1
|
Tosteson ANA, Kirkland KB, Holthoff MM, Van Citters AD, Brooks GA, Cullinan AM, Dowling-Schmitt MC, Holmes AB, Meehan KR, Oliver BJ, Wasp GT, Wilson MM, Nelson EC. Harnessing the Collective Expertise of Patients, Care Partners, Clinical Teams, and Researchers Through a Coproduction Learning Health System: A Case Study of the Dartmouth Health Promise Partnership. J Ambul Care Manage 2023; 46:127-138. [PMID: 36820633 PMCID: PMC9976397 DOI: 10.1097/jac.0000000000000460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The coproduction learning health system (CLHS) model extends the definition of a learning health system to explicitly bring together patients and care partners, health care teams, administrators, and scientists to share the work of optimizing health outcomes, improving care value, and generating new knowledge. The CLHS model highlights a partnership for coproduction that is supported by data that can be used to support individual patient care, quality improvement, and research. We provide a case study that describes the application of this model to transform care within an oncology program at an academic medical center.
Collapse
Affiliation(s)
- Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Hanover, New Hampshire (Drs Tosteson, Kirkland, Brooks, Oliver, and Nelson and Mss Holthoff and Van Citters); Dartmouth Cancer Center, Geisel School of Medicine and Dartmouth Health, Lebanon, New Hampshire (Drs Tosteson, Brooks, Meehan, and Wasp and Ms Dowling-Schmitt); Division of Palliative Medicine, Department of Medicine, Dartmouth Hitchcock Medical Center & Clinics, Lebanon, New Hampshire (Drs Kirkland, Cullinan, and Wilson); and Office of Care Experience, Value Institute, Dartmouth Health, Lebanon, New Hampshire (Dr Oliver). Ms Holmes is a patient advisors at Dartmouth Hitchcock Medical Center & Clinics, Lebanon, New Hampshire
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Tse CS, Melmed GY, Siegel CA, Weng CH, Shah SA, Weaver SA, Oliver BJ, Elwyn G, van Deen WK. Bidirectional Correlations Between Health Confidence and Inflammatory Bowel Disease Activity: A Nationwide Longitudinal Cohort Study. Inflamm Bowel Dis 2023; 29:161-166. [PMID: 35640124 DOI: 10.1093/ibd/izac107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/15/2022] [Indexed: 02/05/2023]
Abstract
Lay Summary
Health confidence—an individual’s belief in their ability and agency to affect disease outcomes—has bidirectional temporal correlations with inflammatory bowel disease activity. Low health confidence is associated with higher risks for future disease activity, and inflammatory bowel disease flares erode confidence.
Collapse
Affiliation(s)
- Chung Sang Tse
- Division of Gastroenterology, University of California, San Diego, La Jolla, CA, USA
| | - Gil Y Melmed
- Inflammatory Bowel and Immunobiology Research Institute, Karsh Division of Digestive and Liver Diseases, Cedars-Sinai, Los Angeles, CA, USA
| | - Corey A Siegel
- Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Chien-Hsiang Weng
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Samir A Shah
- Division of Gastroenterology, Warren Alpert Medical School of Brown University, Providence, RI, USA.,Gastroenterology Associates, Providence, RI, USA
| | | | - Brant J Oliver
- Department of Community and Family Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.,Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.,Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Office of Patient Experience, Value Institute Learning Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Glyn Elwyn
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Welmoed K van Deen
- Health Technology Assessment Research Group, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
3
|
Tse CS, Siegel CA, Weaver SA, Oliver BJ, Bresee C, van Deen WK, Melmed GY. Health Confidence Is Associated With Disease Outcomes and Health Care Utilization in Inflammatory Bowel Disease: A Nationwide Cross-sectional Study. Inflamm Bowel Dis 2022; 28:1565-1572. [PMID: 34893849 DOI: 10.1093/ibd/izab313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND We aimed to examine the associations between health confidence (one's belief on the degree of control on their health and disease), inflammatory bowel disease (IBD) outcomes, and health care utilization among adults with IBD. METHODS In total, 17,205 surveys were analyzed from a cross-sectional sample of IBD patients at 23 gastroenterology (GI) practices participating in the Crohn's and Colitis Foundations' IBD Qorus Learning Health System. We used bivariate analyses and multivariable logistic regression to examine associations between health confidence and disease activity, opioid use, glucocorticoid use, well-being, and health care utilization. We used receiver operating curve analysis to determine a clinically relevant cutoff for health confidence (0-10 Likert scale). RESULTS Health confidence was highly correlated with patients' well-being, symptomatic disease activity, opioid use, and glucocorticoid use (all P < .0001). Health confidence scores <8 had 69% sensitivity for emergency department (ED) visits and 66% for hospitalizations. In patients with inactive disease, patients with low health confidence (<8) were 10 times more likely to call/message the GI office >4 times/month (adjusted odds ratio [aOR], 10.3; 95% CI, 6.1-17.3; P < .0001), 3-4 times more likely to have an IBD-related ED visit (aOR, 4.0; 95% CI, 2.9, 5.4. P < .0001), or hospitalization (aOR, 3.0, 95% CI, 2.1, 4.1, P < .0001) compared with patients with high health confidence (≥8). CONCLUSIONS In a large, national sample of adults with IBD, there were strong associations between patients' health confidence and multiple disease outcome measures. Health confidence scores <8 on a 0-10 Likert scale may be clinically useful to screen for patients who are at risk for ED visits and hospitalizations.
Collapse
Affiliation(s)
- Chung Sang Tse
- Inflammatory Bowel Disease Preceptorship, University of California, San Diego, La Jolla, CA, USA
| | - Corey A Siegel
- Section Chief of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Brant J Oliver
- Departments of Community & Family Medicine, Psychiatry, and The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Health and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Catherine Bresee
- Biostatistics Core, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Welmoed K van Deen
- Assistant Professor, Erasmus School of Health Policy and Management, Health Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Gil Y Melmed
- Co-Director, Cedars-Sinai Inflammatory Bowel Disease Center, Karsh Division of Gastroenterology, Cedars-Sinai, Los Angeles, CA, USA
| |
Collapse
|
4
|
Austin AM, Leggett CG, Schmidt P, Bolin P, Nelson EC, Oliver BJ, King AC. Utilization Patterns and Outcomes of People With Diabetes and COVID-19: Evidence From United States Medicare Beneficiaries in 2020. Front Clin Diabetes Healthc 2022; 3:920478. [PMID: 36992748 PMCID: PMC10012137 DOI: 10.3389/fcdhc.2022.920478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022]
Abstract
ObjectiveDetermine differences in utilization patterns, disease severity, and outcomes between patients with and without diabetes mellitus diagnosed with COVID-19 in 2020Research Design and MethodsWe used an observational cohort comprised of Medicare fee-for-service beneficiaries with a medical claim indicating a COVID-19 diagnosis. We performed inverse probability weighting between beneficiaries with and without diabetes to account for differences in socio-demographic characteristics and comorbidities.ResultsIn the unweighted comparison of beneficiaries, all characteristics were significantly different (P<0.001). Beneficiaries with diabetes were younger, more likely to be black, had more comorbidities, higher rates of Medicare-Medicaid dual-eligibility, and were less likely to be female. In the weighted sample, hospitalization rates for COVID-19 among beneficiaries with diabetes was higher (20.5% vs 17.1%; p < 0.001). Outcomes of hospitalizations were similarly worse among beneficiaries with diabetes: admissions to ICU during hospitalizations (7.78% vs. 6.11%; p < 0.001); in-hospital mortality (3.85% vs 2.93%; p < 0.001); and ICU mortality (2.41% vs 1.77%). Beneficiaries with diabetes had more ambulatory care visits (8.9 vs. 7.8, p < 0.001) and higher overall mortality (17.3% vs. 14.9%, p < 0.001) following COVID-19 diagnosis.ConclusionBeneficiaries with diabetes and COVID-19 had higher rates of hospitalization, ICU use and overall mortality. While the mechanism of how diabetes impacts the severity of COVID-19 may not be fully understood, there are important clinical implications for persons with diabetes. A diagnosis of COVID-19 leads to greater financial and clinical burden than for their counterparts, persons without diabetes, including perhaps most significantly, higher death rates.
Collapse
Affiliation(s)
- Andrea M. Austin
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Christopher G. Leggett
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Peter Schmidt
- Grossman School of Medicine, New York University, New York, NY, United States
| | - Paul Bolin
- Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Eugene C. Nelson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Brant J. Oliver
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Departments of Community & Family Medicine and Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Office of Patient Experience, Value Institute, Dartmouth-Hitchcock, Lebanon, NH, United States
| | - Ashleigh C. King
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- *Correspondence: Ashleigh C. King,
| |
Collapse
|
5
|
Lind J, Persson S, Vincent J, Lindenfalk B, Oliver BJ, Smith AD, Andersson Gäre B. Contact patterns and costs of multiple sclerosis in the Swedish healthcare system-A population-based quantitative study. Brain Behav 2022; 12:e2582. [PMID: 35511113 PMCID: PMC9226803 DOI: 10.1002/brb3.2582] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/23/2022] [Revised: 03/11/2022] [Accepted: 03/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The burden of disease for persons with multiple sclerosis (MS) and society is changing due to new treatments. Knowledge about the total need for care is necessary in relation to changing needs and new service models. OBJECTIVE The aim of this study was to describe the contact patterns for MS patients, calculate costs in health care, and create meaningful subgroups to analyze contact patterns. METHODS All patients diagnosed with MS at Ryhov Hospital were included. All contacts in the region from January 1, 2018, until September 30, 2019, were retrieved from the hospital administrative system. Data about age, sex, contacts, and diagnosis were registered. The cost was calculated using case costing, and costs for prescriptions were calculated from medical files. RESULTS During the 21-month period, patients (n = 305) had 9628 contacts and 7471 physical visits, with a total cost of $7,766,109. Seventeen percent of the patients accounted for 48% of the visits. The median annual cost was $7386 in the group with 10 or fewer visits, compared to $22,491 in patients with more than 50 visits. CONCLUSION There are considerable differences in the utilization of care and cost between patients with MS in an unselected population, meaning that the care needs to be better customized to each patient's demands.
Collapse
Affiliation(s)
- Jonas Lind
- Section of Neurology, Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.,Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sofia Persson
- Department of Public Health and Health Care, Region Jönköping County, Jönköping, Sweden.,Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Jonatan Vincent
- Department of Public Health and Health Care, Region Jönköping County, Jönköping, Sweden
| | - Bertil Lindenfalk
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Brant J Oliver
- Departments of Community and Family Medicine, Psychiatry, and the Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA
| | - Andrew D Smith
- Multiple Sclerosis Center, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine Dartmouth College, Lebanon, New Hampshire, USA
| | - Boel Andersson Gäre
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping and Futurum, Region Jönköping County, Sweden
| |
Collapse
|
6
|
Oliver BJ, Kennedy AM, van Deen WK, Weaver SA, Heller C, Holthoff MM, Bank J, Melmed GY, Siegel CA, Nelson EC. Development of Balanced Whole System Value Measures for Inflammatory Bowel Disease Care in the IBD Qorus Collaborative Using a Modified Delphi Process. Inflamm Bowel Dis 2022; 28:327-336. [PMID: 34037211 DOI: 10.1093/ibd/izab091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/05/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The IBD Qorus Collaborative aims to reduce variation and increase the value of care for the adult inflammatory bowel disease (IBD) community. To evaluate the success of the collaborative, we aimed to develop a balanced set of outcome measures that reflect a multistakeholder view of value in IBD care. To achieve this, we used the Clinical Value Compass framework and engaged a mixed-stakeholder group to conduct a modified Delphi process. The end result was a 10-measure set to assess the value of IBD care. METHOD The modified Delphi process included 3 iterative rounds of blinded voting and interactive webinar-style discussion. We recruited 18 participants for the Delphi panel, including clinicians, researchers, patients, Crohn's & Colitis Foundation staff, and payers. Participants first identified constructs to measure, then identified the tools to measure those constructs. A literature review and environmental scan of current measures in 4 domains were performed, and relevant measures were proposed for discussion and voting in each domain. Throughout the process, participants were invited to contribute additional measures. CONCLUSION The modified Delphi process led to selection of 10 value measures across 4 domains: (1) patient experience; (2) functional status; (3) clinical status; and (4) health care costs and utilization. We have successfully completed a 3-stage modified Delphi process to develop a balanced set of value measures for adult IBD care. The value measure set expands upon prior efforts that have established quality measures for IBD care by adding cost and experience of care elements. This work positions IBD Qorus to better assess, study, improve, and demonstrate value at individual, system, and population levels and will inform and empower related research, improvement, and implementation efforts.
Collapse
Affiliation(s)
- Brant J Oliver
- Departments of Community & Family Medicine, Psychiatry, and the Dartmouth Institute, Geisel School of Medicine at Dartmouth, USA
| | - Alice M Kennedy
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine and Dartmouth, Lebanon, New Hampshire, USA
| | | | | | - Caren Heller
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Megan M Holthoff
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine and Dartmouth, Lebanon, New Hampshire, USA
| | - Jeffrey Bank
- University of Utah Health, Salt Lake City, Utah, USA
| | - Gil Y Melmed
- The Crohn's & Colitis Foundation, New York, New York, USA
| | - Corey A Siegel
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Eugene C Nelson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine and Dartmouth, Lebanon, New Hampshire, USA
| |
Collapse
|
7
|
N’Dri LA, Waters DD, Walsh K, Mehta F, Oliver BJ. System-Level Variation in Multiple Sclerosis Disease-Modifying Therapy Utilization: Findings From the Multiple Sclerosis Continuous Quality Improvement Research Collaborative. Perm J 2021; 25:21.025. [PMID: 35348092 PMCID: PMC8784072 DOI: 10.7812/tpp/21.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/30/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Multiple Sclerosis Continuous Quality Improvement (MS-CQI) Collaborative is the first multicenter improvement research collaborative for multiple sclerosis (MS). The main objective of this study is to describe baseline system-level variation in disease-modifying therapy (DMT) utilization across 4 MS centers participating in MS-CQI. METHODS Electronic health record data from the first year of the 3-year MS-CQI study were analyzed. Participants were adults ≥ 18 years with MS presenting to any of the 4 MS-CQI centers. DMT utilization was categorized into oral, infusion, and injection types. Multinomial logistic regression was used to investigate associations between centers and DMT utilization. RESULTS Overall, 2,029 patients were included in the analysis. Of those patients, 75.1% were female, mean age was 50 years, and 87.4% had relapsing-remitting MS. Overall, 32.7% were on an oral DMT, 23.5% on an infusion DMT, and 43.9% on an injection DMT. Overall, statistically significant differences (p < 0.01) were observed across centers for proportions of patients who received oral, infusion, and no DMTs. There were also overall significant differences (p < 0.01) across MS types for proportions of encounters who received oral, infusion, injection, no DMTs, and mean age varied significantly across centers. CONCLUSION System-level effects on MS treatment and outcomes have not been previously studied and our findings contribute initial evidence concerning system-level variation in DMT utilization. Results suggest system-level variation in DMT utilization (ie, after adjusting for individual level factors, MS center or location of care a person with MS engages in care influences DMT treatment choices), resulting in a lack of standardization in DMT management. Continued research and improvement efforts targeting system-level performance could improve outcomes for people with MS.
Collapse
Affiliation(s)
| | | | - Karen Walsh
- Jefferson College of Population Health, Philadelphia, PA
| | - Falguni Mehta
- Departments of Community and Family Medicine, Psychiatry, and the Dartmouth Institute for Health Policy and Clinical Practice (TDI), Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Brant J Oliver
- Departments of Community and Family Medicine, Psychiatry, and the Dartmouth Institute for Health Policy and Clinical Practice (TDI), Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth-Hitchcock Health, Lebanon, NH
- Department of Veterans Affairs National Quality Scholars (VAQS) and Health Professions Education and Evaluation Research (HPEER) Advanced Fellowship Programs, White River Junction, VT and Houston, TX
| | - for the MS-CQI Investigators
- Jefferson College of Population Health, Philadelphia, PA
- Departments of Community and Family Medicine, Psychiatry, and the Dartmouth Institute for Health Policy and Clinical Practice (TDI), Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth-Hitchcock Health, Lebanon, NH
- Department of Veterans Affairs National Quality Scholars (VAQS) and Health Professions Education and Evaluation Research (HPEER) Advanced Fellowship Programs, White River Junction, VT and Houston, TX
| |
Collapse
|
8
|
Schmidt P, Nelson EC, Kearney G, Kraft S, Oliver BJ. International, national and local trends in the spread of COVID-19: a geographic view of COVID-19 spread and the role to be played by coproduction. Int J Qual Health Care 2021; 33:ii71-ii77. [PMID: 34849958 PMCID: PMC8690201 DOI: 10.1093/intqhc/mzab074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/14/2021] [Revised: 03/12/2021] [Accepted: 04/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND COVID-19, a respiratory disease caused by the SARS-CoV-2 virus, emerged in 2019 and led to a worldwide pandemic in 2020. The COVID-19 pandemic has been a massive natural experiment in the formation of mitigation strategies to prevent cases and to provide effective healthcare for those afflicted. Regional differences in the impact of the pandemic on morbidity and mortality have been driven by political and regional differences in the coproduction of public health and social policy. We explored the United States (US) experience of COVID-19 for trends and correlations with other nations and also at the national, regional, state and local levels. OBJECTIVE To identify geographic and temporal trends in the spread of COVID-19 in the United States. METHODS Population data on COVID-19 cases and mortality were acquired on a daily basis from multiple publicly available databases, including the New York Times and Johns Hopkins University. At each geographic level (national, state and county), geographic entities' reported cases were evaluated for correlations using linear least-squares methods to identify patterns of correlation in the cases independent of scale. We evaluated for two specific characteristics: (i) the nature of the curvature of the line linking across percentile scores, ranging from concave to convex and (ii) the area under this curve, indicating how effectively a selected region (nation, state and county) is linked to its entire containing unit (world, country and state). We used this approach to identify three distinct COVID behavior phenotypes, each of which consisted of a number of states in the USA. RESULTS We found that COVID activity in the USA follows a unique trend compared to other countries and that within the USA during the first year of the pandemic, three initial COVID phenotypes emerged: (i) the metropolitan outbreak (early outbreak phenotype); (ii) the regional outbreak (summer peak phenotype) and (iii) trans-regional outbreak (fall/winter peak phenotype), which, taken in sum, represent the overall USA national trend. Each phenotype has specific behavioral characteristics and is composed of a cluster of different states experiencing different conditions. CONCLUSION Our findings suggest a new opportunity for public health strategy in the pandemic, namely to apply targeted public health approaches to address the specific needs of each phenotype. In the future, we should create databases that capture key health and hardship data elements at the smallest geographic level possible and use these to track trends, predict the future and apply targeted coproduction approaches to more effectively and efficiently safeguard population health, economic vitality and social well-being.
Collapse
Affiliation(s)
- Peter Schmidt
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Eugene C Nelson
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Gregory Kearney
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Sally Kraft
- Population Health, Dartmouth-Hitchcock Health, Lebanon, NH, USA
| | - Brant J Oliver
- Population Health, Dartmouth-Hitchcock Health, Lebanon, NH, USA
- Departments of Community and Family Medicine and Psychiatry, Dartmouth-Hitchcock Health and Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Department of Veterans Affairs, VAQS and HPEER Advanced Fellowship Programs, White River Junction, Houston, TX, USA
| |
Collapse
|
9
|
Oliver BJ, Schmidt P, Tomlin S, Kraft SA, Fisher E, Nelson EC. A 'COVID Compass' for navigating the pandemic. Int J Qual Health Care 2021; 33:ii78-ii80. [PMID: 34849969 DOI: 10.1093/intqhc/mzab053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/14/2021] [Revised: 03/10/2021] [Accepted: 03/24/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The greatest challenge confronting political, public health, business, education and social welfare leaders in the COVID pandemic era is to restore the economy, businesses and schools without further risking public health. The 'COVID Compass' project aims to provide helpful information to guide local decisions by tracking state and local policies over time and their impact on a balanced set of outcomes-health metrics, economic trends and social hardship indicators. METHODS We selected a parsimonious set of 'local level' health, economic and hardship outcomes and linked them to 'local level' actions aimed to decrease COVID-19 health effects and to mitigate hardship for people, businesses and the economy. Data trends will be released frequently (e.g. weekly and monthly) to show changes in health economic and social hardship 'outcomes' (based on quantitative data), alongside policy, health care, public health and individual/social 'actions' (based on both qualitative and quantitative data). RESULTS Work on initial analytic and visualization prototypes of the COVID Compass is currently in progress at national, state and local levels. CONCLUSION Building a national, regional and local integrated database platform that captures upstream policies, actions and behaviors and links them to downstream health, economic and social hardship outcomes will offer a more comprehensive view of the data necessary for decision-makers and citizens to more effectively and intelligently monitor and mitigate harms caused by the pandemic.
Collapse
Affiliation(s)
- Brant J Oliver
- Departments of Community & Family Medicine and Psychiatry, Dartmouth-Hitchcock Health and Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA.,Department of Veterans Affairs, White River Junction, VAQS and HPEER Advanced Fellowship Programs, Debakey VA Medical Center. 2002 Holcombe Blvd., Houston, TX 77030, USA.,The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Peter Schmidt
- Brody School of Medicine, East Carolina University, 600 Moye Blvd, Greenville, NC 27834, USA
| | - Stephanie Tomlin
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Sally A Kraft
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA.,Center for Population Health, Dartmouth-Hitchcock Health, Lebanon, NH 03756, USA
| | - Elliott Fisher
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Eugene C Nelson
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| |
Collapse
|
10
|
Oliver BJ, Forcino RC, Batalden PB. Initial development of a self-assessment approach for coproduction value creation by an international community of practice. Int J Qual Health Care 2021; 33:ii48-ii54. [PMID: 34849960 DOI: 10.1093/intqhc/mzab077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/15/2021] [Revised: 03/26/2021] [Accepted: 05/03/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Coproduction offers a new way of conceptualizing healthcare as a service that is co-created by people (health professionals and people seeking health services) rather than a product that is generated by providers or health systems and delivered to patients. This offers new possibilities for those introducing and testing changes, and it enables additional ways of creating value. Fjeldstad and colleagues describe the architecture of several kinds of value creating systems: (i) Chain; (ii) Shop; (iii) Network and (iv) Access. An international Value Creating Business Model Community of practice (VCBM CoP) was formed by the International Coproduction of Health Network and explored these types of systems and developed a self-assessment guide for health systems to use to assess value. METHODS An international community of practice comprising leaders, clinicians, patients and finance specialists representing 12 health systems from four countries (USA, UK, Israel and Sweden) met monthly for 1 year and used a semi-structured process to iteratively refine and adapt Fjeldstad's model for use in healthcare and develop a draft self-assessment guide. The process concluded with initial focus group user experience sessions with six health systems. RESULTS The community of practice successfully completed a 1-year journey of discovery, development and learning, resulting in two products: (1) a full-version self-assessment guide (detailed) and (2) an abbreviated 'short-form' of the guide. Initial focus-group results suggest that there is initial perceived feasibility, acceptability and utility of the guides and that further development and research is reasonable to pursue. Results suggest significant variation and context specificity in the use of the guide, simple and complex knowledge transfer applications in use, and the need for the development of simple and technology supported versions for use in the future. CONCLUSION The VCBM CoP has successfully completed a 1-year collaborative learning cycle, resulting in the development of a self-assessment guide that is now ready for additional investigation using formal research methods. The CO-VALUE study has been designed to build on the work of the CoP and includes qualitative and quantitative assessment phases and a concept mapping study.
Collapse
Affiliation(s)
- Brant J Oliver
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH 03756, USA.,Department of Community and Family Medicine, Dartmouth-Hitchcock Health, D-H Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, D-H Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Rachel C Forcino
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Paul B Batalden
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH 03756, USA
| |
Collapse
|
11
|
Oliver BJ, Walsh K, Messier R, Mehta F, Cabot A, Klawiter E, Pagnotta P, Solomon A, England SE. System-Level Variation in Multiple Sclerosis Care Outcomes: Initial Findings from the Multiple Sclerosis Continuous Quality Improvement Research Collaborative. Popul Health Manag 2021; 25:46-56. [PMID: 34134513 DOI: 10.1089/pop.2021.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Multiple sclerosis (MS) is a "3C" (complex, chronic, costly) condition that is a common and disabling neurological illness affecting approximately 1 million adults in the United States. MS has been studied at the basic science, individual, and population levels, but not at the system level to assess small-area variation effects on MS population health outcomes. System-level effects have been observed in other 3C conditions including cystic fibrosis, rheumatoid arthritis, and inflammatory bowel disease. The authors report here on system-level variation findings from the baseline period during the first year of the Multiple Sclerosis Continuous Quality Improvement (MS-CQI) study. Stepwise binary logistic regression analyses were conducted to investigate system-level (small-area variation) effects on MS relapses (exacerbations), disease-modifying therapy (DMT) utilization, and brain MRI utilization, controlling for demographics (age and sex) and other potential confounders. Significant differences were observed in people with MS (PwMS) between centers for a number of demographic and disease characteristics, including sex, age, and MS subtype. Controlling for these factors, significant system-level effects were observed on outcomes, including DMT utilization, MRI utilization, and relapses. Significant relationships also were observed between outcomes and urgent care utilization, including emergency department visits and hospitalizations. This initial study provides evidence establishing the presence of system-level variation effects on MS outcomes in a multicenter population study - where PwMS get their care can influence their outcomes. Results support continued systems-level research and improvement initiatives to optimize MS population health outcomes in this challenging and costly complex chronic condition.
Collapse
Affiliation(s)
- Brant J Oliver
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock-Health, Lebanon, New Hampshire, USA.,The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Multiple Sclerosis Specialty Care Program, Concord Hospital Neurology, Concord, New Hampshire, USA
| | - Karen Walsh
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | | | - Falguni Mehta
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock-Health, Lebanon, New Hampshire, USA
| | - Ann Cabot
- Multiple Sclerosis Specialty Care Program, Concord Hospital Neurology, Concord, New Hampshire, USA
| | - Eric Klawiter
- Multiple Sclerosis Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia Pagnotta
- Multiple Sclerosis Center, Department of Neurology, University of Vermont Medical Center and Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | | | | |
Collapse
|
12
|
Horstman MJ, Miltner RS, Wallhagen MI, Patrician PA, Oliver BJ, Roumie CL, Dolansky MA, Perez F, Naik AD, Godwin KM. Developing Leaders and Scholars in Health Care Improvement: The VA Quality Scholars Program Competencies. Acad Med 2021; 96:68-74. [PMID: 32769476 DOI: 10.1097/acm.0000000000003658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite the need for leaders in health care improvement across health professions, there are no standards for the knowledge and skills that should be achieved through advanced interprofessional health care improvement training. Existing health care improvement training competencies focus on foundational knowledge expected of all trainees or for specific career pathways. Health care improvement leaders fill multiple roles within organizations and promote interprofessional improvement practice. The diverse skill set required of modern health care improvement leaders necessitates the development of training competencies specifically for fellowships in applied health care improvement. The authors describe the development of the revised national Veterans Affairs Quality Scholars (VAQS) Program competencies. The VAQS Program is an interprofessional, postdoctoral training program whose mission is to develop leaders and scholars to improve health care. An interprofessional committee of VAQS faculty reviewed and revised the competencies over 4 months beginning in fall 2018. The first draft was developed using 111 competencies submitted by 11 VAQS training sites and a review of published competencies. The final version included 22 competencies spanning 5 domains: interprofessional collaboration and teamwork, improvement and implementation science, organization and system leadership, methodological skills and analytic techniques for improvement and research, and teaching and coaching. Once attained, the VAQS competencies will guide the skill development that interprofessional health care improvement leaders need to participate in and lead health care improvement scholarship and implementation. These broad competencies are relevant to advanced training programs that develop health care improvement leaders and scholars and may be used by employers to understand the knowledge and skills expected of individuals who complete advanced fellowships in applied health care improvement.
Collapse
Affiliation(s)
- Molly J Horstman
- M.J. Horstman is assistant professor, Department of Medicine, Section of Health Services Research, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, investigator, Center for Innovations in Quality, Effectiveness, and Safety, and core faculty, VA Quality Scholars Coordinating Center, Houston, Texas
| | - Rebecca S Miltner
- R.S. Miltner is associate professor, University of Alabama at Birmingham School of Nursing, and associate faculty scholar, VA Quality Scholars Fellowship Program, Birmingham VA Medical Center site, Birmingham, Alabama
| | - Margaret I Wallhagen
- M.I. Wallhagen is professor, Department of Physiological Nursing, director, UCSF Hartford Center of Gerontological Nursing Excellence, and senior nurse faculty scholar, VA Quality Scholars Fellowship Program, San Francisco VA Medical Center site, San Francisco, California
| | - Patricia A Patrician
- P.A. Patrician is professor and Rachel Z. Booth Endowed Chair in Nursing, University of Alabama at Birmingham School of Nursing, and senior faculty scholar, VA Quality Scholars Fellowship Program, Birmingham VA Medical Center site, Birmingham, Alabama
| | - Brant J Oliver
- B.J. Oliver is associate professor, Departments of Community and Family Medicine, Psychiatry, and Dartmouth Institute at Dartmouth-Hitchcock Medical Center, and Geisel School of Medicine at Dartmouth, adjunct associate professor, MGH Institute of Health Professions School of Nursing, Hanover, New Hampshire, and faculty senior scholar, VA Quality Scholars Fellowship Program, White River Junction VAMC site, White River Junction, Vermont
| | - Christianne L Roumie
- C.L. Roumie is associate professor of internal medicine and pediatrics, Vanderbilt University Medical Center and VA Tennessee Valley Healthcare System, Geriatrics Research and Education Clinical Center, Nashville, Tennessee
| | - Mary A Dolansky
- M.A. Dolansky is associate professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, associate director, VA Quality Scholars Fellowship Program, senior nurse faculty, Cleveland VA Quality Scholars Fellowship Program site, and director, Quality and Safety Education for Nurses Institute, Cleveland, Ohio
| | - Federico Perez
- F. Perez is associate professor, Department of Medicine, Case Western Reserve University School of Medicine, faculty scholar, VA Quality Scholars Fellowship Program, Cleveland VA Medical Center site, and investigator, VISN-10 Geriatrics Research, Education, and Clinical Center, Cleveland, Ohio
| | - Aanand D Naik
- A.D. Naik is investigator, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, senior advisor for the VA Quality Scholars Coordinating Center, and associate professor, Department of Medicine, Sections of Health Services Research and Geriatrics, Baylor College of Medicine, Houston, Texas
| | - Kyler M Godwin
- K.M. Godwin is assistant professor, Department of Medicine, Section of Health Services Research, Baylor College of Medicine, investigator, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, and director, VA Quality Scholars Coordinating Center, Houston, Texas
| |
Collapse
|
13
|
Oliver BJ, Batalden PB, DiMilia PR, Forcino RC, Foster TC, Nelson EC, Garre BA. COproduction VALUE creation in healthcare service (CO-VALUE): an international multicentre protocol to describe the application of a model of value creation for use in systems of coproduced healthcare services and to evaluate the initial feasibility, utility and acceptability of associated system-level value creation assessment approaches. BMJ Open 2020; 10:e037578. [PMID: 33020095 PMCID: PMC7537448 DOI: 10.1136/bmjopen-2020-037578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Coproduction introduces a fundamental shift in how healthcare service is conceptualised. The mechanistic idea of healthcare being a 'product' generated by the healthcare system and delivered to patients is replaced by that of a service co-created by the healthcare system and the users of healthcare services. Fjeldstad et al offer an approach for conceptualising value creation in complex service contexts that we believe is applicable to coproduction of healthcare service. We have adapted Fjeldstad's value creation model based on a detailed case study of a renal haemodialysis service in Jonkoping, Sweden, which demonstrates coproduction characteristics and key elements of Fjeldstad's model. METHODS AND ANALYSIS We propose a five-part coproduction value creation model for healthcare service: (1) value chain, characterised by a standardised set of processes that serve a commonly occurring need; (2) value shop, which offers a customised response for unique cases; (3) a facilitated value network, which involves groups of individuals struggling with similar challenges; (4) interconnection between shop, chain and network elements and (5) leadership. We will seek to articulate and assess the value creation model through the work of a community of practice comprised of a diverse international workgroup with representation from executive, financial and clinical leaders as well as other key stakeholders from multiple health systems. We then will conduct pilot studies of a qualitative self-assessment process in participating health systems, and ultimately develop and test quantitative measures for assessing coproduction value creation. ETHICS AND DISSEMINATION This study has been approved by the Dartmouth-Hitchcock Health Institutional Review Board (D-HH IRB) as a minimal risk research study. Findings and scholarship will be disseminated broadly through continuous engagement with health system stakeholders, national and international academic presentations and publications and an internet-based electronic platform for publicly accessible study information.
Collapse
Affiliation(s)
- Brant J Oliver
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Paul B Batalden
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Peter Rocco DiMilia
- Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Rachel C Forcino
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Tina C Foster
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Eugene C Nelson
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | | |
Collapse
|
14
|
Abstract
Patient activation is an important aspect of self-management for adults with chronic non cancerous health conditions (CHC). However, there is limited evidence about which measures of patient activation and healthrelated quality of life are most useful to clinicians. This systematic review examined regarding the types of measures used to evaluate a patient's readiness for self-management including patient activation and healthrelated quality of life (HRQOL). Two such as measurements are the Patient Activation Measure (PAM) and overall PROMIS® Global health. Ten articles were identified which included measurement of patient activation and HRQOL. The results indicate that HRQOL is evaluated with various measurement tools. Most researchers agree that patient activation and the measurement of global HRQOL positively contribute to successful self-management strategies.
Collapse
Affiliation(s)
| | | | - Brant J Oliver
- Departments of Community & Family Medicine, Psychiatry, The Dartmouth Institute for Health Policy & Clinical Practice, The Geisel School of Medicine at Dartmouth
| |
Collapse
|
15
|
Adelson KB, Herbst RS, Peterson P, Ingram M, Oliver BJ, Agrawal T, Davies M, Rudell E. NSCLC: Integrating the “Yale model shared decision-making solution” into the practice setting. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7054 Background: Lung cancer patients are faced with treatment choices that involve complex decisions that can be preference-sensitive. In 2017 the National Quality Forum initiated a “Call to Action” to integrate shared decision-making (SDM) processes into practice in which clinicians and patients work together to make healthcare decisions that align with what matters most to patients. Projects In Knowledge, @Point of Care, Dartmouth and Yale collaborated to develop a pilot educational initiative to address and improve patient-centered care and SDM processes in the institutional cancer-care setting. Methods: Training materials co-developed for the Yale NSCLC team members (oncologists, nurses/NPs, social worker) address SDM, Checkpoint Inhibitor Therapy in NSCLC, and clinician-patient role play methods for implementing SDM in treatment discussions/decisions. Qualitative interview and observational methods were used to assess improved SDM performance by the multidisciplinary Yale NSCLC team by comparing baseline pre-intervention to post-intervention interviews and rating observed performance on case study role-play scenarios. Following the training and assessments, a focus group that included all team members was conducted to assess the acceptability, feasibility, and repeatability of the program and to inform future education. Results: Training empowered all Yale NSCLC team members to show pre- to post-education improvement in SDM (34% to 88%). Areas of greatest improvement: 1) providing reasonable treatment options to patients (+58%); 2) determining decision style preference – to what extent a patient wants to participate in the treatment decision process with their clinician (+76%); 3) determining patients’ risk tolerance regarding treatments that may be more efficacious but may have more side effects (+77); and 4) determining patients’ goals/preferences (+88%). Conclusions: Educational training improved SDM skills by all Yale NSCLC team members, which can lead to improved clinician-patient decision-making and patient-centric care. The training process also facilitated team building and encouraged ongoing participation in SDM.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Marianne Davies
- Yale University & Yale Comprehensive Cancer Center, New Haven, CT
| | | |
Collapse
|
16
|
Oliver BJ, Pomerleau M, Potter M, Phillips A, Carpenter S, Ciesielski S, Pusey-Reid E, Marcous A, Grobecker P. Optimizing NCLEX-RN Pass Rate Performance Using an Educational Microsystems Improvement Approach. J Nurs Educ 2018; 57:265-274. [DOI: 10.3928/01484834-20180420-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 11/29/2017] [Indexed: 11/20/2022]
|
17
|
Godfrey MM, Oliver BJ. Accelerating the rate of improvement in cystic fibrosis care: contributions and insights of the learning and leadership collaborative. BMJ Qual Saf 2015; 23 Suppl 1:i23-i32. [PMID: 24608547 DOI: 10.1136/bmjqs-2014-002804] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The Learning and Leadership Collaborative (LLC) supports cystic fibrosis (CF) centres' responses to the variation in CF outcomes in the USA. Between 2002 and 2013, the Cystic Fibrosis Foundation (CFF) designed, tested and modified the LLC to guide front line staff efforts in these efforts. This paper describes the CFF LLC evolution and essential elements that have facilitated increased improvement capability of CF centres and improved CF outcomes. METHODS CF centre improvement teams across the USA have participated in 11 LLCs of 12 months' duration since 2002. Based on the Dartmouth Microsystem Improvement Curriculum, the original LLC included face to face meetings, an email listserv, conference calls and completion of between learning session task books. The LLCs evolved over time to include internet based learning, an electronic repository of improvement resources and examples, change ideas driven by evidence based clinical practice guidelines, benchmarking site visits, an applied QI measurement curriculum and team coaching. RESULTS Over 90% of the CF centres in the USA have participated in the LLCs and have increased their improvement capabilities. Ten essential elements were identified as contributors to the successful LLCs: LLC national leadership and coordination, local leadership, people with CF and families involvement, registry data transparency, standardised improvement curriculum with evidence based change ideas, internet resources with reminders, team coaching, regular progress reporting and tracking, benchmarking site visits and applied improvement measurement. CONCLUSIONS The LLCs have contributed to improved medical and process outcomes over the past 10 years. Ten essential elements of the LLCs may benefit improvement efforts in other chronic care populations and health systems.
Collapse
Affiliation(s)
- Marjorie M Godfrey
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, , New Hampshire, USA
| | | |
Collapse
|
18
|
Estrada CA, Dolansky MA, Singh MK, Oliver BJ, Callaway-Lane C, Splaine M, Gilman S, Patrician PA. Mastering improvement science skills in the new era of quality and safety: the Veterans Affairs National Quality Scholars Program. J Eval Clin Pract 2012; 18:508-14. [PMID: 22304698 DOI: 10.1111/j.1365-2753.2011.01816.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Healthcare professionals need a new skill set to ensure the success of quality improvement in healthcare. The Department of Veterans Affairs (VA) initiated the VA National Quality Scholars fellowship in 1998; its mission is to improve the quality of care, ensure safety, accelerate healthcare re-design, and advance the improvement science by educating the next generation of leaders in quality and safety. We describe the critical need for leadership in quality and safety and interprofessional education, illustrate the curriculum, provide lessons learned by fellows, summarize key lessons learned from the implementation of an interprofessional education approach, and present most recent accomplishments. METHODS Narrative review. RESULTS As of 2011, 106 program alumni are embedded in the health care delivery system across the United States. Since 2009, when nurse fellows joined the program, of the first nine graduating interdisciplinary fellows, the tailored curriculum has resulted in five advanced academic degrees, 42 projects, 29 teaching activities, 44 presentations, 36 publications, six grants funded or submitted, and two awards. CONCLUSIONS The VA National Quality Scholars program continues to nurture and develop leaders for the new millennium focusing on interprofessional education. The nations' health care systems need strong interdisciplinary leaders in advanced quality improvement science who are dedicated to improving the overall quality of health and health care.
Collapse
Affiliation(s)
- Carlos A Estrada
- Birmingham Veterans Affairs Medical Center, Division of General Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Oliver BJ, Kohli E, Kasper LH. Interferon therapy in relapsing-remitting multiple sclerosis: A systematic review and meta-analysis of the comparative trials. J Neurol Sci 2011; 302:96-105. [DOI: 10.1016/j.jns.2010.11.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 11/01/2010] [Indexed: 11/24/2022]
|
20
|
Affiliation(s)
- Brant J Oliver
- Multiple Sclerosis Center at Dartmouth, Department of Medicine, Section of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|
21
|
Bellini T, Clark NA, Muzny CD, Wu L, Garland CW, Schaefer DW, Oliver BJ. Phase behavior of the liquid crystal 8CB in a silica aerogel. Phys Rev Lett 1992; 69:788-791. [PMID: 10047033 DOI: 10.1103/physrevlett.69.788] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|
22
|
Oliver BJ. Family therapy; an institutional approach. Can J Psychiatr Nurs 1974; 15:11-2. [PMID: 4493906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|