The Coming Golden Age of Disruptive Innovation in Health Care

Zimlichman, Eyal; Levin-Scherz, Jeffrey

doi:10.1007/s11606-013-2335-2

Cited by 14 publications

(9 citation statements)

References 4 publications

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“…Thus, a deeper understanding of ways to engage generalists in PrEP provision could facilitate wider and more equitable access to PrEP, particularly in areas with limited access to LGBT specialists, such as rural areas. 24 For LGBT specialists, PrEP was a positive ''disruptive innovation'' 25,26 despite their initial skepticism about its benefits, and PrEP prescribing had become normative. Because these clinicians provided care to many at-risk MSM, PrEP had revolutionized their approach to preventive sexual healthcare.…”

Section: Discussionmentioning

confidence: 99%

Differing Experiences with Pre-Exposure Prophylaxis in Boston Among Lesbian, Gay, Bisexual, and Transgender Specialists and Generalists in Primary Care: Implications for Scale-Up

Krakower

Ware

Maloney

et al. 2017

AIDS Patient Care and STDs

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The Centers for Disease Control and Prevention estimates that one in four sexually active men who have sex with men (MSM) could decrease their HIV risk by using HIV pre-exposure prophylaxis (PrEP). Because many MSM access healthcare from primary care providers (PCPs), these clinicians could play an important role in providing access to PrEP. Semistructured qualitative interviews were conducted with 31 PCPs in Boston, MA, to explore how they approach decisions about prescribing PrEP to MSM and their experiences with PrEP provision. Purposive sampling included 12 PCPs from an urban community health center specializing in the care of lesbian, gay, bisexual, and transgender persons ("LGBT specialists") and 19 PCPs from a general academic medical center ("generalists"). Analyses utilized an inductive approach to identify emergent themes. Both groups of PCPs approached prescribing decisions about PrEP as a process of informed decision-making with patients. Providers would defer to patients' preferences if they were unsure about the appropriateness of PrEP. LGBT specialists and generalists were at vastly different stages of adopting PrEP into practice. For LGBT specialists, PrEP was a disruptive innovation that rapidly became normative in practice. Generalists had limited experience with PrEP; however, they desired succinct decision-support tools to help them achieve proficiency, because they considered preventive medicine to be central to their professional role. As generalists vastly outnumber LGBT specialists in the United States, interventions to support PrEP provision by generalists could accelerate the scale-up of PrEP for MSM nationally, which could in turn decrease HIV incidence for this priority population.

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Section: Discussionmentioning

confidence: 99%

Differing Experiences with Pre-Exposure Prophylaxis in Boston Among Lesbian, Gay, Bisexual, and Transgender Specialists and Generalists in Primary Care: Implications for Scale-Up

Krakower

Ware

Maloney

et al. 2017

AIDS Patient Care and STDs

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“…(41) To properly support quality geriatric emergency care, the electronic medical record of older patients must include easy access to and exchange of information regarding baseline and current functional status, cognitive status, fall risk, pertinent illness and medication lists, caregiver contact information, and advance directives. Policy makers should focus efforts on facilitating technology, or at least data transfer, and minimizing Health Insurance Portability and Accountability Act–related impediments to patient information exchange.…”

Section: Transforming Emergency Care For Older Adultsmentioning

confidence: 99%

Transforming Emergency Care For Older Adults

et al. 2013

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Already crowded and stressful, US emergency departments are facing the challenge of serving an aging population that requires complex and lengthy evaluations. Creative solutions are necessary to improve the value and ensure the quality of emergency care delivered to older adults while more fully addressing their complex underlying physical, social, cognitive, and situational needs. Developing models of geriatric emergency care, including some that are already in use at dedicated geriatric emergency departments, incorporate a variety of physical, procedural, and staffing changes. Among the options for “geriatricizing” emergency care are approaches that may eliminate the need for an emergency department visit, such as telemedicine; for initial hospitalization, such as patient observation units; and for rehospitalization, such as comprehensive discharge planning. By transforming its current safety-net role to becoming a partner in care coordination, emergency departments have the opportunity to better integrate into the broader health care system, improve patient health outcomes, contribute to optimizing the health care system, and reduce overall costs of care—keys to improving emergency care for patients of all ages.

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“…Our findings suggest that it may be difficult for ECHO to act as a disruptive innovation that alters traditional patterns of HIV care in settings where patients have traditionally traveled long distances for care in distant HIV specialty clinics . Available evidence indicates that the majority of rural persons with HIV in the United States travel to distant HIV specialty clinics for care, often bypassing opportunities for care in more nearby primary care clinics .…”

Section: Discussionmentioning

confidence: 92%