Jones, Lyell K

AbstractNeurology trainee assessment is a required component of the education feedback loop, allowing programs and trainees to measure their progress toward established educational goals. In the era of competency-based medical education, assessment systems should be designed to inform decisions about each trainee's acquisition of the many competencies required for independent clinical neurology practice. In addition to the need to inform trainees and programs regarding trainee performance, assessment systems must be equipped to satisfy requirements established by accrediting bodies. Educational goals should be thoughtfully established prior to assessment system design to ensure that assessment priorities align with the overall goal of equipping graduates to deliver high-quality neurologic care. This article provides an overview of modern principles of medical education as they can be applied to neurologic education, complemented by practical recommendations for neurologic educators to develop or improve assessment systems within their own training programs.

Background: Activity aprons are commercially available products used to occupy patients with dementia at home or in long-term care facilities. We hypothesized that inpatient use of activity aprons could potentially reduce or eliminate behaviors that result in self-harm, increased nursing supervision, and restraint use in an inpatient hospital setting. Methods: A single-center prospective randomized controlled pilot study was performed from July 2015 to November 2016 comparing activity apron plus standard care versus standard care alone. Consecutively enrolled patients were randomized by stratified randomization using age (cutoff: 80 years) and preexisting diagnosis of dementia or cognitive impairment. Primary outcomes were safety and feasibility of apron use. Secondary outcomes included duration of hospitalization postrandomization and individual nursing assignment (IA), time in restraints, nonphysical restraints use, falls, apron-related complications, dismissal destination, and 30-day hospital readmission. Results: Thirty patients were enrolled, with 13 randomized to apron and 17 randomized to the control group. There was no statistically significant reduction in mean length of hospital stay (15.8 vs 21.5 day; P = .40), duration of IA compared to non-apron control group (6.4 vs 9.1, respectively; P = .39), or antipsychotic medication use (61.5% vs 70.6% in control group; P = .60). No complications secondary to apron use were seen. Conclusions: Activity aprons are a safe addition to the standard of care when managing encephalopathic patients in the inpatient setting. These aprons may have a role as part of a comprehensive complement of interventions to address delirium and encephalopathy in hospitalized patients.

ABSTRACTBeginning in 2017, most physicians who participate in Medicare are subject to the Medicare Access and CHIP Reauthorization Act (MACRA), the milestone legislation that signals the US health care system's transition from volume‐based to value‐based care. Here we review emerging trends in development of value‐based healthcare systems in the US. MACRA and the resulting Quality Payment Program create 2 participation pathways, the Merit‐based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (AAPM) pathway. Although there are several program incentives for AAPM participation, to date there have been few AAPM options for specialists. MIPS and its widening bonus and penalty window will likely be the primary participation pathway in the early years of the program. Value‐based payment has the potential to reshape health care delivery in the United States, with implications for neuromuscular and electrodiagnostic (EDX) specialists. Meaningful quality measures are required for neuromuscular and EDX specialists. Muscle Nerve 56: 679–683, 2017