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Haun JN, Panaite V, Cotner BA, Melillo C, Venkatachalam HH, Fowler CA, Lapcevic W, Alman AC, French DD, Zilka B, Messina W. Primary care virtual resource use prior and post COVID-19 pandemic onset. BMC Health Serv Res 2022; 22:1370. [PMID: 36401239 PMCID: PMC9673210 DOI: 10.1186/s12913-022-08790-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background The COVID-19 pandemic has been a catalyst for rapid uptake of virtual care through the use of virtual health resources (VHR). In the Department of Veterans Affairs (VA) Healthcare System, virtual care has been critical to maintaining healthcare access for patients during COVID-19. In the current study we describe primary care patient aligned care team (PACT) VHR use patterns within one VA medical center (i.e., hospital facility and five community-based outpatient clinics) pre- and post-COVID-19 onset. Methods VHR provider and patient use data from 106 individual PACTs were extracted monthly between September 2019 to September 2020. Data were extracted from VHA web-based project application and tracking databases. Using longitudinal data, mixed effect models were used to compare pre- and post-COVID onset slopes. Results Findings highlight an increase in patient users of secure messaging (SM) and telehealth. The rate of utilization among these patients increased for SM but not for telehealth visits or online prescription refill (RxRefill) use. Finally, VetLink Kiosk check ins that are done at in person visits, diminished abruptly after COVID-19 onset. Conclusions These data provide a baseline of VHR use at the PACT level after the initial impact of the COVID-19 pandemic and can inform healthcare delivery changes within the VA systems over time. Moreover, this project produced a data extraction blueprint, that is the first of its kind to track VA VHR use leveraging secondary data sources. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08790-w.
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Haun JN, Cotner BA, Melillo C, Panaite V, Messina W, Patel-Teague S, Zilka B. Informing Proactive integrated virtual healthcare resource use in primary care. BMC Health Serv Res 2021; 21:802. [PMID: 34384405 PMCID: PMC8358911 DOI: 10.1186/s12913-021-06783-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 07/07/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Proactive integrated virtual healthcare resource (VHR) use can improve efficiency, maximize resource capacity for delivering optimal coordinated care and improve patient outcomes. Proactive integrated VHR use is vital for delivering high quality care. Our objectives were to identify proactive integrated VHR use among primary care teams, best practices and targeted implementation strategies to promote proactive integrated VHR use. METHODS This is a mixed-method descriptive study. We employed a community-based participatory approach to collect data and the Consolidated Framework for Implementation Research to analyze and contextualize findings. A cross-sectional sample of primary care team members (n = 65) from a Department of Veterans Affairs medical center participated in focus groups, follow-up interviews (n = 16), and respond to self-report surveys. Operational subject matter experts (n = 15) participated in informant interviews. RESULTS Survey data described current use and factors that influenced singular VHR use and were convergent with qualitative findings. Focus group and interview data described no evidence of proactive integrated VHR use. Differences and similarities were identified between both utilization groups, such as facilitators and barriers, recommendations, patient education and preferred implementation strategies. All groups reported issues around VHR availability knowledge and access and functionality. Participants identified the need for best practices that are specific to care tasks and performance measures. Expert informant interviews identified a list of VHR tools that could be proactively integrated across the healthcare continuum. CONCLUSIONS Health systems are leveraging technologies to proactively integrate VHR to maximize information exchange, clinical decision support and patient engagement. VHR is critical during global pandemics, such as COVID-19, to maintain access to care coordination and delivery while abiding by public health recommendations. Though recent requirements for reducing contact create an intrinsic motivation, cultural change through education and best practices of proactive integrated use across the healthcare continuum is needed to create a culture of VHR super users.
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Affiliation(s)
- Jolie N Haun
- Research and Development Service, James A. Haley VA Hospital and Clinics, 8900 Grand Oak Circle (151R), Tampa, FL, 33637-1022, USA
- Department of Community & Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Bridget A Cotner
- Research and Development Service, James A. Haley VA Hospital and Clinics, 8900 Grand Oak Circle (151R), Tampa, FL, 33637-1022, USA
- Department of Anthropology, University of South Florida, Tampa, FL, USA
| | - Christine Melillo
- Research and Development Service, James A. Haley VA Hospital and Clinics, 8900 Grand Oak Circle (151R), Tampa, FL, 33637-1022, USA.
| | - Vanessa Panaite
- Research and Development Service, James A. Haley VA Hospital and Clinics, 8900 Grand Oak Circle (151R), Tampa, FL, 33637-1022, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | | | - Shilpa Patel-Teague
- Veterans Integrated Service Network 8 Network Office, St Petersburg, FL, USA
| | - Brian Zilka
- James A. Haley Veterans Hospital, Tampa, FL, USA
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Sharma HP. Enhancing practice efficiency: A key organizational strategy to improve professional fulfillment in allergy and immunology. Ann Allergy Asthma Immunol 2020; 126:235-239. [PMID: 33309885 DOI: 10.1016/j.anai.2020.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/11/2020] [Accepted: 12/02/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To review evidence-based strategies that have been noted to improve professional fulfillment and reduce burnout by enhancing practice efficiency. DATA SOURCES A comprehensive literature review was conducted to evaluate the strategies to improve efficiency of practice-a key driver of burnout among physicians. STUDY SELECTIONS Studies of efficiency-enhancing practices relevant to allergy-immunology were included. RESULTS Professional burnout is prevalent among physicians and is associated with negative outcomes affecting physicians, patients, and health care organizations. Recent surveys suggest at least 35% of US allergists-immunologists experience burnout. There are multiple drivers of professional burnout, some at the individual level and others at the organizational or practice level. Strategies to improve professional fulfillment may be conceptualized using the Stanford physician wellness framework, in which efforts target the following 3 reciprocal domains: culture, personal resilience, and practice efficiency. Organizational strategies that support physician well-being by creating a more efficient practice environment hold great promise, particularly for allergists-immunologists. The reduction of administrative burden and fostering of team-based care have been found in multiple studies to be cost-effective strategies to improve physician and patient satisfaction. CONCLUSION To ensure the well-being of the US allergy-immunology workforce and optimize patient outcomes, both private and academic allergy-immunology institutions should prioritize the adoption and iterative evaluation and refinement of these strategies to cocreate an efficient and ideal practice environment.
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Affiliation(s)
- Hemant P Sharma
- Division of Allergy and Immunology, Children's National Hospital, Washington, District of Columbia; George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
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Olson K, Marchalik D, Farley H, Dean SM, Lawrence EC, Hamidi MS, Rowe S, McCool JM, O'Donovan CA, Micek MA, Stewart MT. Organizational strategies to reduce physician burnout and improve professional fulfillment. Curr Probl Pediatr Adolesc Health Care 2019; 49:100664. [PMID: 31588019 DOI: 10.1016/j.cppeds.2019.100664] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Burnout is highly prevalent among physicians and has been associated with negative outcomes for physicians, patients, staff, and health-care organizations. Reducing physician burnout and increasing physician well-being is a priority. Systematic reviews suggest that organization-based interventions are more effective in reducing physician burnout than interventions targeted at individual physicians. This consensus review by leaders in the field across multiple institutions presents emerging trends and exemplary evidence-based strategies to improve professional fulfillment and reduce physician burnout using Stanford's tripartite model of physician professional fulfillment as an organizing framework: practice efficiency, culture, and personal resilience to support physician well-being. These strategies include leadership traits, latitude of control and autonomy, collegiality, diversity, teamwork, top-of-license workflows, electronic health record (EHR) usability, peer support, confidential mental health services, work-life integration and reducing barriers to practicing a healthy lifestyle. The review concludes with evidence-based recommendations on establishing an effective physician wellness program.
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Affiliation(s)
- Kristine Olson
- Yale School of Medicine, Yale New Haven Health, 20 York Street, New Haven, CT 06510, United States.
| | - Daniel Marchalik
- Medstar Health, Georgetown University School of Medicine, Washington, DC, United States
| | - Heather Farley
- Christiana Care Health System, Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, United States
| | - Shannon M Dean
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | | | - Maryam S Hamidi
- Department of Psychiatry and Behavioral Sciences, Stanford Medicine WellMD Center, Stanford University, Stanford, CA, United States
| | - Susannah Rowe
- Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - Joanne M McCool
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Mark A Micek
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Miriam T Stewart
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Abstract
Forms of large-scale change, such as the regiona l re-distribution of clinical services, are an enduring reform orthodoxy in health systems of high-income countries. The topic is of relevance and importance to medical sociology because of the way that large-scale change significantly disrupts and transforms therapeutic landscapes, relationships and practices. In this paper we review the literature on large-scale change. We find that the literature is dominated by competing forms of knowledge, such as health services research, and show how sociology can contribute new and critical perspectives and insights on what is for many people a troubling issue.
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Affiliation(s)
- Lorelei Jones
- School of Health Sciences, University of Bangor, Bangor, UK
| | - Alec Fraser
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ellen Stewart
- Centre for Biomedicine, Self and Society, University of Edinburgh, Edinburgh, UK
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Olson K, Sinsky C, Rinne ST, Long T, Vender R, Mukherjee S, Bennick M, Linzer M. Cross-sectional survey of workplace stressors associated with physician burnout measured by the Mini-Z and the Maslach Burnout Inventory. Stress Health 2019; 35:157-175. [PMID: 30467949 DOI: 10.1002/smi.2849] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 10/16/2018] [Accepted: 11/13/2018] [Indexed: 11/12/2022]
Abstract
Rising physician burnout has adverse effects on healthcare. This study aimed to identify remediable stressors associated with burnout using the 10-item Mini-Z and the Maslach Burnout Inventory (MBI), and to compare performance of the Mini-Z's single-item burnout metric against the 22-item MBI. Surveys were emailed to 4,118 clinicians affiliated with an academic health system; 1,252 clicked the link, and 557 responded (completion rate 44%). Four hundred seventy-five practicing physicians were included: academic faculty (372), hospital employed (52), and private practitioners (81). Prevalence of burnout via the MBI was 56.6%. Predictors of burnout were poor control over workload [OR = 8.24, 95% CI 4.(81, 14.11)], inefficient teamwork [OR = 7.61, 95% (CI 3.28, 17.67)], insufficient documentation time [OR = 5.83, 95% (CI 3.35, 10.15)], hectic-chaotic work atmosphere [OR = 3.49, 95% (CI 2.12, 5.74)], lack of value-alignment with leadership [OR = 3.27, 95% (CI 2.12, 5.74)], and excessive electronic medical record time at home [OR = 1.99, 95% CI (1.21, 3.27)]. Academic faculty experienced more burnout than private practitioners (59.9% vs. 42.0%, p = 0.013). Odds of burnout associated with stressors were generally concordant via Mini-Z's burnout metric versus the MBI. The Mini-Z is a brief, valid method to identify stressors associated with burnout and guide interventions.
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Affiliation(s)
- Kristine Olson
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christine Sinsky
- Professional Satisfaction, American Medical Association, Chicago, Illinois, USA
| | - Seppo T Rinne
- Department of Internal Medicine, Center for Healthcare Organization & Implementation Research, Veterans Affairs, Bedford, Massachusetts, USA
| | - Theodore Long
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ronald Vender
- Associate Dean of Clinical Affairs, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sandip Mukherjee
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Bennick
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare System, University of Minnesota, and Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA
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Etingen B, Hill JN, Miller LJ, Schwartz A, LaVela SL, Jordan N. An Exploratory Pilot Study to Describe Shared Decision-Making for PTSD Treatment Planning: The Provider Perspective. Mil Med 2019; 184:467-475. [PMID: 30901448 DOI: 10.1093/milmed/usy407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/25/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe current practices used by Veterans Administration (VA) mental health (MH) providers involved in post-traumatic stress disorder (PTSD) treatment planning to support engagement of veterans with PTSD in shared decision-making (SDM). METHODS Semi-structured interviews with MH providers (n = 9) were conducted at 1 large VA, audio-recorded, and transcribed verbatim. Transcripts were analyzed deductively, guided by a published account of the integral SDM components for MH care. RESULTS While discussing forming a cohesive team with patients, providers noted the importance of establishing rapport and assessing treatment readiness. Providers' clinical knowledge/expertise, knowledge of the facility's treatment options, knowledge of how to navigate the VA MH care system, and patient factors (goals/preferences, factors influencing treatment engagement) were noted as important to consider when patients and providers exchange information. When negotiating the treatment plan, providers indicated that conversations should include treatment recommendations and concurrent opportunities for personalization. They also emphasized the importance of discussions to finalize a mutually agreeable patient- and provider-informed treatment plan and measure treatment impact. CONCLUSION These results offer a preliminary understanding of VA MH providers' facilitation of SDM for PTSD care. Findings may provide insights for MH providers who wish to engage patients with PTSD in SDM.
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Affiliation(s)
- Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL
| | - Jennifer N Hill
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL
| | - Laura J Miller
- Women's Mental Health, Mental Health Service Line, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL
| | - Alan Schwartz
- Department of Medical Education & Department of Pediatrics, University of Illinois at Chicago, 1853 W. Polk (MC 785), Chicago, IL
| | - Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 710 North Lake Shore Drive, Chicago, IL
| | - Neil Jordan
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL.,Departments of Psychiatry & Behavioral Sciences and Preventive Medicine, Feinberg School of Medicine, Northwestern University, 446 East Ontario (#7-200), Chicago, IL
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Giannitrapani KF, Soban L, Hamilton AB, Rodriguez H, Huynh A, Stockdale S, Yano EM, Rubenstein LV. Role expansion on interprofessional primary care teams: Barriers of role self-efficacy among clinical associates. Healthc (Amst) 2016; 4:321-6. [PMID: 28007226 DOI: 10.1016/j.hjdsi.2016.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Interprofessional team-based models of primary care that expand the role of clinical associates (CAs) are increasingly adopted in primary care practices. In this study we query team members of a newly implemented patient centered medical home (PCMH) to identify facilitators and barriers of occupational role self-efficacy, a belief of possessing the capacity to execute their new team based role effectively. METHODS 79 key informants, members of primary care teams at six Veterans Health Administration (VA) clinics, were interviewed to assess their experiences with implementing expanded roles for CAs. All sites had implemented Patient Aligned Care Teams, the VA's version of PCMH. RESULTS Three themes that produced the self-efficacy necessary for successful role expansion of CAs were identified: (1) role training (2) time and resources for roles and (3) cross-disciplinary role agreement. Sub-themes emerged around role challenges. Training sub themes included incomplete or limited training, inconsistencies in trainings within a site, and not receiving training with team members. Insufficient resources sub-themes included limited time for expanded tasks, inadequate space, low staffing, and poor task mix. Cross-disciplinary agreement failed to occur specifically when there was insufficient coordination between medicine and nursing leadership about staff roles, poor primary care provider (PCPs) knowledge of the boundaries of staff roles, and lack of synchronicity between staff roles and what PCPs would like staff roles to include. CONCLUSIONS These identified themes have implications for healthcare professionals working in interprofessional teams in a variety of settings and indicate the need for interdisciplinary leadership based solutions. IMPLICATIONS Clarifying the factors that impact self-efficacy for the role expansion of PACT staff can inform strategies for role transformation for enhanced primary care delivery.
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