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Jin J, Yu J, Wang J. Impact of improved prehospital emergency medical service system on the time management of chest pain patients in the emergency department. Am J Transl Res 2021; 13:7743-7755. [PMID: 34377251 PMCID: PMC8340254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To investigate the impact of an improved prehospital emergency medical service system (EMSS) on the time management of chest pain (CP) patients in the Emergency Department in our hospital and define the role of the improved prehospital EMSS in the treatment of CP patients. METHODS All patients with ST-elevation myocardial infarction (STEMI) undergoing coronary artery stent placement (CASP) in our hospital from August 2011 to December 2012 were included in this study, and were randomly divided into a study group (SG) and control group (COG) by the random number table method. The critical time periods [e.g., time to dispatch ambulance upon the receipt of the call to 120, time from hospital entrance to the Emergency Department, time from arrival at hospital to: first treatment, to first electrocardiogram (ECG), to monitoring of vital signs, to establishment of venous access device (VAD), and to entrance to catheter room in the two groups were sorted out for statistical analysis. RESULTS Improved prehospital EMSS can markedly shorten the time to dispatch ambulance upon the receipt of the call to 120, time from hospital entrance to the Emergency Department, and time to first treatment, time to first ECG, to monitoring of vital signs, to establishment of VAD, and to entrance to the catheter room; it also prolonged the 5-year survival rate (P < 0.05). CONCLUSION Improved prehospital EMSS can significantly improve the time management of CP patients in the Emergency Department.
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Affiliation(s)
- Jing Jin
- Nursing Department, The First People’s Hospital of Fuyang HangzhouHangzhou 311400, Zhejiang, China
| | - Jiajia Yu
- Emergency Department, The First People’s Hospital of Fuyang HangzhouHangzhou 311400, Zhejiang, China
| | - Junjun Wang
- Emergency Department, The First People’s Hospital of Fuyang HangzhouHangzhou 311400, Zhejiang, China
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Anderson JL, Oliveira J E Silva L, Brito JP, Hargraves IG, Hess EP. Development of an electronic conversation aid to support shared decision making for children with acute otitis media. JAMIA Open 2021; 4:ooab024. [PMID: 33898937 PMCID: PMC8054029 DOI: 10.1093/jamiaopen/ooab024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/22/2021] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objective The overuse of antibiotics for acute otitis media (AOM) in children is a healthcare quality issue in part arising from conflicting parent and physician understanding of the risks and benefits of antibiotics for AOM. Our objective was to develop a conversation aid that supports shared decision making (SDM) with parents of children who are diagnosed with non-severe AOM in the acute care setting. Materials and Methods We developed a web-based encounter tool following a human-centered design approach that includes active collaboration with parents, clinicians, and designers using literature review, observations of clinical encounters, parental and clinician surveys, and interviews. Insights from these processes informed the iterative creation of prototypes that were reviewed and field-tested in patient encounters. Results The ear pain conversation aid includes five sections: (1) A home page that opens the discussion on the etiologies of AOM; (2) the various options available for AOM management; (3) a pictograph of the impact of antibiotic therapy on pain control; (4) a pictograph of complication rates with and without antibiotics; and (5) a summary page on management choices. This open-access, web-based tool is located at www.earpaindecisionaid.org. Conclusions We collaboratively developed an evidence-based conversation aid to facilitate SDM for AOM. This decision aid has the potential to improve parental medical knowledge of AOM, physician/parent communication, and possibly decrease the overuse of antibiotics for this condition.
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Affiliation(s)
- Jana L Anderson
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Juan P Brito
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian G Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Erik P Hess
- Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA
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3
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Probst MA, Tschatscher CF, Lohse CM, Fernanda Bellolio M, Hess EP. Factors Associated With Patient Involvement in Emergency Care Decisions: A Secondary Analysis of the Chest Pain Choice Multicenter Randomized Trial. Acad Emerg Med 2018; 25:1107-1117. [PMID: 29904986 DOI: 10.1111/acem.13503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/22/2018] [Accepted: 06/12/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Shared decision making in the emergency department (ED) can increase patient engagement for patients presenting with chest pain. However, little is known regarding which factors are associated with actual patient involvement in decision making or patients' desired involvement in emergency care decisions. We examined which factors were associated with patients' actual and desired involvement in decision making among ED chest pain patients. METHODS This is a secondary analysis of data from a randomized trial of a shared decision-making intervention in ED patients with low-risk chest pain. We evaluated the degree to which patients were involved in decision making using the OPTION-12 (observing patient involvement) scale and patients' reported desire for involvement in decision making using the Control Preferences Scale (CPS). We measured the associations of patient factors with OPTION-12 and CPS scores using multivariable regression. RESULTS Of the 898 patients enrolled, mean (±SD) age was 51.5 (±11.4) years and 59% were female. Multivariable analysis revealed that only two factors were significantly associated with OPTION-12 scores: study site and use of the decision aid. OPTION-12 scores were 10.3 (standard error = 0.6) points higher for patients randomized to the decision aid compared to usual care (p < 0.001). Higher health literacy was associated with lower scores on the CPS, indicating greater desire for involvement (odds ratio = 0.91, p < 0.001). CONCLUSIONS Patients' reported desire for involvement in decision making was higher among those with higher health literacy. After study site and other potential confounding factors were adjusted for, only use of the decision aid was associated with observed patient involvement in decision making. As the science and practice of shared decision making in the ED moves toward implementation, high-fidelity integration of the decision aid into the flow of care will be necessary to realize desired outcomes.
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Affiliation(s)
- Marc A. Probst
- Department of Emergency Medicine Mount Sinai Medical Center New York NY
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4
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Recommendations for patient engagement in patient-oriented emergency medicine research. CAN J EMERG MED 2018; 20:435-442. [PMID: 29690943 DOI: 10.1017/cem.2018.370] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To make pragmatic recommendations on best practices for the engagement of patients in emergency medicine (EM) research. METHODS We created a panel of expert Canadian EM researchers, physicians, and a patient partner to develop our recommendations. We used mixed methods consisting of 1) a literature review; 2) a survey of Canadian EM researchers; 3) qualitative interviews with key informants; and 4) feedback during the 2017 Canadian Association of Emergency Physicians (CAEP) Academic Symposium. RESULTS We synthesized our literature review into categories including identification and engagement, patients' roles, perceived benefits, harms, and barriers to patient engagement; 40/75 (53% response rate) invited researchers completed our survey. Among respondents, 58% had engaged patients in research, and 83% intended to engage patients in future research. However, 95% stated that they need further guidance to engage patients. Our qualitative interviews revealed barriers to patient engagement, including the need for training and patient partner recruitment.Our panel recommends 1) an overarching positive recommendation to support patient engagement in EM research; 2) seven policy-level recommendations for CAEP to support the creation of a national patient council, to develop, adopt and adapt training material, guidelines, and tools for patient engagement, and to support increased patient engagement in EM research; and 3) nine pragmatic recommendations about engaging patients in the preparatory, execution, and translational phases of EM research. CONCLUSION Patient engagement can improve EM research by helping researchers select meaningful outcomes, increase social acceptability of studies, and design knowledge translation strategies that target patients' needs.
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Egerton-Warburton D, Cullen L, Keijzers G, Fatovich DM. ‘What the hell is water?’ How to use deliberate clinical inertia in common emergency department situations. Emerg Med Australas 2018; 30:426-430. [DOI: 10.1111/1742-6723.12950] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Diana Egerton-Warburton
- School of Clinical Science at Monash Health; Monash University Faculty of Medicine, Nursing and Health Sciences; Melbourne Victoria Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Queensland University of Technology; The University of Queensland; Brisbane Queensland Australia
| | - Gerben Keijzers
- Department of Emergency Medicine; Gold Coast University Hospital; Gold Coast Queensland Australia
- School of Medicine; Bond University; Gold Coast Queensland Australia
- School of Medicine, Griffith University; Gold Coast Queensland Australia
| | - Daniel M Fatovich
- Emergency Medicine; Royal Perth Hospital, The University of Western Australia; Perth Western Australia Australia
- Centre for Clinical Research in Emergency Medicine; Harry Perkins Institute of Medical Research; Perth Western Australia Australia
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Schaffer JT, Hess EP, Hollander JE, Kline JA, Torres CA, Diercks DB, Jones R, Owen KP, Meisel ZF, Demers M, Leblanc A, Inselman J, Herrin J, Montori VM, Shah ND. Impact of a Shared Decision Making Intervention on Health Care Utilization: A Secondary Analysis of the Chest Pain Choice Multicenter Randomized Trial. Acad Emerg Med 2018; 25:293-300. [PMID: 29218817 DOI: 10.1111/acem.13355] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 11/09/2017] [Accepted: 12/01/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patients at low risk for acute coronary syndrome are frequently admitted for observation and cardiac testing, resulting in substantial burden and cost to the patient and the health care system. OBJECTIVES The purpose of this investigation was to measure the effect of the Chest Pain Choice (CPC) decision aid on overall health care utilization as well as utilization of specific services both during the index emergency department (ED) visit and in the subsequent 45 days. METHODS This was a planned secondary analysis of data from a pragmatic multicenter randomized trial of shared decision making in adults presenting to the ED with chest pain who were being considered for observation unit admission for cardiac stress testing or coronary computed tomography angiography. The trial compared an intervention group engaged in shared decision making facilitated by the CPC decision aid to a control group receiving usual care. Hospital-level billing data were used to measure utilization for the index ED visit and during the following 45 days. Patients in both groups also were asked to keep a diary recording health care utilization over the same 45-day period. Outcomes assessed included length of time in the ED and observation, ED visits, office visits, hospitalizations, testing, imaging, and procedures. RESULTS Of the 898 patients included in the original trial, we were able to contact 834 (92.9%) patients for 45-day health care diary review. There was no difference in patient-reported health care utilization between the study arms. Hospital-level billing data were obtained for all 898 (100%) patients. During the initial ED visit the length of stay (LOS) was similar, and there was no difference in the frequency of observation unit admission between study arms. However, the mean observation unit LOS was 95 minutes (95% confidence interval [CI] = 40.8-149.8) shorter in the CPC arm and the mean number of tests was lower in the CPC arm (decrease in 19.4 imaging studies per 100 patients, 95% CI = 15.5-23.3). When evaluating the entire encounter and follow-up period, the intervention arm underwent fewer tests (decrease in 125.6 tests per 100 patients, 95% CI = 29.3-221.6). More specifically, there were fewer advanced cardiac imaging tests completed (25.8 fewer per 100 patients, 95% CI = 3.74-47.9) in the intervention arm. CONCLUSIONS Shared decision making in low-risk chest pain can lead to decreased diagnostic testing without worsening outcomes measured over 45 days.
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Affiliation(s)
| | - Erik P. Hess
- Department of Emergency Medicine Division of Emergency Medicine Research Mayo Clinic Rochester MN
- Division of Health Care Policy and Research Department of Health Sciences Research Mayo Clinic Rochester MN
- Knowledge and Evaluation Research Unit Rochester MN
| | - Judd E. Hollander
- Department of Emergency Medicine Thomas Jefferson University Philadelphia PA
| | - Jeffrey A. Kline
- Department of Emergency Medicine Indiana University Indianapolis IN
| | | | - Deborah B. Diercks
- Department of Emergency Medicine University of Texas Southwestern Dallas TX
| | - Russell Jones
- Department of Emergency Medicine University of California Davis Sacramento CA
| | - Kelly P. Owen
- Department of Emergency Medicine University of California Davis Sacramento CA
| | - Zachary F. Meisel
- Department of Emergency Medicine Perelman School of Medicine Philadelphia PA
| | | | - Annie Leblanc
- Knowledge and Evaluation Research Unit Rochester MN
- Caregiver Representative Rochester MN
| | - Jonathan Inselman
- Division of Health Care Policy and Research Department of Health Sciences Research Mayo Clinic Rochester MN
- Knowledge and Evaluation Research Unit Rochester MN
| | - Jeph Herrin
- Yale University School of Medicine New Haven CT
- Health Research & Educational Trust Chicago IL
| | - Victor M. Montori
- Division of Endocrinology Diabetes, Metabolism, and Nutrition Department of Internal Medicine Mayo Clinic Rochester MN
- Knowledge and Evaluation Research Unit Rochester MN
| | - Nilay D. Shah
- Division of Health Care Policy and Research Department of Health Sciences Research Mayo Clinic Rochester MN
- Knowledge and Evaluation Research Unit Rochester MN
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Chen A, Lillrank PM, Tenhunen H, Peltokorpi A, Torkki P, Heinonen S, Stefanovic V. Context-based patient choice management in healthcare. Int J Health Care Qual Assur 2018; 31:52-68. [DOI: 10.1108/ijhcqa-01-2017-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
In healthcare, there is limited knowledge of and experience with patient choice management. The purpose of this paper is to focus on patient choice, apply and test demand-supply-based operating (DSO) logic integrated with clinical setting in clarifying choice contexts, investigate patient’s choice-making at different contexts and suggest context-based choice architectures to manage and develop patient choice.
Design/methodology/approach
Prenatal screening and testing in the Helsinki and Uusimaa Hospital District (HUS), Finland, was taken as an example. Choice points were contextualized by using the DSO framework. Women’s reflections, behaviors and experience at different choice contexts were studied by interviewing women participating in prenatal screening and testing. Semi-structured interview data were processed by thematic analysis.
Findings
By applying DSO logic, four choice contexts (prevention, cure, electives and continuous care) were relevant in the prenatal screening and testing episode. Women had different choice-making in prevention and cure mode contexts regarding choice activeness, information needs, social influence, preferences, emotion status and choice-making difficulty. Default choice was widely accepted by women in prevention mode and individual counseling can help women make informed choice in cure mode.
Originality/value
The authors apply the DSO model to contextualize the patient choice in one care episode and compare patient choice-making at different contexts. The authors also suggest the possible context-based choice architectures to manage and promote patient choice
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Probst MA, Kanzaria HK, Schoenfeld EM, Menchine MD, Breslin M, Walsh C, Melnick ER, Hess EP. Shared Decisionmaking in the Emergency Department: A Guiding Framework for Clinicians. Ann Emerg Med 2017; 70:688-695. [PMID: 28559034 PMCID: PMC5834305 DOI: 10.1016/j.annemergmed.2017.03.063] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/22/2017] [Accepted: 03/27/2017] [Indexed: 01/27/2023]
Abstract
Shared decisionmaking has been proposed as a method to promote active engagement of patients in emergency care decisions. Despite the recent attention shared decisionmaking has received in the emergency medicine community, including being the topic of the 2016 Academic Emergency Medicine Consensus Conference, misconceptions remain in regard to the precise meaning of the term, the process, and the conditions under which it is most likely to be valuable. With the help of a patient representative and an interaction designer, we developed a simple framework to illustrate how shared decisionmaking should be approached in clinical practice. We believe it should be the preferred or default approach to decisionmaking, except in clinical situations in which 3 factors interfere. These 3 factors are lack of clinical uncertainty or equipoise, patient decisionmaking ability, and time, all of which can render shared decisionmaking infeasible. Clinical equipoise refers to scenarios in which there are 2 or more medically reasonable management options. Patient decisionmaking ability refers to a patient's capacity and willingness to participate in his or her emergency care decisions. Time refers to the acuity of the clinical situation (which may require immediate action) and the time that the clinician has to devote to the shared decisionmaking conversation. In scenarios in which there is only one medically reasonable management option, informed consent is indicated, with compassionate persuasion used as appropriate. If time or patient capacity is lacking, physician-directed decisionmaking will occur. With this framework as the foundation, we discuss the process of shared decisionmaking and how it can be used in practice. Finally, we highlight 5 common misconceptions in regard to shared decisionmaking in the ED. With an improved understanding of shared decisionmaking, this approach should be used to facilitate the provision of high-quality, patient-centered emergency care.
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Affiliation(s)
- Marc A Probst
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Hemal K Kanzaria
- Department of Emergency Medicine, University of California at San Francisco, San Francisco General Hospital, San Francisco, CA
| | - Elizabeth M Schoenfeld
- Department of Emergency Medicine, Baystate Medical Center/Tufts School of Medicine, Springfield, MA
| | - Michael D Menchine
- Department of Emergency Medicine, University of Southern California/Keck School of Medicine, Los Angeles, CA
| | | | | | - Edward R Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Erik P Hess
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
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9
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Probst MA, Noseworthy PA, Brito JP, Hess EP. Shared Decision-Making as the Future of Emergency Cardiology. Can J Cardiol 2017; 34:117-124. [PMID: 29289400 DOI: 10.1016/j.cjca.2017.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 02/07/2023] Open
Abstract
Shared decision-making is playing an increasingly large role in emergency cardiovascular care. Although there are many challenges to successfully performing shared decision-making in the emergency department, there are numerous clinical scenarios in which it should be used. In this article, we explore new research and emerging decision aids in the following emergency care scenarios: (1) low-risk chest pain; (2) new-onset atrial fibrillation; and (3) moderate-risk syncope. These decision aids are designed to engage patients and facilitate shared decision-making for specific treatment and disposition (admit vs discharge) decisions. We then offer a 3-step, practical approach to performing shared decision-making in the acute care setting, on the basis of broad stakeholder input and previous conceptual work. Step 1 involves simply acknowledging that a clinical decision needs to be made. Step 2 involves a shared discussion about the working diagnosis and the options for care in the context of the patient's values, preferences, and circumstances. The third and final step requires the patient and provider to agree on a plan of action regarding further medical care. The implementation of shared decision-making in emergency cardiology has the potential to shift the paradigm of clinical practice from paternalism toward mutualism and improve the quality and experience of care for our patients.
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Affiliation(s)
- Marc A Probst
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York, USA.
| | - Peter A Noseworthy
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA; Heart Rhythm Section, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA; Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Erik P Hess
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA; Division of Healthcare Policy and Research, Mayo Clinic, Rochester, Minnesota, USA; Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
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10
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Rising KL, Hollander JE, Schaffer JT, Kline JA, Torres CA, Diercks DB, Jones R, Owen KP, Meisel ZF, Demers M, Leblanc A, Shah ND, Inselman J, Herrin J, Montori VM, Hess EP. Effectiveness of a Decision Aid in Potentially Vulnerable Patients: A Secondary Analysis of the Chest Pain Choice Multicenter Randomized Trial. Med Decis Making 2017; 38:69-78. [DOI: 10.1177/0272989x17706363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. We test the hypotheses that use of the Chest Pain Choice (CPC) decision aid (DA) would be similarly effective in potentially vulnerable subgroups but increase knowledge more in patients with higher education and trust in physicians more in patients from racial minority groups. Methods. This was a secondary analysis of a multicenter randomized trial in adults with chest pain potentially due to acute coronary syndrome. The trial compared an intervention group engaged in shared decision making (SDM) using CPC to a control group receiving usual care (UC). We assessed for subgroup effects based on age, sex, race, income, insurance, education, literacy, and numeracy. We dichotomized each characteristic and tested for interactions using regression models with indicators for arm assignment and study site. Results. Of 898 patients (451 DA, 447 UC), over 50% were female, over one-third were black, nearly one-third had a high school education or less, and over 60% had “low” health literacy. The DA did not increase knowledge more in patients with higher education ( P for interaction = 0.06) but did increase knowledge more in the “typical” than in the “low” numeracy subgroup (10.6% v. 4.7%, absolute difference [AD] = 5.9%, P for interaction = 0.025). The DA did not significantly increase patient trust in physicians in racial minorities ( P for interaction = 0.06) but did increase trust more in patients with “low” literacy compared with those with “typical” literacy (3.7% v. –1.4%, AD = 5.1, P for interaction = 0.011). Conclusions. CPC benefited all sociodemographic groups to a similar extent, with greater knowledge transfer in patients with higher numeracy and greater physician trust in patients with “low” health literacy. Tailoring SDM interventions to patient characteristics may be necessary for optimal effectiveness.
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Affiliation(s)
- Kristin L. Rising
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
| | - Jason T. Schaffer
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
| | - Jeffrey A. Kline
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
| | - Carlos A. Torres
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
| | - Deborah B. Diercks
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
| | - Russell Jones
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
| | - Kelly P. Owen
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
| | - Zachary F. Meisel
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
| | - Michel Demers
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
| | - Annie Leblanc
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
| | - Nilay D. Shah
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
| | - Jonathan Inselman
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
| | - Jeph Herrin
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
| | - Victor M. Montori
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
| | - Erik P. Hess
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (KLR, JEH)
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA (JTS, JAK)
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA (CAT)
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas, USA (DBD)
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA (RJ, KPO)
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11
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Hess EP, Hollander JE, Schaffer JT, Kline JA, Torres CA, Diercks DB, Jones R, Owen KP, Meisel ZF, Demers M, Leblanc A, Shah ND, Inselman J, Herrin J, Castaneda-Guarderas A, Montori VM. Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial. BMJ 2016; 355:i6165. [PMID: 27919865 PMCID: PMC5152707 DOI: 10.1136/bmj.i6165] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome. DESIGN Multicenter pragmatic parallel randomized controlled trial. SETTING Six emergency departments in the United States. PARTICIPANTS 898 adults (aged >17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain. INTERVENTIONS Patients were randomly assigned (1:1) by an electronic, web based system to shared decision making facilitated by a decision aid or to usual care. The primary outcome, selected by patient and caregiver advisers, was patient knowledge of their risk for acute coronary syndrome and options for care; secondary outcomes were involvement in the decision to be admitted, proportion of patients admitted for cardiac testing, and the 30 day rate of major adverse cardiac events. RESULTS Compared with the usual care arm, patients in the decision aid arm had greater knowledge of their risk for acute coronary syndrome and options for care (questions correct: decision aid, 4.2 v usual care, 3.6; mean difference 0.66, 95% confidence interval 0.46 to 0.86), were more involved in the decision (observing patient involvement scores: decision aid, 18.3 v usual care, 7.9; 10.3, 9.1 to 11.5), and less frequently decided with their clinician to be admitted for cardiac testing (decision aid, 37% v usual care, 52%; absolute difference 15%; P<0.001). There were no major adverse cardiac events due to the intervention. CONCLUSIONS Use of a decision aid in patients at low risk for acute coronary syndrome increased patient knowledge about their risk, increased engagement, and safely decreased the rate of admission to an observation unit for cardiac testing.Trial registration ClinicalTrials.gov NCT01969240.
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Affiliation(s)
- Erik P Hess
- Department of Emergency Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55906, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Robert D and Patricia E Kern Center for the Science of Healthcare Delivery, Rochester, MN, USA
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason T Schaffer
- Department of Emergency Medicine, Indiana University, Indianapolis, IN, USA
| | - Jeffrey A Kline
- Department of Emergency Medicine, Indiana University, Indianapolis, IN, USA
| | - Carlos A Torres
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Russell Jones
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Kelly P Owen
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Zachary F Meisel
- Department of Emergency Medicine, Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Annie Leblanc
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Nilay D Shah
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jonathan Inselman
- Mayo Clinic Robert D and Patricia E Kern Center for the Science of Healthcare Delivery, Rochester, MN, USA
| | - Jeph Herrin
- Health Research & Educational Trust, Chicago IL, USA
| | - Ana Castaneda-Guarderas
- Department of Emergency Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55906, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
- Department of Emergency Medicine, Aventura Hospital and Medical Center, Aventura, FL, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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12
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Chen EH, Kanzaria HK, Itakura K, Booker-Vaughns J, Yadav K, Kane BG. The Role of Education in the Implementation of Shared Decision Making in Emergency Medicine: A Research Agenda. Acad Emerg Med 2016; 23:1362-1367. [PMID: 27442908 DOI: 10.1111/acem.13059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 06/29/2016] [Accepted: 07/17/2016] [Indexed: 01/17/2023]
Abstract
Shared decision making (SDM) is a patient-centered communication skill that is essential for all physicians to provide quality care. Like any competency or procedural skill, it can and should be introduced to medical students during their clerkships (undergraduate medical education), taught and assessed during residency training (graduate medical education), and have documentation of maintenance throughout an emergency physician's career (denoted as continuing medical education). A subgroup representing academic emergency medicine (EM) faculty, residents, content experts, and patients convened at the 2016 Academic Emergency Medicine Consensus Conference on SDM to develop a research agenda toward improving implementation of SDM through sustainable education efforts. After developing a list of potential priorities, the subgroup presented the priorities in turn to the consensus group, to the EM program directors (CORD-EM), and finally at the conference itself. The two highest-priority questions were related to determining or developing EM-applicable available tools and on-shift interventions for SDM and working to determine the proportion of the broader SDM curriculum that should be taught and assessed at each level of training. Educating patients and the community about SDM was also raised as an important concept for consideration. The remaining research priorities were divided into high-, moderate-, and lower-priority groups. Moreover, there was consensus that the overall approach to SDM should be consistent with the high-quality educational design utilized for other pertinent topics in EM.
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Affiliation(s)
- Esther H. Chen
- Department of Emergency Medicine; University of California, San Francisco; San Francisco CA
| | - Hemal K. Kanzaria
- Department of Emergency Medicine; University of California, San Francisco; San Francisco CA
| | - Kaoru Itakura
- Department of Emergency Medicine; Harbor-UCLA Medical Center; Los Angeles CA
| | - Juanita Booker-Vaughns
- LA Biomedical Research Institute, Community Council; Harbor-UCLA Medical Center; Los Angeles CA
| | - Kabir Yadav
- Department of Emergency Medicine; Harbor-UCLA Medical Center; Los Angeles CA
| | - Bryan G. Kane
- Department of Emergency Medicine; Lehigh Valley Health Network; Allentown PA
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13
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Schoenfeld EM, Goff SL, Elia TR, Khordipour ER, Poronsky KE, Nault KA, Lindenauer PK, Mazor KM. The Physician-as-Stakeholder: An Exploratory Qualitative Analysis of Physicians' Motivations for Using Shared Decision Making in the Emergency Department. Acad Emerg Med 2016; 23:1417-1427. [PMID: 27385557 DOI: 10.1111/acem.13043] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/16/2016] [Accepted: 06/28/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Shared decision making (SDM) is increasingly recognized as an important facet of patient-centered care. Despite growing interest in SDM in the emergency department (ED), little is known about emergency physicians' (EPs') motivations for using SDM. Understanding current patterns of SDM use and EP's rationale for using SDM is essential for the development of interventions to increase use. OBJECTIVES Recognizing the EP as an important stakeholder in SDM research, we sought to identify and explore factors that may motivate EPs' engagement in SDM. METHODS In this qualitative study, informed by the Theory of Planned Behavior and Social Cognitive Theory, we conducted semistructured interviews with a purposeful sample of EPs. Interviews were recorded and transcribed verbatim. Using a directed qualitative content analysis approach, three members of the research team performed open coding of the transcripts in an iterative process, building a provisional code book as coding progressed. Respondent validation was employed to ensure methodologic rigor. RESULTS Fifteen EPs, ages 31-65, from both academic and community practice settings, were interviewed. Several had not heard of the specific phrase "shared decision making," but all understood the concept and felt that they used SDM techniques to some degree. Most noted they had often had an agenda when they used SDM, which often motivated them to have the conversation. Agendas described included counteracting an algorithmic or defensive approach to diagnosis and treatment, avoiding harmful tests, or sharing uncertainty. All participants believed that patients benefited from SDM in terms of satisfaction, engagement, or education. Nearly all participants identified research outcomes that they felt would encourage their use of SDM (e.g., improvements in patient engagement, mitigation of risk) and many prioritized patient-centered outcomes over systems outcomes such as improved resource utilization. Little consensus was seen, however, regarding the importance of individual outcomes: of eight potential research outcomes participants endorsed, no single outcome was endorsed by even half of the physicians interviewed. CONCLUSION Emergency physicians identified many factors that motivated them to use SDM. This study informs current research on SDM in the ED, particularly regarding the motivations of the physician-as-stakeholder.
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Affiliation(s)
- Elizabeth M. Schoenfeld
- Department of Emergency Medicine; Baystate Medical Center; Springfield MA
- Center for Quality of Care Research; Baystate Medical Center; Springfield MA
- Tufts University School of Medicine; Boston MA
| | - Sarah L. Goff
- Center for Quality of Care Research; Baystate Medical Center; Springfield MA
- Division of General Medicine; Baystate Medical Center; Springfield MA
| | - Tala R. Elia
- Department of Emergency Medicine; Baystate Medical Center; Springfield MA
- Tufts University School of Medicine; Boston MA
| | - Errel R. Khordipour
- Department of Emergency Medicine; Baystate Medical Center; Springfield MA
- Tufts University School of Medicine; Boston MA
| | - Kye E. Poronsky
- Department of Emergency Medicine; Baystate Medical Center; Springfield MA
| | - Kelly A. Nault
- Department of Emergency Medicine; Baystate Medical Center; Springfield MA
| | - Peter K. Lindenauer
- Center for Quality of Care Research; Baystate Medical Center; Springfield MA
- Division of General Medicine; Baystate Medical Center; Springfield MA
- Tufts University School of Medicine; Boston MA
| | - Kathleen M. Mazor
- Department of Medicine; University of Massachusetts Medical School; Worcester MA
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14
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Melnick ER, Probst MA, Schoenfeld E, Collins SP, Breslin M, Walsh C, Kuppermann N, Dunn P, Abella BS, Boatright D, Hess EP. Development and Testing of Shared Decision Making Interventions for Use in Emergency Care: A Research Agenda. Acad Emerg Med 2016; 23:1346-1353. [PMID: 27457137 DOI: 10.1111/acem.13045] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 06/30/2016] [Accepted: 07/07/2016] [Indexed: 11/30/2022]
Abstract
Decision aids are evidenced-based tools designed to increase patient understanding of medical options and possible outcomes, facilitate conversation between patients and clinicians, and improve patient engagement. Decision aids have been used for shared decision making (SDM) interventions outside of the ED setting for more than a decade. Their use in the ED has only recently begun to be studied. This article provides background on this topic and the conclusions of the 2016 Academic Emergency Medicine consensus conference SDM in practice work group regarding "Shared Decision Making in the Emergency Department: Development of a Policy-Relevant, Patient-Centered Research Agenda." The goal was to determine a prioritized research agenda for the development and testing of SDM interventions for use in emergency care that was most important to patients, clinicians, caregivers, and other key stakeholders. Using the nominal group technique, the consensus working group proposed prioritized research questions in six key domains: 1) content (i.e., clinical scenario or decision area), 2) level of evidence available, 3) tool design strategies, 4) risk communication, 5) stakeholders, and 6) outcomes.
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Affiliation(s)
- Edward R. Melnick
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Marc A. Probst
- Department of Emergency Medicine; Icahn School of Medicine at Mount Sinai; New York NY
| | | | - Sean P. Collins
- Department of Emergency Medicine; Vanderbilt University; Nashville TN
| | | | | | - Nathan Kuppermann
- Department of Emergency Medicine; University of California; Davis School of Medicine; Sacramento CA
| | - Pat Dunn
- Patient and Healthcare Innovations and Center for Health Technology and Innovation; American Heart Association; Dallas TX
| | - Benjamin S. Abella
- Department of Emergency Medicine; University of Pennsylvania; Philadelphia PA
| | - Dowin Boatright
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
- Robert Wood Johnson Clinical Scholar Program; Yale University School of Medicine; New Haven CT
| | - Erik P. Hess
- Department of Emergency Medicine; Mayo Clinic College of Medicine; Rochester MN
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15
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Bellamkonda VR, Kumar R, Scanlan-Hanson LN, Hess JJ, Hellmich TR, Bellamkonda E, Campbell RL, Hess EP, Nestler DM. Pilot Study of Kano "Attractive Quality" Techniques to Identify Change in Emergency Department Patient Experience. Ann Emerg Med 2016; 68:553-561. [PMID: 27125817 DOI: 10.1016/j.annemergmed.2016.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 01/26/2016] [Accepted: 02/01/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE We describe the use of the Kano Attractive Quality analytic tool to improve an identified patient experience gap in perceived compassion by emergency department (ED) providers. METHODS In phase 1, point-of-service surveying assessed baseline patient perception of ED provider compassion. Phase 2 deployed Kano surveys to predict the effect of 4 proposed interventions on patient perception. Finally, phase 3 compared patients receiving standard care versus the Kano-identified intervention to assess the actual effect on patient experience. RESULTS In phase 1, 193 of 200 surveys (97%) were completed, showing a baseline median score of 4 out of 5 (interquartile range [IQR] 3 to 5), with top box percentage of 33% for patients' perception of receiving compassionate care. In phase 2, 158 of 180 surveys (88%) using Kano-formatted questions were completed, and the data predicted that increasing shared decisionmaking would cause the greatest improvement in the patient experience. Finally, in phase 3, 45 of 49 surveys (92%) were returned and demonstrated a significant improvement in perceived concern and sensitivity, 5 (IQR 5 to 5) versus 4 (IQR 3 to 5) with a difference of 1 (95% CI 0.1-1.9) and a top box rating of 79% versus 35% with a difference of 44% (95% CI 12-66) by patients who received dedicated shared decisionmaking interventions versus those receiving standard of care. CONCLUSION Kano analysis is likely predictive of change in patient experience. Kano methods may prove as useful in changing management of the health care industry as it has been in other industries.
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Affiliation(s)
| | - Rishi Kumar
- Department of Internal Medicine, Hennepin County Medical Center, Minneapolis, MN
| | | | - Jennifer J Hess
- Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Thomas R Hellmich
- Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Erica Bellamkonda
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Erik P Hess
- Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - David M Nestler
- Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
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16
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Probst MA, Kanzaria HK, Frosch DL, Hess EP, Winkel G, Ngai KM, Richardson LD. Perceived Appropriateness of Shared Decision-making in the Emergency Department: A Survey Study. Acad Emerg Med 2016; 23:375-81. [PMID: 26806170 PMCID: PMC5308213 DOI: 10.1111/acem.12904] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/12/2015] [Accepted: 11/16/2015] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The objective was to describe perceptions of practicing emergency physicians (EPs) regarding the appropriateness and medicolegal implications of using shared decision-making (SDM) in the emergency department (ED). METHODS We conducted a cross-sectional survey of EPs at a large, national professional meeting to assess perceived appropriateness of SDM for different categories of ED management (e.g., diagnostic testing, treatment, disposition) and in common clinical scenarios (e.g., low-risk chest pain, syncope, minor head injury). A 21-item survey instrument was iteratively developed through review by content experts, cognitive testing, and pilot testing. Descriptive and multivariate analyses were conducted. RESULTS We approached 737 EPs; 709 (96%) completed the survey. Two-thirds (67.8%) of respondents were male; 51% practiced in an academic setting and 44% in the community. Of the seven management decision categories presented, SDM was reported to be most frequently appropriate for deciding on invasive procedures (71.5%), computed tomography (CT) scanning (56.7%), and post-ED disposition (56.3%). Among the specific clinical scenarios, use of thrombolytics for acute ischemic stroke was felt to be most frequently appropriate for SDM (83.4%), followed by lumbar puncture to rule out subarachnoid hemorrhage (73.8%) and CT head for pediatric minor head injury (69.9%). Most EPs (66.8%) felt that using and documenting SDM would decrease their medicolegal risk while a minority (14.2%) felt that it would increase their risk. CONCLUSIONS Acceptance of SDM among EPs appears to be strong across management categories (diagnostic testing, treatment, and disposition) and in a variety of clinical scenarios. SDM is perceived by most EPs to be medicolegally protective.
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Affiliation(s)
- Marc A Probst
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hemal K Kanzaria
- The Department of Emergency Medicine, University of California at San Francisco, San Francisco General Hospital, San Francisco, CA
| | - Dominick L Frosch
- The Patient Care Program, Gordon and Betty Moore Foundation, Palo Alto, CA
- The Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Erik P Hess
- The Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | - Gary Winkel
- The Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ka Ming Ngai
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lynne D Richardson
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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17
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Hess EP, Marin J, Mills A. Medically unnecessary advanced diagnostic imaging and shared decision-making in the emergency department: opportunities for future research. Acad Emerg Med 2015; 22:475-7. [PMID: 25771709 DOI: 10.1111/acem.12636] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Erik P. Hess
- Departments of Emergency Medicine and Health Sciences Research; Mayo Clinic; Rochester MN
| | - Jennifer Marin
- Departments of Pediatrics and Emergency Medicine; Children's Hospital of Pittsburgh; Pittsburgh PA
| | - Angela Mills
- Department of Emergency Medicine; University of Pennsylvania Perelman School of Medicine; Philadelphia PA
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18
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Rising KL, Printz AD, Hess EP. Patient-Centered Care in Acute Cardiovascular Disease. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2015. [DOI: 10.1007/s40138-014-0061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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