David A. Fleming

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OBJECTIVE A key aspect of the role of clinicians caring for patients in the setting of advanced illness focuses on attending to the needs of informal caregivers during the end-of-life period. The purpose of this study was twofold: (1) to complement and enrich existing quantitative findings regarding caregiver burden near the end of life, and (2) to identify(More)
Telemedicine, defined as the use of advanced telecommunication technologies to bridge geographic distance and improve delivery of care, is perceived by many as a way to eliminate barriers to quality care at the end of life. The use of telemedicine in hospice, known as telehospice, is a novel approach to such care, and few pilot studies have investigated its(More)
This study explored the association between perceptions of health care quality and quality of life in patients with advanced metastatic cancer and their informal caregivers (n=39). Patients' and caregivers' perceptions of health care quality, mental health, health-related quality of life, symptoms, and burden were measured. The key findings included the(More)
BACKGROUND The purpose of this study is to determine the prevalence of diabetes distress and its relationship with health behaviours and clinical outcomes in low-income patients. METHODS Secondary analyses were conducted using baseline data from a clinical trial evaluating a diabetes self-management intervention. Interviews were conducted with 666(More)
Ethical dilemmas are encountered frequently in long term facilities, encompassing a myriad of concerns related to end of life care, rehospitalization, artificial hydration and nutrition, capacity for decision making, use of sedation, and dealing with conflict that may arise amongst those caring for and about the patient. Having a formalized means of sorting(More)
This position paper concerns improving health care in the United States. Unlike previous highly focused policy papers by the American College of Physicians, this article takes a comprehensive approach to improving access, quality, and efficiency of care. The first part describes health care in the United States. The second compares it with health care in(More)
In this issue, Baron and Johnson (1) describe the history of and rationale for the creation of the American Board of Internal Medicine (ABIM) and recent changes in maintenance of certification (MOC). They focus on setting standards and identifying “good doctors” who meet those standards. By implication, those who do not participate or are unsuccessful in(More)
BACKGROUND Health care delivery teams have received much attention in recent years from researchers and practitioners. Recent empirical research has demonstrated that objective and subjective outcomes tend to be improved when care teams function smoothly and efficiently. However, little is known about how the work environment, or care context, influences(More)
Christine Lubinski, Judith Aberg, Arlene D. Bardeguez, Richard Elion, Patricia Emmanuel, Daniel Kuritzkes, Michael Saag, Kathleen E. Squires, Andrea Weddle, Jennifer Rainey, M. Renee Zerehi, J. Fred Ralston, David A. Fleming, David Bronson, Molly Cook, Charles Cutler, Yul Ejnes, Robert Gluckman, Mark Liebow, Kenneth Musana, Mark E. Mayer, Mark W. Purtle, P.(More)