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Oxenbøll Collet M, Albertsen H, Egerod I. Patient and family engagement in Danish intensive care units: A national survey. Nurs Crit Care 2024; 29:614-621. [PMID: 37402590 DOI: 10.1111/nicc.12947] [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: 03/31/2023] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Patient and family engagement in the intensive care unit increases the quality of care and patient safety. AIM The aim of our study was to describe current practice and experiences of contemporary patient and family engagement in the intensive care unit at the individual level, the organizational level, and in the research process according to critical care nurses. DESIGN/METHOD We conducted a national qualitative survey of intensive care units in Denmark from 5th May-5th June 2021. Questionnaires were piloted and sent to intensive care nurse specialists and research nurses at 41 intensive care units, allowing one respondent per unit. All respondents were provided with written information about the study by email, and by activating the survey link, they accepted participation. RESULTS Thirty-two nurses responded to the invitation, 24 completed and 8 partially completed the survey, yielding a response rate of 78%. At the individual level, 27 respondents stated that they involved patients and 25 said they involved family in daily treatment and care. At the organizational level, 28 intensive care units had an overall strategy or guideline for patient and family engagement, and 4 units had established a PFE panel. And, finally, 11 units engaged patients and families in the research process. CONCLUSIONS Our survey suggested that patient and family engagement was implemented to some degree at the individual level, organizational level, and in the research process, but only 4 units had established a PFE panel at the organizational level, which is key to engagement. RELEVANCE TO CLINICAL PRACTICE Patient engagement increases when patients are more awake, and family engagement increases when patients are unable to participate. Engagement increases when patient and family engagement panels are implemented.
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Affiliation(s)
- Marie Oxenbøll Collet
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Helle Albertsen
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Yu J, Shen N, Conway S, Hiebert M, Lai-Zhao B, McCann M, Mehta RR, Miranda M, Putterman C, Santisteban JA, Thomson N, Young C, Chiuccariello L, Hunter K, Hill S. A holistic approach to integrating patient, family, and lived experience voices in the development of the BrainHealth Databank: a digital learning health system to enable artificial intelligence in the clinic. Front Health Serv 2023; 3:1198195. [PMID: 37927443 PMCID: PMC10625404 DOI: 10.3389/frhs.2023.1198195] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
Artificial intelligence, machine learning, and digital health innovations have tremendous potential to advance patient-centred, data-driven mental healthcare. To enable the clinical application of such innovations, the Krembil Centre for Neuroinformatics at the Centre for Addiction and Mental Health, Canada's largest mental health hospital, embarked on a journey to co-create a digital learning health system called the BrainHealth Databank (BHDB). Working with clinicians, scientists, and administrators alongside patients, families, and persons with lived experience (PFLE), this hospital-wide team has adopted a systems approach that integrates clinical and research data and practices to improve care and accelerate research. PFLE engagement was intentional and initiated at the conception stage of the BHDB to help ensure the initiative would achieve its goal of understanding the community's needs while improving patient care and experience. The BHDB team implemented an evolving, dynamic strategy to support continuous and active PFLE engagement in all aspects of the BHDB that has and will continue to impact patients and families directly. We describe PFLE consultation, co-design, and partnership in various BHDB activities and projects. In all three examples, we discuss the factors contributing to successful PFLE engagement, share lessons learned, and highlight areas for growth and improvement. By sharing how the BHDB navigated and fostered PFLE engagement, we hope to motivate and inspire the health informatics community to collectively chart their paths in PFLE engagement to support advancements in digital health and artificial intelligence.
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Affiliation(s)
- Joanna Yu
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Health and Technology, Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | - Nelson Shen
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- AMS Healthcare, Toronto, ON, Canada
| | - Susan Conway
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Melissa Hiebert
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Benson Lai-Zhao
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Miriam McCann
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Rohan R. Mehta
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Morena Miranda
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Connie Putterman
- Centre for Addictions and Mental Health, Toronto, ON, Canada
- CanChild, Hamilton, ON, Canada
- CHILD-BRIGHT Network, Montreal, QC, Canada
- Kids Brain Health Network, Burnaby, ON, Canada
- Province of Ontario Neurodevelopmental (POND) Network, Toronto, ON, Canada
| | - Jose Arturo Santisteban
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nicole Thomson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Courtney Young
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | | | - Kimberly Hunter
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Sean Hill
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Health and Technology, Vector Institute for Artificial Intelligence, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Marshall AP, Van Scoy LJ, Chaboyer W, Chew M, Davidson J, Day AG, Martinez A, Patel J, Roberts S, Skrobik Y, Taylor B, Tobiano G, Heyland DK. A randomised controlled trial of a nutrition and a decision support intervention to enable partnerships with families of critically ill patients. J Clin Nurs 2023; 32:6723-6742. [PMID: 37161555 DOI: 10.1111/jocn.16752] [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] [Received: 09/02/2022] [Revised: 03/14/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
AIMS AND OBJECTIVES The aim of the study was to investigate the effect of supporting family members to partner with health professionals on nutrition intakes and decision-making and to evaluate intervention and study feasibility. BACKGROUND Family partnerships can improve outcomes for critically ill patients and family members. Interventions that support families to engage with health professionals require evaluation. DESIGN A multi-centre, randomised, parallel group superiority Phase II randomised controlled trial. METHODS In nine intensive care units (ICUs) across three countries, critically ill patients ≥60 years, or those 55-59 years with advanced chronic diseases and expected ICU length of stay >72 h and their family member were enrolled between 9 May 2017 and 31 March 2020. Participants were randomised (1:1:1) to either a decision support or nutrition optimisation family-centred intervention, or usual care. Primary outcomes included protein and energy intake during ICU and hospital stay (nutrition intervention) and family satisfaction (decision support). Study feasibility was assessed as a composite of consent rate, intervention adherence, contamination and physician awareness of intervention assignment. RESULTS We randomised 135 patients/family members (consent rate 51.7%). The average rate of randomisation was 0.5 (0.13-1.53) per month. Unavailability (staff/family) was the major contributor to families not being approached for consent. Declined consent was attributed to families feeling overwhelmed (58/126, 46%). Pandemic visitor restrictions contributed to early study cessation. Intervention adherence for the decision support intervention was 76.9%-100.0% and for the nutrition intervention was 44.8%-100.0%. Nutritional adequacy, decisional conflict, satisfaction with decision-making and overall family satisfaction with ICU were similar for all groups. CONCLUSIONS Active partnerships between family members and health professionals are important but can be challenging to achieve in critical care contexts. We were unable to demonstrate the efficacy of either intervention. Feasibility outcomes suggest further refinement of interventions and study protocol may be warranted. RELEVANCE TO CLINICAL PRACTICE Interventions to promote family partnerships in critical illness are needed but require a greater understanding of the extent to which families want and are able to engage and the activities in which they have most impact. REPORTING METHOD This study has been reported following the Consolidated Standards of Reporting Trials (CONSORT) and the Template for Intervention Description and Replication (TIDieR) guidelines. PATIENT OR PUBLIC CONTRIBUTION Patients and caregivers were engaged in and contributed to the development and subsequent iterations of the two family-centred interventions use in this study. CLINICAL TRIAL REGISTRATION NUMBER Trial registration. CLINICALTRIALS gov, ID: NCT02920086. Registered on 30 September 2016. First patient enrolled on 9 May 2017 https://clinicaltrials.gov/ct2/results?cond=&term=NCT02920086&cntry=&state=&city=&dist=.
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Affiliation(s)
- Andrea P Marshall
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Intensive Care Unit, Gold Coast Health, Southport, Queensland, Australia
| | - Lauren J Van Scoy
- Department of Medicine, Humanities, and Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Mary Chew
- Phoenix VA Healthcare System, Phoenix, Arizona, USA
| | - Judy Davidson
- San Diego Health, University of California, San Diego, California, USA
| | - Andrew G Day
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Angelly Martinez
- Intensive Care Unit, Gold Coast Health, Southport, Queensland, Australia
| | - Jayshil Patel
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shelley Roberts
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Gold Coast Health, Southport, Queensland, Australia
| | - Yoanna Skrobik
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Beth Taylor
- Barnes Jewish Hospital, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Georgia Tobiano
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Gold Coast Health, Southport, Queensland, Australia
| | - Daren K Heyland
- Department of Critical Care Medicine, Queens's University, Kingston, Ontario, Canada
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Xie A, Hsu YJ, Speed TJ, Villanueva M, Hanna I, Slupek DA, Nguyen J, Shechter R, Hanna MN. Patient engagement and prescription opioid use in perioperative pain management. J Opioid Manag 2022; 18:421-433. [PMID: 36226782 PMCID: PMC10698916 DOI: 10.5055/jom.2022.0736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/16/2023]
Abstract
OBJECTIVE To examine (1) patient perceptions regarding their engagement and the engagement of their families in perioperative pain management, (2) demographic and clinical characteristics associated with perceived patient and family engagement, and (3) the association between perceived patient and family engagement and patient outcomes. DESIGN A prospective, observational study. SETTING The Personalized Pain Program (PPP) at the Johns Hopkins Hospital in Baltimore, Maryland. PARTICIPANTS Patients having more than one visit to the PPP. INTERVENTIONS n/a. MAIN OUTCOME MEASURES Since the inception of the PPP, patients were surveyed prior to each clinic visit to assess their pain severity and interference using the Brief Pain Inventory. Starting August 22, 2018, two additional questions were added to the survey to assess patient perceptions of their engagement and the engagement of their families in perioperative pain management. In addition, electronic medical records were reviewed to collect data on daily opioid consumption during the first and last PPP visits presurgery and post-surgery. RESULTS The final analysis included 511 survey responses from 155 patients. Perceived engagement of the patient in perioperative pain management improved over time (p < .001) and was significantly associated with reduction in prescription opioid consumption after surgery (coef = 12.7, SE = 5.8, p = .031). CONCLUSIONS Surgical patients and their family members should be actively engaged in perioperative pain management to improve prescription opioid use and the quality and safety of perioperative care.
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Affiliation(s)
- Anping Xie
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yea-Jen Hsu
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Traci J. Speed
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mariel Villanueva
- Helene Fuld Leadership Program, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Irini Hanna
- University of Maryland School of Dentistry, Baltimore, MD, USA
| | - David A. Slupek
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | - Jaclyn Nguyen
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ronen Shechter
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marie N. Hanna
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mangal S, Arcia A, Carter E. Environmental Scan of Parent-Facing Health Information About Antibiotics in US Children's Hospital Websites. J Pediatric Infect Dis Soc 2022; 11:291-294. [PMID: 35230447 PMCID: PMC9214779 DOI: 10.1093/jpids/piac004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 01/14/2022] [Indexed: 11/14/2022]
Abstract
Nearly half of free-standing children's hospital websites contain parent-facing resources about antibiotics. Most resources have information on safe antibiotic use, antibiotic resistance, and questions to ask clinicians. Accessibility can be improved by increasing readability, available languages, and multimedia. Future research should evaluate information accuracy, actionability, and comprehension with target audiences.
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Affiliation(s)
- Sabrina Mangal
- Columbia University School of Nursing, New York, New York, USA
| | - Adriana Arcia
- Columbia University School of Nursing, New York, New York, USA
| | - Eileen Carter
- Columbia University School of Nursing, New York, New York, USA
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Kimura M, Toyoda M, Saito N, Takahashi M, Isozumi K, Kato E, Kawanami D, Fukagawa M. The Importance of Patient and Family Engagement, the Needs for Self-Monitoring of Blood Glucose (SMBG) - Our Perspectives Learned Through a Story of SMBG Assistive Devices Made by a Husband of the Patient with Diabetes. Diabetes Metab Syndr Obes 2022; 15:1627-1638. [PMID: 35642182 PMCID: PMC9148577 DOI: 10.2147/dmso.s363762] [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: 03/01/2022] [Accepted: 05/13/2022] [Indexed: 11/23/2022] Open
Abstract
Despite some negative reports regarding the need for the self-monitoring of blood glucose (SMBG), including the issue of cost-effectiveness, there are still many users, and in diabetes treatment, which is largely dependent on the patient's self-care, SMBG remains an important tool in establishing such self-care habits, with several reports supporting this notion. In addition, devices are needed to assist in SMBG for patients with diabetes who have difficulty performing SMBG, such as the elderly or those with visual impairment. In current diabetes care, it is reported that patient-centered care that respects the preferences, needs, and values of individual patients and personalized care that consider the characteristics and comorbidities of each patient are important. Through a case study of a patient with diabetes who had difficulty performing SMBG due to visual impairment, we learned of the needs of SMBG and its assistive devices and the importance of patient and family engagement with emphasis on patient-centered and personalized care. We herein report what we learned through this case in the form of perspectives. Through this report, we hope that medical professionals involved in diabetes care will learn of the importance and needs of these issues and apply them to their actual clinical practice.
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Affiliation(s)
- Moritsugu Kimura
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
- Correspondence: Moritsugu Kimura, Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan, Tel +81-463-93-1121 (ext. 2490), Fax +81-463-91-3350, Email
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Nobumichi Saito
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Makiko Takahashi
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Konomi Isozumi
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Eri Kato
- Seichi Clinic, Isehara, Kanagawa, Japan
| | - Daiji Kawanami
- Department of Endocrinology and Diabetes Mellitus, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Mangal S, Pho A, Arcia A, Carter E. Patient and Family Engagement in Catheter-Associated Urinary Tract Infection (CAUTI) Prevention: A Systematic Review. Jt Comm J Qual Patient Saf 2021; 47:591-603. [PMID: 34215555 PMCID: PMC8506981 DOI: 10.1016/j.jcjq.2021.05.009] [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] [Received: 01/12/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are detrimental to health and are largely preventable with adherence to CAUTI prevention guidelines. Patient and family engagement in CAUTI prevention is often encouraged in these guidelines; however, little is known about how this engagement is operationalized in practice. A systematic review was conducted to synthesize the content, format, and outcomes of interventions that engage patients and/or families in CAUTI prevention. METHODS Two reviewers independently screened records from four databases up to March 2021 and searched reference lists of final articles. Included articles were primary research, tested an intervention, involved indwelling urinary catheters, and described at least one patient and/or family engagement method. Articles were appraised for quality using the Downs and Black checklist. RESULTS After 720 records were screened, 12 were included. Study quality ranged from good to poor, scoring lowest in internal validity. The most common formats of patient/family engagement were flyers/handouts (83.3%) and verbal education (58.3%). Common content areas were urinary catheter care and maintenance strategies. Most study outcomes (83.3%) measured CAUTI rates, and half measured patient/family-related outcomes. Improvements were seen in at least one outcome across all studies, but less than half (41.7%) showed statistically significant results. CONCLUSION The researchers found that most interventions lacked sufficient detail on the content, delivery, and/or outcome measurement of patient/family engagement, which limits transferability. More high-quality, generalizable trials are warranted in this area. Future research should focus on integrating publicly available resources into practice that can be tested for comprehension and revised based on feedback from target audiences.
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Affiliation(s)
- Sabrina Mangal
- Columbia University School of Nursing, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA (Present affiliation)
| | - Anthony Pho
- Columbia University School of Nursing, New York, NY, USA
- Stanford University School of Medicine, Stanford, CA, USA (Present affiliation)
| | - Adriana Arcia
- Columbia University School of Nursing, New York, NY, USA
| | - Eileen Carter
- Columbia University School of Nursing, New York, NY, USA
- University of Connecticut School of Nursing, Storrs, CT, USA (Present affiliation)
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Thirsk LM, Vandall-Walker V, Rasiah J, Keyko K. A Taxonomy of Supports and Barriers to Family-Centered Adult Critical Care: A Qualitative Descriptive Study. J Fam Nurs 2021; 27:199-211. [PMID: 33769127 PMCID: PMC8361475 DOI: 10.1177/1074840721999372] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Family-centered care (FCC) improves the quality and safety of health care provision, reduces cost, and improves patient, family, and provider satisfaction. Despite several decades of advocacy, research, and evidence, there are still challenges in uptake and adoption of FCC practices in adult critical care. The objective of this study was to understand the supports and barriers to family-centered adult critical care (FcACC). A qualitative descriptive design was used to develop a taxonomy. Interviews and focus groups were conducted with 21 participants in Alberta, Canada, from 2013 to 2014. Analysis revealed two main domains of supports and barriers to FcACC: PEOPLE and STRUCTURES. These domains were further classified into concepts and subconcepts that captured all the reported data. Many factors at individual, group, and organizational levels influenced the enactment of FcACC. These included health care provider beliefs, influence of primary versus secondary tasks, perceptions of family work, nurses' emotional labor, and organizational culture.
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Affiliation(s)
| | | | | | - Kacey Keyko
- Edmonton Southside Primary Care
Network, Alberta, Canada
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Shen N, Jankowicz D, Strudwick G. Patient and Family Engagement Approaches for Digital Health Initiatives: Protocol for a Case Study. JMIR Res Protoc 2021; 10:e24274. [PMID: 34287212 PMCID: PMC8339977 DOI: 10.2196/24274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/31/2021] [Accepted: 05/13/2021] [Indexed: 01/04/2023] Open
Abstract
Background Digital health initiatives such as patient portals, virtual care platforms, and smartphone-based apps are being implemented at a rapid pace in health care organizations worldwide. This is often done to improve access beyond traditional in-person care and enhance care quality. Recent studies have indicated that better outcomes of using these initiatives and technologies may be achieved when patients and their family members are engaged in all aspects of planning, implementation, use, and evaluation. However, little guidance exists for how health care administrators can achieve effective engagement in digital health initiatives specifically. Objective The objective of this study is to document processes related to planning and implementing patient and family engagement (PFE) in digital health initiatives. This information will be used to develop tangible resources (eg, a field guide) that other organizations can use to implement PFE approaches for digital health initiatives in their organizations. Methods A previously developed multidimensional conceptual framework for PFE in health and health care contexts will be used to guide this work. To understand the intricacies involved in using PFE approaches in digital health strategies, a case study will be conducted. More specifically, this work will employ an embedded single-case design with PFE in digital health initiatives at a large Canadian mental health and addictions teaching hospital. Multiple digital health projects being undertaken at the study site will be explored to better understand where the PFE is intended to support the design, implementation, and operation of the digital health platform or technology. These projects will form the individual units of analysis. Data collection will involve field notes and artifact collection by a participant observer and interviews with the various digital health project teams. Data analysis will include a content and thematic analysis, triangulation of the findings, and a chronological mapping of data to a PFE process. Results Funding for this work was provided by the Canadian Institutes of Health Research (CIHR), via a Health System Impact Fellowship. As of August 2020, digital health projects that will form the case study units have been identified, and the participant observer has started to embed themselves into these projects. Although the development and collection of field notes and artifacts, respectively, have begun, interviews have not been conducted. The study is expected to conclude in September 2021. Once this study is complete, the development of a field guide and resources to support the uptake of PFE strategies in digital health will begin. Conclusions By better understanding the processes involved in PFE in digital health projects, guidance can be provided to relevant stakeholders and organizations about how to do this work in an effective manner. It is then anticipated that with the increasing use of PFE approaches, there may be improved uptake, experience, and outcomes associated with using digital health technologies. International Registered Report Identifier (IRRID) PRR1-10.2196/24274
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Affiliation(s)
- Nelson Shen
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Gillian Strudwick
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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10
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Bourgeois FC, Fossa A, Gerard M, Davis ME, Taylor YJ, Connor CD, Vaden T, McWilliams A, Spencer MD, Folcarelli P, Bell SK. A patient and family reporting system for perceived ambulatory note mistakes: experience at 3 U.S. healthcare centers. J Am Med Inform Assoc 2021; 26:1566-1573. [PMID: 31504576 DOI: 10.1093/jamia/ocz142] [Citation(s) in RCA: 12] [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] [Received: 04/29/2019] [Revised: 07/09/2019] [Accepted: 07/22/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The study sought to test a patient and family online reporting system for perceived ambulatory visit note inaccuracies. MATERIALS AND METHODS We implemented a patient and family electronic reporting system at 3 U.S. healthcare centers: a northeast urban academic adult medical center (AD), a northeast urban academic pediatric medical center (PED), and a southeast nonprofit hospital network (NET). Patients and families reported potential documentation inaccuracies after reading primary care and subspecialty visit notes. Results were characterized using descriptive statistics and coded for clinical relevance. RESULTS We received 1440 patient and family reports (780 AD, 402 PED, and 258 NET), and 27% of the reports identified a potential inaccuracy (25% AD, 35% PED, 28% NET). Among these, patients and families indicated that the potential inaccuracy was important or very important in 58% of reports (55% AD, 55% PED, 71% NET). The most common types of potential inaccuracies included description of symptoms (21%), past medical problems (21%), medications (18%), and important information that was missing (15%). Most patient- and family-reported inaccuracies resulted in a change to care or to the medical record (55% AD, 67% PED, data not available at NET). DISCUSSION About one-quarter of patients and families using an online reporting system identified potential documentation inaccuracies in visit notes and more than half were considered important by patients and clinicians, underscoring the potential role of patients and families as ambulatory safety partners. CONCLUSIONS Partnering with patients and families to obtain reports on inaccuracies in visit notes may contribute to safer care. Mechanisms to encourage greater use of patient and family reporting systems are needed.
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Affiliation(s)
- Fabienne C Bourgeois
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alan Fossa
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Macda Gerard
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Marion E Davis
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Yhenneko J Taylor
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Crystal D Connor
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Tracela Vaden
- Department of Internal Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Andrew McWilliams
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA.,Department of Internal Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Melanie D Spencer
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Patricia Folcarelli
- Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Picklyk D, Volk S, Burns KK. The Provincial Patient and Family Group (PFG) for Alberta Health Services Transforms How Care is Planned and Delivered: A Decade of Experience. J Patient Exp 2021; 8:2374373521989245. [PMID: 34179362 PMCID: PMC8205415 DOI: 10.1177/2374373521989245] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although many health care organizations made significant headway in building relationships with patients and families at the point of care, there continues to be opportunities to partner with them at the system level. One such opportunity is the Patient and Family Advisory Group (PFG) at Alberta Health Services (AHS). Developed 10 years ago as a formal group of patient and family volunteers, PFG has provided advice on over 350 key organization initiatives, including the Patient First Strategy and the Family Visitation policies and guidelines. Through the formal partnership with PFG and its members who bring their lived experiences with the health system and its services, AHS has demonstrated its commitment to designing and improving services with the user in mind. Now entering its second decade, PFG, supported by AHS leadership, continues to explore new strategic approaches with internal and external stakeholders to reinforce the importance of Patient and Family-Centered Care.
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Affiliation(s)
- Deanna Picklyk
- Engagement and Patient Experience, Alberta Health Services, Edmonton, Alberta, Canada
| | - Shawn Volk
- Engagement and Patient Experience, Alberta Health Services, Edmonton, Alberta, Canada
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Garrity B, Berry J, Crofton C, Ward E, Cox J, Glader L, Bastianelli L, Emans J, Glotzbecker M, Emara N, Salem J, Jabur T, Higgins S, Shapiro J, Singer S. Parent-to-Parent Advice on Considering Spinal Fusion in Children with Neuromuscular Scoliosis. J Pediatr 2019; 213:149-154. [PMID: 31253410 DOI: 10.1016/j.jpeds.2019.05.055] [Citation(s) in RCA: 5] [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: 02/15/2019] [Revised: 05/03/2019] [Accepted: 05/21/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To convey advice from families whose children recently underwent spinal fusion to families whose children are under consideration for initial spinal fusion for neuromuscular scoliosis and to providers who counsel families on this decision. STUDY DESIGN We interviewed 18 families of children who underwent spinal fusion between August 2017 and January 2019 at a freestanding children's hospital. We conducted phone interviews a median of 65 (IQR 51-77) days after surgery. We audio recorded, transcribed, and coded (line-by-line) interviews using grounded theory by 2 independent reviewers, and discussed among investigators to induce themes associated with surgical decision making and preparation. RESULTS Six themes emerged about decision making and preparation for spinal fusion: (1) simplify risks and benefits; it is easy to get lost in the details; (2) families prolonging the decision whether or not to pursue spinal fusion surgery may not benefit the child; (3) anticipate anxiety and fear when making a decision about spinal fusion; (4) realize that your child might experience a large amount of pain; (5) anticipate a long recovery and healing process after spinal fusion; and (6) be engaged and advocate for your child throughout the perioperative spinal fusion process. CONCLUSIONS Parents of children who had recently undergone spinal fusion had strong perceptions about what information to convey to families considering surgery, which may improve communication between future parents and physicians. Further investigation is needed to assess how best to incorporate the wisdom and experiences of parent peers into shared decision making and preparation for spinal fusion in children with neuromuscular scoliosis.
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Affiliation(s)
- Brigid Garrity
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Jay Berry
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| | - Charis Crofton
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Erin Ward
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Joanne Cox
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Laurie Glader
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - John Emans
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | | | - Norah Emara
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Joseph Salem
- Healthcare Systems Engineering Institute, Northeastern University, Boston, MA; North Shore Medical Center, Salem, MA
| | - Tiago Jabur
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA
| | | | - Jillian Shapiro
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Sara Singer
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
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Gritzer L, Davenport M, Dark M, Khanna N. Coaching Small Primary Care Practices to Use Patient Portals. Ann Fam Med 2019; 17:S83. [PMID: 31405883 PMCID: PMC6827674 DOI: 10.1370/afm.2381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/31/2018] [Accepted: 12/13/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Lauren Gritzer
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Michael Dark
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Niharika Khanna
- University of Maryland School of Medicine, Baltimore, Maryland
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14
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Black A, Strain K, Wallsworth C, Charlton SG, Chang W, McNamee K, Hamilton C. What constitutes meaningful engagement for patients and families as partners on research teams? J Health Serv Res Policy 2018; 23:158-167. [PMID: 29504424 PMCID: PMC6041763 DOI: 10.1177/1355819618762960] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective There is growing emphasis on health care organizations to ensure that lay people are meaningfully engaged as partners on research teams. Our aim was to explore the perspectives of patients, family members and informal caregivers who have been involved on health care research teams in Canada and elicit their recommendations for meaningful engagement. Methods We conducted a qualitative study guided by thematic analysis of transcripts of focus groups and interviews of 19 experienced patient research partners in Canada. Results We identified four main themes: research environment, expectations, support and value, which highlight participants' combined perspectives on important factors to ensure their engagement in research is meaningful. Conclusions Our findings add to the evolving evidence base on the perspectives of lay people involved in health care research and their recommendations for research leaders on meaningful engagement. Our study suggests that research leaders should provide a welcoming research environment, outline appropriate expectations for patient research partners on research teams, support patient research partners' engagement in projects and recognize the value patient research partners bring to health research.
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Affiliation(s)
- Agnes Black
- 1 Director, Research and Knowledge Translation, Professional Practice Office, Providence Health Care, Canada
| | | | | | - Sara-Grey Charlton
- 3 Practice Consultant, Professional Practice Office, Providence Health Care, Canada
| | - Wilma Chang
- 4 Research Assistant, Professional Practice Office, Providence Health Care, Canada
| | - Kate McNamee
- 3 Practice Consultant, Professional Practice Office, Providence Health Care, Canada
| | - Clayon Hamilton
- 5 Post-Doctoral Fellow, Department of Physical Therapy, University of British Columbia, Canada.,6 Post-Doctoral Trainee, Arthritis Research Canada, Canada
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15
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Prior SJ, Campbell S. Patient and Family Involvement: A Discussion of Co-Led Redesign of Healthcare Services. J Particip Med 2018; 10:e5. [PMID: 33052119 PMCID: PMC7489197 DOI: 10.2196/jopm.8957] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/13/2017] [Indexed: 12/30/2022] Open
Abstract
The involvement of patients and their families in the redesign of healthcare services is an important option in providing a service that addresses the patients’ needs and improves health outcomes. However, it is a resource-intensive approach, and it is currently not clear when it should be used, and what should be the reasoning behind this decision. Some health systems of international standing have created a patient engagement program as a selling point. This paper discusses how co-led redesign can be beneficial in improving health service and more effectively engaging patients. Potential barriers for patient involvement are discussed. Patient involvement can be integrated into the health system at three main levels of engagement: direct care, organizational design and governance, and policy-making. The aim of this paper is to describe how co-led redesign is compatible with different levels of patient involvement and to address the challenges in delivering a co-led redesign in healthcare. Co-led redesign not only involves the collection of quantitative data for assessing the current systems but also the collection of qualitative data through patient, family, and staff interviews to determine the barriers to patient satisfaction. Co-led redesign is a resource-rich process that requires expertise in data collection and a clinical group that is devoted to implementing recommended changes. Currently, a number of countries have utilized co-led redesign for many different types of healthcare services. Resource availability and cost, process time, and lack of outcome measures are three major limiting factors.
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Affiliation(s)
- Sarah Jane Prior
- Rural Clinical School, Faculty of Health, University of Tasmania, Burnie, Australia.,Health Service Innovation Tasmania, Faculty of Health, University of Tasmania, Hospital Campus, Burnie, Australia
| | - Steven Campbell
- School of Health Sciences, Faculty of Health, University of Tasmania, Newnham, Australia
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Abstract
BACKGROUND Patient and family engagement (PFE) is vital to the spirit of the medical home. This article reflects the efforts of an expert consensus panel, the Patient and Family Engagement Workgroup, as part of the Society of General Internal Medicine's 2013 Research Conference. OBJECTIVE To review extant literature on PFE in pediatric and adult medicine and quality improvement, highlight emerging best practices and models, suggest questions for future research, and provide references to tools and resources to facilitate implementation of PFE strategies. METHODS We conducted a narrative review of relevant articles published from 2000 to 2015. Additional information was retrieved from personal contact with experts and recommended sources from workgroup members. RESULTS Despite the theoretical importance of PFE and policy recommendations that PFE occurs at all levels across the health care system, evidence of effectiveness is limited, particularly for quality improvement. There is some evidence that PFE is effective, mostly related to engagement in the care of individual patients, but the evidence is mixed and few studies have assessed the effect of PFE on health outcomes. Measurement issues and the lack of a single comprehensive conceptual model pose challenges to progress in this field. Recommendations for future research and a list of practical tools and resources to facilitate PFE are provided. CONCLUSIONS Although PFE appeals to patients, families, providers, and policy-makers, research is needed to assess outcomes beyond satisfaction, address implementation barriers, and support engagement in practice redesign and quality improvement. Partnering with patients and families has great potential to support high-quality health care and optimize outcomes.
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Affiliation(s)
- Crystal W. Cené
- Division of General Internal Medicine, University of North Carolina at Chapel Hill School of Medicine
| | | | | | - Beverly Baker
- National Center for Family Professional Partnerships, Family Voices, Inc
| | - Renee Davis
- Drexel University School of Public Health/College of Medicine, Philadelphia PA
| | - Renee Turchi
- Division of General Pediatrics, St. Christopher’s Hospital for Children, Philadelphia, PA
- Drexel University School of Public Health/College of Medicine, Philadelphia PA
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Holden RJ, Carayon P, Gurses AP, Hoonakker P, Hundt AS, Ozok AA, Rivera-Rodriguez AJ. SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics 2013; 56:1669-86. [PMID: 24088063 PMCID: PMC3835697 DOI: 10.1080/00140139.2013.838643] [Citation(s) in RCA: 572] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Healthcare practitioners, patient safety leaders, educators and researchers increasingly recognise the value of human factors/ergonomics and make use of the discipline's person-centred models of sociotechnical systems. This paper first reviews one of the most widely used healthcare human factors systems models, the Systems Engineering Initiative for Patient Safety (SEIPS) model, and then introduces an extended model, 'SEIPS 2.0'. SEIPS 2.0 incorporates three novel concepts into the original model: configuration, engagement and adaptation. The concept of configuration highlights the dynamic, hierarchical and interactive properties of sociotechnical systems, making it possible to depict how health-related performance is shaped at 'a moment in time'. Engagement conveys that various individuals and teams can perform health-related activities separately and collaboratively. Engaged individuals often include patients, family caregivers and other non-professionals. Adaptation is introduced as a feedback mechanism that explains how dynamic systems evolve in planned and unplanned ways. Key implications and future directions for human factors research in healthcare are discussed.
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Affiliation(s)
- Richard J. Holden
- Assistant Professor, Department of Medicine, Division of General Internal Medicine & Public Health, Department of Biomedical Informatics Vanderbilt University School of Medicine, Phone: +1-615-936-4343, Fax: +1-615-936-7373, Center for Research and Innovation in Systems Safety, 719 Medical Arts Building, 1211 21st Avenue S, Nashville, TN, 37212
| | - Pascale Carayon
- Procter & Gamble Bascom Professor in Total Quality, Department of Industrial and Systems Engineering, Director of the Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3126 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706 - USA, tel: +1-608-265-0503 or +1-608-263-2520, fax: +1-608-263-1425
| | - Ayse P. Gurses
- Associate Professor, Armstrong Institute for Patient Safety and Quality, Department of Anesthesiology and Critical Care Medicine, Division of Health Sciences Informatics, School of Medicine, Department of Health Policy and Management, Bloomberg School of Public Health, Department of Civil Engineering, Whiting School of Engineering, The Johns Hopkins University, 750 E. Pratt St. 15Floor, Baltimore, MD 21202, Phone: +1-410-637-4387
| | - Peter Hoonakker
- Research Scientist and Associate Director of Research, Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3132 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706 – USA, Phone: +1-608-658 0837, Fax: +1-608-263-1425
| | - Ann Schoofs Hundt
- Associate Scientist and Associate Director of Education, Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3132 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706 – USA, Phone: +1-608-262-9100, Fax: +1-608-263-1425
| | - A. Ant Ozok
- Associate Professor, Department of Information Systems, UMBC, Adjunct Associate Professor, Department of Anesthesiology, Visiting Associate Professor, The Armstrong Institute of Patient Safety and Quality, School of Medicine, The Johns Hopkins University, 1000 Hilltop Circle, Baltimore, MD 21250, Phone : +1-410-455-8627, Fax : +1-410-455-1073
| | - A. Joy Rivera-Rodriguez
- Assistant Professor, Department of Industrial Engineering, Clemson University, Phone: +1-864-656-3114, Fax: +1-864-656-0795, 130-C Freeman Hall, Box 340920 Clemson, SC 29631
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