American Journal of Medicine最新文献

The debate over whether obesity constitutes disease reveals a fundamental limitation in biomedical disease models. We propose a bio-biographical framework recognizing that disease emerges when biological processes and biographical context, including for example lived experience, social position, chronic stressors, trauma, couple together to generate present or potential harm meaningful to the person. Biography is not external to disease but constitutive of it, shaping causation, expression, and trajectory through embodied mechanisms. This reconceptualization applies beyond obesity to cancer, cardiovascular disease, neurodegeneration and more, offering a new foundation for medicine that acknowledges both biological mechanisms and disrupted human lives.

Purpose: VA's Clinical Resource Hubs (CRH) are well-positioned to fill pain care gaps experienced by rural-dwelling patients through regional hub-and-spoke models. We examined how CRHs integrated Whole Health approaches to expand access to this care for chronic pain.

Methods: Qualitative interviews conducted with employees in 4 CRHs were rapidly analyzed to examine how CRHs organized and delivered Whole Health care.

Results: CRH's delivered Whole Health care in interdisciplinary pain, stand-alone Whole Health, and primary care clinics. All offered varied Whole Health services (Whole Health coaching, complementary and integrative health therapies, and Whole Health groups), and incorporated key elements of person-centered communication to ensure care aligned with what mattered most to patients. Considerations unique to CRH delivery included multiple referral pathways, orienting patients to this short-term centralized care model, obtaining medical clearance, ensuring care continuity upon discharge, and telehealth adaptations. Participants perceived multiple benefits of Whole Health in CRHs for the healthcare system and patients.

Conclusions: Whole Health care can be successfully integrated into innovative centralized health system models like CRHs, enhancing accessibility. Replicating these models requires establishment of clear entry and discharge processes, and attention to virtual care delivery.

Over 40% of patients are discharged to post-acute care services which serve predominantly older adults with cardiovascular or cerebrovascular disease and substantial age-related complexity. Post-acute care settings are often siloed from the broader healthcare system, creating care gaps, suboptimal outcomes, and higher-than-average readmission rates. As value-based care models increasingly emphasize holistic, equitable care for an aging population, Post-acute care represents a major opportunity for improvement, including the use of preventive strategies and standardized, evidence-based processes. Certification programs in post-acute care could strengthen patient and family engagement in prevention and wellness, integrate routine geriatric assessments, and promote consistent application of personalized clinical practice guidelines following cardiovascular events and stroke. The American Heart Association (AHA)/American Stroke Association (ASA) is well suited to lead this effort, with a strong history of building registries, accreditation frameworks, and recognition programs that elevate guideline-recommended heart and stroke care. Leveraging new tools and data systems, the AHA/ASA is generating the evidence needed to support widespread post-acute care certification, with the goal of improving care quality and long-term outcomes for patients transitioning from acute hospitalization.