1
|
Park J, Jindal A, Kuo P, Tanana M, Lafata JE, Tai-Seale M, Atkins DC, Imel ZE, Smyth P. Automated rating of patient and physician emotion in primary care visits. PATIENT EDUCATION AND COUNSELING 2021; 104:2098-2105. [PMID: 33468364 DOI: 10.1016/j.pec.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Train machine learning models that automatically predict emotional valence of patient and physician in primary care visits. METHODS Using transcripts from 353 primary care office visits with 350 patients and 84 physicians (Cook, 2002 [1], Tai-Seale et al., 2015 [2]), we developed two machine learning models (a recurrent neural network with a hierarchical structure and a logistic regression classifier) to recognize the emotional valence (positive, negative, neutral) (Posner et al., 2005 [3]) of each utterance. We examined the agreement of human-generated ratings of emotional valence with machine learning model ratings of emotion. RESULTS The agreement of emotion ratings from the recurrent neural network model with human ratings was comparable to that of human-human inter-rater agreement. The weighted-average of the correlation coefficients for the recurrent neural network model with human raters was 0.60, and the human rater agreement was also 0.60. CONCLUSIONS The recurrent neural network model predicted the emotional valence of patients and physicians in primary care visits with similar reliability as human raters. PRACTICE IMPLICATIONS As the first machine learning-based evaluation of emotion recognition in primary care visit conversations, our work provides valuable baselines for future applications that might help monitor patient emotional signals, supporting physicians in empathic communication, or examining the role of emotion in patient-centered care.
Collapse
Affiliation(s)
- Jihyun Park
- Department of Computer Science, University of California, Irvine, USA; Apple Inc., Cupertino, USA.
| | - Abhishek Jindal
- Department of Computer Science, University of California, Irvine, USA; Hewlett Packard Enterprise, San Jose, USA
| | - Patty Kuo
- Department of Educational Psychology, University of Utah, Salt Lake City, USA
| | - Michael Tanana
- Social Research Institute, University of Utah, Salt Lake City, USA
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, USA; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, USA
| | - Ming Tai-Seale
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | - David C Atkins
- Department of Psychiatry and Behavioral Science, University of Washington, Seattle, USA
| | - Zac E Imel
- Department of Educational Psychology, University of Utah, Salt Lake City, USA.
| | - Padhraic Smyth
- Department of Computer Science, University of California, Irvine, USA.
| |
Collapse
|
2
|
Shukor AR, Biotech M. Psychometric Properties of the Problem-Oriented Patient Experience-Primary Care (POPE-PC) Survey. Perm J 2020; 24:19.191. [PMID: 33196428 DOI: 10.7812/tpp/19.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Measuring the experiences of patients regarding delivery and receipt of person-oriented primary care is of increasing policy and research interest and is a core component of the Institute for Healthcare Improvement's Quadruple Aim. OBJECTIVE To describe the Problem-Oriented Patient Experience-Primary Care (POPE-PC) survey, a novel instrument designed to measure patients' experiences of primary care, and to assess the instrument's psychometric properties. METHODS Psychometric testing was performed using data from a Canadian urgent primary care center, derived from March 2019 to September 2019. Patients automatically received the 9-question survey by email after leaving the clinic. Exploratory factor analysis (EFA) on all questions and the entire dataset was performed using parallel analysis and scree plot for factor extraction. Internal consistency was assessed by calculating Cronbach α. A split-half cross-validation of the ensuing factor structure was conducted. A correlation analysis helped explore associations between the survey's questions. RESULTS Results from the initial EFA indicate that the POPE-PC has a conceptually sound 2-factor structure, with good internal consistency. A split-half validation yielded the same findings, reaffirming that the 2-factor model has good psychometric properties. The correlation analysis indicated that the concept of respect is strongly associated with clinical functions related to problem recognition. DISCUSSION Problem recognition, despite being the cornerstone of person-oriented primary care, remains largely overlooked in health services research. The POPE-PC's validity and problem orientation render it potentially useful in rigorously assessing patient experiences of problem-oriented primary care. CONCLUSION The survey's conceptual underpinning and psychometric properties, coupled with its simple and parsimonious design, enable application in primary care settings to provide person-oriented care.
Collapse
Affiliation(s)
- Ali Rafik Shukor
- Seymour Health Centre, Inc. Vancouver, British Columbia, Canada.,Department of Public Health, Amsterdam University Medical Center, The Netherlands
| | | |
Collapse
|
3
|
Adults With Diabetes Distress Often Want to Talk With Their Health Professionals About It: Findings From an Audit of 4 Australian Specialist Diabetes Clinics. Can J Diabetes 2020; 44:473-480. [DOI: 10.1016/j.jcjd.2020.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/19/2020] [Accepted: 02/10/2020] [Indexed: 11/23/2022]
|
4
|
Hirsch-Moverman Y, Mantell JE, Lebelo L, Wynn C, Hesseling AC, Howard AA, Nachman S, Frederix K, Maama LB, El-Sadr WM. Tuberculosis preventive treatment preferences among care givers of children in Lesotho: a pilot study. Int J Tuberc Lung Dis 2019; 22:858-862. [PMID: 29991393 DOI: 10.5588/ijtld.17.0809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Shorter-duration regimens for preventing drug-susceptible tuberculosis (TB) have been shown to be safe and efficacious in children, and may improve acceptability, adherence, and treatment completion. While these regimens have been used in children in low TB burden countries, they are not yet widely used in high TB burden countries. SETTING Five health facilities in one district in Lesotho, a high TB burden country. OBJECTIVE Assess the preventive treatment preferences of care givers of child TB contacts. DESIGN Qualitative data were collected using in-depth interviews with 12 care givers whose children completed preventive treatment, and analyzed using grounded theory. FINDINGS Care givers were interested in being involved in the children's treatment decisions. Pill burden, treatment duration and related frequency of dosing were identified as important factors that influenced preventive treatment preferences among care givers. CONCLUSION Understanding care giver preferences and involving them in treatment decisions may facilitate efforts to implement successful preventive treatment for TB among children in high TB burden countries.
Collapse
Affiliation(s)
- Y Hirsch-Moverman
- ICAP at Columbia University, Mailman School of Public Health, New York, Department of Epidemiology, Columbia University, New York
| | - J E Mantell
- HIV Center for Clinical & Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Columbia University, Department of Psychiatry, New York
| | - L Lebelo
- ICAP at Columbia University, Mailman School of Public Health, New York
| | - C Wynn
- Department of Sociomedical Sciences, Columbia University, New York, New York, USA
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A A Howard
- ICAP at Columbia University, Mailman School of Public Health, New York, Department of Epidemiology, Columbia University, New York
| | - S Nachman
- Pediatric Infectious Diseases, State University of New York Stony Brook, Stony Brook, New York, USA
| | - K Frederix
- ICAP at Columbia University, Mailman School of Public Health, New York
| | - L B Maama
- Lesotho Ministry of Health National Tuberculosis Program, Maseru, Lesotho
| | - W M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, New York, Department of Epidemiology, Columbia University, New York
| |
Collapse
|
5
|
Cerier E, Beal EW, Chakedis J, Chen Q, Paredes A, Sun S, Cloyd JM, Pawlik TM. Patient-provider relationships and health outcomes among hepatopancreatobiliary patients. J Surg Res 2018; 228:290-298. [DOI: 10.1016/j.jss.2018.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/20/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
|
6
|
Tai-Seale M, Olson CW, Li J, Chan AS, Morikawa C, Durbin M, Wang W, Luft HS. Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine. Health Aff (Millwood) 2018; 36:655-662. [PMID: 28373331 DOI: 10.1377/hlthaff.2016.0811] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Time spent by physicians is a key resource in health care delivery. This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians' use of time. We used data on physicians' time allocation patterns captured by over thirty-one million EHR transactions in the period 2011-14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients' EHRs. Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Desktop medicine consists of activities such as communicating with patients through a secure patient portal, responding to patients' online requests for prescription refills or medical advice, ordering tests, sending staff messages, and reviewing test results. Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated to desktop medicine. Staffing and scheduling in the physician's office, as well as provider payment models for primary care practice, should account for these desktop medicine efforts.
Collapse
Affiliation(s)
- Ming Tai-Seale
- Ming Tai-Seale is associate director of the Palo Alto Medical Foundation Research Institute, in Mountain View, California
| | - Cliff W Olson
- Cliff W. Olson is director of the Information Management Group at the Palo Alto Medical Foundation Research Institute
| | - Jinnan Li
- Jinnan Li is a quantitative analyst at the Palo Alto Medical Foundation Research Institute
| | - Albert S Chan
- Albert S. Chan is vice president for digital patient experience at Sutter Health, in Emeryville, California
| | - Criss Morikawa
- Criss Morikawa is director of data and analytics at the Palo Alto Medical Foundation, in Mountain View, California
| | - Meg Durbin
- Meg Durbin is chief medical officer at Canopy Health, in Emeryville, California
| | - Wei Wang
- Wei Wang is a data scientist at Intuit Inc., in Mountain View
| | - Harold S Luft
- Harold S. Luft is director of the Palo Alto Medical Foundation Research Institute
| |
Collapse
|
7
|
Zweifel P. The triple challenge of mental health. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:309-313. [PMID: 29086086 DOI: 10.1007/s10198-017-0937-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Peter Zweifel
- Emeritus, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
8
|
Kimerling R, Pavao J, Wong A. Patient Activation and Mental Health Care Experiences Among Women Veterans. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:506-13. [PMID: 25917224 DOI: 10.1007/s10488-015-0653-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We utilized a nationally representative survey of women veteran primary care users to examine associations between patient activation and mental health care experiences. A dose-response relationship was observed, with odds of high quality ratings significantly greater at each successive level of patient activation. Higher activation levels were also significantly associated with preference concordant care for gender-related preferences (use of female providers, women-only settings, and women-only groups as often as desired). Results add to the growing literature documenting better health care experiences among more activated patients, and suggest that patient activation may play an important role in promoting engagement with mental health care.
Collapse
Affiliation(s)
- Rachel Kimerling
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, PTSD-324, Menlo Park, CA, 94025, USA. .,Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152 MPD), Menlo Park, CA, 94025, USA.
| | - Joanne Pavao
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, PTSD-324, Menlo Park, CA, 94025, USA
| | - Ava Wong
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152 MPD), Menlo Park, CA, 94025, USA
| |
Collapse
|
9
|
Stomski NJ, Morrison P. Participation in mental healthcare: a qualitative meta-synthesis. Int J Ment Health Syst 2017; 11:67. [PMID: 29151851 PMCID: PMC5678577 DOI: 10.1186/s13033-017-0174-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/27/2017] [Indexed: 01/14/2023] Open
Abstract
Background Facilitation of service user participation in the co-production of mental healthcare planning and service delivery is an integral component of contemporary mental health policy and clinical guidelines. However, many service users continue to experience exclusion from the planning of their care. This review synthesizes qualitative research about participation in mental healthcare and articulates essential processes that enable service user participation in mental health care. Methods Electronic databases were systematically searched. Studies were included if they were peer reviewed qualitative studies, published between 2000 and 2015, examining participation in mental health care. The Critical Appraisal Skills Program checklist was used to assess the quality of each included study. Constant comparison was used to identify similar constructs across several studies, which were then abstracted into thematic constructs. Results The synthesis resulted in the identification of six principal themes, which articulate key processes that facilitate service user participation in mental healthcare. These themes included: exercising influence; tokenism; sharing knowledge; lacking capacity; respect; and empathy. Conclusions This meta-synthesis demonstrates that service user participation in mental healthcare remains a policy aspiration, which generally has not been translated into clinical practice. The continued lack of impact on policy on the delivery of mental healthcare suggests that change may have to be community driven. Systemic service user advocacy groups could contribute critically to promoting authentic service user participation in the co-production of mental health services.
Collapse
Affiliation(s)
- Norman J Stomski
- School of Health Professions, Murdoch University, ECL 2049 90 South St, Murdoch, WA 6150 Australia
| | - Paul Morrison
- School of Health Professions, Murdoch University, ECL 2049 90 South St, Murdoch, WA 6150 Australia
| |
Collapse
|
10
|
Higgins T, Larson E, Schnall R. Unraveling the meaning of patient engagement: A concept analysis. PATIENT EDUCATION AND COUNSELING 2017; 100:30-36. [PMID: 27665500 DOI: 10.1016/j.pec.2016.09.002] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/25/2016] [Accepted: 09/02/2016] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Patient engagement has been credited with contributing to improved outcomes and experiences of care. Patient engagement has become a widely used term, but remains a poorly understood concept in healthcare. Citations for the term have increased throughout the healthcare-related disciplines without a common definition. This study seeks to define the concept by identifying its attributes in the context of its use. METHODS A concept analysis of the scientific literature in the health disciplines was performed using the Rogers method. RESULTS The analysis revealed four defining attributes of patient engagement: personalization, access, commitment and therapeutic alliance. Patient engagement is defined as the desire and capability to actively choose to participate in care in a way uniquely appropriate to the individual, in cooperation with a healthcare provider or institution, for the purposes of maximizing outcomes or improving experiences of care. CONCLUSION Patient engagement is both process and behavior and is shaped by the relationship between the patient and provider and the environment in which healthcare delivery takes place. PRACTICE IMPLICATIONS The definition and the identified attributes serve as a heuristic in designing patient engagement strategies and as a basis for future development of the patient engagement concept in healthcare.
Collapse
Affiliation(s)
- Tracy Higgins
- Columbia University School of Nursing, United States
| | - Elaine Larson
- Columbia University School of Nursing, United States; Columbia University, Mailman School of Public Health, Department of Epidemiology, United States
| | | |
Collapse
|
11
|
Fukui S, Matthias MS, Salyers MP. Core domains of shared decision-making during psychiatric visits: scientific and preference-based discussions. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 42:40-6. [PMID: 24500023 DOI: 10.1007/s10488-014-0539-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Shared decision-making (SDM) is imperative to person-centered care, yet little is known about what aspects of SDM are targeted during psychiatric visits. This secondary data analysis (191 psychiatric visits with 11 providers, coded with a validated SDM coding system) revealed two factors (scientific and preference-based discussions) underlying SDM communication. Preference-based discussion occurred less. Both provider and consumer initiation of SDM elements and decision complexity were associated with greater discussions in both factors, but were more strongly associated with scientific discussion. Longer visit length correlated with only scientific discussion. Providers' understanding of core domains could facilitate engaging consumers in SDM.
Collapse
Affiliation(s)
- Sadaaki Fukui
- The University of Kansas School of Social Welfare Center for Mental Health Research and Innovation, 1545 Lilac Lane, Lawrence, KS, 66044, USA,
| | | | | |
Collapse
|
12
|
Tai-Seale M, Elwyn G, Wilson CJ, Stults C, Dillon EC, Li M, Chuang J, Meehan A, Frosch DL. Enhancing Shared Decision Making Through Carefully Designed Interventions That Target Patient And Provider Behavior. Health Aff (Millwood) 2016; 35:605-12. [DOI: 10.1377/hlthaff.2015.1398] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ming Tai-Seale
- Ming Tai-Seale is a senior scientist in health policy research at the Palo Alto Medical Foundation Research Institute, in Mountain View, California
| | - Glyn Elwyn
- Glyn Elwyn is a professor at the Dartmouth Center for Health Care Delivery Science, in Hanover, New Hampshire
| | - Caroline J. Wilson
- Caroline J. Wilson is a consulting quantitative research analyst at the Palo Alto Medical Foundation Research Institute
| | - Cheryl Stults
- Cheryl Stults is a research sociologist at the Palo Alto Medical Foundation Research Institute
| | - Ellis C. Dillon
- Ellis C. Dillon is a research sociologist at the Palo Alto Medical Foundation Research Institute
| | - Martina Li
- Martina Li is a project manager at the Palo Alto Medical Foundation Research Institute
| | - Judith Chuang
- Judith Chuang is a research associate at the Palo Alto Medical Foundation Research Institute
| | - Amy Meehan
- Amy Meehan is a research associate at the Palo Alto Medical Foundation Research Institute
| | - Dominick L. Frosch
- Dominick L. Frosch is a senior scientist and chief care delivery evaluation officer at the Palo Alto Medical Foundation and an associate professor in the Department of Medicine at the University of California, Los Angeles
| |
Collapse
|
13
|
Kaskie BP, Leung C, Kaplan MS. Deploying an Ecological Model to Stem the Rising Tide of Firearm Suicide in Older Age. J Aging Soc Policy 2016; 28:233-45. [DOI: 10.1080/08959420.2016.1167512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
14
|
Henry SG, Chen M, Matthias MS, Bell RA, Kravitz RL. Development of the Chronic Pain Coding System (CPCS) for Characterizing Patient-Clinician Discussions About Chronic Pain and Opioids. PAIN MEDICINE 2016; 17:1892-1905. [PMID: 26936453 DOI: 10.1093/pm/pnw005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To describe the development and initial application of the Chronic Pain Coding System. DESIGN Secondary analysis of data from a randomized clinical trial. SETTING Six primary care clinics in northern California. SUBJECTS Forty-five primary care visits involving 33 clinicians and 45 patients on opioids for chronic noncancer pain. METHODS The authors developed a structured coding system to accurately and objectively characterize discussions about pain and opioids. Two coders applied the final system to visit transcripts. Intercoder agreement for major coding categories was moderate to substantial (kappa = 0.5-0.7). Mixed effects regression was used to test six hypotheses to assess preliminary construct validity. RESULTS Greater baseline pain interference was associated with longer pain discussions (P = 0.007) and more patient requests for clinician action (P = 0.02) but not more frequent negative patient evaluations of pain (P = 0.15). Greater clinician-reported visit difficulty was associated with more frequent disagreements with clinician recommendations (P = 0.003) and longer discussions of opioid risks (P = 0.049) but not more frequent requests for clinician action (P = 0.11). Rates of agreement versus disagreement with patient requests and clinician recommendations were similar for opioid-related and non-opioid-related utterances. CONCLUSIONS This coding system appears to be a reliable and valid tool for characterizing patient-clinician communication about opioids and chronic pain during clinic visits. Objective data on how patients and clinicians discuss chronic pain and opioids are necessary to identify communication patterns and strategies for improving the quality and productivity of discussions about chronic pain that may lead to more effective pain management and reduce inappropriate opioid prescribing.
Collapse
Affiliation(s)
- Stephen G Henry
- *Department of Internal Medicine, University of California Davis, Sacramento, California;
| | - Meng Chen
- Department of Communication, University of California Davis, Davis, California
| | - Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana.,Regenstrief Institute, Indianapolis, Indiana.,Department of Communication Studies, Indiana University-Purdue University, Indianapolis, Indiana.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robert A Bell
- Department of Communication, University of California Davis, Davis, California.,Department of Public Health Sciences, University of California Davis, Davis, California, USA
| | - Richard L Kravitz
- *Department of Internal Medicine, University of California Davis, Sacramento, California
| |
Collapse
|
15
|
Tai-Seale M, Sullivan G, Cheney A, Thomas K, Frosch D. The Language of Engagement: "Aha!" Moments from Engaging Patients and Community Partners in Two Pilot Projects of the Patient-Centered Outcomes Research Institute. Perm J 2016; 20:89-92. [PMID: 26909777 DOI: 10.7812/tpp/15-123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Compared with people living in the community, researchers often have different frameworks or paradigms for thinking about health and wellness. These differing frameworks are often accompanied by differences in terminology or language. The purpose of this commentary is to describe some of our "Aha!" moments from conducting two pilot studies funded by the Patient-Centered Outcomes Research Institute. Over time, we came to understand how our language and word choices may have been acting as a wedge between ourselves and our community research partners. We learned that fruitful collaborative work must attend to the creation of a common language, which we refer to as the language of engagement. Such patient-centered language can effectively build a bridge between researchers and community partners. We encourage other researchers to think critically about their cultural competency, to be mindful of the social power dynamics between patient and physician, to reflect on how their understanding might differ from those of their patient partners, and to find ways to use a common language that engages patients and other community partners.
Collapse
Affiliation(s)
- Ming Tai-Seale
- Senior Scientist at the Palo Alto Medical Foundation's Research Institute and a Consulting Professor at Stanford School of Medicine Department of Health Research and Policy in CA.
| | - Greer Sullivan
- Associate Dean for Population Based Research and Professor of Psychiatry at the University of California, Riverside.
| | - Ann Cheney
- Medical Anthropologist and Assistant Professor in Residence at the University of California, Riverside School of Medicine.
| | - Kathleen Thomas
- Health Economist, a Research Fellow at the Sheps Center for Health Services Research, and Adjunct Associate Professor of Health Policy and Management at the University of North Carolina at Chapel Hill.
| | - Dominick Frosch
- Fellow in the Gordon and Betty Moore Foundation's Patient Care Program and Associate Professor of Medicine at the University of California, Los Angeles. He is a Consulting Investigator for the Palo Alto Medical Foundation Research Institute in CA.
| |
Collapse
|
16
|
Barr PJ, Forcino RC, Mishra M, Blitzer R, Elwyn G. Competing priorities in treatment decision-making: a US national survey of individuals with depression and clinicians who treat depression. BMJ Open 2016; 6:e009585. [PMID: 26747036 PMCID: PMC4716198 DOI: 10.1136/bmjopen-2015-009585] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To identify information priorities for consumers and clinicians making depression treatment decisions and assess shared decision-making (SDM) in routine depression care. DESIGN 20 questions related to common features of depression treatments were provided. Participants were initially asked to select which features were important, and in a second stage they were asked to rank their top 5 'important features' in order of importance. Clinicians were asked to provide rankings according to both consumer and clinician perspectives. Consumers completed CollaboRATE, a measure of SDM. Multiple logistic regression analysis identified consumer characteristics associated with CollaboRATE scores. SETTING Online cross-sectional surveys fielded in September to December 2014. PARTICIPANTS We administered surveys to convenience samples of US adults with depression and clinicians who treat depression. Consumer sampling was targeted to reflect age, gender and educational attainment of adults with depression in the USA. PRIMARY OUTCOME MEASURES Information priority rankings; CollaboRATE, a 3-item consumer-reported measure of SDM. RESULTS 972 consumers and 244 clinicians completed the surveys. The highest ranked question for both consumers and clinicians was 'Will the treatment work?' Clinicians were aware of consumers' priorities, yet did not always prioritise that information themselves, particularly insurance coverage and cost of treatment. Only 18% of consumers reported high levels of SDM. Working with a psychiatrist (OR 1.87; 95% CI 1.07 to 3.26) and female gender (OR 2.04; 95% CI 1.25 to 3.34) were associated with top CollaboRATE scores. CONCLUSIONS While clinicians know what information is important to consumers making depression treatment decisions, they do not always address these concerns. This mismatch, coupled with low SDM, adversely affects the quality of depression care. Development of a decision support intervention based on our findings can improve levels of SDM and provide clinicians and consumers with a tool to address the existing misalignment in information priorities.
Collapse
Affiliation(s)
- Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Rachel C Forcino
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Manish Mishra
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- The Dartmouth Center for Health Care Delivery Science, Hanover, New Hampshire, USA
| | - Rachel Blitzer
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
- The Dartmouth Center for Health Care Delivery Science, Hanover, New Hampshire, USA
| |
Collapse
|
17
|
Ell K, Aranda MP, Wu S, Oh H, Lee PJ, Guterman J. Promotora assisted depression care among predominately Hispanic patients with concurrent chronic illness: Public care system clinical trial design. Contemp Clin Trials 2015; 46:39-47. [PMID: 26600285 DOI: 10.1016/j.cct.2015.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/12/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
Abstract
Depression frequently negatively affects patient overall self-care and social stress management within United States safety net care systems. Rates of major depression are significantly high among low-income predominantly Hispanic/Latino with chronic illness, such as diabetes and heart disease. The study design of the A Helping Hand to Activate Patient-Centered Depression Care among Low-income Patients (AHH) randomized clinical trial aims to enhance patient depression care receipt and overall bio-psychosocial self-care management. The AHH trial is conducted in collaboration with three Los Angeles County Department of Health Services (DHS) safety net clinics that provide Patient-Centered Medical Home (PCMH) care. The study compares AHH intervention (AHH) in which community-based bilingual promotoras provide in-person or telephone patient engagement and intervention aimed to reduce the burden and strain on patients, families, and care providers by assessing, enhancing, and facilitating patient depression and co-morbid illness self-care management skill, and activating patient communication with clinic medical providers versus DHS PCMH team usual care (PCMHUC). AHH independent bilingual recruiters screened 1957 and enrolled 348 predominantly Hispanic/Latino patients, of whom 296 (85%) had diabetes, 14 (4%) with heart disease, and 38 (11%) with both diseases. Recruiters identified depressed patients by baseline Patient Health Questionnaire-9 scores of 10 or more, completed baseline assessments, and randomized patients to either AHH or PCMHUC study group. The comprehensive assessments will be repeated at 6 and 12months by an independent bilingual follow-up interviewer. Baseline and outcome data include mental health assessment and treatment receipt, co-morbid illness self-care, social relationships, and environmental stressor assessments.
Collapse
Affiliation(s)
- Kathleen Ell
- School of Social Work, University of Southern California, United States.
| | - María P Aranda
- School of Social Work, University of Southern California, United States.
| | - Shinyi Wu
- School of Social Work, University of Southern California, United States; Edward R. Roybal Institute on Aging, University of Southern California, United States; Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States.
| | - Hyunsung Oh
- School of Social Work, Arizona State University, United States.
| | - Pey-Jiuan Lee
- School of Social Work, University of Southern California, United States.
| | - Jeffrey Guterman
- Los Angeles County Department of Health Services, Research and Innovation, David Geffen School of Medicine, University of California Los Angeles, United States.
| |
Collapse
|
18
|
Sansoni JE, Grootemaat P, Duncan C. Question Prompt Lists in health consultations: A review. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)00258-X. [PMID: 26104993 DOI: 10.1016/j.pec.2015.05.015] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 04/14/2015] [Accepted: 05/24/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This review examines the use and effectiveness of Question Prompt Lists (QPL) as communication aids to enhance patient question asking, information provision to patients and patient participation in health and medical consultations. METHODS A systematic search was undertaken to identify relevant literature concerning QPLs including academic databases, Google-based and snowball searching. Forty-two relevant studies reporting 50 interventions were identified. RESULTS Although findings varied there was some evidence that a QPL endorsed by the physician increased total question asking. Using a QPL increased question asking concerning specific content areas (e.g. prognosis). There was some evidence that physicians provided more information during consultations. There were no consistent findings concerning effects on patient knowledge recall, anxiety and satisfaction or consultation time. Some interventions that increased question asking had longer consultation times. CONCLUSION There is evidence that an appropriate QPL, endorsed by the physician and provided immediately before the consultation, may increase patient question asking and lead to more information being provided by the physician. PRACTICE IMPLICATIONS There is increasing evidence to support QPL use in routine practice. Further trials might address the issues identified including an assessment of QPL optimal length and QPL adaptation for cultural and special needs groups.
Collapse
Affiliation(s)
- Janet E Sansoni
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia.
| | - Pam Grootemaat
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - Cathy Duncan
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| |
Collapse
|
19
|
Frampton SB, Guastello S, Lepore M. Compassion as the foundation of patient-centered care: the importance of compassion in action. J Comp Eff Res 2014; 2:443-55. [PMID: 24236742 DOI: 10.2217/cer.13.54] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The Institute of Medicine defines patient-centered care as "providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions." What is missing in this definition is an explicit emphasis on compassion. This perspective article draws on the experience of Planetree (CT, USA), a not-for-profit organization that partners with healthcare establishments to drive adoption of patient-centered care principles and practices by connecting healthcare professionals with the voices and perspectives of the patients and family members who utilize their services. Across hundreds of focus groups facilitated by Planetree, patients and their loved ones emphasize that paramount among their needs, preferences and values are compassionate human interactions. For care to be truly patient-centered, a foundation of compassion is essential. Reports from patients and the media, and research from healthcare systems around the world demonstrate the fallacy of assuming that compassion is a current or prevalent feature of the care experience. Concurrently, a growing evidence base highlights the supreme importance of compassion in driving high-quality, high-value care. However, good intentions are not sufficient for delivering compassionate care. Drawing on the experiences of exemplary patient-centered hospitals (recognized as such following a rigorous culture audit to determine fulfillment of the criteria for formal recognition as a Designated® Patient-Centered Hospital [Planetree]), this paper explores practical approaches for embedding compassion in healthcare delivery and organizational culture to meet patients' expressed desires for empathic and respectful human interactions.
Collapse
|
20
|
Lê Cook B, Brown JD, Loder S, Wissow L. Acculturation differences in communicating information about child mental health between Latino parents and primary care providers. J Immigr Minor Health 2014; 16:1093-102. [PMID: 24705736 PMCID: PMC4185306 DOI: 10.1007/s10903-014-0010-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Significant Latino-white disparities in youth mental health care access and quality exist yet little is known about Latino parents' communication with providers about youth mental health and the role of acculturation in influencing this communication. We estimated regression models to assess the association between time in the US and the number of psychosocial issues discussed with the medical assistant (MA) and doctor, adjusting for child and parent mental health and sociodemographics. Other proxies of acculturation were also investigated including measures of Spanish and English language proficiency and nativity. Parent's length of time in the US was positively associated with their communication of: their child's psychosocial problems with their child's MA, stress in their own life with their child's MA, and their child's school problems with their child's doctor. These differences were especially apparent for parents living in the US for >10 years. Parent-child language discordance, parent and child nativity were also significantly associated with communication of psychosocial problems. Greater provider and MA awareness of variation in resistance to communicating psychosocial issues could improve communication, and improve the prevention, diagnosis and treatment of youth mental illness.
Collapse
Affiliation(s)
- Benjamin Lê Cook
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Assistant Professor, Department of Psychiatry, Harvard Medical School, 120 Beacon Street, 4 Floor, Somerville, MA 02143, 617-503-8449, 617-503-8430 (fax),
| | - Jonathan D. Brown
- Mathematica Policy Research, 1100 1st St NE #1200, Washington, DC 20002, (202) 484-9220,
| | - Stephen Loder
- Center for Multicultural Mental Health Research, Cambridge Health, Alliance, 120 Beacon Street, 4 Floor, Somerville, MA 02143, 617-503-8440, 617-503-8430 (fax),
| | - Larry Wissow
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Street, #703 Baltimore, MD 21287, 410-614-1243,
| |
Collapse
|
21
|
Alegría M, Carson N, Flores M, Li X, Shi P, Lessios AS, Polo A, Allen M, Fierro M, Interian A, Jimenez A, La Roche M, Lee C, Lewis-Fernández R, Livas-Stein G, Safar L, Schuman C, Storey J, Shrout PE. Activation, self-management, engagement, and retention in behavioral health care: a randomized clinical trial of the DECIDE intervention. JAMA Psychiatry 2014; 71:557-65. [PMID: 24647680 PMCID: PMC4311517 DOI: 10.1001/jamapsychiatry.2013.4519] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Given minority patients' unequal access to quality care, patient activation and self-management strategies have been suggested as a promising approach to improving mental health care. OBJECTIVE To determine whether the DECIDE (Decide the problem; Explore the questions; Closed or open-ended questions; Identify the who, why, or how of the problem; Direct questions to your health care professional; Enjoy a shared solution) intervention, an educational strategy that teaches patients to ask questions and make collaborative decisions with their health care professional, improves patient activation and self-management, as well as engagement and retention in behavioral health care. DESIGN, SETTING, AND PATIENTS In this multisite randomized clinical trial performed from February 1, 2009, through October 9, 2011 (date of last follow-up interview), we recruited 647 English- or Spanish-speaking patients 18 to 70 years old from 13 outpatient community mental health clinics across 5 states and 1 US territory. A total of 722 patients were included in analyses of secondary outcomes. INTERVENTIONS Three DECIDE training sessions delivered by a care manager vs giving patients a brochure on management of behavioral health. MAIN OUTCOMES AND MEASURES Primary outcomes were patient assessment of activation (Patient Activation Scale) and self-management (Perceived Efficacy in Patient-Physician Interactions). Secondary outcomes included patient engagement (proportion of visits attended of those scheduled) and retention (attending at least 4 visits in the 6 months after the baseline research assessment), collected through medical record review or electronic records. RESULTS Patients assigned to DECIDE reported significant increases in activation (mean β = 1.74, SD = 0.58; P = .003) and self-management (mean β = 2.42, SD = 0.90; P = .008) relative to control patients, but there was no evidence of an effect on engagement or retention in care. CONCLUSIONS AND RELEVANCE The DECIDE intervention appears to help patients learn to effectively ask questions and participate in decisions about their behavioral health care, but a health care professional component might be needed to augment engagement in care. DECIDE appears to have promise as a strategy for changing the role of minority patients in behavioral health care. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01226329
Collapse
|
22
|
Wu S, Ell K, Gross-Schulman SG, Sklaroff LM, Katon WJ, Nezu AM, Lee PJ, Vidyanti I, Chou CP, Guterman JJ. Technology-facilitated depression care management among predominantly Latino diabetes patients within a public safety net care system: comparative effectiveness trial design. Contemp Clin Trials 2013; 37:342-54. [PMID: 24215775 DOI: 10.1016/j.cct.2013.11.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/29/2013] [Accepted: 11/01/2013] [Indexed: 01/15/2023]
Abstract
Health disparities in minority populations are well recognized. Hispanics and Latinos constitute the largest ethnic minority group in the United States; a significant proportion receives their care via a safety net. The prevalence of diabetes mellitus and comorbid depression is high among this group, but the uptake of evidence-based collaborative depression care management has been suboptimal. The study design and baseline characteristics of the enrolled sample in the Diabetes-Depression Care-management Adoption Trial (DCAT) establishes a quasi-experimental comparative effectiveness research clinical trial aimed at accelerating the adoption of collaborative depression care in safety net clinics. The study was conducted in collaboration with the Los Angeles County Department of Health Services at eight county-operated clinics. DCAT has enrolled 1406 low-income, predominantly Hispanic/Latino patients with diabetes to test a translational model of depression care management. This three-group study compares usual care with a collaborative care team support model and a technology-facilitated depression care model that provides automated telephonic depression screening and monitoring tailored to patient conditions and preferences. Call results are integrated into a diabetes disease management registry that delivers provider notifications, generates tasks, and issues critical alerts. All subjects receive comprehensive assessments at baseline, 6, 12, and 18 months by independent English-Spanish bilingual interviewers. Study outcomes include depression outcomes, treatment adherence, satisfaction, acceptance of assessment and monitoring technology, social and economic stress reduction, diabetes self-care management, health care utilization, and care management model cost and cost-effectiveness comparisons. DCAT's goal is to optimize depression screening, treatment, follow-up, outcomes, and cost savings to reduce health disparities.
Collapse
Affiliation(s)
- Shinyi Wu
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States; RAND Corporation, United States.
| | - Kathleen Ell
- School of Social Work, University of Southern California, United States.
| | | | | | - Wayne J Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States.
| | - Art M Nezu
- Drexel University College of Arts and Sciences, United States.
| | - Pey-Jiuan Lee
- School of Social Work, University of Southern California, United States.
| | - Irene Vidyanti
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States.
| | - Chih-Ping Chou
- Keck School of Medicine, Department of Preventive Medicine, University of Southern California, United States.
| | - Jeffrey J Guterman
- Los Angeles County Department of Health Services, United States; David Geffen School of Medicine at UCLA, United States.
| |
Collapse
|
23
|
Barkil-Oteo A. Collaborative care for depression in primary care: how psychiatry could "troubleshoot" current treatments and practices. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2013; 86:139-46. [PMID: 23766735 PMCID: PMC3670434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The bulk of mental health services for people with depression are provided in primary care settings. Primary care providers prescribe 79 percent of antidepressant medications and see 60 percent of people being treated for depression in the United States, and they do that with little support from specialist services. Depression is not effectively managed in the primary care setting. Collaborative care based on a team approach, a population health perspective, and measurement-based care has been proven to treat depression more effectively than care as usual in a variety of settings and for different populations, and it increases people's access to medications and behavioral therapies. Psychiatry has the responsibility of supporting the primary care sector in delivering mental health services by disseminating collaborative care approaches under recent initiatives and opportunities made possible by the Affordable Care Act (ACA).
Collapse
|