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Health Systems Science Curricula in Undergraduate Medical Education: Identifying and Defining a Potential Curricular Framework

Gonzalo, Jed D; Dekhtyar, Michael; Starr, Stephanie R; Borkan, Jeffrey; Brunett, Patrick; Fancher, Tonya; Green, Jennifer; Grethlein, Sara Jo; Lai, Cindy; Lawson, Luan; Monrad, Seetha; O'Sullivan, Patricia; Schwartz, Mark D; Skochelak, Susan
PURPOSE: The authors performed a review of 30 Accelerating Change in Medical Education full grant submissions and an analysis of the health systems science (HSS)-related curricula at the 11 grant recipient schools to develop a potential comprehensive HSS curricular framework with domains and subcategories. METHOD: In phase 1, to identify domains, grant submissions were analyzed and coded using constant comparative analysis. In phase 2, a detailed review of all existing and planned syllabi and curriculum documents at the grantee schools was performed, and content in the core curricular domains was coded into subcategories. The lead investigators reviewed and discussed drafts of the categorization scheme, collapsed and combined domains and subcategories, and resolved disagreements via group discussion. RESULTS: Analysis yielded three types of domains: core, cross-cutting, and linking. Core domains included health care structures and processes; health care policy, economics, and management; clinical informatics and health information technology; population and public health; value-based care; and health system improvement. Cross-cutting domains included leadership and change agency; teamwork and interprofessional education; evidence-based medicine and practice; professionalism and ethics; and scholarship. One linking domain was identified: systems thinking. CONCLUSIONS: This broad framework aims to build on the traditional definition of systems-based practice and highlight the need for medical and other health professions schools to better align education programs with the anticipated needs of the systems in which students will practice. HSS will require a critical investigation into existing curricula to determine the most efficient methods for integration with the basic and clinical sciences.
PMID: 27049541
ISSN: 1938-808x
CID: 2066102

Incidence of tuberculosis, serious bacterial infection, and lymphoma in patients with rheumatoid arthritis receiving biologic and non-biologic treatment in Taiwan [Meeting Abstract]

Chiu, Y M; Lang, H C; Lin, H Y; Yang, M T; Fang, C; Lai, C; Tang, B; Rahman, M U
Introduction: Our study assesses the incidence of TB, serious bacterial infection (SBI) and lymphoma in rheumatoid arthritis (RA) patients who received anti-TNF therapy and non-biologic treatment in Taiwan, as limited data exists. Methods: National Health Insurance Research Database data (1999-2009, covering 99.9% of the Taiwan population) were analyzed.1 Eligible patients (>18 years) were required to have: >2 recorded RA diagnostic codes (ICD-9 "714.0x"), a catastrophic illness card and had received traditional Disease Modifying Anti-Rheumatic Drugs (tDMARDs) or biologic DMARDs (bDMARDs). Patients with prior TB/SBI/lymphoma were excluded. Propensity scoring matched patients received tDMARDs and bDMARDs 2:1, adjusting for age, gender, disease severity, and co-morbidities. Incidence rates (IR) of TB, SBI and lymphoma were defined: (number of events/total patient exposure years); ratios (IRRs) were calculated across therapies. Results: Of 34 947 eligible patients (mean age 60.6 years, 79% female, mean RA duration 7.6 years), the bDMARDs group had higher incidence of TB, SBI and lymphoma than the tDMARDs only group (Table). Within the bDMARDs group 3109 patients (77.1%) were treated solely with ETN and 865 patients (21.4%) solely with ADA. Patients receiving ADA had higher rates of TB, SBI and lymphoma, which also occurred earlier, than those receiving ETN. All stated differences were statistically significant, except bMARDs versus tMARDs SBI and ADA versus ETN lymphoma incidence (Table). Conclusions: bDMARDs increase the risk of TB, SBI and lymphoma, risks to differing extents: risk was lower with ETN than ADA. (Table Presented)
EMBASE:71477596
ISSN: 1756-1841
CID: 1058242

Incidence of tuberculosis, serious infections, and lymphoma in patients with rheumatoid arthritis who received biologics and non-biologic treatment in taiwan [Meeting Abstract]

Chiu, Y M; Lang, H C; Lin, H Y; Yang, M T; Fang, C; Lai, C; Tang, B
Background The risk of tuberculosis (TB), infection and lymphoma is a major concern for anti-tumor necrosis factor (anti-TNF) therapies. However, limited comparative data about the rates in Asia and Taiwan Objectives To assess the incidence of TB, serious bacterial infection and lymphoma in rheumatoid arthritis patients who received anti-TNF therapy and non-biologic treatment in Taiwan. Methods The National Health Insurance Research Database (NHIRD) 1999-2009 data were analyzed. NHIRD comprises longitudinal patient-level data which covers long-term disease tracking on almost 99.9% of population in Taiwan. Adult patients (age >18) have at least twice diagnosis of RA (ICD-9 "714.0x") and hold catastrophic illness card who received traditional disease-modified anti-rheumatic drug (TDMARDs) or BDMARDs (including etanercept, adalimumab or rituximab were included in the analysis. Patients with prior TB, serious infections or lymphoma were excluded. Patients who received TDMARDs were matched with BDMARDs cohort with 2:1 ratio using propensity score method to adjust age, gender, disease severity, and co-morbidities. Incidence rates of TB, serious infection and lymphoma were defined as number of events divided by total patient exposure years. Incidence rate ratios (IRRs) were calculated between patients on TDMARDs vs. BDMARDs, and among different BDMARDs. Results Of total patients in between 1999 and 2009, 35,589 met the inclusion criteria, and were included in the analysis. The average duration of RA was 8.2 years; 79.1% was female, and the average age was 60.6 years. Patients on BDMARDs group had higher incidences of TB, serious infections and lymphoma compared with patients who received TDMARDs only (Table 1). Within BDMARDs group, 3,335 patients (75.8%) and 1,029 patients (23.2%) and had ever received first line treatment of etanercept and adalimumab respectively. Patients on etanercept group had lower incidences of TB, serious infections and lymphoma compared with patients on adalimumab group. All !
EMBASE:71328612
ISSN: 0003-4967
CID: 837332