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Merker VL, Hyde JK, Herbst A, Solch AK, Mohr DC, Gaj L, Dvorin K, Dryden EM. Evaluating the Impacts of Patient Engagement on Health Services Research Teams: Lessons from the Veteran Consulting Network. J Gen Intern Med 2022; 37:33-41. [PMID: 35349028 PMCID: PMC8993982 DOI: 10.1007/s11606-021-06987-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/15/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite increasing commitment to patient engagement in research, evaluation of the impact of these efforts on research processes, products, and teams is limited. OBJECTIVE To explore the impacts of engaging patients as consultants to research studies by examining the experiences, impacts, and lessons learned from a program facilitating patient engagement at a Veterans Health Administration research center. DESIGN We developed a logic model to articulate the activities being implemented to support patient engagement and their anticipated outcomes. Then, we conducted qualitative, semi-structured interviews with participants in the local Veteran Consulting Network to qualitatively explore these outcomes. PARTICIPANTS Twelve researchers and eleven Veteran patients with experience working on at least one grant or funded study. APPROACH Interview transcripts were inductively coded using a consensus-based approach. Findings were synthesized using framework analysis and mapped back onto our logic model of expected patient engagement impacts. KEY RESULTS Patient engagement improved the perceived quality and relevance of research studies as patient consultants challenged researchers' assumptions about patient populations and clinical contexts and gave feedback that helped improve the feasibility of proposed grants, readability of study materials, comprehensiveness of study assessments, and cultural sensitivity and relevance of interventions. Patient engagement also had personal benefits to researchers and patients. Researchers reported improved communication skills and higher job satisfaction. Patients reported a sense of purpose and satisfaction from their work with greater awareness of and appreciation for research. CONCLUSIONS Engaging patients in research can have multiple benefits to the people and work involved. Our evaluation process can serve as a template for other organizations to plan for and assess the impact of their own patient engagement programs. Creating logic models and updating them based on feedback from program users make engagement goals explicit, help verify expected mechanisms to achieve impact, and facilitate organizational learning.
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Affiliation(s)
- Vanessa L Merker
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA. .,Department of Neurology and Cancer Center, Massachusetts General Hospital, MA, Boston, USA.
| | - Justeen K Hyde
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Abigail Herbst
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Amanda K Solch
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - David C Mohr
- Center of Helathcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, USA
| | - Lauren Gaj
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Kelly Dvorin
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Eileen M Dryden
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
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Vimalananda VG, Orlander JD, Afable MK, Fincke BG, Solch AK, Rinne ST, Kim EJ, Cutrona SL, Thomas DD, Strymish JL, Simon SR. Electronic consultations (E-consults) and their outcomes: a systematic review. J Am Med Inform Assoc 2021; 27:471-479. [PMID: 31621847 DOI: 10.1093/jamia/ocz185] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [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: 04/30/2019] [Revised: 08/06/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Electronic consultations (e-consults) are clinician-to-clinician communications that may obviate face-to-face specialist visits. E-consult programs have spread within the US and internationally despite limited data on outcomes. We conducted a systematic review of the recent peer-reviewed literature on the effect of e-consults on access, cost, quality, and patient and clinician experience and identified the gaps in existing research on these outcomes. MATERIALS AND METHODS We searched 4 databases for empirical studies published between 1/1/2015 and 2/28/2019 that reported on one or more outcomes of interest. Two investigators reviewed titles and abstracts. One investigator abstracted information from each relevant article, and another confirmed the abstraction. We applied the GRADE criteria for the strength of evidence for each outcome. RESULTS We found only modest empirical evidence for effectiveness of e-consults on important outcomes. Most studies are observational and within a single health care system, and comprehensive assessments are lacking. For those outcomes that have been reported, findings are generally positive, with mixed results for clinician experience. These findings reassure but also raise concern for publication bias. CONCLUSION Despite stakeholder enthusiasm and encouraging results in the literature to date, more rigorous study designs applied across all outcomes are needed. Policy makers need to know what benefits may be expected in what contexts, so they can define appropriate measures of success and determine how to achieve them.
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Affiliation(s)
- Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jay D Orlander
- Department of General Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA.,Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Melissa K Afable
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Quality, Safety and Value, Partners Healthcare System, Boston, Massachusetts, USA
| | - B Graeme Fincke
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Amanda K Solch
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA
| | - Seppo T Rinne
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Eun Ji Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Division of General Internal Medicine, Zucker School of Medicine, Hofstra Northwell, Manhasset, New York, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Dylan D Thomas
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Judith L Strymish
- Department of Medicine, Harvard Medical School, Cambridge, Massachusetts, USA.,Department of Medicine and Infectious Diseases, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Steven R Simon
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Cambridge, Massachusetts, USA.,Geriatrics and Extended Care Service, VA Boston Healthcare System, Boston, Massachusetts, USA
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Anderson E, Solch AK, Fincke BG, Meterko M, Wormwood JB, Vimalananda VG. Concerns of Primary Care Clinicians Practicing in an Integrated Health System: a Qualitative Study. J Gen Intern Med 2020; 35:3218-3226. [PMID: 32918198 PMCID: PMC7661604 DOI: 10.1007/s11606-020-06193-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/08/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Clinician well-being is a major priority for healthcare organizations. However, the impact of workplace environment on clinicians' well-being is poorly understood. Integrated health systems are a particularly relevant type of practice environment to focus on, given the increasing rates of practice consolidation and integration. OBJECTIVE To improve understanding of the concerns of primary care clinicians (PCCs) practicing in an integrated health system. DESIGN We analyzed free-text comment box responses offered on a national survey about care coordination by 555 PCCs in the Veterans Health Administration, one of the largest integrated health systems in the USA. PARTICIPANTS A total of 555 PCCs who left free-text comments on a national survey of care coordination in the VHA (30% out of 1862 eligible respondents). Demographics and coordination scale scores were similar between respondents who left comments vs. those who did not. APPROACH The data were coded and analyzed in line with the grounded theory approach. Key themes were identified by team consensus and illustrative quotations were chosen to illustrate each theme. KEY RESULTS VHA PCCs described some pressures shared across practice environments, such as prohibitive administrative burden, but also reported several concerns particular to integrated settings, including "dumping" by specialists and moral distress related to a concern for patients. Frustrations due to several aspects of responsibility around referrals may be unique to integrated health systems with salaried clinicians and/or where specialists have the ability to reject referrals. CONCLUSION PCCs in integrated health systems feel many of the same pressures as their counterparts in non-integrated settings, but they are also confronted with unique stressors related to these systems' organizational features that restrict clinicians' autonomy. An understanding of these concerns can guide efforts to improve the well-being of PCCs in existing integrated health systems, as well as in practices on their way to integration.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA.
| | - Amanda K Solch
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
| | - B Graeme Fincke
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Mark Meterko
- VHA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID), Bedford, MA, USA
| | - Jolie B Wormwood
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
- University of New Hampshire, Durham, NH, USA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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