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Coombes FC, Strudwick K, Martin-Khan MG, Russell TG. A comparison of prospective observations and chart audits for measuring quality of care of musculoskeletal injuries in the emergency department. Australas Emerg Care 2022:S2588-994X(22)00071-9. [DOI: 10.1016/j.auec.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022]
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Kotz D, O'Donnell A, McPherson S, Thomas KH. Using primary care databases for addiction research: An introduction and overview of strengths and weaknesses. Addict Behav Rep 2022; 15:100407. [PMID: 35111898 PMCID: PMC8789598 DOI: 10.1016/j.abrep.2022.100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/16/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022] Open
Abstract
Primary care databases extract and combine routine data from the electronic patient records of various participating practices on a regular basis. These databases can be used for innovative and relevant addiction research, but such use requires a thorough understanding of how data were originally collected and how they need to be processed and statistically analysed to produce sound scientific evidence. The aims of this paper are therefore to (1) make a case for why primary care databases should be considered more frequently for addiction research; (2) provide an overview of how primary care databases are constructed; (3) highlight important methodological and statistical strengths and weaknesses of using primary care databases for research; and (4) give practical advice about how a researcher can get access to databases. Three major primary care databases from the UK serve as examples: Clinical Practice Research Datalink (CPRD), The Health Improvement Network (THIN), and QResearch.
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Affiliation(s)
- Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich‐Heine‐University Düsseldorf, Germany
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sterling McPherson
- Program of Excellence in Addictions Research and the Analytics and PsychoPharmacology Laboratory (APPL), Washington State University, Elson S. Floyd College of Medicine, USA
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McNeely J, Mazumdar M, Appleton N, Bunting AM, Polyn A, Floyd S, Sharma A, Shelley D, Cleland CM. Leveraging technology to address unhealthy drug use in primary care: Effectiveness of the Substance use Screening and Intervention Tool (SUSIT). Subst Abus 2022; 43:564-572. [PMID: 34586976 PMCID: PMC9968463 DOI: 10.1080/08897077.2021.1975868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Screening for unhealthy drug use is now recommended for adult primary care patients, but primary care providers (PCPs) generally lack the time and knowledge required to screen and deliver an intervention during the medical visit. To address these barriers, we developed a tablet computer-based 'Substance Use Screening and Intervention Tool (SUSIT)'. Using the SUSIT, patients self-administer screening questionnaires prior to the medical visit, and results are presented to the PCP at the point of care, paired with clinical decision support (CDS) that guides them in providing a brief intervention (BI) for unhealthy drug use. Methods: PCPs and their patients with moderate-risk drug use were recruited from primary care and HIV clinics. A pre-post design compared a control 'screening only' (SO) period to an intervention 'SUSIT' period. Unique patients were enrolled in each period. In both conditions, patients completed screening and identified their drug of most concern (DOMC) before the visit, and completed a questionnaire about BI delivery by the PCP after the visit. In the SUSIT condition only, PCPs received the tablet with the patient's screening results and CDS. Multilevel models with random intercepts and patients nested within PCPs examined the effect of the SUSIT intervention on PCP delivery of BI. Results: 20 PCPs and 79 patients (42 SO, 37 SUSIT) participated. Most patients had moderate-risk marijuana use (92.4%), and selected marijuana as the DOMC (68.4%). Moderate-risk use of drugs other than marijuana included cocaine (15.2%), hallucinogens (12.7%), and sedatives (12.7%). Compared to the SO condition, patients in SUSIT had higher odds of receiving any BI for drug use, with an adjusted odds ratio of 11.59 (95% confidence interval: 3.39, 39.25), and received more elements of BI for drug use. Conclusions: The SUSIT significantly increased delivery of BI for drug use by PCPs during routine primary care encounters.
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Affiliation(s)
- Jennifer McNeely
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Medha Mazumdar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Noa Appleton
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Amanda M. Bunting
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Antonia Polyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Steven Floyd
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Akarsh Sharma
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Donna Shelley
- Department of Public Health Policy and Management, New York University Global School of Public Health
| | - Charles M. Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Hepatitis B Vaccination Among Adults With Diabetes Mellitus, U.S., 2018. Am J Prev Med 2021; 61:652-664. [PMID: 34294463 PMCID: PMC9077536 DOI: 10.1016/j.amepre.2021.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Hepatitis B vaccination is routinely recommended for adults with diabetes mellitus aged <60 years and for those aged ≥60 years at the discretion of their healthcare provider. The purpose of this study is to assess hepatitis B vaccination coverage among adults with and without diabetes mellitus. METHODS Data from the 2014-2018 National Health Interview Survey were analyzed in 2020 to determine hepatitis B vaccination series completion (≥3 doses) among adults aged 18-59 and ≥60 years with diabetes mellitus. Multivariable logistic regression analysis was conducted to identify the factors independently associated with hepatitis B vaccination among adults aged 18-59 and ≥60 years with diabetes mellitus. RESULTS In 2018, among adults aged 18-59 years with diabetes mellitus, 33.2% had received hepatitis B vaccination (≥3 doses), an increase of 9.7 percentage points from 2014 (p<0.05). Among adults aged ≥60 years with diabetes mellitus, coverage was 15.3% in 2018 and did not increase during 2014-2018. Coverage was not significantly different among adults with diabetes mellitus compared with those without diabetes mellitus, even after controlling for the assessed factors. Among adults with diabetes mellitus aged 18-59 and ≥60 years, younger age, having some college or college education, having been tested for HIV, being healthcare personnel, or having traveled to hepatitis B virus-endemic areas were independently associated with an increased likelihood of vaccination. CONCLUSIONS Self-reported hepatitis B vaccination coverage among adults with diabetes mellitus remains suboptimal. Healthcare providers should assess patients' diabetes status, recommend and offer needed vaccinations to patients, or refer them to alternate sites for vaccination.
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Kharofa RY, Khalsa AS, Zeller MH, Modi AC, Ollberding NJ, Copeland KA. Giving "prescriptions" for paediatric weight management follow-up in primary care. Clin Obes 2021; 11:e12448. [PMID: 33733574 DOI: 10.1111/cob.12448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/04/2021] [Accepted: 02/12/2021] [Indexed: 12/01/2022]
Abstract
The American Academy of Paediatrics recommends that primary care paediatricians "prescribe" follow-up for weight management between well child checks. We sought to describe rates and predictors of prescribed and actual clinic attendance for weight management in primary care in a predominantly low-income population. A chart review was performed at a large, hospital-based, primary care clinic, where a treatment algorithm for obesity exists. Eligible children were 6 to 12 years of age with a body mass index (BMI) ≥85th percentile and seen for a well child check in 2014. Primary outcomes were the physician prescribing follow-up in primary care and the patient returning for weight management. Multivariable logistic regression was used to identify predictors of prescribing follow-up and predictors of return. Participants included 1339 patients: mean age 9 years (SD: 1.8 years); 53% female; 79% Black; 89% Medicaid-insured; 56% with an obese BMI (vs overweight). Twenty-seven percent of patients were prescribed follow-up in primary care, of which 13% returned (only 4% of the original sample). The odds of the physician prescribing follow-up were greater if the child had obesity (vs overweight), was older, female or non-Medicaid insured. Older and non-Black patients had greater odds of returning. Patients prescribed follow-up within 2 months or less (vs 3-6 months) were also more likely to return (aOR 2.66; CI: 1.34, 5.26). Rates of prescription for weight management in primary care are low and few patients return, even when follow-up is prescribed. Prescribing follow-up at shorter intervals from the index visit (≤ 2 months) may improve patient return.
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Affiliation(s)
- Roohi Y Kharofa
- Centre for Better Health and Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amrik Singh Khalsa
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Meg H Zeller
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Centre for Child Behavior and Nutrition Research and Training, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
| | - Avani C Modi
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Centre for Adherence and Self-Management, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
| | - Nicholas J Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
| | - Kristen A Copeland
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
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Kim MK, Baumgartner JN, Headley J, Kirya J, Kaggwa J, Egger JR. Medical record bias in documentation of obstetric and neonatal clinical quality of care indicators in Uganda. J Clin Epidemiol 2021; 136:10-19. [PMID: 33667620 DOI: 10.1016/j.jclinepi.2021.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 11/30/2020] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To achieve a high quality of care (QoC), accurate measurements are needed. This study evaluated the validity of QoC data from the medical records for childbirth deliveries and assessed whether medical records can be used to evaluate the efficacy of interventions to improve QoC. STUDY DESIGN AND SETTING This study was part of a larger study of QoC training program in Uganda. Study data were collected in two phases: (1) validation data from 321 direct observations of deliveries paired with the corresponding medical records; (2) surveillance data from 1,146 medical records of deliveries. Sensitivity, specificity, and predictive values were used to measure the validity of the medical record from the validation data. Quantitative bias analysis was conducted to evaluate QoC program efficacy in the surveillance data using prevalence ratio and odds ratio. RESULTS On average, sensitivity (84%) of the medical record was higher than the specificity (34%) across 11 QoC indicators, showing a higher validity in identifying the performed procedure. For 5 out of 11 indicators, bias-corrected odds ratios and prevalence ratios deviated significantly from uncorrected estimates. CONCLUSION The medical records demonstrated poor validity in measuring QoC compared with direct observation. Using the medical record to assess QoC program efficacy should be interpreted carefully.
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Affiliation(s)
- Min Kyung Kim
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joy Noel Baumgartner
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27708, USA
| | - Jennifer Headley
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27708, USA
| | | | - James Kaggwa
- Makerere University - Johns Hopkins University (MI-JHU) Research Collaboration, Kampala, Uganda
| | - Joseph R Egger
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27708, USA.
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Zhong C, Luo Z, Liang C, Zhou M, Kuang L. An overview of general practitioner consultations in China: a direct observational study. Fam Pract 2020; 37:682-688. [PMID: 32328659 DOI: 10.1093/fampra/cmaa039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND General practitioner (GP) consultation has long been considered an important component of general practice, but few studies have focused on its characteristics in China. OBJECTIVE This study aimed to explore the content and elucidate the characteristics of GP consultations in general practice in China. METHODS A multimethod investigation of GP consultations in eight community health centres in Guangzhou and Shenzhen, China was conducted between July 2018 and January 2019. Data from 445 GP consultations were collected by direct observation and audio tape and analysed by a modified Davis Observation Code with indicators for frequencies and detailed time durations. GP and patient characteristics were collected by post-visit surveys. RESULTS The mean visit duration was approximately 5.4 minutes. GPs spent the most time on treatment planning, history taking, negotiating, notetaking and physical examination and less time on health promotion, family information collecting, discussing substance use, procedures and counselling. The time spent on procedures ranked first (66 seconds), followed by history taking (65 seconds) and treatment planning (63 seconds). Besides, patients were very active in the consultation, specifically for topics related to medicine ordering and drug costs. CONCLUSIONS This study described the profile of GP consultations and illustrated the complexity of care provided by GPs in China. As patient activation in GP consultations becomes increasingly important, future studies need to explore how to promote the engagement of patients in the whole consultation process other than just requesting for medicine.
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Affiliation(s)
- Chenwen Zhong
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhuojun Luo
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Cuiying Liang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Mengping Zhou
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
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Nguyen BKH, Wu BS, Sanoff HK, Lafata JE. Patient-Oncologist Communication Regarding Oral Chemotherapy During Routine Office Visits. JCO Oncol Pract 2020; 16:e660-e667. [PMID: 32119593 PMCID: PMC7427422 DOI: 10.1200/jop.19.00550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although studies in other clinical areas have shown that patient-clinician communication can positively influence adherence to medications, little is known about how oncologists address medication counseling during routine office visits. We describe patient-oncologist office-based discussions of oral chemotherapy treatment. METHODS Transcripts of 24 patient-oncologist office visits were obtained from a national database. Patients were aged ≥ 19 years and prescribed capecitabine for colorectal cancer. We developed a structured coding worksheet using medication-counseling concepts previously identified as important to medication adherence and a grounded approach. Two coders reviewed transcripts for oncologists' provision of medication information, assessment of patients' adherence to medication, and the provision of self-management support for management of adverse effects. We assessed interrater reliability with Cohen κ statistics. We describe the counseling concepts present within patient-oncologist conversations and present illustrative quotes to describe how they were discussed. RESULTS Oncologists generally provided patients who had yet to initiate therapy comprehensive medication information; those in the midst of treatment received less information. Oncologists discussed patients' continued use of the medication (or discontinuation) among all patients who had initiated therapy (N = 18). How the patient was taking the medication (ie, therapy implementation) was less commonly discussed. Medication adverse effects were also discussed in all encounters. Self-management strategies were commonly provided, albeit mostly in response to a presenting symptom and not preemptively. Patients' use of concurrent medications, financial access to therapy, and assessments of logistical arrangements were discussed more sporadically. CONCLUSION Using audio recordings from a national sample of patient-oncologist office visits, we identified several potentially important opportunities to enhance medication counseling among patients prescribed capecitabine for the treatment of colorectal cancer.
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Affiliation(s)
- Bobbie K H Nguyen
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Benjamin S Wu
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hanna K Sanoff
- UNC Lineberger Comprehensive Cancer Center, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC.,UNC Lineberger Comprehensive Cancer Center, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Life beyond 5 Years after TAVI: Patients' Perceived Health Status and Long-Term Outcome after Transcatheter Aortic Valve Implantation. J Interv Cardiol 2019; 2019:4292987. [PMID: 31772530 PMCID: PMC6794985 DOI: 10.1155/2019/4292987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/09/2019] [Accepted: 08/26/2019] [Indexed: 11/25/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is currently recommended for patients with severe aortic stenosis at intermediate or high surgical risk. The decision process during TAVI evaluation includes a thorough benefit-risk assessment, and knowledge about long-term benefits and outcomes may improve patients' expectation management. Objective To evaluate patients' perceived health status and self-reported long-term outcome more than 5 years after TAVI. Methods and Results Demographic and procedure data were obtained from all patients treated with TAVI at our institution from 2006 to 2012. A cross-sectional survey was conducted on the patients alive, measuring health status, including the EQ-5D-5L questionnaire, and clinical outcomes. 103 patients (22.8%) were alive at a median follow-up period of 7 years (5.4–9.8). 99 (96%) of the 103 patients were included in the final analysis. The mean age at follow-up was 86.5 years ± 8.0 years, and 56.6% were female. Almost all patients (93.9%) described an improvement of their quality of life after receiving TAVI. At late follow-up, the mean utility index and EQ-VAS score were 0.80 ± 0.20 and 58.49 ± 11.49, respectively. Mobility was found to be the most frequently reported limitation (85.4%), while anxiety/depression was the least frequently reported limitation (19.8%). With respect to functional class, 64.7% were in New York Heart Association (NYHA) class III or IV, compared to 67.0% prior to TAVI (p=0.51). Self-reported long-term outcomes revealed mainly low long-term complication rates. 74 total hospitalizations were reported after TAVI, and among those 43% for cardiovascular reasons. Within cardiovascular rehospitalizations, new pacemaker implantations were the most frequently reported (18.9%), followed by cardiac decompensation and coronary heart disease (15.6%). Conclusion The majority of the patients described an improvement of health status after TAVI. More than five years after TAVI, the patients' perceived health status was satisfactory, and the incidence of clinical events and hospitalizations was very low.
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Morón-Duarte LS, Ramirez Varela A, Bassani DG, Bertoldi AD, Domingues MR, Wehrmeister FC, Silveira MF. Agreement of antenatal care indicators from self-reported questionnaire and the antenatal care card of women in the 2015 Pelotas birth cohort, Rio Grande do Sul, Brazil. BMC Pregnancy Childbirth 2019; 19:410. [PMID: 31703634 PMCID: PMC6839160 DOI: 10.1186/s12884-019-2573-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 10/25/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Studies of healthcare service use during the pregnancy-postpartum cycle often rely on self-reported data. The reliability of self-reported information is often questioned as administrative data or medical records, such as antenatal care cards, are usually preferred. In this study, we measured the agreement of antenatal care indicators from self-reported information and antenatal care cards of pregnant women in the 2015 Pelotas Birth Cohort, Brazil. METHODS In a sample of 3923 mothers, indicator agreement strengths were estimated from Kappa and prevalence-and-bias-adjusted Kappa (PABAK) coefficients. Maternal characteristics associated with indicator agreements were assessed with heterogeneity chi-squared tests. RESULTS The self-reported questionnaire and the antenatal care card showed a moderate to high agreement in 10 of 21 (48%) antenatal care indicators that assessed care service use, clinical examination and diseases during pregnancy. Counseling indicators performed poorly. Self-reported information presented a higher frequency data and a higher sensitivity but slightly lower specificity when compared to the antenatal card. Factors associated with higher agreement between both data sources included lower maternal age, higher level of education, primiparous status, and being a recipient of health care in the public sector. CONCLUSIONS Self-reported questionnaire and antenatal care cards provided substantially different information on indicator performance. Reliance on only one source of data to assess antenatal care quality may be questionable for some indicators. From a public health perspective, it is recommended that antenatal care programs use multiple data sources to estimate quality and effectiveness of health promotion and disease prevention in pregnant women and their offspring.
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Affiliation(s)
- Lina Sofia Morón-Duarte
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160 - Centro, Pelotas, Rio Grande do Sul, 96020-220, Brazil.
| | - Andrea Ramirez Varela
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160 - Centro, Pelotas, Rio Grande do Sul, 96020-220, Brazil
| | - Diego G Bassani
- Center for Global Child Health, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Andrea Dâmaso Bertoldi
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160 - Centro, Pelotas, Rio Grande do Sul, 96020-220, Brazil
| | - Marlos R Domingues
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160 - Centro, Pelotas, Rio Grande do Sul, 96020-220, Brazil
| | - Fernando C Wehrmeister
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160 - Centro, Pelotas, Rio Grande do Sul, 96020-220, Brazil
| | - Mariangela Freitas Silveira
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160 - Centro, Pelotas, Rio Grande do Sul, 96020-220, Brazil
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Diaz A, Vo B, Baade PD, Matthews V, Nattabi B, Bailie J, Whop LJ, Bailie R, Garvey G. Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193630. [PMID: 31569670 PMCID: PMC6801551 DOI: 10.3390/ijerph16193630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/23/2019] [Indexed: 12/02/2022]
Abstract
Aboriginal and Torres Strait Islander women have significantly higher cervical cancer incidence and mortality than other Australian women. In this study, we assessed the documented delivery of cervical screening for women attending Indigenous Primary Health Care (PHC) centres across Australia and identified service-level factors associated with between-centre variation in screening coverage. We analysed 3801 clinical audit records for PHC clients aged 20–64 years from 135 Indigenous PHC centres participating in the Audit for Best Practice in Chronic Disease (ABCD) continuous quality improvement (CQI) program across five Australian states/territories during 2005 to 2014. Multilevel logistic regression models were used to identify service-level factors associated with screening, while accounting for differences in client-level factors. There was substantial variation in the proportion of clients who had a documented cervical screen in the previous two years across the participating PHC centres (median 50%, interquartile range (IQR): 29–67%), persisting over years and audit cycle. Centre-level factors explained 40% of the variation; client-level factors did not reduce the between-centre variation. Screening coverage was associated with longer time enrolled in the CQI program and very remote location. Indigenous PHC centres play an important role in providing cervical screening to Aboriginal and Torres Strait Islander women. Thus, their leadership is essential to ensure that Australia’s public health commitment to the elimination of cervical cancer includes Aboriginal and Torres Strait Islander women. A sustained commitment to CQI may improve PHC centres delivery of cervical screening; however, factors that may impact on service delivery, such as organisational, geographical and environmental factors, warrant further investigation.
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Affiliation(s)
- Abbey Diaz
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia.
| | - Brenda Vo
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia.
| | - Peter D Baade
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia.
- Cancer Research Centre, Cancer Council Queensland, Herston 4006, Australia.
| | - Veronica Matthews
- University Centre for Rural Health, The University of Sydney, Lismore 2480, Australia.
| | - Barbara Nattabi
- School of Population and Global Health, The University of Western Australia, Crawley 6009, Australia.
| | - Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Lismore 2480, Australia.
| | - Lisa J Whop
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia.
| | - Ross Bailie
- University Centre for Rural Health, The University of Sydney, Lismore 2480, Australia.
| | - Gail Garvey
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia.
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Kameoka J, Kikukawa M, Kobayashi D, Okubo T, Ishii S, Kagaya Y. A Medical Record Peer-Review System to Evaluate Residents' Clinical Competence: Criterion Validity Analysis. TOHOKU J EXP MED 2019; 248:253-260. [PMID: 31434837 DOI: 10.1620/tjem.248.253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In contrast to input evaluation (education delivered at school) and output evaluation (students' capability at graduation), the methods of outcome evaluation (performance after graduation) of medical education have not been sufficiently established. To establish a method to measure the quality of patient care and conduct outcome evaluation, we have been developing a peer review system of medical records. Here, we undertook a pilot study to evaluate the criterion validity of our system by using "evaluation by program directors (supervisors in the hospitals)" as a criterion standard. We selected 13 senior residents from three teaching hospitals. Five reviewers (general internists working in other hospitals) visited the hospitals independently and evaluated five patients' records for each resident based on the previously established sheet comprising 15 items. Independently, program directors of the senior residents evaluated their clinical performance using an evaluation sheet comprising ten items. Pearson's analysis revealed statistically significant correlation coefficients in three pairs of assessments including clinical reasoning (r = 0.5848, P = 0.0358). Bootstrap analysis revealed statistically significant correlation coefficients in additional 5 pairs including history taking (r = 0.509, 95% confidence interval: 0.034-0.847). In contrast, the correlation coefficients were low in some items: r = 0.132 (-0.393-0.639) for physical examination and r = 0.089 (-0.847-0.472) for attitude toward patients. To the best of our knowledge, this is the first study, albeit a pilot one, that investigates the criterion validity of medical record evaluations conducted by comparing the assessments of medical records with those by program directors.
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Affiliation(s)
- Junichi Kameoka
- Division of Hematology and Rheumatology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University.,Office of Medical Education, Tohoku University Graduate School of Medicine
| | - Makoto Kikukawa
- Department of Medical Education, Faculty of Medical Sciences, Kyushu University
| | - Daiki Kobayashi
- Division of General Internal Medicine, Department of Internal Medicine, St. Luke's International Hospital
| | - Tomoya Okubo
- Research Division, The National Center for University Entrance Examinations
| | - Seiichi Ishii
- Office of Medical Education, Tohoku University Graduate School of Medicine
| | - Yutaka Kagaya
- Office of Medical Education, Tohoku University Graduate School of Medicine
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Khanji C, Schnitzer ME, Bareil C, Perreault S, Lalonde L. Concordance of care processes between medical records and patient self-administered questionnaires. BMC FAMILY PRACTICE 2019; 20:92. [PMID: 31269902 PMCID: PMC6607524 DOI: 10.1186/s12875-019-0979-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 06/13/2019] [Indexed: 11/10/2022]
Abstract
Background Despite the increasing use of medical records to measure quality of care, studies have shown that their validity is suboptimal. The objective of this study is to assess the concordance of cardiovascular care processes evaluated through medical record review and patient self-administered questionnaires (SAQs) using ten quality indicators (TRANSIT indicators). These indicators were developed as part of a participatory research program (TRANSIT study) dedicated to TRANSforming InTerprofessional clinical practices to improve cardiovascular disease (CVD) prevention in primary care. Methods For every patient participating in the TRANSIT study, the compliance to each indicator (individual scores) as well as the mean compliance to all indicators of a category (subscale scores) and to the complete set of ten indicators (overall scale score) were established. Concordance between results obtained using medical records and patient SAQs was assessed by prevalence-adjusted bias-adjusted kappa (PABAK) coefficients as well as intraclass correlation coefficients (ICCs) and 95% confidence intervals (95% CI). Generalized linear mixed models (GLMM) were used to identify patients’ sociodemographic and clinical characteristics associated with agreement between the two data sources. Results The TRANSIT study was conducted in a primary care setting among patients (n = 759) with multimorbidity, at moderate (16%) and high risk (83%) of cardiovascular diseases. Quality of care, as measured by the TRANSIT indicators, varied substantially between medical records and patient SAQ. Concordance between the two data sources, as measured by ICCs (95% CI), was poor for the subscale (0.18 [0.08–0.27] to 0.46 [0.40–0.52]) and overall (0.46 [0.40–0.53]) compliance scale scores. GLMM showed that agreement was not affected by patients’ characteristics. Conclusions In quality improvement strategies, researchers must acknowledge that care processes may not be consistently recorded in medical records. They must also be aware that the evaluation of the quality of care may vary depending on the source of information, the clinician responsible of documenting the interventions, and the domain of care. Electronic supplementary material The online version of this article (10.1186/s12875-019-0979-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cynthia Khanji
- Faculty of pharmacy, University of Montreal, 2940 Polytechnique Road, Montreal, Quebec, H3T1J4, Canada
| | - Mireille E Schnitzer
- Faculty of pharmacy, University of Montreal, 2940 Polytechnique Road, Montreal, Quebec, H3T1J4, Canada
| | - Céline Bareil
- HEC Montréal, University of Montreal, 3000 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T2A7, Canada
| | - Sylvie Perreault
- Faculty of pharmacy, University of Montreal, 2940 Polytechnique Road, Montreal, Quebec, H3T1J4, Canada.,Sanofi Aventis Endowment Chair in Drug Utilization, Montreal, Canada
| | - Lyne Lalonde
- Faculty of pharmacy, University of Montreal, 2940 Polytechnique Road, Montreal, Quebec, H3T1J4, Canada. .,Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Montreal, Canada.
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Cheung PC, Gazmararian JA, Kramer MR, Drews-Botsch CD, Welsh JA. Impact of an American board of pediatrics maintenance of certification (MOC) on weight-related counseling at well-child check-ups. PATIENT EDUCATION AND COUNSELING 2019; 102:113-118. [PMID: 30170823 PMCID: PMC6289845 DOI: 10.1016/j.pec.2018.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The Healthy Weight Counseling Maintenance of Certification (MOC) program integrates pediatrician training and clinic changes to promote use of evidence-based, diet and physical activity (PA) health messages and counseling strategies. This interrupted time series study assessed the impact of this MOC program on provision of weight-related counseling. METHODS We randomly selected 10-15 well-child visit charts at three time points before and three time points after 102 Georgia pediatricians began the MOC in 2012-2015. Linear binomial regression compared the frequency of behavior-change goal setting and health messaging documentation (fruit/vegetable consumption, sugar-sweetened beverage consumption, out-of-home food consumption, PA, and screen time) before and after MOC participation. RESULTS At baseline, pediatricians documented behavior-change goals with 44% of patients, with an additional 49% of patients having documented goals after their pediatrician started the MOC (99.5% confidence interval [CI]: 21-77%). Similarly, absolute increases in the proportion of patients with documentation for sugar-sweetened beverage consumption (adjusted prevalence difference [aPD]: 37%; 99.5% CI: 13-62%) and out-of-home eating were observed (aPD: 38%; 99.5% CI: 12-64%). CONCLUSION The Healthy Weight Counseling MOC is associated with increased and sustained use of evidence-based health messages and counseling strategies. PRACTICE IMPLICATIONS Continuing education and facilitation of system changes help improve physicians' weight-related counseling.
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Affiliation(s)
- Patricia C Cheung
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Julie A Gazmararian
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Carolyn D Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Jean A Welsh
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Wellness Department, Children's Healthcare of Atlanta, Atlanta, GA, USA.
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15
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Gill C, Arnold B, Nugent S, Rajwani A, Xu M, Black T, Doan Q. Reliability of HEARTSMAP as a Tool for Evaluating Psychosocial Assessment Documentation Practices in Emergency Departments for Pediatric Mental Health Complaints. Acad Emerg Med 2018; 25:1375-1384. [PMID: 29924893 DOI: 10.1111/acem.13506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/01/2018] [Accepted: 06/18/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The goal of this study was to assess the reliability of HEARTSMAP as a standardized tool for evaluating the quality of psychosocial assessment documentation of pediatric mental health (MH) presentations to the emergency department (ED). In addition, we report on current documentation practices. METHODS We conducted a retrospective cross-sectional study of pediatric (up to age 17) MH-related visits to four EDs between April 1, 2013, and March 31, 2014. The primary outcome was the inter-rater agreement when evaluating the completeness of pediatric emergency psychosocial assessments using the HEARTSMAP tool. The secondary outcome was to describe the adequacy of documentation of emergency pediatric MH assessments, using HEARTSMAP as a guide for a complete assessment. RESULTS A total of 400 medical records (100 from each site) were reviewed. We observed near-perfect inter-rater agreement (κ = 0.99-1.00) regarding the presence of documentation and good-to-perfect agreement (κ = 0.71-1.00) regarding whether sufficient information was documented to score a severity level for every component of an emergency psychosocial assessment. Inter-rater agreement regarding whether referrals or resources were documented for identified needs was observed to be good to very good (κ = 0.62-0.98). Current psychosocial documentation practices were found to be inconsistent with significant variability in the presence of documentation pertaining to HEARTSMAP sections between medical centers and initial clinician assessor and whether specialized MH services were involved prior to discharge. CONCLUSIONS The HEARTSMAP tool can be reliably used to assess pediatric psychosocial assessment documentation across a diverse range of EDs. Current documentation practices are variable and often inadequate, and the HEARTSMAP tool can aid in quality improvement initiatives to standardize and optimize care for the growing burden of pediatric mental illness.
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Affiliation(s)
- Carson Gill
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brendan Arnold
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean Nugent
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alykhan Rajwani
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Xu
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tyler Black
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Division of Emergency Medicine, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
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16
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Practice Roles and Characteristics of Integrative and Functional Nutrition Registered Dietitian Nutritionists. J Acad Nutr Diet 2018; 118:2356-2368.e1. [DOI: 10.1016/j.jand.2018.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/29/2018] [Indexed: 01/23/2023]
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17
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Lu PJ, O'Halloran AC, Williams WW, Nelson NP. Hepatitis B vaccination coverage among adults aged ≥18 years traveling to a country of high or intermediate endemicity, United States, 2015. Vaccine 2018:S0264-410X(18)30376-1. [PMID: 29716773 DOI: 10.1016/j.vaccine.2018.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Persons from the United States who travel to developing countries are at substantial risk for hepatitis B virus (HBV) infection. Hepatitis B vaccine has been recommended for adults at increased risk for infection, including travelers to high or intermediate hepatitis B endemic countries. PURPOSE To assess hepatitis B vaccination coverage among adults ≥18 years traveling to a country of high or intermediate endemicity from the United States. METHODS Data from the 2015 National Health Interview Survey (NHIS) were analyzed to determine hepatitis B vaccination coverage (≥1 dose) and series completion (≥3 doses) among persons aged ≥18 years who reported traveling to a country of high or intermediate hepatitis B endemicity. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with hepatitis B vaccination. RESULTS In 2015, hepatitis B vaccination coverage (≥1 dose) among adults aged ≥18 years who reported traveling to high or intermediate hepatitis B endemic countries was 38.6%, significantly higher compared with 25.9% among non-travelers. Series completion (≥3 doses) was 31.7% and 21.2%, respectively (P < 0.05). On multivariable analysis among all respondents, travel status was significantly associated with hepatitis B vaccination coverage and series completion. Other characteristics independently associated with vaccination (≥1 dose, and ≥3 doses) among travelers included age, race/ethnicity, educational level, duration of US residence, number of physician contacts in the past year, status of ever being tested for HIV, and healthcare personnel status. CONCLUSIONS Although travel to a country of high or intermediate hepatitis B endemicity was associated with higher likelihood of hepatitis B vaccination, hepatitis B vaccination coverage was low among adult travelers to these areas. Healthcare providers should ask their patients about travel plans and recommend and offer travel related vaccinations to their patients or refer them to alternate sites for vaccination.
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Affiliation(s)
- Peng-Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, United States.
| | - Alissa C O'Halloran
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, United States
| | - Walter W Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, United States
| | - Noele P Nelson
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, & TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333, United States
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Lu PJ, O'Halloran AC, Williams WW, Nelson NP. Hepatitis B vaccination coverage among adults aged ≥ 18 years traveling to a country of high or intermediate endemicity, United States, 2015. Vaccine 2018; 36:2471-2479. [PMID: 29605514 PMCID: PMC6161823 DOI: 10.1016/j.vaccine.2018.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Persons from the United States who travel to developing countries are at substantial risk for hepatitis B virus (HBV) infection. Hepatitis B vaccine has been recommended for adults at increased risk for infection, including travelers to high or intermediate hepatitis B endemic countries. PURPOSE To assess hepatitis B vaccination coverage among adults ≥ 18 years traveling to a country of high or intermediate endemicity from the United States. METHODS Data from the 2015 National Health Interview Survey (NHIS) were analyzed to determine hepatitis B vaccination coverage (≥1 dose) and series completion (≥3 doses) among persons aged ≥ 18 years who reported traveling to a country of high or intermediate hepatitis B endemicity. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with hepatitis B vaccination. RESULTS In 2015, hepatitis B vaccination coverage (≥1 dose) among adults aged ≥ 18 years who reported traveling to high or intermediate hepatitis B endemic countries was 38.6%, significantly higher compared with 25.9% among non-travelers. Series completion (≥3 doses) was 31.7% and 21.2%, respectively (P < 0.05). On multivariable analysis among all respondents, travel status was significantly associated with hepatitis B vaccination coverage and series completion. Other characteristics independently associated with vaccination (≥1 dose, and ≥ 3 doses) among travelers included age, race/ethnicity, educational level, duration of U.S. residence, number of physician contacts in the past year, status of ever being tested for HIV, and healthcare personnel status. CONCLUSIONS Although travel to a country of high or intermediate hepatitis B endemicity was associated with higher likelihood of hepatitis B vaccination, hepatitis B vaccination coverage was low among adult travelers to these areas. Healthcare providers should ask their patients about travel plans and recommend and offer travel related vaccinations to their patients or refer them to alternate sites for vaccination.
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Affiliation(s)
- Peng-Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333, United States.
| | - Alissa C O'Halloran
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333, United States
| | - Walter W Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333, United States
| | - Noele P Nelson
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, & TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333, United States
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Increased Rates of Documented Alcohol Counseling in Primary Care: More Counseling or Just More Documentation? J Gen Intern Med 2018; 33:268-274. [PMID: 29047076 PMCID: PMC5834950 DOI: 10.1007/s11606-017-4163-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/21/2017] [Accepted: 08/10/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Clinical performance measures often require documentation of patient counseling by healthcare providers. Little is known about whether such measures encourage delivery of counseling or merely its documentation. OBJECTIVE To assess changes in provider documentation of alcohol counseling and patient report of receiving alcohol counseling in the Veterans Administration (VA) from 2009 to 2012. DESIGN Retrospective time-series analysis. PARTICIPANTS A total of 5413 men who screened positive for unhealthy alcohol use at an outpatient visit and responded to a confidential mailed survey regarding alcohol counseling from a VA provider in the prior year. MAIN MEASURES Rates of provider documentation of alcohol counseling in the electronic health record and patient report of such counseling on the survey were assessed over 4 fiscal years. Annual rates were calculated overall and with patients categorized into four mutually exclusive groups based on their own reports of alcohol counseling (yes/no) and whether alcohol counseling was documented by a provider (yes/no). KEY RESULTS Provider documentation of alcohol counseling increased 23.6% (95% CI: 17.0, 30.2), from 59.4% to 83.0%, while patient report of alcohol counseling showed no significant change (4.0%, 95% CI: -2.3, 10.3), increasing from 66.1% to 70.1%. An 18.7% (95% CI: 11.7, 25.7) increase in the proportion of patients who reported counseling that was documented by a provider largely reflected a 14.7% decline (95% CI: 8.5, 20.8) in the proportion of patients who reported alcohol counseling that was not documented by a provider. The proportion of patients who did not report counseling but whose providers documented it did not show a significant change (4.9%, 95%CI: 0.0, 9.9). CONCLUSIONS If patient report is accurate, increased rates of documented alcohol counseling in the VA from 2009 to 2012 predominantly reflected improved documentation of previously undocumented counseling rather than delivery of additional counseling or increased documentation of counseling that did not meaningfully occur.
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20
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Primary care provider approaches to preventive health delivery: a qualitative study. Prim Health Care Res Dev 2018; 19:464-474. [PMID: 29307319 DOI: 10.1017/s1463423617000858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AimThe objective of this study was to seek decision-making insights on the provider level to gain understanding of the values that shape how providers deliver preventive health in the primary care setting. BACKGROUND The primary care clinic is a core site for preventive health delivery. While many studies have identified barriers to preventive health, less is known regarding how primary care providers (PCPs) make preventive health decisions such as what services to provide, under what circumstances, and why they might choose one over another. METHODS Qualitative methods were chosen to deeply explore these issues. We conducted semi-structured, one-on-one interviews with 21 PCPs at clinics affiliated with an academic medical center. Interviews with providers were recorded and transcribed. We conducted a qualitative analysis to identify themes and develop a theoretical framework using Grounded Theory methods.FindingsThe following themes were revealed: longitudinal care with an established PCP-patient relationship is perceived as integral to preventive health; conflict and doubt accompany non-preventive visits; PCPs defer preventive health for pragmatic reasons; when preventive health is addressed, providers use multiple contextual factors to decide which interventions are discussed; and PCPs desired team-based preventive health delivery, but wish to maintain their role when shared decision-making is required. We present a conceptual framework called Pragmatic Deferral.
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21
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Goodwin MA, Stange KC, Zyzanski SJ, Crabtree BF, Borawski EA, Flocke SA. The Hawthorne effect in direct observation research with physicians and patients. J Eval Clin Pract 2017; 23:1322-1328. [PMID: 28752911 PMCID: PMC5741487 DOI: 10.1111/jep.12781] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES This study examines the degree to which a "Hawthorne effect" alters outpatient-visit content. METHODS Trained research nurses directly observed 4454 visits to 138 family physicians. Multiple data sources were used to examine the Hawthorne effect including differences in medical record documentation for observed visits and the prior visit by the same patient, time use during visits on the first versus the second observation day of each physician, and report by the patient, physician, and observer of the effect of observation. RESULTS Visits on the first versus the second observation day were longer by an average of 1 minute (P < .001); there were time-use differences for 4 of 20 behaviour categories evaluated. No effect of the observer on the interaction was reported by 74% of patients and 55% of physicians. Most of those that reported an affect indicated it was slight. Patients with non-White race, lower-educational level, and poorer health were more likely to report being affected by the observer. CONCLUSIONS In a study that was designed to minimize the Hawthorne effect, the presence of an observer had little effect on most patient-physician visits but appeared to at least slightly effect a subgroup of vulnerable patients.
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Affiliation(s)
- Meredith A Goodwin
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kurt C Stange
- Department of Family Medicine and Community Health, Department of Epidemiology and Biostatistics, Department of Sociology, and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Stephen J Zyzanski
- Department of Family Medicine and Community Health, Department of Epidemiology and Biostatistics, and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Benjamin F Crabtree
- Department of Family Medicine, Rutgers University, New Brunswick, New Jersey, USA
| | - Elaine A Borawski
- Prevention Research Center for Healthy Neighborhoods and Department of Epidemiology and Biostatistics, and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Susan A Flocke
- Department of Family Medicine and Community Health, Department of Epidemiology and Biostatistics, Prevention Research Center for Healthy Neighborhoods and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
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Fenton AT, Elliott MN, Schwebel DC, Berkowitz Z, Liddon NC, Tortolero SR, Cuccaro PM, Davies SL, Schuster MA. Unequal interactions: Examining the role of patient-centered care in reducing inequitable diffusion of a medical innovation, the human papillomavirus (HPV) vaccine. Soc Sci Med 2017; 200:238-248. [PMID: 29157686 DOI: 10.1016/j.socscimed.2017.09.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 09/07/2017] [Accepted: 09/14/2017] [Indexed: 11/19/2022]
Abstract
RATIONALE Studies of inequities in diffusion of medical innovations rarely consider the role of patient-centered care. OBJECTIVE We used uptake of the human papillomavirus (HPV) vaccine shortly after its licensing to explore the role of patient-centered care. METHODS Using a longitudinal multi-site survey of US parents and adolescents, we assessed whether patient-centered care ratings might shape racial/ethnic and socioeconomic gaps at two decision points in the HPV vaccination process: (1) Whether a medical provider recommends the vaccine and (2) whether a parent decides to vaccinate. RESULTS We did not find evidence that the association of patient-centeredness with vaccination varies by parent education. In contrast, parent ratings of providers' patient-centeredness were significantly associated with racial/ethnic disparities in parents' reports of receiving a HPV vaccine recommendation from a provider: Among parents who rate patient-centered care as low, white parents' odds of receiving such a recommendation are 2.6 times higher than black parents' odds, but the racial/ethnic gap nearly disappears when parents report high patient-centeredness. Moderated mediation analyses suggest that patient-centeredness is a major contributor underlying vaccination uptake disparities: Among parents who report low patient-centeredness, white parents' odds of vaccinating their child are 8.1 times higher than black parents' odds, while both groups are equally likely to vaccinate when patient-centeredness is high. CONCLUSION The results indicate that patient-centered care, which has been a relatively understudied factor in the unequal diffusion of medical innovations, deserves more attention. Efforts to raise HPV vaccination rates should explore why certain patient groups may be less likely to receive recommendations and should support providers to consistently inform all patient groups about vaccination.
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Affiliation(s)
- Anny T Fenton
- Department of Sociology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.
| | - Marc N Elliott
- 1776 Main Street, RAND Corporation, Santa Monica, CA 90401, USA.
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Campbell Hall 415, 1530 3rd Avenue South, Birmingham, AL 35294, USA.
| | - Zahava Berkowitz
- Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, CDC, 1600 Clifton Road Atlanta, GA 30329, USA.
| | - Nicole C Liddon
- Division of Adolescent and School Health, CDC, 1600 Clifton Road Atlanta, GA 30329, USA.
| | - Susan R Tortolero
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA.
| | - Paula M Cuccaro
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA.
| | - Suzy L Davies
- Department of Health Behavior, UAB Center for the Study of Community Health, 1665 University Boulevard, Birmingham, AL 35294, USA.
| | - Mark A Schuster
- Division of General Pediatrics, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Enders, 300 Longwood Avenue, Boston, MA 02115, USA; Kaiser Permanente School of Medicine, 100 South Los Robles Avenue, Pasadena, CA 91106, USA.
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Gooding HC, Cheever E, Forman SF, Hatoun J, Jooma F, Touloumtzis C, Vernacchio L. Implementation and Evaluation of Two Educational Strategies to Improve Screening for Eating Disorders in Pediatric Primary Care. J Adolesc Health 2017; 60:606-611. [PMID: 28109735 DOI: 10.1016/j.jadohealth.2016.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Routine screening for disordered eating or body image concerns is recommended by the American Academy of Pediatrics. We evaluated the ability of two educational interventions to increase screening for eating disorders in pediatric primary care practice, predicting that the "active-learning" group would have an increase in documented screening after intervention. METHODS We studied 303 practitioners in a large independent practice association located in the northeastern United States. We used a quasi-experimental design to test the effect of printed educational materials ("print-learning" group, n = 280 participants) compared with in-person shared learning followed by on-line spaced education ("active-learning" group, n = 23 participants) on documented screening of adolescents for eating disorder symptoms during preventive care visits. A subset of 88 participants completed additional surveys regarding knowledge of eating disorders, comfort screening for, diagnosing, and treating eating disorders, and satisfaction with their training regarding eating disorders. RESULTS During the preintervention period, 4.5% of patients seen by practitioners in both the print-learning and active-learning groups had chart documentation of screening for eating disorder symptoms or body image concerns. This increased to 22% in the active-learning group and 5.7% in the print-learning group in the postintervention period, a statistically significant result. Compared with print-learning participants, active-learning group participants had greater eating disorder knowledge scores, increases in comfort diagnosing eating disorders, and satisfaction with their training in this area. CONCLUSIONS In-person shared learning followed by on-line spaced education is more effective than print educational materials for increasing provider documentation of screening for eating disorders in primary care.
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Affiliation(s)
- Holly C Gooding
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | | | - Sara F Forman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Hatoun
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Farah Jooma
- Pediatric Physicians' Organization at Boston Children's Hospital, Brookline, Massachusetts
| | - Currie Touloumtzis
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Louis Vernacchio
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Pediatric Physicians' Organization at Boston Children's Hospital, Brookline, Massachusetts
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Riese A, Gao H, Baird J, Mello MJ, Ranney ML. Including Youth Violence Screening on Previsit Questionnaires and the Effect on Other Health Risk Behavior Discussions. Clin Pediatr (Phila) 2017; 56:284-287. [PMID: 27270962 DOI: 10.1177/0009922816652228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alison Riese
- 1 Alpert Medical School of Brown University, Providence, RI, USA.,2 Injury Prevention Center of Rhode Island Hospital, Providence, RI, USA
| | - Hans Gao
- 1 Alpert Medical School of Brown University, Providence, RI, USA
| | - Janette Baird
- 1 Alpert Medical School of Brown University, Providence, RI, USA.,2 Injury Prevention Center of Rhode Island Hospital, Providence, RI, USA
| | - Michael J Mello
- 1 Alpert Medical School of Brown University, Providence, RI, USA.,2 Injury Prevention Center of Rhode Island Hospital, Providence, RI, USA
| | - Megan L Ranney
- 1 Alpert Medical School of Brown University, Providence, RI, USA.,2 Injury Prevention Center of Rhode Island Hospital, Providence, RI, USA
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Shelley D, Kumar P, Lee L, Nguyen L, Nguyen TT, VanDevanter N, Cleland CM, Nguyen NT. Health care providers' adherence to tobacco treatment for waterpipe, cigarette and dual users in Vietnam. Addict Behav 2017; 64:49-53. [PMID: 27543834 DOI: 10.1016/j.addbeh.2016.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/07/2016] [Accepted: 08/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Almost half of adult men in Vietnam are current cigarette smokers. Recent surveys also suggest a high prevalence of water pipe use, particularly in rural areas. Yet services to treat tobacco dependence are not readily available. The purpose of this study was to characterize current tobacco use treatment patterns among Vietnamese health care providers and factors influencing adherence to recommended guidelines for tobacco use screening and cessation interventions for water pipe, cigarette and dual users. METHODS We conducted cross sectional surveys of 929 male current tobacco users immediately after they completed a primary care visit at one of 18 community health centers. RESULTS Thirty-four percent of smokers used cigarettes only, 24% water pipe only, and 42% were dual users. Overall 12% of patients reported that a provider asked them if they used tobacco products during the visit. Providers were significantly more likely to screen cigarette smokers compared with water pipe or dual users (16%, 9% and 11% respectively). Similarly, 9% of current cigarette smokers received advice to quit compared to 6% of water pipe and 5% of dual users. No patients reported that their health care provider offered them assistance to quit (e.g., self-help materials, referral). CONCLUSION Despite ratifying the Framework Convention on Tobacco Control, Vietnam has not made progress in implementing policies and systems to ensure smokers are receiving evidence-based treatment. High rates of water pipe and dual use indicate a need for health care provider training and policy changes to facilitate treatment for both cigarette and water pipe use.
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Geldsetzer P, Fink G, Vaikath M, Bärnighausen T. Sampling for Patient Exit Interviews: Assessment of Methods Using Mathematical Derivation and Computer Simulations. Health Serv Res 2016; 53:256-272. [PMID: 27882543 PMCID: PMC5785309 DOI: 10.1111/1475-6773.12611] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective (1) To evaluate the operational efficiency of various sampling methods for patient exit interviews; (2) to discuss under what circumstances each method yields an unbiased sample; and (3) to propose a new, operationally efficient, and unbiased sampling method. Study Design Literature review, mathematical derivation, and Monte Carlo simulations. Principal Findings Our simulations show that in patient exit interviews it is most operationally efficient if the interviewer, after completing an interview, selects the next patient exiting the clinical consultation. We demonstrate mathematically that this method yields a biased sample: patients who spend a longer time with the clinician are overrepresented. This bias can be removed by selecting the next patient who enters, rather than exits, the consultation room. We show that this sampling method is operationally more efficient than alternative methods (systematic and simple random sampling) in most primary health care settings. Conclusion Under the assumption that the order in which patients enter the consultation room is unrelated to the length of time spent with the clinician and the interviewer, selecting the next patient entering the consultation room tends to be the operationally most efficient unbiased sampling method for patient exit interviews.
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Affiliation(s)
- Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Günther Fink
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Maria Vaikath
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA.,Institute of Public Health, Heidelberg University, Heidelberg, Germany.,Africa Health Research Institute, KwaZulu-Natal, South Africa
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Chang JC, Holland CL, Tarr JA, Rubio D, Rodriguez KL, Kraemer KL, Day N, Arnold RM. Perinatal Illicit Drug and Marijuana Use. Am J Health Promot 2016; 31:35-42. [PMID: 26559718 DOI: 10.4278/ajhp.141215-qual-625] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess use, screening, and disclosure of perinatal marijuana and other illicit drugs during first obstetric visits. DESIGN Observational study that qualitatively assesses provider screening and patient disclosure of substance use. SETTING Study sites were five urban outpatient prenatal clinics and practices located in Pittsburgh, Pennsylvania. PARTICIPANTS Pregnant patients and obstetric providers were recruited as participants. METHODS We audio recorded patient-provider conversations during first obstetric visits and obtained patient urine samples for drug analyses. Audio recordings were reviewed for provider screening and patient disclosure of illicit drug use. Urine analyses were compared with audio recordings to determine disclosure. RESULTS Four hundred and twenty-two pregnant patients provided complete audio recordings and urine samples for analyses. Providers asked about illicit drug use in 81% of the visits. One hundred twenty-three patients (29%) disclosed any current or past illicit drug use; 48 patients (11%) disclosed current use of marijuana while pregnant. One hundred and forty-five samples (34%) tested positive for one or more substances; marijuana was most commonly detected (N = 114, 27%). Of patients who tested positive for any substance, 66 (46%) did not disclose any use; only 36% of patients who tested positive for marijuana disclosed current use. CONCLUSION Although marijuana is illegal in Pennsylvania, a high proportion of pregnant patients used marijuana, with many not disclosing use to their obstetric care providers.
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Affiliation(s)
- Judy C Chang
- 1 Department of Obstetrics, Gynecology and Reproductive Sciences and General Internal Medicine, Magee-Womens Research Institute, and the Center for Research in Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Cynthia L Holland
- 2 Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, Pennsylvania
| | - Jill A Tarr
- 2 Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, Pennsylvania
| | - Doris Rubio
- 3 Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Keri L Rodriguez
- 3 Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,5 Center for Health Equity Research & Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Kevin L Kraemer
- 3 Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nancy Day
- 4 Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert M Arnold
- 3 Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,6 Institute to Enhance Palliative Care, and Director, Pittsburgh, Pennsylvania
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The Determinants of Reported Personal and Household Hygiene Behaviour: A Multi-Country Study. PLoS One 2016; 11:e0159551. [PMID: 27541259 PMCID: PMC4991820 DOI: 10.1371/journal.pone.0159551] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 07/04/2016] [Indexed: 11/19/2022] Open
Abstract
A substantial proportion of the total infectious disease burden world-wide is due to person-to-person spread of pathogens within households. A questionnaire-based survey on the determinants of hand-washing with soap and cleaning of household surfaces was conducted in at least 1000 households in each of twelve countries across the world (N = 12,239). A structural equation model of hygiene behaviour and its consequences derived from theory was then estimated on this dataset for both behaviours, using a maximum likelihood procedure. The analysis showed that the frequency of handwashing with soap is significantly related to how automatically it is performed, and whether or not someone is busy, or tired. Surface cleaning was strongly linked to possessing a cleaning routine, the perception that one is living in a dirty environment and that others are doing the behaviour, whether one has a strong sense of contamination, as well as a felt need to keep one's surroundings tidy. Being concerned with good manners is also linked to the performance of both behaviours. This study is the first to identify the role of manners, orderliness and routine on hygiene behaviours globally. Such findings should prove helpful in designing programs to improve domestic hygiene practices.
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Sanders M, Fiscella K, Veazie P, Dolan JG, Jerant A. Does patient time spent viewing computer-tailored colorectal cancer screening materials predict patient-reported discussion of screening with providers? HEALTH EDUCATION RESEARCH 2016; 31:555-562. [PMID: 27343254 PMCID: PMC4945861 DOI: 10.1093/her/cyw032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 05/18/2016] [Indexed: 06/06/2023]
Abstract
The main aim is to examine whether patients' viewing time on information about colorectal cancer (CRC) screening before a primary care physician (PCP) visit is associated with discussion of screening options during the visit. We analyzed data from a multi-center randomized controlled trial of a tailored interactive multimedia computer program (IMCP) to activate patients to undergo CRC screening, deployed in primary care offices immediately before a visit. We employed usage time information stored in the IMCP to examine the association of patient time spent using the program with patient-reported discussion of screening during the visit, adjusting for previous CRC screening recommendation and reading speed.On average, patients spent 33 minutes on the program. In adjusted analyses, 30 minutes spent using the program was associated with a 41% increase in the odds of the patient having a discussion with their PCP (1.04, 1.59, 95% CI). In a separate analysis of the tailoring modules; the modules encouraging adherence to the tailored screening recommendation and discussion with the patient's PCP yielded significant results. Other predictors of screening discussion included better self-reported physical health and increased patient activation. Time spent on the program predicted greater patient-physician discussion of screening during a linked visit.Usage time information gathered automatically by IMCPs offers promise for objectively assessing patient engagement around a topic and predicting likelihood of discussion between patients and their clinician.
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Affiliation(s)
- Mechelle Sanders
- Departments of Family Medicine and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin Fiscella
- Departments of Family Medicine and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Peter Veazie
- Department of Public Health Science, University of Rochester Medical Center, Rochester, NY, USA
| | - James G Dolan
- Department of Public Health Science, University of Rochester Medical Center, Rochester, NY, USA
| | - Anthony Jerant
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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Bailie C, Matthews V, Bailie J, Burgess P, Copley K, Kennedy C, Moore L, Larkins S, Thompson S, Bailie RS. Determinants and Gaps in Preventive Care Delivery for Indigenous Australians: A Cross-sectional Analysis. Front Public Health 2016; 4:34. [PMID: 27014672 PMCID: PMC4785185 DOI: 10.3389/fpubh.2016.00034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 02/15/2016] [Indexed: 11/26/2022] Open
Abstract
Background Potentially preventable chronic diseases are the greatest contributor to the health gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Preventive care is important for earlier detection and control of chronic disease, and a number of recent policy initiatives have aimed to enhance delivery of preventive care. We examined documented delivery of recommended preventive services for Indigenous peoples across Australia and investigated the influence of health center and client level factors on adherence to best practice guidelines. Methods Clinical audit data from 2012 to 2014 for 3,623 well adult clients (aged 15–54) of 101 health centers from four Australian states and territories were analyzed to determine adherence to delivery of 26 recommended preventive services classified into five different modes of care on the basis of the way in which they are delivered (e.g., basic measurement; laboratory tests and imaging; assessment and brief interventions, eye, ear, and oral checks; follow-up of abnormal findings). Summary statistics were used to describe the delivery of each service item across jurisdictions. Multilevel regression models were used to quantify the variation in service delivery attributable to health center and client level factors and to identify factors associated with higher quality care. Results Delivery of recommended preventive care varied widely between service items, with good delivery of most basic measurements but poor follow-up of abnormal findings. Health center characteristics were associated with most variation. Higher quality care was associated with Northern Territory location, urban services, and smaller service population size. Client factors associated with higher quality care included age between 25 and 34 years, female sex, and more regular attendance. Conclusion Wide variation in documented preventive care delivery, poor follow-up of abnormal findings, and system factors that influence quality of care should be addressed through continuous quality improvement approaches that engage stakeholders at multiple levels (including, for example, access to care in the community, appropriate decision support for practitioners, and financial incentives and context appropriate guidelines).
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Affiliation(s)
- Christopher Bailie
- School of Medicine, University of Queensland , Brisbane, QLD , Australia
| | - Veronica Matthews
- Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Jodie Bailie
- Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Paul Burgess
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Primary Health Care Branch, Top End Health Service, Northern Territory Government, Darwin, NT, Australia
| | - Kerry Copley
- Aboriginal Medical Services Alliance NT (AMSANT) , Darwin, NT , Australia
| | - Catherine Kennedy
- Maari Ma Health Aboriginal Corporation , Broken Hill, NSW , Australia
| | - Liz Moore
- Aboriginal Medical Services Alliance NT (AMSANT) , Darwin, NT , Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia; Anton Breinl Research Centre for Health Systems Strengthening, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, School of Primary, Aboriginal and Rural Health Care, University of Western Australia , Geraldton, WA , Australia
| | - Ross Stewart Bailie
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; School of Population Health, University of Queensland, Brisbane, QLD, Australia
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Yang HY, Chen HJ, Marsteller JA, Liang L, Shi L, Wang Y. Patient-health care professional gender or race/ethnicity concordance and its association with weight-related advice in the United States. PATIENT EDUCATION AND COUNSELING 2016; 99:271-278. [PMID: 26349935 PMCID: PMC6159929 DOI: 10.1016/j.pec.2015.08.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/22/2015] [Accepted: 08/27/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Examine association between adult patients' and health care providers' (HCPs) gender or race/ethnicity concordance and patients' reported receiving weight-related advice from HCP's in USA. METHODS Using Medical Expenditure Panel Survey (MEPS) 2004-2007 data, studied prevalence of weight-related advice (on exercise and diet) given to patients and its association with patients/HCPs concordance in gender (n=9,686) and race/ethnicity (n=8,825). RESULTS Overall, 46% of patients received HCP advice on diet and 49% on exercise. Overweight females seeing female HCPs were more likely to receive exercise advice than those seeing male HCPs (OR=1.44 [95% CI: 1.10-1.89]). Race/ethnicity concordance was associated with lower odds of advice-receiving in certain populations (OR=0.80 [0.67-0.97] for exercise and OR=0.42 [0.19-0.91] for diet among white patients, OR=0.47 [0.23-0.98] for exercise among Hispanic overweight patients). CONCLUSIONS Patient/HCP gender or race/ethnicity concordance was not positively associated with HCPs providing weight-related advice. Patients with female HCPs or with racial/ethnic discordant HCPs (especially black or Asian HCPs) were more likely to receive advice. PRACTICE IMPLICATIONS Health care providers need be empowered, particularly white and male HCPs, to improve delivery of weight-related advice. It may reflect better of receiving weight-related advice based on patients' recall.
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Affiliation(s)
- Hsing-Yu Yang
- Department of Nursing, Mackay Medical College, Taipei, Taiwan; Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hsin-Jen Chen
- Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Jill A Marsteller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lan Liang
- Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Leiyu Shi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Youfa Wang
- Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
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Abstract
BACKGROUND The head impulse test (HIT) is an evidenced based clinical tool to differentiate between peripheral and central causes of vertigo. Our objective was to determine the rate of utilization of the HIT in the emergency room (ER). METHODS A retrospective chart review of patients presenting to the ER over one year who received a final diagnosis of dizziness or vertigo. Details of clinical examinations, investigations, and diagnosis were recorded. Patients were grouped into episodic, acute constant, and chronic vertigo groups. RESULTS HIT was performed in only 31 of 642 (5%) patients with vertigo. In the acute constant group it was negative in 6 of 6 patients ultimately diagnosed with stroke and positive in 6 of 13 cases of peripheral vertigo. DISCUSSION Despite good published evidence regarding its use the HIT is under-utilized in the ER. Physicians need to be aware of the HIT and newer video HITs and make use of them in practice.
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Koster ES, Blom L, Overbeeke MR, Philbert D, Vervloet M, Koopman L, van Dijk L. Quality of pharmaceutical care at the pharmacy counter: patients' experiences versus video observation. Patient Prefer Adherence 2016; 10:363-9. [PMID: 27042025 PMCID: PMC4809339 DOI: 10.2147/ppa.s102032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Consumer Quality Index questionnaires are used to assess quality of care from patients' experiences. OBJECTIVE To provide insight into the agreement about quality of pharmaceutical care, measured both by a patient questionnaire and video observations. METHODS Pharmaceutical encounters in four pharmacies were video-recorded. Patients completed a questionnaire based upon the Consumer Quality Index Pharmaceutical Care after the encounter containing questions about patients' experiences regarding information provision, medication counseling, and pharmacy staff's communication style. An observation protocol was used to code the recorded encounters. Agreement between video observation and patients' experiences was calculated. RESULTS In total, 109 encounters were included for analysis. For the domains "medication counseling" and "communication style", agreement between patients' experiences and observations was very high (>90%). Less agreement (45%) was found for "information provision", which was rated more positive by patients compared to the observations, especially for the topic, encouragement of patients' questioning behavior. CONCLUSION A questionnaire is useful to assess the quality of medication counseling and pharmacy staff's communication style, but might be less suitable to evaluate information provision and pharmacy staff's encouragement of patients' questioning behavior. Although patients may believe that they have received all necessary information to use their new medicine, some information on specific instructions was not addressed during the encounter. When using questionnaires to get insight into information provision, observations of encounters are very informative to validate the patient questionnaires and make necessary adjustments.
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Affiliation(s)
- Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
- Correspondence: Ellen S Koster, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, PO Box 80082, 3508 TB Utrecht, the Netherlands, Tel +31 30 253 7324, Fax +31 30 253 9166, Email
| | - Lyda Blom
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Marloes R Overbeeke
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Daphne Philbert
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Marcia Vervloet
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, the Netherlands
| | - Laura Koopman
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, the Netherlands
- National Health Care Institute, Diemen, the Netherlands
| | - Liset van Dijk
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, the Netherlands
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Shelley D, VanDevanter N, Cleland CC, Nguyen L, Nguyen N. Implementing tobacco use treatment guidelines in community health centers in Vietnam. Implement Sci 2015; 10:142. [PMID: 26453554 PMCID: PMC4600252 DOI: 10.1186/s13012-015-0328-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/18/2015] [Indexed: 11/29/2022] Open
Abstract
Background Vietnam has a smoking prevalence that is the second highest among Southeast Asian countries (SEACs). According to the World Health Organization (WHO), most reductions in mortality from tobacco use in the near future will be achieved through helping current users quit. Yet, largely due to a lack of research on strategies for implementing WHO-endorsed treatment guidelines in primary care settings, services to treat tobacco dependence are not readily available to smokers in low middle-income countries (LMICs) like Vietnam. The objective of this study is to conduct a cluster randomized controlled trial that compares the effectiveness of two system-level strategies for implementing evidence-based guidelines for the treatment of tobacco use in 26 public community health centers (CHCs) in Vietnam. Methods/Design The current study will use a cluster-randomized design and multiple data sources (patient exit interviews, provider and village health worker (VHW) surveys, and semi-structured provider/VHW interviews) to study the process of adapting and implementing clinical practice guidelines in Vietnam and theory-driven mechanisms hypothesized to explain the comparative effectiveness of the two strategies for implementation. CHCs will be randomly assigned to either of the following: (1) training plus clinical reminder system (TC) or (2) TC + referral to a VHW (TCR) for three in person counseling sessions. The primary outcome is provider adherence to tobacco use treatment guidelines. The secondary outcome is 6-month biochemically verified smoking abstinence. Discussion The proposed implementation strategies draw on evidence-based approaches and a growing literature that supports the effectiveness of integrating community health workers as members of the health care team to improve access to preventive services. We hypothesize that the value of these implementation strategies is additive and that incorporating a referral resource that allows providers to delegate the task of offering counseling (TCR) will be superior to TC alone in improving delivery of cessation assistance to smokers. The findings of this research have potential to guide large-scale adoption of promising strategies for implementing and disseminating tobacco use treatment guidelines throughout the public health system in Vietnam and will serve as a model for similar action in other LMICs. Trial registration NCT01967654 Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0328-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Donna Shelley
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, 7th floor, New York, NY, 10016, USA.
| | - Nancy VanDevanter
- New York University College of Nursing, 433 First Ave, New York, NY, 10010, USA.
| | - Charles C Cleland
- Center for Drug Use and HIV Research, New York University College of Nursing, 433 First Ave, New York, NY, 10010, USA.
| | - Linh Nguyen
- Institute of Social Medical Studies, No. 18, Lot 12B, Trung Yen 10, Trung Hoa, Cau Giay District, Hanoi, Vietnam.
| | - Nam Nguyen
- Institute of Social Medical Studies, No. 18, Lot 12B, Trung Yen 10, Trung Hoa, Cau Giay District, Hanoi, Vietnam.
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Lapham GT, Rubinsky AD, Shortreed SM, Hawkins EJ, Richards J, Williams EC, Berger D, Chavez LJ, Kivlahan DR, Bradley KA. Comparison of provider-documented and patient-reported brief intervention for unhealthy alcohol use in VA outpatients. Drug Alcohol Depend 2015; 153:159-66. [PMID: 26072218 PMCID: PMC4620927 DOI: 10.1016/j.drugalcdep.2015.05.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/05/2015] [Accepted: 05/18/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Performance measures for brief alcohol interventions (BIs) are currently based on provider documentation of BI. However, provider documentation may not be a reliable measure of whether or not patients are offered clinically meaningful BIs. In particular, BI documented with clinical decision support in an electronic medical record (EMR) could appear identical irrespective of the quality of BI provided. We hypothesized that differences in how BI was implemented across health systems could lead to differences in the proportion of documented BI recalled and reported by patients across health systems. METHODS Male outpatients with unhealthy alcohol use identified by confidential satisfaction surveys (2009-2012) were assessed for whether they reported receiving BI in the past year (patient-reported BI) and whether they had BI documented in the EMR during the same period (documented BI). We evaluated and compared the prevalence of documented BI to patient-reported BI across 21 VA networks to determine whether documented BI had a variable association with patient-reported BI across the networks. RESULTS Of 9896 eligible male outpatients with unhealthy alcohol use, 59.0% (95% CI 57.4-60.5%) reported BI (50.4-64.9% across networks) and 37.4% (95% CI 36.0-38.9%) had BI documented in the EMR (28.0-44.2% across networks). Overall, 72.9% (95% CI 70.8-75.5%) of patients with documented BI also reported BI. The association between documented BI and patient-reported BI did not vary across VA networks in adjusted logistic regression models. CONCLUSIONS Performance measures of BI that rely on provider documentation in EMRs appear comparable to patient report for comparing care across VA networks.
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Affiliation(s)
- Gwen T Lapham
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States; Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States.
| | - Anna D Rubinsky
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States.
| | - Susan M Shortreed
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States.
| | - Eric J Hawkins
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States.
| | - Julie Richards
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States.
| | - Emily C Williams
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Health Services, University of Washington, 1959 Pacific Street, Seattle, WA 98195, United States.
| | - Douglas Berger
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States; Primary and Specialty Medical Care Services, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States.
| | - Laura J Chavez
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Health Services, University of Washington, 1959 Pacific Street, Seattle, WA 98195, United States.
| | - Daniel R Kivlahan
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States.
| | - Katharine A Bradley
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States; Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States.
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Mahoney MC, Masucci Twarozek A, Saad-Harfouche F, Widman C, Erwin DO, Underwood W, Fox CH. Assessing the delivery of cessation services to smokers in urban, safety-net clinics. J Community Health 2015; 39:879-85. [PMID: 24557716 DOI: 10.1007/s10900-014-9843-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Inequities in smoking behaviors continue to exist with higher rates among persons with limited formal education and for those living below the poverty level. This report describes the scope of tobacco cessation services delivered to low socio-economic status (SES) patients in several primary care medical offices, considered as "safety-net" sources of health care. Using a cross-sectional design, a random sample of records were reviewed for 922 smokers from 4 medical offices. The primary outcome variable was the delivery of smoking cessation services as documented in medical records; information on patient demographics and number of visits during the past 12 months was also abstracted. Smoking status was assessed during the last office visit for 65 % of smokers, 59 % were advised to quit, readiness to quit was assessed for 24 %, 2 % indicated a willingness to quit within the next 30 days and a quit date was established for 1 %. Among smokers not yet ready to quit, few were counseled on the "5 R's" (Relevance, Risks, Rewards, Roadblocks, Repetition). These results expand our understanding of the unfortunately limited scope of cessation services delivered to persons seen in safety-net medical offices and call attention to the need to redouble efforts to more effectively address smoking cessation among diverse, low SES patients served by safety-net primary care clinics.
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Affiliation(s)
- Martin C Mahoney
- Department of Medicine, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA,
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Johnson HM, Olson AG, LaMantia JN, Kind AJH, Pandhi N, Mendonça EA, Craven M, Smith MA. Documented lifestyle education among young adults with incident hypertension. J Gen Intern Med 2015; 30:556-64. [PMID: 25373831 PMCID: PMC4395591 DOI: 10.1007/s11606-014-3059-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 08/05/2014] [Accepted: 09/26/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Only 38% of young adults with hypertension have controlled blood pressure. Lifestyle education is a critical initial step for hypertension control. Previous studies have not assessed the type and frequency of lifestyle education in young adults with incident hypertension. OBJECTIVE The purpose of this study was to determine patient, provider, and visit predictors of documented lifestyle education among young adults with incident hypertension. DESIGN We conducted a retrospective analysis of manually abstracted electronic health record data. PARTICIPANTS A random selection of adults 18-39 years old (n = 500), managed by a large academic practice from 2008 to 2011 and who met JNC 7 clinical criteria for incident hypertension, participated in the study. MAIN MEASURES The primary outcome was the presence of any documented lifestyle education during one year after meeting criteria for incident hypertension. Abstracted topics included documented patient education for exercise, tobacco cessation, alcohol use, stress management/stress reduction, Dietary Approaches to Stop Hypertension (DASH) diet, and weight loss. Clinic visits were categorized based upon a modified established taxonomy to characterize patients' patterns of outpatient service. We excluded patients with previous hypertension diagnoses, previous antihypertensive medications, or pregnancy. Logistic regression was used to identify predictors of documented education. KEY RESULTS Overall, 55% (n = 275) of patients had documented lifestyle education within one year of incident hypertension. Exercise was the most frequent topic (64%). Young adult males had significantly decreased odds of receiving documented education. Patients with a previous diagnosis of hyperlipidemia or a family history of hypertension or coronary artery disease had increased odds of documented education. Among visit types, chronic disease visits predicted documented lifestyle education, but not acute or other/preventive visits. CONCLUSIONS Among young adults with incident hypertension, only 55% had documented lifestyle education within one year. Knowledge of patient, provider, and visit predictors of education can help better target the development of interventions to improve young adult health education and hypertension control.
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Affiliation(s)
- Heather M Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA,
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Riese A, Mello MJ, Baird J, Steele DW, Ranney ML. Prompting discussions of youth violence using electronic previsit questionnaires in primary care: a cluster randomized trial. Acad Pediatr 2015; 15:345-52. [PMID: 25906703 DOI: 10.1016/j.acap.2015.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 01/06/2015] [Accepted: 01/13/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Youth violence (YV) screening during primary care visits is not routinely performed. Electronic previsit questionnaires (PVQs) are viewed favorably by adolescents and can prompt disclosure and discussion of sensitive health topics. This study aimed to determine the efficacy of an electronic PVQ in prompting YV discussions. METHODS A 4-month cluster-randomized controlled trial was conducted in a large urban academic primary care clinic. The clinic's 4 practice groups were randomized to intervention or control assignment. A consecutive sample of adolescents aged 13 to 19 years presenting for annual visits were recruited. Participants completed an electronic PVQ (TickiT) either with (intervention) or without (control) YV questions. PVQ results were delivered to physicians before the visit. The frequency of YV discussions was measured using exit surveys of adolescents. Patients who reported YV discussion rated the helpfulness of the discussion. Multilevel mixed effect logistic regression was conducted to compare likelihood of YV discussion between intervention and control groups. RESULTS A total of 183 adolescents (90% of eligible) participated. Overall, 30% of adolescents reported some YV involvement. Sixty-five percent of the intervention group and 42% of the control group reported discussing YV during their visit. Thirty-one percent of adolescents in the intervention group who disclosed YV involvement reported not having a YV discussion. The intervention group had 2.6 (95% confidence interval 1.2-5.6) times the odds of discussing YV. Sixty-six percent of adolescents who discussed YV with their doctor rated the discussion as very helpful. CONCLUSIONS An electronic PVQ with items related to YV is acceptable and feasible, and it significantly improves frequency of patient-provider YV discussion.
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Affiliation(s)
- Alison Riese
- Injury Prevention Center of Rhode Island Hospital, Providence, RI; Pediatrics, Alpert Medical School of Brown University, Providence, RI.
| | - Michael J Mello
- Injury Prevention Center of Rhode Island Hospital, Providence, RI; Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Janette Baird
- Injury Prevention Center of Rhode Island Hospital, Providence, RI; Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Dale W Steele
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI; Pediatrics, Alpert Medical School of Brown University, Providence, RI
| | - Megan L Ranney
- Injury Prevention Center of Rhode Island Hospital, Providence, RI; Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI
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Zaballos M, Canal MI, Martínez R, Membrillo MJ, Gonzalez FJ, Orozco HD, Sanz FJ, Lopez-Gil M. Preoperative smoking cessation counseling activities of anesthesiologists: a cross-sectional study. BMC Anesthesiol 2015; 15:60. [PMID: 25927569 PMCID: PMC4426771 DOI: 10.1186/s12871-015-0036-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 04/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smokers undergoing surgery are at a higher risk of complications than non-smokers. Preoperative evaluation by an anesthesiologist could provide an excellent opportunity to promote smoking cessation. Previous surveys of anesthesiologists have found that self-reported smoking cessation counseling rates have room for improvement, but no study has surveyed patients to obtain more accurate estimates. METHODS A single-center study was conducted from January 2010 to June 2010 in a tertiary teaching hospital. A telephone survey was conducted, which included all adult cigarette smokers who visited the preoperative anesthesia clinic. The survey recorded anesthesiologist-delivered interventions to help patients quit smoking before surgery. At the end of the study period, the self-reported smoking cessation counseling of the anesthesiologist was evaluated by questionnaire. RESULTS One thousand one hundred and sixty-five patients were evaluated, of which 217 were current smokers with a median pack-year of 15 (interquartile range 5.25-30.00) and 34% were scheduled to undergo major surgery. With regard to preoperative interventions, most anesthesiologists (85%) asked about smoking status, although only 31% advised patients about the health risks of smoking and 23% advised patients to quit before surgery. Provision of assistance to help patients quit was provided in 3% of cases. By contrast, 75% of anesthesiologists stated that they frequently or almost always advised patients about the health risks of smoking. CONCLUSIONS This study shows significant discrepancies between direct patient surveys of preoperative smoking cessation counseling activities by anesthesiologists and the self-reported perceptions of the anesthesiologists. Future studies are urgently needed to evaluate the provision of educational materials and other interventions to improve smoking cessation counseling rates among anesthesiologists and to narrow these discrepancies.
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Affiliation(s)
- Matilde Zaballos
- Department of Toxicology, Faculty of Medicine Complutense University, Madrid, Spain. .,Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Maria Iluminada Canal
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Rocío Martínez
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Maria José Membrillo
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Francisco J Gonzalez
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Hugo D Orozco
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Francisco J Sanz
- Department of Anaesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
| | - Maite Lopez-Gil
- Head of the Department of Anesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
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Gnädinger M, Ceschi A, Conen D, Herzig L, Puhan M, Staehelin A, Zoller M. Medication incidents in primary care medicine: protocol of a study by the Swiss Federal Sentinel Reporting System. BMJ Open 2015; 5:e007773. [PMID: 25908679 PMCID: PMC4410132 DOI: 10.1136/bmjopen-2015-007773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/RATIONALE Patient safety is a major concern in healthcare systems worldwide. Although most safety research has been conducted in the inpatient setting, evidence indicates that medical errors and adverse events are a threat to patients in the primary care setting as well. Since information about the frequency and outcomes of safety incidents in primary care is required, the goals of this study are to describe the type, frequency, seasonal and regional distribution of medication incidents in primary care in Switzerland and to elucidate possible risk factors for medication incidents. STUDY DESIGN AND SETTING We will conduct a prospective surveillance study to identify cases of medication incidents among primary care patients in Switzerland over the course of the year 2015. PARTICIPANTS Patients undergoing drug treatment by 167 general practitioners or paediatricians reporting to the Swiss Federal Sentinel Reporting System. INCLUSION CRITERIA Any erroneous event, as defined by the physician, related to the medication process and interfering with normal treatment course. EXCLUSION CRITERIA Lack of treatment effect, adverse drug reactions or drug-drug or drug-disease interactions without detectable treatment error. PRIMARY OUTCOME Medication incidents. RISK FACTORS Age, gender, polymedication, morbidity, care dependency, hospitalisation. STATISTICAL ANALYSIS Descriptive statistics to assess type, frequency, seasonal and regional distribution of medication incidents and logistic regression to assess their association with potential risk factors. Estimated sample size: 500 medication incidents. LIMITATIONS We will take into account under-reporting and selective reporting among others as potential sources of bias or imprecision when interpreting the results. ETHICS AND DISSEMINATION No formal request was necessary because of fully anonymised data. The results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT0229537.
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Affiliation(s)
- Markus Gnädinger
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Alessandro Ceschi
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zürich, Switzerland
- National Poisons Centre, Tox Info Suisse, Associated Institute of the University of Zurich, University Hospital Zurich, Zürich, Switzerland
| | | | - Lilli Herzig
- Policlinique Médicale, University of Lausanne, Lausanne, UK
| | - Milo Puhan
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Alfred Staehelin
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
- Sentinel Surveillance Network, Swiss Federal Office of Public Health, Bern, Switzerland
| | - Marco Zoller
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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Harris AHS, Ellerbe L, Phelps TE, Finney JW, Bowe T, Gupta S, Asch SM, Humphreys K, Trafton J. Examining the Specification Validity of the HEDIS Quality Measures for Substance Use Disorders. J Subst Abuse Treat 2015; 53:16-21. [PMID: 25736624 DOI: 10.1016/j.jsat.2015.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/30/2014] [Accepted: 01/06/2015] [Indexed: 10/24/2022]
Abstract
Accurate operationalization is a major challenge in developing quality measures for substance use disorder treatment. Specification validity is a term used to describe whether a quality measure is operationalized such that it captures the intended care processes and patients. This study assessed the specification validity of the 2009 Healthcare Effectiveness Data and Information Set (HEDIS®) substance use disorder initiation and engagement measures by examining whether encounters assumed to include relevant treatment have corroborating evidence in the clinical progress notes. The positive predictive values were excellent (>90%) for residential and outpatient records selected from addiction treatment programs but more modest for records generated in non-addiction settings, and were highly variable across facilities. Stakeholders using these measures to compare care quality should be mindful of the clinical composition of the data and determine if similar validation work has been conducted on the systems being evaluated.
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Affiliation(s)
- Alex H S Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Road (MPD152), Menlo Park, CA 94025.
| | - Laura Ellerbe
- Center for Innovation to Implementation, VA Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Road (MPD152), Menlo Park, CA 94025.
| | - Tyler E Phelps
- Center for Innovation to Implementation, VA Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Road (MPD152), Menlo Park, CA 94025.
| | - John W Finney
- Center for Innovation to Implementation, VA Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Road (MPD152), Menlo Park, CA 94025.
| | - Thomas Bowe
- Center for Innovation to Implementation, VA Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Road (MPD152), Menlo Park, CA 94025.
| | - Shalini Gupta
- Center for Innovation to Implementation, VA Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Road (MPD152), Menlo Park, CA 94025.
| | - Steven M Asch
- Center for Innovation to Implementation, VA Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Road (MPD152), Menlo Park, CA 94025.
| | - Keith Humphreys
- Center for Innovation to Implementation, VA Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Road (MPD152), Menlo Park, CA 94025.
| | - Jodie Trafton
- Program Evaluation and Resource Center, VA Palo Alto Health Care System and Stanford University School of Medicine, 795 Willow Road (MPD152), Menlo Park, CA 94025.
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Validity of participant-reported diagnoses in an online patient registry: a report from the NF1 Patient Registry Initiative. Contemp Clin Trials 2014; 40:212-7. [PMID: 25533730 DOI: 10.1016/j.cct.2014.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/10/2014] [Accepted: 12/12/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND With increased internet accessibility worldwide, it is now possible to assemble individuals with rare diseases through web-based patient registries. However, the validity of participant-reported medical diagnoses is unknown. The objective of this study was to evaluate the accuracy of participant-reported Neurofibromatosis Type 1 (NF1) diagnoses among participants in the NF1 Patient Registry Initiative (NPRI). METHODS Subjects enrolled in the NPRI from 5/17/2011 to 7/7/2014 were included. Medical records (MRs) were obtained for participants who returned medical record release forms (MRRFs) during the study period. Participants were classified as having definite, probable, suspected, or no NF1 diagnosis based on MR information. To assess whether a returned MRRF served as a reliable marker of MR-documented NF1, we calculated the positive predictive value (PPV) as the proportion of individuals with MR-documented NF1 among those from whom MRs were obtained. We further examined whether a returned MRRF predicted the number of reported NF1 clinical signs in multivariable linear regression analyses. RESULTS A total of 1456 individuals were included in the analyses. Of 416 individuals who returned MRRFs, 205 MRs were reviewed within the study period. The PPV ranged from 72.0 to 98.5% when including definite or definite/probable/suspected cases, respectively. The mean number of reported NF1 clinical signs was similar between those who returned (mean=3.3 ± 1.2) and did not return (mean=3.2 ± 1.3) their MRRFs. MRRF return was not a significant predictor of the number of NF1 clinical signs after adjusting for covariates. CONCLUSION These data strongly suggest that individuals enrolling in the NPRI accurately report their NF1 diagnosis.
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Pulford J, Siba PM, Mueller I, Hetzel MW. The exit interview as a proxy measure of malaria case management practice: sensitivity and specificity relative to direct observation. BMC Health Serv Res 2014; 14:628. [PMID: 25465383 PMCID: PMC4259085 DOI: 10.1186/s12913-014-0628-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper aims to assess the sensitivity and specificity of exit interviews as a measure of malaria case management practice as compared to direct observation. METHODS The malaria case management of 1654 febrile patients attending 110 health facilities from across Papua New Guinea was directly observed by a trained research officer as part of a repeat cross sectional survey. Patient recall of 5 forms of clinical advice and 5 forms of clinical action were then assessed at service exit and statistical analyses on matched observation/exit interview data conducted. RESULTS The sensitivity of exit interviews with respect to clinical advice ranged from 36.2% to 96.4% and specificity from 53.5% to 98.6%. With respect to clinical actions, sensitivity of the exit interviews ranged from 83.9% to 98.3% and specificity from 70.6% to 98.1%. CONCLUSION The exit interview appears to be a valid measure of objective malaria case management practices such as the completion of a diagnostic test or the provision of antimalarial medication, but may be a less valid measure of low frequency, subjective practices such as the provision of malaria prevention advice.
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Affiliation(s)
- Justin Pulford
- Papua New Guinea Institute of Medical Research (PNGIMR), PO Box 60, Goroka, EHP 441, Papua New Guinea. .,School of Population Health, The University of Queensland, Herston, Qld 4006, Australia.
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research (PNGIMR), PO Box 60, Goroka, EHP 441, Papua New Guinea.
| | - Ivo Mueller
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain. .,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.
| | - Manuel W Hetzel
- Papua New Guinea Institute of Medical Research (PNGIMR), PO Box 60, Goroka, EHP 441, Papua New Guinea. .,Swiss Tropical and Public Health Institute, PO Box, 4002, Basel, Switzerland. .,University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
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Martinez RG, Lewis CC, Weiner BJ. Instrumentation issues in implementation science. Implement Sci 2014; 9:118. [PMID: 25185799 PMCID: PMC4164742 DOI: 10.1186/s13012-014-0118-8] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 08/26/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Like many new fields, implementation science has become vulnerable to instrumentation issues that potentially threaten the strength of the developing knowledge base. For instance, many implementation studies report findings based on instruments that do not have established psychometric properties. This article aims to review six pressing instrumentation issues, discuss the impact of these issues on the field, and provide practical recommendations. DISCUSSION This debate centers on the impact of the following instrumentation issues: use of frameworks, theories, and models; role of psychometric properties; use of 'home-grown' and adapted instruments; choosing the most appropriate evaluation method and approach; practicality; and need for decision-making tools. Practical recommendations include: use of consensus definitions for key implementation constructs; reporting standards (e.g., regarding psychometrics, instrument adaptation); when to use multiple forms of observation and mixed methods; and accessing instrument repositories and decision aid tools. SUMMARY This debate provides an overview of six key instrumentation issues and offers several courses of action to limit the impact of these issues on the field. With careful attention to these issues, the field of implementation science can potentially move forward at the rapid pace that is respectfully demanded by community stakeholders.
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Affiliation(s)
- Ruben G Martinez
- />Department of Psychology, Virginia Commonwealth University, 806 West Franklin St., Richmond, VA 23220 USA
| | - Cara C Lewis
- />Department of Psychological and Brain Sciences, Indiana University, 1101 E. 10th St., Bloomington, IN 47405 USA
- />Department of Psychiatry & Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Rm BB1644, Seattle, WA 98195-6560 USA
| | - Bryan J Weiner
- />1102-C McGavran-Greenberg Hall, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7411, Chapel Hill, 27599-7411 USA
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Stevens GD, Shi L, Vane C, Peters AL. Do experiences consistent with a medical-home model improve diabetes care measures reported by adult Medicaid patients? Diabetes Care 2014; 37:2565-71. [PMID: 24947789 PMCID: PMC4140163 DOI: 10.2337/dc14-0440] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The patient-centered medical home has gained much traction. Little is known about the relationship between the model and specific health care processes for chronic diseases such as diabetes. This study assesses the impact of features of a medical home on diabetes care. RESEARCH DESIGN AND METHODS A cross-sectional survey of 540 patients with Medicaid (Medi-Cal) health insurance and type 2 diabetes in Los Angeles County was performed. The Primary Care Assessment Tools was used to measure seven features of medical-home performance. RESULTS The response rate of the patient survey was 68.9%. Patient-reported medical-home performance averaged a score of 2.85 ± 0.29 (on a 1-4 scale, with 4 equaling the best care). Patients who received more timely and thorough diabetes care reported higher medical-home performance in every feature except for the comprehensiveness-services available. For example, the first-contact access feature score was higher among patients who had an HbA1c test in the past 6 months versus those who did not (2.38 vs. 2.25; P < 0.05). Before and after adjusting for sociodemographics and health status, total medical-home performance was positively associated with each diabetes care measure. A 1-point increase in total medical-home score was associated with 4.53 higher odds of an HbA1c test in the past 6 months and 1.88 higher odds of an eye exam in the past year. CONCLUSIONS Features consistent with higher medical-home performance are associated with improvements in patient-reported diabetes care process measures, even in this low socioeconomic status setting. The patient-centered medical-home model may help in caring for people with type 2 diabetes.
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Affiliation(s)
- Gregory D Stevens
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Leiyu Shi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christina Vane
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anne L Peters
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Mô Dang V, François P, Batailler P, Seigneurin A, Vittoz JP, Sellier E, Labarère J. Medical record-keeping and patient perception of hospital care quality. Int J Health Care Qual Assur 2014; 27:531-43. [DOI: 10.1108/ijhcqa-06-2013-0072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Medical record represents the main information support used by healthcare providers. The purpose of this paper is to examine whether patient perception of hospital care quality related to compliance with medical-record keeping.
Design/methodology/approach
– The authors merged the original data collected as part of a nationwide audit of medical records with overall and subscale perception scores (range 0-100, with higher scores denoting better rating) computed for 191 respondents to a cross-sectional survey of patients discharged from a university hospital.
Findings
– The median overall patient perception score was 77 (25th-75th percentiles, 68-87) and differed according to the presence of discharge summary completed within eight days of discharge (81 v. 75, p=0.03 after adjusting for baseline patient and hospital stay characteristics). No independent associations were found between patient perception scores and the documentation of pain assessment and nutritional disorder screening. Yet, medical record-keeping quality was independently associated with higher patient perception scores for the nurses’ interpersonal and technical skills component.
Research limitations/implications
– First, this was a single-center study conducted in a large full-teaching hospital and the findings may not apply to other facilities. Second, the analysis might be underpowered to detect small but clinically significant differences in patient perception scores according to compliance with recording standards. Third, the authors could not investigate whether electronic medical record contributed to better compliance with recording standards and eventually higher patient perception scores.
Practical implications
– Because of the potential consequences of poor recording for patient safety, further efforts are warranted to improve the accuracy and completeness of documentation in medical records.
Originality/value
– A modest relationship exists between the quality of medical-record keeping and patient perception of hospital care.
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Henry SG, Feng B, Franks P, Bell RA, Tancredi DJ, Gottfeld D, Kravitz RL. Methods for assessing patient-clinician communication about depression in primary care: what you see depends on how you look. Health Serv Res 2014; 49:1684-700. [PMID: 24837881 DOI: 10.1111/1475-6773.12187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To advance research on depression communication and treatment by comparing assessments of communication about depression from patient report, clinician report, and chart review to assessments from transcripts. DATA One hundred sixty-four primary care visits from seven health care systems (2010-2011). STUDY DESIGN Presence or absence of discussion about depressive symptoms, treatment recommendations, and follow-up was measured using patient and clinician postvisit questionnaires, chart review, and coding of audio transcripts. Sensitivity and specificity of indirect measures compared to transcripts were calculated. PRINCIPAL FINDINGS Patient report was sensitive for mood (83 percent) and sleep (83 percent) but not suicide (55 percent). Patient report was specific for suicide (86 percent) but not for other symptoms (44-75 percent). Clinician report was sensitive for all symptoms (83-98 percent) and specific for sleep, memory, and suicide (80-87 percent), but not for other symptoms (45-48 percent). Chart review was not sensitive for symptoms (50-73 percent), but it was specific for sleep, memory, and suicide (88-96 percent). All indirect measures had low sensitivity for treatment recommendations (patient report: 24-42 percent, clinician report 38-50 percent, chart review 49-67 percent) but high specificity (89-96 percent). For definite follow-up plans, all three indirect measures were sensitive (82-96 percent) but not specific (40-57 percent). CONCLUSIONS Clinician report and chart review generally had the most favorable sensitivity and specificity for measuring discussion of depressive symptoms and treatment recommendations, respectively.
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Affiliation(s)
- Stephen G Henry
- Division of General Medicine, Geriatrics, and Bioethics, Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA
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Ostroff JS, Li Y, Shelley DR. Dentists United to Extinguish Tobacco (DUET): a study protocol for a cluster randomized, controlled trial for enhancing implementation of clinical practice guidelines for treating tobacco dependence in dental care settings. Implement Sci 2014; 9:25. [PMID: 24559178 PMCID: PMC3936874 DOI: 10.1186/1748-5908-9-25] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although dental care settings provide an exceptional opportunity to reach smokers and provide brief cessation advice and treatment to reduce oral and other tobacco-related health conditions, dental care providers demonstrate limited adherence to evidence-based guidelines for treatment of tobacco use and dependence. METHODS/DESIGN Guided by a multi-level, conceptual framework that emphasizes changes in provider beliefs and organizational characteristics as drivers of improvement in tobacco treatment delivery, the current protocol will use a cluster, randomized design and multiple data sources (patient exit interviews, provider surveys, site observations, chart audits, and semi-structured provider interviews) to study the process of implementing clinical practice guidelines for treating tobacco dependence in 18 public dental care clinics in New York City. The specific aims of this comparative-effectiveness research trial are to: compare the effectiveness of three promising strategies for implementation of tobacco use treatment guidelines-staff training and current best practices (CBP), CBP + provider performance feedback (PF), and CBP + PF + provider reimbursement for delivery of tobacco cessation treatment (pay-for-performance, or P4P); examine potential theory-driven mechanisms hypothesized to explain the comparative effectiveness of three strategies for implementation; and identify baseline organizational factors that influence the implementation of evidence-based tobacco use treatment practices in dental clinics. The primary outcome is change in providers' tobacco treatment practices and the secondary outcomes are cost per quit, use of tobacco cessation treatments, quit attempts, and smoking abstinence. DISCUSSION We hypothesize that the value of these promising implementation strategies is additive and that incorporating all three strategies (CBP, PF, and P4P) will be superior to CBP alone and CBP + PF in improving delivery of cessation assistance to smokers. The findings will improve knowledge pertinent to the implementation, dissemination, and sustained utilization of evidence-based tobacco use treatment in dental practices. TRIAL REGISTRATION NCT01615237.
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Affiliation(s)
- Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10022, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10022, USA
| | - Donna R Shelley
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, 7th floor, New York, NY 10016, USA
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Akers AY, Davis EM, Jackson Foster LJ, Morrison P, Sucato G, Miller E, Lee M. Parental report of receipt of adolescent preventive health counseling services from pediatric providers. PATIENT EDUCATION AND COUNSELING 2014; 94:269-75. [PMID: 24238626 PMCID: PMC4382670 DOI: 10.1016/j.pec.2013.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/18/2013] [Accepted: 10/06/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Little is known about prevention-focused counseling health providers deliver to parents of adolescents. This study compared parental report of discussions with their adolescents' providers about a range of adolescent prevention topics. METHODS Between June and November 2009, a questionnaire was provided to parents accompanying adolescents aged 11-18 on outpatient clinic visits. Parents indicated, anonymously, which of 22 prevention topics they remembered discussing with their adolescent's provider. Hierarchical logistic regression models were used to identify correlates of parental recall. RESULTS Among the 358 participants, 83% reported discussing at least one prevention topic. More parents reported discussing general prevention topics than mental health or high-risk topics (e.g. sex). Adolescent gender, visit type, having a usual source of care, and parental beliefs about their adolescents' risk behaviors correlated with parental report of discussions about high-risk and mental health topics. CONCLUSION Most parents recalled discussing one or more topics with their adolescent's health provider. However, parental report of discussions about topics linked to significant adolescent morbidity was low. PRACTICE IMPLICATIONS Strategies to improve the frequency, timeliness and appropriateness of counseling services delivered to parents about adolescent preventive health are needed. Strategies that utilize decision support tools or patient education tools may be warranted.
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Affiliation(s)
- Aletha Y Akers
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, Pittsburgh, USA.
| | - Esa M Davis
- Department of Medicine, University of Pittsburgh, Pittsburgh, USA
| | | | - Penelope Morrison
- RAND-University of Pittsburgh Health Institute, University of Pittsburgh, Pittsburgh, USA
| | - Gina Sucato
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, USA
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, USA
| | - Minjae Lee
- Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston, Houston, USA
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Johns TL, Metzger K, Lawrence E. Smoking Cessation Counseling in Family Medicine: Changing Patient Perceptions. J Prim Care Community Health 2014; 5:194-7. [PMID: 24407173 DOI: 10.1177/2150131913518564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Tobacco use causes significant morbidity and mortality. Although studies show that people who smoke cigarettes are more likely to quit when health care providers recommend cessation, many patients may not perceive that advice was given. PURPOSE Using a survey, to determine if a provider visual cue improves patient perception that smoking cessation counseling occurred. Another objective is to evaluate effects on frequency of specific counseling elements. METHODS This was a quasi-experimental intervention study with a pre-post test design. The intervention was a quitline reference card attached to the billing form as a prompt for providers to address smoking cessation. The patient survey included 6 elements, each assigned 1 point. The outcomes were the mean survey summary score preintervention compared to postintervention and the distribution of individual elements. RESULTS Preintervention, 40 patients who smoke cigarettes completed the survey; 46 patients were enrolled postintervention. The groups were similar, with no significant differences in age, gender, or race/ethnicity. Mean survey summary scores pre- and postintervention were 4.1 and 5.1, respectively (P < .05). Compared with preintervention, more patients perceived the recommendation for a smoking cessation course postintervention (40% vs 83%, P < .05). No significant differences in perceptions of other counseling elements were found. CONCLUSIONS Providing a visual cue such as a quitline card is an effective and inexpensive means of prompting a provider to discuss smoking cessation and can be easily integrated into practice. Our results indicate that this strategy improves patient perceptions of counseling with potential to improve community health through education.
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Affiliation(s)
- Tracy L Johns
- University of South Florida-Morton Plant Mease Family Medicine Residency Program, Dr. Joseph A. Eaddy Family Medicine Research Center, Clearwater, FL, USA
| | | | - Elizabeth Lawrence
- University of South Florida-Morton Plant Mease Family Medicine Residency Program, Dr. Joseph A. Eaddy Family Medicine Research Center, Clearwater, FL, USA
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