suggested by our evaluation, identifying and addressing these practical needs is an important step prior to beginning implementation. While there is currently no existing readiness assessment specifically designed for LDCT programs, other assessment tools exist and could be adapted for use among sites considering LDCT.

For example, the Diabetes Care Coordination Readiness Assessment is designed to measure primary care clinic readiness to coordinate care for adult patients with diabetes [ 34 ]. The tool considers five domains: organizational capacity, care coordination, clinical management, quality improvement, and infrastructure when assessing for implementation readiness. A wide range of other readiness assessment tools exist and could be adapted, including the Practice Transformation Readiness Assessment and Quality Improvement Capacity Assessment [ 35 , 36 ].

Specifically, for LDCT, an assessment could include identifying competing priorities, concurrent activities, ongoing or upcoming systems challenges, and system readiness. If there is reluctance or hesitation about implementing or if an organization feels unprepared for LDCT implementation, then it would be important to consider these challenges and ensure full buy-in to the program before beginning. After buy-in was established, we found that having at least one champion who is enthusiastic and knowledgeable about the project can help provide guidance throughout the initial planning and implementation process.

The value of a program champion has consistently been demonstrated in the literature [ 38 ]. Ideally, given the complexity of LDCT screening, it would be best to have both administrative leadership and a physician champion. We found that these champions should be involved in the day-to-day implementation and monitoring of the program. Specifically, this includes an individual who is dedicated to communication between the FQHC or primary care site and screening facility.

Other studies have similarly found that two champions can help with implementation success—a project champion who leads change efforts specific to the implementation of a program and an organizational change champion who focuses on higher-level issues, such as mobilizing resources and linking the project vision with the vision of the broader organization [ 39 ].

Developing a successful program also requires careful planning. In our pilot study, implementation was more effective when using a bottom-up approach with frontline staff who were responsible for implementation rather than a top-down approach. This approach helped gain buy-in and input when rolling out implementation to providers, whereas administrative leadership overseeing and directing the implementation process without frontline staff input resulted in missed opportunities and miscommunication.

These observations are especially true in the context of LDCT screening, which is relatively new and unknown for staff and providers alike. While we used CFIR as an evaluation framework applied retrospectively, it would also be possible to use CFIR and other frameworks as an implementation planning framework.

For example, combining CFIR with the Theoretical Domains Framework TDR could help identify multilevel determinants that should be considered in the implementation planning stage [ 40 ]. The process of planning and using a stepwise approach to implementation with built-in opportunities for evaluation allows for regular updates and modifications to the process as needed.

As we found in our pilot study, this stepwise method of implementation and scale-up is not necessarily a quick process, but careful planning using an implementation framework could help anticipate and mitigate challenges. Our study is not without limitations. We provide a qualitative overview of LDCT program implementation in two unique settings; while both sites had high lung cancer incidence and aimed to develop partnerships between FQHCs and accredited screening facilities, there were many practical differences between the sites that were not revealed until implementation began.

Although we interviewed a wide range of staff across sites and at multiple time points, our findings cannot be widely generalized. Relatedly, these sites had high levels of support from ACS staff and ample funding, which likely does not reflect the implementation experience at other sites. In addition, we retrospectively applied CFIR as a framework for qualitative interview analysis. Our initial interview guide did not specifically consider CFIR constructs; however, future studies could incorporate elements of CFIR throughout the planning of the program, development of the evaluation, and qualitative and quantitative measures of implementation success.

Finally, we did not interview patients as part of our evaluation. Given the exploratory nature of this pilot study and limited resources, we opted to focus on capturing the experiences of health professionals involved in implementation. Future studies should engage patients to further explore patient-level barriers and facilitators. Screening patients for lung cancer using LDCT has been shown to improve health outcomes for high-risk adults but, without commitment, readiness, and resources, the road to successful program implementation can be a long one.

Our pilot study identified a variety of facilitators and barriers to program implementation and provided two starkly contrasting examples of how implementing and managing screening programs can be complex, time consuming, and resource intensive. However, with thoughtful planning and execution, open communication, and motivated staff, health systems can ultimately build a path to lung cancer screening for their patients and reduce lung cancer deaths.

Conflicts of Interest: M. Author Contributions : M. Ethical Approval: This study did not contain any studies with human participants performed by any of the authors. The pilot study and evaluation were reviewed by the Morehouse School of Medicine Institutional Review Board and given a nonresearch determination. This article does not contain any studies with animals performed by any of the authors. Informed Consent: Informed consent was obtained from all individual participants included in the study.

Because our analysis used an implementation science framework, we chose the Standards for Reporting Implementation Studies StaRI Standard as our reporting guideline because it is one of the most commonly used among qualitative and implementation science research. National Cancer Institute. Patient and physician guide: National Lung Screening Trial. Accessed August 10, Reduced lung-cancer mortality with low-dose computed tomographic screening.

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Case study on the implementation of a lung cancer screening program in federally qualified health centers. Public Health Rep. In press. Measuring primary care organizational capacity for diabetes care coordination: The Diabetes Care Coordination Readiness Assessment.

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J Am Board Fam Med. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In.

SBM Journals. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Compliance with Ethical Standards. Reporting Guidelines:. Journal Article. Successes and challenges of implementing a lung cancer screening program in federally qualified health centers: a qualitative analysis using the Consolidated Framework for Implementation Research.

Oxford Academic. Megan M Cotter. Correspondence to: M. Cotter, megan. Robert A Smith. Lesley Watson. Select Format Select format. Permissions Icon Permissions. Abstract In recent years, studies have shown that low-dose computed tomography LDCT is a safe and effective way to screen high-risk adults for lung cancer. CFIR Constructs. Site A. Site B. They felt like it was just something extra added on during the day. Keep smoking, but get screened for lung cancer because that could change your viewpoint.

At that point, it really became something that people could take advantage of. We have a list of all the patients that have come back in that two-week time period. Pulmonologists, EP surgeon, the manager, me as the imagining screening navigator, the lung cancer navigator, all around the table at the same time.

They go through each of those patients and look at scans together, discuss what still needs to be done next, whether it would be a three month follow up, does it look more like infection? Or do we need to go ahead and set them up for a PET right away?

They all have all that discussion around the table together. And there have been large university studies on this sort of thing. That has made a big impact. My MA will do the intake, and she will automatically ask them about their smoking history. That would be my recommendation. The imaging navigator is in charge of arranging the scans and arranging the follow-up type of things and keeping track of who needs a scan It goes to the group with a lung navigator within that group.

So how do we really do it? Like how could it look? Open in new tab. Google Scholar PubMed. Google Scholar Crossref. Search ADS. For commercial re-use, please contact journals. Issue Section:. Download all slides. Supplementary data. Views 1, More metrics information. Email alerts Article activity alert. Advance article alerts. New issue alert. Receive exclusive offers and updates from Oxford Academic. Related articles in Web of Science Google Scholar. Citing articles via Web of Science 3. Latest Most Read Most Cited Adaptation process of a culturally congruent parenting intervention for parents of Hispanic adolescents to an online synchronous format.

The association of impulsivity with effects of the ChooseWell workplace nudge intervention on diet and weight. The identity of the credentialing committee members and their knowledge of tick-borne illnesses were also unknown to me. I, on the other hand, disclosed that I had: 1 completed My letter and supporting documentation exceeded pages; except for the patient letters, the content was comprised of papers from the peer-reviewed medical literature.

Three months later, the. And so, I was forced to pick between the small group of marginalized, suffering Lyme disease patients that I had helped and my non-Lyme disease patients who made up the bulk of the practice. I was mentored by a Lyme specialist in the state and my collaborating physician was supportive of my work. As patients from across my state and region began seeking my care, I came to the attention of local infectious disease ID physicians who disapproved of a nurse practitioner using diagnosis and treatment methods that challenged the prevailing paradigm.

Despite evidence to the contrary, some local physicians were convinced that Lyme disease did not exist in their state and they promoted the idea that a short course of doxycycline is sufficient therapy for patients who acquire the infection elsewhere.

Many patients with typical symptoms of Lyme disease who had consulted these ID physicians were told they were simply depressed and needed psychotherapy.

When these same patients later saw me, they were treated with antibiotics and improved. Toward the end of the investigation, my collaborating MD was warned by the executive director of the BME that he was putting himself at risk by working with me. In my state, nurse practitioners are required to practice in collaboration with MDs. Although many local physicians referred patients to me, none would agree to collaborate with me out of fear of the state BME.

Thus, the state BME essentially ran me out of the state, leaving most of my patients stranded without ongoing access to care for their Lyme disease. I was initially the subject of a Utilization Review inquiry by a regional health carrier in The carrier identified a dozen cases of Lyme disease patients who had received intramuscular penicillin. I wrote three referenced responses to their inquiry and the investigation was discontinued.

The following year the state medical board launched an investigation of the same cases initially identified by the regional carrier. I was interviewed in by an investigator at the Health Department.

The medical board did not seek any action. After receiving two additional cases, the medical board reopened the investigation in Ultimately, I signed a consent order for misconduct related to problems with taking an adequate history, performing an appropriate physical examination, and failing to construct differential diagnoses and conduct a thorough diagnostic evaluation.

The agreement allowed me to practice medicine during my three-year probationary period but required that I be closely supervised by a physician monitor.

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Borrelia burgdorferi in a newborn despite oral penicillin for Lyme borreliosis during pregnancy. The Pediatric Infectious Disease Journal , 7 4 , Wormser, G. Impact of clinical variables on Borrelia burgdorferi-specific antibody seropositivity in acute-phase sera from patients in North America with culture-confirmed early Lyme disease.

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Background Health equity, in which patients with tick-borne diseases TBDs can reach their full health potential unburdened by structural and societal constraints, is the priority for the Access to Care and Education Subcommittee. What Is Health Equity? Why Is Health Equity Important? Yet, many patients with one or more TBDs face daunting health inequities such as: Decreased quality of life Johnson et al.

The Purpose of This Report The goals of this report are to highlight existing inequities experienced by patients with TBDs, to focus attention on the government policies and processes that are major root causes of these inequities, and to propose actionable solutions to improve the health of this marginalized and often-neglected patient community.

Methods See Appendix 1. Results and Findings For consideration by the Tick-Borne Disease Working Group, the Access to Care and Education Subcommittee has identified one major priority and seven potential actions to achieve it.

Priority 1. To ensure health equity for patients with tick-borne diseases TBDs so that they may reach their full health potential unburdened by structural and societal constraints.

Patient Barriers in Select Subpopulations of Patients with Tick-Borne Diseases The mistaken practice of applying Lyme disease surveillance case criteria as diagnostic criteria may be a barrier that prevents certain patient populations from being accurately and promptly diagnosed and treated Bacon et al. Structural Barriers Structural barriers include policies and processes that exclude patients from meaningful participation in decisions that ultimately affect their ability to access quality care.

The Training, Education, Access to Care, and Reimbursement Subcommittee Report to the Tick-Borne Disease Working Group defined the qualifications required of meaningful patient representatives and the process for selecting these representatives: To serve as a meaningful representative, patients or advocates representing the persistent Lyme disease community should: a have or have had persistent Lyme disease or be someone who serves or has served as a caregiver to a persistent Lyme disease patient; and b should be an officer or director of a recognized and trusted patient advocacy organization representing patients with persistent Lyme disease, or someone vetted and approved by such a group.

To ensure process integrity in the selection of patient representatives through open and transparent selection processes, including public calls for nominations and soliciting nominations through recognized and trusted patient advocacy groups representing patients with persistent Lyme disease.

This is best accomplished by a preventing disease through appropriate public awareness campaigns and b diagnosing and effectively treating cases of Lyme disease as early as possible. Local public health authorities and clinicians should coordinate public awareness programs for Lyme disease and other TBDs that are locale specific in terms of potential diseases and population-specific risks.

Primary prevention of TBDs includes a whole host of strategies to avoid and prevent tick bites. In the case of Lyme disease, antibiotic prophylaxis of a known blacklegged tick bite is also available Cameron et al.

However, because the evidence from the largest U.

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WebCenters for Medicare and Medicaid Services. The Centers for Medicare and Medicaid Services (CMS) provides health coverage to more than million people through Missing: meghan starinski. Jul 1,  · CMS is using their authority to regulate Medicare Advantage (MA), Medicaid, Children's Health Insurance Program (CHIP), and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs) to enforce this rule. In August , CMS detailed how organizations can meet the mandate. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Security Boulevard, Baltimore, MD Missing: meghan starinski.