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Humphreys L, Bigby C, Araten-Bergman T, Iacono T. Active Support Measure: a multilevel exploratory factor analysis. J Intellect Disabil Res 2024; 68:564-572. [PMID: 38413188 DOI: 10.1111/jir.13126] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/14/2023] [Accepted: 01/08/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Active Support is a person-centred practice that enables people with intellectual disabilities (IDs) to engage in meaningful activities and social interactions. The Active Support Measure (ASM) is an observational tool designed to measure the quality of support that people with IDs living in supported accommodation services receive from staff. The aim of the study was to explore the underlying constructs of the ASM. METHODS Multilevel exploratory factor analysis was conducted on ASM data (n = 884 people with IDs across 236 accommodation services) collected during a longitudinal study of Active Support in Australian accommodation services. RESULTS Multilevel exploratory factor analysis indicated that 12 of the ASM's 15 items loaded on two factors, named Supporting Engagement in Activities and Interacting with the Person. CONCLUSIONS The 12-item ASM measures two dimensions of the quality of staff support. Both technical and interpersonal skills comprise good Active Support.
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Affiliation(s)
- L Humphreys
- Living with Disability Research Centre, La Trobe University, Bundoora, Australia
| | - C Bigby
- Living with Disability Research Centre, La Trobe University, Bundoora, Australia
| | - T Araten-Bergman
- Living with Disability Research Centre, La Trobe University, Bundoora, Australia
| | - T Iacono
- Living with Disability Research Centre, La Trobe University, Bendigo, Australia
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2
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Karimi M, Dhopeshwarkar R, Jiménez F, Ryan S, Plourde E. Improving Data Infrastructure for Person-Centered Outcomes Research on Intellectual and Developmental Disabilities. Am J Intellect Dev Disabil 2024; 129:231-241. [PMID: 38657962 DOI: 10.1352/1944-7558-129.3.231] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/28/2023] [Indexed: 04/26/2024]
Abstract
Individuals with intellectual and developmental disabilities (IDD) continue to experience disparities in health and well-being despite improved provisions of person-centered care. Patient-centered outcomes research (PCOR) translates evidence into practice for meaningful outcomes. This piece describes findings from an environmental scan and stakeholder outreach to identify and prioritize opportunities to enhance IDD PCOR data infrastructure. These opportunities include developing a standardized research definition; advancing data standards for service systems; improving capture of IDD at point of care; developing standardized outcome measures; and encouraging Medicaid data use for IDD research. Within this piece, we discuss the implications of addressing data gaps for enhanced research. While the identified activities provide a path towards advancing IDD PCOR data infrastructure, collaborative efforts between government, researchers, and others are paramount.
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Affiliation(s)
- Madjid Karimi
- Madjid Karimi, U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
| | - Rina Dhopeshwarkar
- Rina Dhopeshwarkar, Frances Jiménez, and Sofia Ryan, Health Sciences Department, NORC at the University of Chicago
| | - Frances Jiménez
- Rina Dhopeshwarkar, Frances Jiménez, and Sofia Ryan, Health Sciences Department, NORC at the University of Chicago
| | - Sofia Ryan
- Rina Dhopeshwarkar, Frances Jiménez, and Sofia Ryan, Health Sciences Department, NORC at the University of Chicago
| | - Emma Plourde
- Emma Plourde, Office of Behavioral Health, Disability, and Aging Policy, Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services
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O'Kane L, Guarrera JV, Lunsford KE. Standardized Patient-centered Approach to Perioperative Antibiotics in Liver Transplantation. Transplantation 2024; 108:1068-1069. [PMID: 38044492 DOI: 10.1097/tp.0000000000004837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Lisa O'Kane
- Department of Surgery, St Joseph's University Medical Center, Paterson, NJ
| | - James V Guarrera
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Keri E Lunsford
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, Rutgers New Jersey Medical School, Newark, NJ
- Center for Immunity and Inflammation, Rutgers New Jersey Medical School, Newark, NJ
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Weiner DE, Delgado C, Flythe JE, Forfang DL, Manley T, McGonigal LJ, McNamara E, Murphy H, Roach JL, Watnick SG, Weinhandl E, Willis K, Berns JS. Patient-Centered Quality Measures for Dialysis Care: A Report of a Kidney Disease Outcomes Quality Initiative (KDOQI) Scientific Workshop Sponsored by the National Kidney Foundation. Am J Kidney Dis 2024; 83:636-647. [PMID: 37972814 DOI: 10.1053/j.ajkd.2023.09.015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 11/19/2023]
Abstract
Providing high-quality patient-centered care is the central mission of dialysis facilities. Assessing quality and patient-centeredness of dialysis care is necessary for continuous dialysis facility improvement. Based predominantly on readily measured items, current quality measures in dialysis care emphasize biochemical and utilization outcomes, with very few patient-reported items. Additionally, current metrics often do not account for patient preferences and may compromise patient-centered care by limiting the ability of providers to individualize care targets, such as dialysis adequacy, based on patient priorities rather than a fixed numerical target. Developing, implementing, and maintaining a quality program using readily quantifiable data while also allowing for individualization of care targets that emphasize the goals of patients and their care partners provided the motivation for a September 2022 Kidney Disease Outcomes Quality Initiative (KDOQI) Workshop on Patient-Centered Quality Measures for Dialysis Care. Workshop participants focused on 4 questions: (1) What are the outcomes that are most important to patients and their care partners? (2) How can social determinants of health be accounted for in quality measures? (3) How can individualized care be effectively addressed in population-level quality programs? (4) What are the optimal means for collecting valid and robust patient-reported outcome data? Workshop participants identified numerous gaps within the current quality system and favored a conceptually broader, but not larger, quality system that stresses highly meaningful and adaptive measures that incorporate patient-centered principles, individual life goals, and social risk factors. Workshop participants also identified a need for new, low-burden tools to assess patient goals and priorities.
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Affiliation(s)
| | - Cynthia Delgado
- San Francisco Veterans Affairs Health Care System and the University of California, San Francisco, CA
| | | | | | | | | | | | | | | | - Suzanne G Watnick
- Northwest Kidney Centers, Seattle, WA; University of Washington, Seattle, WA; Puget Sound VA, Seattle, WA
| | - Eric Weinhandl
- University of Minnesota, Minneapolis, MN; Satellite Healthcare, San Jose, CA
| | | | - Jeffrey S Berns
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Gionfriddo MR, Duboski V, Middernacht A, Kern MS, Graham J, Wright EA. A mixed methods evaluation of medication reconciliation in the primary care setting. PLoS One 2021; 16:e0260882. [PMID: 34855888 PMCID: PMC8638945 DOI: 10.1371/journal.pone.0260882] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To understand the extent to which behaviors consistent with high quality medication reconciliation occurred in primary care settings and explore barriers to high quality medication reconciliation. DESIGN Fully mixed sequential equal status design including ethnographic observations, semi-structured interviews, and surveys. SETTING Primary care practices within an integrated healthcare delivery system in the United States. PARTICIPANTS We conducted 170 observations of patient encounters across 15 primary care clinics, 48 semi-structured interviews with staff, and 10 semi-structured interviews with patients. We also sent out surveys to 2,541 eligible staff with 616 responses (24% response rate) and to 5,132 eligible patients with 577 responses (11% response rate). RESULTS Inconsistency emerged as a major barrier to effective medication reconciliation. This inconsistency was present across a variety of factors such as the lack of standardized workflows for conducting medication reconciliation, a lack of knowledge about medication and the process of medication reconciliation, varying levels of importance ascribed to medication reconciliation, and inadequate integration of medication reconciliation into clinical workflows. Findings were generally consistent across all data collection methods. CONCLUSION We have identified several barriers which impact the process of medication reconciliation in primary care settings. Our key finding is that the process of medication reconciliation is plagued by inconsistencies which contribute to inaccurate medication lists. These inconsistencies can be broken down into several categories (standardization, knowledge, importance, and inadequate integration) which can be targets for future studies and interventions.
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Affiliation(s)
- Michael R. Gionfriddo
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, United States of America
- * E-mail:
| | - Vanessa Duboski
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, United States of America
| | - Allison Middernacht
- Wilkes University School of Pharmacy, Wilkes-Barre, PA, United States of America
| | - Melissa S. Kern
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, United States of America
| | - Jove Graham
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, United States of America
| | - Eric A. Wright
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, United States of America
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Rock LK. Communication as a High-Stakes Clinical Skill: "Just-in-Time" Simulation and Vicarious Observational Learning to Promote Patient- and Family-Centered Care and to Improve Trainee Skill. Acad Med 2021; 96:1534-1539. [PMID: 33769341 PMCID: PMC8541893 DOI: 10.1097/acm.0000000000004077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Patient-provider communication is a hallmark of high-quality care and patient safety; however, the pace and increasingly complex challenges that face overextended teams strain even the most dedicated clinicians. The COVID-19 pandemic has further disrupted communication between clinicians and their patients and families. The dependence on phone communication and the physical barriers of protective gear limit nonverbal communication and diminish clinicians' ability to recognize and respond to emotion. Developing new approaches to teach communication skills to trainees who are often responsible for communicating with patients and their families is challenging, especially during a pandemic or other crisis. "Just-in-time" simulation-simulation-based training immediately before an intervention-provides the scaffolding and support trainees need for conducting difficult conversations, and it enhances patients' and families' experiences. Using a realistic scenario, the author illustrates key steps for effectively using just-in-time simulation-based communication training: assessing the learner's understanding of the situation; determining what aspects of the encounter may prove most challenging; providing a script as a cognitive aid; refreshing or teaching a specific skill; preparing learners emotionally through reflection and mental rehearsal; coaching on the approach, pace, and tone for a delivery that conveys empathy and meaning; and providing specific, honest, and curious feedback to close a performance gap. Additionally, the author acknowledges that clinical conditions sometimes require learning by observing rather than doing and has thus provided guidance for making the most of vicarious observational learning: identify potential challenges in the encounter and explicitly connect them to trainee learning goals, explain why a more advanced member of the team is conducting the conversation, ask the trainee to observe and prepare feedback, choose the location carefully, identify everyone's role at the beginning of the conversation, debrief, share reactions, and thank the trainee for their feedback and observations.
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Affiliation(s)
- Laura K. Rock
- L.K. Rock is a pulmonologist and critical care doctor and director, Communication and Teamwork, Critical Care Medicine, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, and she is assistant professor of medicine, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0003-1462-1652
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Park M, Kim S, Kim E, Kim GE, Jung JH, Kim SY, Kim MJ, Kim DH, Park S, Ho IG, Kim SK, Hwang S, Shin KH, Lee H, Lee B, Lee H, Park M, Koh H, Sohn MH, Rha DW, Kim KW. Multidisciplinary aerodigestive program at a children's hospital: A protocol for a prospective observational study. PLoS One 2021; 16:e0259208. [PMID: 34705883 PMCID: PMC8550601 DOI: 10.1371/journal.pone.0259208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Children with complex chronic multisystemic diseases frequently require care from multiple pediatric subspecialists. The aerodigestive program is a multidisciplinary program that diagnoses and treats pediatric patients with complex multi-systematic problems affecting airway, breathing, feeding, swallowing, or growth. The aim of this study is to present the protocol of the aerodigestive program of a children's hospital. METHODS AND DESIGN This study is a prospective study to evaluate and compare the overall improvement of patients' objective and subjective conditions before and after the AeroDigestive Team (ADT) program. Among children from 1 month to 18 years of age, patients with complex problems of the airway, breathing, feeding, swallowing, or growth meeting at least two parameters of the inclusion criteria were enrolled. The overall process included referral based on the inclusion criteria, enrollment of ADT program with informed consents, interview and questionnaire for assessing patients' medical condition, prescheduling appointment, multi-specialists' evaluation, monthly team meetings, wrap-up discussion with the patients and family, therapeutic intervention, and follow-up at 6 months with the assessment of outcome measures. The outcome was evaluated objectively and subjectively. The objective outcome measure was divided into surgical or medical intervention, assessment of changes in medical condition, and follow-up study. Both caregiver interviews and questionnaires using a scoring system were used as subjective outcome measures before and after the ADT program. Children were scheduled to be followed-up at 6 months after the interventions or ADT meeting. DISCUSSION The aerodigestive program is expected to provide comprehensive and multidisciplinary management of children with complex airway and digestive tract disorders.
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Affiliation(s)
- Mireu Park
- Division of Allergy, Respiratory and Critical Care Medicine, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Kim
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eunyoung Kim
- Department of Nursing, Severance Children Hospital, Yonsei University Health System, Seoul, Korea
| | - Ga Eun Kim
- Division of Allergy, Respiratory and Critical Care Medicine, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hwa Jung
- Division of Allergy, Respiratory and Critical Care Medicine, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Yeon Kim
- Division of Allergy, Respiratory and Critical Care Medicine, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Division of Allergy, Respiratory and Critical Care Medicine, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Da Hee Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Sowon Park
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - In Geol Ho
- Department of Pediatric Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Ki Kim
- Department of Rehabilitation Medicine, Yongin Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sangwon Hwang
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyeong Hun Shin
- Department of Nutrition Care, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Hosun Lee
- Department of Nutrition Care, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Bobae Lee
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeyeon Lee
- Department of Pediatric Occupational Therapy, Severance Rehabilitation hospital, Yonsei University Health System, Seoul, Korea
| | - Minhwa Park
- Department of Pediatric Occupational Therapy, Severance Rehabilitation hospital, Yonsei University Health System, Seoul, Korea
| | - Hong Koh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Division of Allergy, Respiratory and Critical Care Medicine, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Wook Rha
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Division of Allergy, Respiratory and Critical Care Medicine, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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8
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Savitz LA, Bayliss EA. Emerging models of care for individuals with multiple chronic conditions. Health Serv Res 2021; 56 Suppl 1:980-989. [PMID: 34387358 PMCID: PMC8515217 DOI: 10.1111/1475-6773.13774] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To characterize emerging and current practice models to more effectively treat and support patients with multiple chronic conditions (MCC). DATA SOURCES/STUDY SETTING We conducted a rapid literature scoping augmented by key informant interviews with clinicians knowledgeable about MCC care from a broad spectrum of US delivery systems and feedback from multidisciplinary experts at two virtual meetings. STUDY DESIGN Literature findings were triangulated with data from semi-structured interviews with clinical experts. Reflections on early results were obtained from policy, research, clinical, advocacy, and patient representatives at two virtual meetings sponsored by the Agency for Healthcare Research and Quality. Emergent themes addressed were as follows: (1) more timely strategies for MCC care; and (2) trends not previously represented in the peer-reviewed literature. DATA COLLECTION/EXTRACTION METHODS The rapid literature scoping relied on Ovid MEDLINE(R) and Epub Ahead of Print databases for the most recent 5-year period. Qualitative interviews were conducted by telephone. Virtual meetings provided oral and written (chat) captured inputs. PRINCIPAL FINDINGS Although the literature scoping did not identify a specific set of evidence-based care models, key informant discussions identified eight themes reflecting emerging approaches to population-based MCC care. For example, addressing the needs of individuals with MCC through a complexity lens by assessing and addressing social risk factors; extending the care continuum with home-based care; understanding how to address ongoing patient and caregiver supports outside of clinical encounters; and engaging available community resources. CONCLUSIONS Integrating care for MCC patient populations requires processes for determining different subpopulation needs in various settings and lived experiences. Innovation should be anchored at the nexus of payment systems, social risks, medical needs, and community-based resources. Our learnings suggest a need for an ongoing MCC care research agenda to inform new approaches to care delivery incorporating innovations in technology and home-based supports for patients and caregivers.
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Affiliation(s)
| | - Elizabeth A. Bayliss
- Institute for Health Research, Kaiser Permanente ColoradoAuroraColoradoUSA
- Department of Family MedicineUniversity of ColoradoAuroraColoradoUSA
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Lagrotteria A, Swinton M, Simon J, King S, Boryski G, Ma IWY, Dunne F, Singh J, Bernacki RE, You JJ. Clinicians' Perspectives After Implementation of the Serious Illness Care Program: A Qualitative Study. JAMA Netw Open 2021; 4:e2121517. [PMID: 34406399 PMCID: PMC8374609 DOI: 10.1001/jamanetworkopen.2021.21517] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Discussions about goals of care with patients who are seriously ill typically occur infrequently and late in the illness trajectory, are of low quality, and focus narrowly on the patient's resuscitation preferences (ie, code status), risking provision of care that is inconsistent with patients' values. The Serious Illness Care Program (SICP) is a multifaceted communication intervention that builds capacity for clinicians to have earlier, more frequent, and more person-centered conversations. OBJECTIVE To explore clinicians' experiences with the SICP 1 year after implementation. DESIGN, SETTING, AND PARTICIPANTS This qualitative study was conducted at 2 tertiary care hospitals in Canada. The SICP was implemented at Hamilton General Hospital (Hamilton, Ontario) from March 1, 2017, to January 19, 2018, and at Foothills Medical Centre (Calgary, Alberta) from March 1, 2018, to December 31, 2020. A total of 45 clinicians were invited to participate in the study, and 23 clinicians (51.1%) were enrolled and interviewed. Semistructured interviews of clinicians were conducted between August 2018 and May 2019. Content analysis was used to evaluate information obtained from these interviews between May 2019 and May 2020. EXPOSURES The SICP includes clinician training, communication tools, and processes for system change. MAIN OUTCOMES AND MEASURES Clinicians' experiences with and perceptions of the SICP. RESULTS Among 23 clinicians interviewed, 15 (65.2%) were women. The mean (SD) number of years in practice was 14.6 (9.1) at the Hamilton site and 12.0 (6.9) at the Calgary site. Participants included 19 general internists, 3 nurse practitioners, and 1 social worker. The 3 main themes were the ways in which the SICP (1) supported changes in clinician behavior, (2) shifted the focus of goals-of-care conversations beyond discussion of code status, and (3) influenced clinicians personally and professionally. Changes in clinician behavior were supported by having a unit champion, interprofessional engagement, access to copies of the Serious Illness Conversation Guide, and documentation in the electronic medical record. Elements of the program, especially the Serious Illness Conversation Guide, shifted the focus of goals-of-care conversations beyond discussion of code status and influenced clinicians on personal and professional levels. Concerns with the program included finding time to have conversations, building transient relationships, and limiting conversation fluidity. CONCLUSIONS AND RELEVANCE In this qualitative study, hospital clinicians described components of the SICP as supporting changes in their behavior and facilitating meaningful patient interactions that shifted the focus of goals-of-care conversations beyond discussion of code status. The perceived benefits of SICP implementation stimulated uptake within the medical units. These findings suggest that the SICP may prompt hospital culture changes in goals-of-care dialogue with patients and the care of hospitalized patients with serious illness.
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Affiliation(s)
- Andrew Lagrotteria
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marilyn Swinton
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Simon
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Seema King
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Irene Wai Yan Ma
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona Dunne
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Japteg Singh
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rachelle E. Bernacki
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - John J. You
- Division of General Internal and Hospitalist Medicine, Department of Medicine, Trillium Health Partners, Credit Valley Hospital, Mississauga, Ontario, Canada
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Abstract
GENERAL PURPOSE To educate wound care practitioners about methods of communication that can help promote patient adherence to wound healing recommendations. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Distinguish the use of theoretical frameworks to promote patient adherence to prescribed wound healing recommendations.2. Synthesize the principles of motivational interviewing to best encourage patients to adhere to prescribed wound healing recommendations.3. Select the appropriate self-care strategies for patients who have nonhealing wounds.
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11
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Bleicher J, Stokes SM, Brooke BS, Glasgow RE, Huang LC. Patient-centered Opioid Prescribing: Breaking Away From One-Size-Fits-All Prescribing Guidelines. J Surg Res 2021; 264:1-7. [PMID: 33744772 PMCID: PMC8222090 DOI: 10.1016/j.jss.2021.01.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/14/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Procedure-based opioid-prescribing guidelines have reduced the amount of opioids prescribed after surgery; however, many patients are still overprescribed opioids. The 24-h predischarge opioid consumption (PDOC) metric has been proposed to guide patient-centered prescribing. MATERIALS AND METHODS This is a single-institution, retrospective study of patients who underwent major abdominal surgery. We assessed the correlation between inpatient opioid use and discharge prescriptions using morphine milligram equivalents (MMEs). The adequacy of discharge prescriptions for individual patients was assessed using 2 models, one assuming constant opioid use (based on 24-h PDOC) and the other assuming a linear taper. RESULTS Of 596 included patients, gastric bypass and colectomy were the most common operations. Median length of stay was 3.5 d. Inpatient opioid use and discharge prescriptions were weakly correlated (r = 0.35). Patients with no opioid use 24 h before discharge (n = 133, 22.3%) were frequently discharged with opioid prescriptions. Patients with high opioid use (24-h PDOC >60 MME) were often discharged with prescriptions that would have lasted <48 h (164/200, 82%). Assuming constant opioid use, discharge prescriptions would have lasted patients a median of 5.1 d. With linear opioid tapering, 440 (72.9%) patients would have had leftover pills. A theoretical discharge prescription of 4 times 24-h PDOC would reduce the median prescription by 130 MMEs and allow a linear taper for 97.6% of patients. CONCLUSIONS At our institution, opioid prescribing was rarely patient-centered, with little correlation between patient's inpatient opioid use and discharge prescriptions. This leads to overprescribing for most patients and underprescribing for others.
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Affiliation(s)
- Josh Bleicher
- Department of Surgery, University of Utah, Salt Lake City, Utah.
| | - Sean M Stokes
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | | | | | - Lyen C Huang
- Department of Surgery, University of Utah, Salt Lake City, Utah
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Xie Z, Yadav S, Larson SA, Mainous AG, Hong YR. Associations of patient-centered medical home with quality of care, patient experience, and health expenditures: A STROBE-compliant cross-sectional study. Medicine (Baltimore) 2021; 100:e26119. [PMID: 34032757 PMCID: PMC8154504 DOI: 10.1097/md.0000000000026119] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/10/2021] [Indexed: 01/04/2023] Open
Abstract
In efforts to improve the delivery of quality primary care, patient-centered medical home (PCMH) model has been promoted. However, evidence on its association with health outcomes has been mixed. The aim of this study was to assess the performance of PCMH model on quality of care, patient experience, health expenditures.This was a cross-sectional study of the 2015-2016 Medical Expenditure Panel Survey-Medical Organization Survey linked data, including 5748 patient-provider pairs. We examined twenty-four quality of care measures (18 high-value and 6 low-value care services), health service utilization, patient experience (patient-provider communication, satisfaction), and health expenditure.Of 5748 patients, representing a weighted population of 56.2 million American adults aged 18 years and older, 44.2% were cared for by PCMH certified providers. 9.3% of those with PCMHs had at least one inpatient stay in the past year, which was comparable to the 11.4% among those with non-PCMHs. Similarly, 17.4% of respondents cared for by PCMH and 18.5% cared for by non-PCMH had at least one ED visit. Overall, we found no significant differences in quality of care measures (neither high-nor low-value of care) between the two groups. The overall satisfaction, the experience of access to care, and communication with providers were also comparable. Patients who were cared for by PCMHs had less total health expenditure (difference $217) and out-of-pocket spending (difference $91) than those cared for by non-PCMHs; however, none of these differences reached the statistical significance (adjusted P > 0.05 for all).This study found no meaningful difference in quality of care, patient experience, health care utilization, or health care expenditures between respondents cared for by PCMH and non-PCMH. Our findings suggest that the PCMH model is not superior in the quality of care delivered to non-PCMH providers.
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Affiliation(s)
- Zhigang Xie
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
| | - Sandhya Yadav
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
| | - Samantha A. Larson
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
| | - Arch G. Mainous
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
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O'Glasser AY, Pfeifer KJ, Edwards AF, Blitz JD, Urman RD. Striving for Evidence-Based, Patient-Centered Guidance: The Impetus Behind the Society for Perioperative Assessment and Quality Improvement (SPAQI) Medication Management Consensus Statements. Mayo Clin Proc 2021; 96:1117-1119. [PMID: 33618849 DOI: 10.1016/j.mayocp.2020.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/02/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Avital Y O'Glasser
- Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland.
| | - Kurt J Pfeifer
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Angela F Edwards
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jeanna D Blitz
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
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14
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Abstract
GENERAL PURPOSE To present a comprehensive review of patient-centered outcomes of topical or systemic interventions applied to those with shingles or postherpetic neuralgia to inform clinical practice and identify related research needs. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will be able to:1. Explain the importance of early diagnosis and treatment of herpes zoster (HZ).2. Identify interventions that have resulted in documented improvement of validated patient-centered outcomes in patients with HZ or postherpetic neuralgia.3. Recognize the average per patient medical costs of HZ in the US.
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15
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Corpora M, Kelley M, Kasler K, Heppner A, Van Haitsma K, Abbott KM. "It's Been a Whole New World": Staff Perceptions of Implementing a Person-Centered Communication Intervention During the COVID-19 Pandemic. J Gerontol Nurs 2021; 47:9-13. [PMID: 34039094 DOI: 10.3928/00989134-20210407-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The coronavirus disease 2019 (COVID-19) has challenged the way nursing homes deliver person-centered care (PCC). Preferences for Activity and Leisure (PAL) Cards are a tool to communicate residents' important preferences to staff. Monthly interviews (N = 32) were conducted with champions who were conducting a PAL Card quality improvement project in Tennessee nursing homes (N = 11) between March and August 2020. Three major themes emerged: Structural Changes (e.g., halting admissions, adding an isolation unit), Resident Burden (e.g., physical isolation, loneliness), and Provider Burnout (e.g., increased workload, mental exhaustion). Further, providers expressed the benefits to using PAL Cards, specifically in regard to blunting the negative impact of each theme. Results showed the overall negative impact of COVID-19 on nursing home communities. Nursing staff experienced greater burden than other staff, reflecting their prominent role in providing direct care to residents with COVID-19. Staff reported that PAL Cards helped promote PCC. [Journal of Gerontological Nursing, 47(5), 9-13.].
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Garcia RA, Spertus JA. Using Patient-Reported Outcomes toAssess Healthcare Quality: Toward Better Measurement of Patient-Centered Care in Cardiovascular Disease. Methodist Debakey Cardiovasc J 2021; 17:e1-e9. [PMID: 34104328 PMCID: PMC8158443 DOI: 10.14797/vuwd7697] [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] [Indexed: 12/11/2022] Open
Abstract
Patient-reported outcomes (PROs) are elicited directly from patients so they can describe their overall health status, including their symptoms, function, and quality of life. While commonly used as end points in clinical trials, PROs can play an important role in routine clinical care, population health management, and as a means for quantifying the quality of patient care. In this review, we propose that PROs be used to improve patient-centered care in the treatment of cardiovascular diseases given their importance to patients and society and their ability to improve doctor- provider communication. Furthermore, given the current variability in patients' health status across different clinics and the fact that PROs can be improved by titrating therapy, we contend that PROs have a key opportunity to serve as measures of healthcare quality.
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Affiliation(s)
- Raul Angel Garcia
- Saint Luke’s Mid America Heart Institute, University of Missouri Kansas City,Kansas City, Missouri
| | - John A Spertus
- Saint Luke’s Mid America Heart Institute, University of Missouri Kansas City,Kansas City, Missouri
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17
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Byrne N. Hobson's choice: patient-centred or standardized care. Adv Health Sci Educ Theory Pract 2021; 26:335-338. [PMID: 31897923 DOI: 10.1007/s10459-019-09951-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 12/18/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Niall Byrne
- The Wilson Centre for Research in Education, 200 Elizabeth Street 1ES-559, Toronto, ON, M5G 2C4, Canada.
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Abstract
ABSTRACT Quality and Safety Education for Nurses (QSEN) was launched in 2005 as a national nursing initiative aimed at preparing nurses with the competencies needed to continuously improve the quality and safety of the health care they provide. The six QSEN competencies-and the knowledge, skills, and attitudes that each entails-have served as a basis for significant curricular revision, more enlightened professional practice, relevant research, and health care system improvements. Since the launch of QSEN, new technologies have emerged, the range of care sites has broadened, new practice roles have emerged, and patients and families have become more active health care consumers. This article highlights these changes, considers Amazon as a powerful contemporary social force, examines the company's core values, and considers their relevancy to the six QSEN competencies. Essential new literacies and cognitive capacities are also identified. Lastly, the authors outline steps nurses can take to incorporate the QSEN competencies, along with the literacies and capacities, into their practice and organizations. Doing so is vital to delivering safe, high-quality care in this rapidly changing health care climate, and will enable nurses to claim their leadership and thrive professionally in an Amazon world.
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Affiliation(s)
- Joanne Disch
- Joanne Disch is professor ad honorem at the University of Minnesota School of Nursing in Minneapolis and has served on the board of Advocate Aurora Health since 2008. Jane Barnsteiner is a professor emerita at the University of Pennsylvania School of Nursing in Philadelphia and editor of translational research and quality improvement at AJN . Contact author: Jane Barnsteiner, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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19
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Abstract
BACKGROUND Despite decades of intensive resource allocation to eliminate preventable harm and increase high reliability in the hospital, the prevalence of serious harm remains consistent. LOCAL PROBLEM A hospital reduced targeted preventable harms using audit and feedback (A&F) but failed to globally reduce harm or increase proactive awareness. Nurse leaders lacked a defined process for identifying errors, mitigating risk, and teaching systems thinking to influence resiliency among teams. METHODS Nurse leaders underwent A&F of daily safety rounds. Adherence data on frequency, high-quality, and high-reliability organizational (HRO) leader practice standards and precursor incident reporting rates were trended. RESULTS Rounding practice adherence increased for the following defined standards: frequency (63%-79%); high quality (50%-90%); and HRO leadership (0%-67%). Precursor incident reporting rates increased 25%. CONCLUSIONS A&F reinforced quality and accountability for daily safety rounds. HRO theory-guided feedback offered an innovative way to translate HRO influence into nurse leader practice.
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Affiliation(s)
- Priya Meyer
- Legacy Health, Portland, Oregon (Dr Meyer); Randall Children's Hospital at Legacy Health, Portland, Oregon (Ms Hill); and Johns Hopkins Health System and Johns Hopkins University School of Nursing, Baltimore, Maryland (Dr Baker)
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20
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Logio LS. Common Symptoms in Outpatient Practice. Med Clin North Am 2021; 105:xvii-xviii. [PMID: 33246527 DOI: 10.1016/j.mcna.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Lia S Logio
- Professor of Medicine Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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21
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Esteves SC, Conforti A, Sunkara SK, Carbone L, Picarelli S, Vaiarelli A, Cimadomo D, Rienzi L, Ubaldi FM, Zullo F, Andersen CY, Orvieto R, Humaidan P, Alviggi C. Improving Reporting of Clinical Studies Using the POSEIDON Criteria: POSORT Guidelines. Front Endocrinol (Lausanne) 2021; 12:587051. [PMID: 33815269 PMCID: PMC8017440 DOI: 10.3389/fendo.2021.587051] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/19/2021] [Indexed: 12/19/2022] Open
Abstract
The POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) criteria were developed to help clinicians identify and classify low-prognosis patients undergoing assisted reproductive technology (ART) and provide guidance for possible therapeutic strategies to overcome infertility. Since its introduction, the number of published studies using the POSEIDON criteria has increased steadily. However, a critical analysis of existing evidence indicates inconsistent and incomplete reporting of critical outcomes. Therefore, we developed guidelines to help researchers improve the quality of reporting in studies applying the POSEIDON criteria. We also discuss the advantages of using the POSEIDON criteria in ART clinical studies and elaborate on possible study designs and critical endpoints. Our ultimate goal is to advance the knowledge concerning the clinical use of the POSEIDON criteria to patients, clinicians, and the infertility community.
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Affiliation(s)
- Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
- Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
- *Correspondence: Sandro C. Esteves, ; orcid.org/0000-0002-1313-9680
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | - Sesh K. Sunkara
- Department of Women’s Health, Faculty of Life Sciences, King’s College London, London, United Kingdom
| | - Luigi Carbone
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | - Silvia Picarelli
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | | | | | - Laura Rienzi
- Center for Reproductive Medicine, GENERA, Rome, Italy
| | | | - Fulvio Zullo
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | - Claus Yding Andersen
- Laboratory of Reproductive Biology, Faculty of Health and Medical Sciences, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Peter Humaidan
- Faculty of Health, Aarhus University, Aarhus, Denmark
- Fertility Clinic Skive, Skive Regional Hospital, Skive, Denmark
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy
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22
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Abstract
To address the global mental health crisis exacerbated by the COVID-19 pandemic, an urgent need has emerged to transform the accessibility, efficiency, and quality of mental health care. The next suite of efforts to transform mental health care must foster the implementation of "learning organizations," that is, organizations that continuously improve patient-centered care through ongoing data collection. The concept of learning organizations is highly regarded, but the key features of such organizations, particularly those providing mental health care, are less well defined. Using telepsychiatry care as an example, the authors of this Open Forum concretely describe the key building blocks for operationalizing a learning organization in mental health care to set a research agenda for services transformation.
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Affiliation(s)
- Rinad Beidas
- Departments of Psychiatry, Medical Ethics & Health Policy, Medicine, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3015, Philadelphia, PA 19104
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Shannon Wiltsey Stirman
- National Center for PTSD, Menlo Park, CA
- Department of Psychiatry and Biobehavioral Sciences, Stanford University, Stanford, CA
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23
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Windon MJ, Le D, D'Souza G, Bigelow E, Pitman K, Boss E, Eisele DW, Fakhry C. Treatment decision-making among patients with oropharyngeal squamous cell cancer: A qualitative study. Oral Oncol 2021; 112:105044. [PMID: 33130545 PMCID: PMC8556673 DOI: 10.1016/j.oraloncology.2020.105044] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022]
Abstract
Oropharyngeal squamous cell cancer (OPSCC) is now the most common site of head and neck squamous cell cancer. Despite the focus on treatment deintensification in clinical trials, little is known about the preferences, experiences and needs of patients with OPSCC when deciding between surgery and radiation therapy as primary treatment with curative intent. In this qualitative study, pre-treatment and post-treatment oropharyngeal cancer patients were recruited to take part in one-on-one interviews (n = 11 pre-treatment) and focus group discussions (n = 15 post-treatment) about treatment decision-making. Recordings were transcribed and assessed for emergent themes using framework analysis. From the one-on-one interviews and focus group discussions with OPSCC patients, fourteen themes were identified. Participants expressed alarm at diagnosis, decisional conflict, and a variety of roles in decision-making (physician-controlled, shared, and autonomous). Decisions were driven by the perceived recommendation of the treatment team, a desire for physical (surgical) tumor removal, fear of adverse effects of treatment, and patient-specific values. Although participants felt well-informed by their treating physicians, they identified a need for additional patient-centered information. Participants were critical of the poor quality of information available on the internet, and acknowledged the advantage of hearing the experiences of post-treatment patients. The experiences identified herein may be used to guide patient-centered communication during patient counseling and to inform interventions designed to support patients' needs at diagnosis, ultimately helping to implement high-quality, patient-centered care.
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Affiliation(s)
- Melina J Windon
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Daisy Le
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elaine Bigelow
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Karen Pitman
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Emily Boss
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David W Eisele
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carole Fakhry
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Bloomberg~Kimmel Institute for Cancer Immunotherapy, Johns Hopkins Medical Institutions, Baltimore, MD, United States.
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24
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Smith DK, Arnold MJ, Larson J. How to refine your approach to peripheral arterial disease. J Fam Pract 2020; 69:500-506. [PMID: 33348342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Early recognition, management of comorbid conditions, and appropriate treatment of peripheral arterial disease can help you improve your patient's outcome.
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Affiliation(s)
- Dustin K Smith
- Jacksonville Family Medicine Residency Program, Naval Hospital Jacksonville, FL, USA.
| | - Michael J Arnold
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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25
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Abstract
BACKGROUND Although a general implementation of person-centered care in Korean long-term care delivery systems would be challenging, person-centered care has the potential to improve resident and staff outcomes through changes in current care services. However, little empirical evidence currently supports a positive relationship between person-centered care environments and staff outcomes. PURPOSE This study was designed to examine the relationship between person-centered care environments and staff outcomes, including job satisfaction and turnover intention, among care staff in Korean long-term care facilities. METHODS This descriptive, correlational study used data from 235 care staff (94 nursing staff and 141 personal care workers) in 13 long-term care facilities in Korea. Data were collected using structured survey questionnaires, including items related to the person-centered care environment, job satisfaction, and turnover intention. Multilevel linear and logistic regression analyses were performed using Mplus Version 7.0. RESULTS After controlling for individual (age, education, monthly income, position, shift work, and job tenure) and organizational (type of facility, location, ownership, bed size, and staffing levels) characteristics, a significant relationship was found between the person-centered care environment and job satisfaction and turnover intention among staff in Korean long-term care facilities. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The study findings indicate that working in a person-centered care environment is key to higher job satisfaction, which is a significant predictor of turnover intention among staff in long-term care facilities. To recruit and retain qualified staff to provide high-quality person-centered care in long-term care facilities, a supportive work environment is crucial. Fostering a person-centered care environment will ultimately improve quality of care for residents.
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Affiliation(s)
- JiSun CHOI
- PhD, RN, Associate Professor, College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea
| | - Da Eun KIM
- PhD, RN, Assistant Professor, College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Republic of Korea
| | - Ju Young YOON
- PhD, RN, Associate Professor, College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
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26
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Heidenreich PA, Fonarow GC, Breathett K, Jurgens CY, Pisani BA, Pozehl BJ, Spertus JA, Taylor KG, Thibodeau JT, Yancy CW, Ziaeian B. 2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes 2020; 13:e000099. [PMID: 33136435 DOI: 10.1161/hcq.0000000000000099] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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27
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Munshi MN, Meneilly GS, Rodríguez-Mañas L, Close KL, Conlin PR, Cukierman-Yaffe T, Forbes A, Ganda OP, Kahn CR, Huang E, Laffel LM, Lee CG, Lee S, Nathan DM, Pandya N, Pratley R, Gabbay R, Sinclair AJ. Diabetes in ageing: pathways for developing the evidence base for clinical guidance. Lancet Diabetes Endocrinol 2020; 8:855-867. [PMID: 32946822 PMCID: PMC8223534 DOI: 10.1016/s2213-8587(20)30230-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/12/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023]
Abstract
Older adults with diabetes are heterogeneous in their medical, functional, and cognitive status, and require careful individualisation of their treatment regimens. However, in the absence of detailed information from clinical trials involving older people with varying characteristics, there is little evidence-based guidance, which is a notable limitation of current approaches to care. It is important to recognise that older people with diabetes might vary in their profiles according to age category, functional health, presence of frailty, and comorbidity profiles. In addition, all older adults with diabetes require an individualised approach to care, ranging from robust individuals to those residing in care homes with a short life expectancy, those requiring palliative care, or those requiring end-of-life management. In this Review, our multidisciplinary team of experts describes the current evidence in several important areas in geriatric diabetes, and outlines key research gaps and research questions in each of these areas with the aim to develop evidence-based recommendations to improve the outcomes of interest in older adults.
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Affiliation(s)
- Medha N Munshi
- Harvard Medical School, Boston, MA, USA; Joslin Diabetes Center, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | | | | | - Kelly L Close
- The diaTribe Foundation San Francisco, CA, USA; Close Concerns, San Francisco, CA, USA
| | - Paul R Conlin
- Harvard Medical School, Boston, MA, USA; Veteran Affairs Boston Healthcare System, Boston, MA, USA
| | - Tali Cukierman-Yaffe
- Division of Endocrinology, Diabetes and Metabolism, Gertner Institute, Ramat Gan, Israel; Sheba Medical Centre, Ramat Gan, Israel; Epidemiology Department, Sackler School of Medicine, Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
| | | | - Om P Ganda
- Harvard Medical School, Boston, MA, USA; Joslin Diabetes Center, Boston, MA, USA
| | - C Ronald Kahn
- Harvard Medical School, Boston, MA, USA; Joslin Diabetes Center, Boston, MA, USA
| | - Elbert Huang
- Center for Chronic Disease Research and Policy, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Lori M Laffel
- Harvard Medical School, Boston, MA, USA; Joslin Diabetes Center, Boston, MA, USA
| | - Christine G Lee
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sei Lee
- University of California San Francisco, San Francisco, CA, USA; Geriatrics and Extended Care, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - David M Nathan
- Harvard Medical School, Boston, MA, USA; Diabetes Research Center and Clinical Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Naushira Pandya
- Department of Geriatrics, Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Aventura Hospital, Aventura, FL, USA
| | - Richard Pratley
- AdventHealth, AdventHealth Diabetes Institute, AdventHealth Translational Research Institute, Orlando, FL, USA
| | - Robert Gabbay
- Harvard Medical School, Boston, MA, USA; Joslin Diabetes Center, Boston, MA, USA
| | - Alan J Sinclair
- King's College London, London, UK; Diabetes Frail, London, UK
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28
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Mitchell JA, Perry R. Disparities in patient-centered communication for Black and Latino men in the U.S.: Cross-sectional results from the 2010 health and retirement study. PLoS One 2020; 15:e0238356. [PMID: 32991624 PMCID: PMC7523955 DOI: 10.1371/journal.pone.0238356] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 08/14/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A lack of patient-centered communication (PCC) with health providers plays an important role in perpetuating disparities in health care outcomes and experiences for minority men. This study aimed to identify factors associated with any racial differences in the experience of PCC among Black and Latino men in a nationally representative sample. METHODS We employed a cross-sectional analysis of four indicators of PCC representative of interactions with doctors and nurses from (N = 3082) non-Latino White, Latino, and Black males from the 2010 Health and Retirement Study (HRS) Core and the linked HRS Health Care Mail in Survey (HCMS). Men's mean age was 66.76 years. The primary independent variable was Race/Ethnicity (i.e. Black and Hispanic/Latino compared to white males) and covariates included age, education, marital status, insurance status, place of care, and self-rated health. RESULTS Bivariate manova analyses revealed racial differences across each of the four facets of PCC experience such that non-Hispanic white men reported PC experiences most frequently followed by black then Hispanic/Latino men. Multivariate linear regressions predictive of PCC by race/ethnicity revealed that for Black men, fewer PCC experiences were predicted by discriminatory experiences, reporting fewer chronic conditions and a lack of insurance coverage. For Hispanic/Latino men, access to a provider proved key where not having a place of usual care solely predicted lower PCC frequency. IMPLICATIONS Researchers and health practitioners should continue to explore the impact of inadequate health care coverage, time-limited medical visits and implicit racial bias on medical encounters for underrepresented patients, and to advocate for accessible, inclusive and responsive communication between minority male patients and their health providers.
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Affiliation(s)
- Jamie A Mitchell
- School of Social Work, University of Michigan, Ann Arbor, MI, United States of America
| | - Ramona Perry
- School of Social Work, University of Michigan, Ann Arbor, MI, United States of America
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29
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Affiliation(s)
- Mattia J Gilmartin
- NICHE, NYU Meyers College of Nursing, 433 First Ave, NY 10010, United States.
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Abstract
Pituitary tumors are common and require complex and sophisticated procedures for both diagnosis and therapy. To maintain the highest standards of quality, it is proposed to manage patients in pituitary tumors centers of excellence (PTCOEs) with patient-centric organizations, with expert clinical endocrinologists and neurosurgeons forming the core. That core needs to be supported by experts from different disciplines such as neuroradiology, neuropathology, radiation oncology, neuro-ophthalmology, otorhinolaryngology, and trained nursing. To provide high-level medical care to patients with pituitary tumors, PTCOEs further pituitary science through research publication, presentation of results at meetings, and performing clinical trials.
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Affiliation(s)
- Stefano Frara
- Institute of Endocrinology, Università Vita-Salute San Raffaele, Via Olgettina Milano, 58, Milano, Milan 20132, Italy
| | - Gemma Rodriguez-Carnero
- Division of Endocrinology, Complejo Hospitalario Universitario de Santiago (USC/SERGAS), Instituto de Investigacion Sanitaria de Santiago (IDIS), Rúa da Choupana, S/N, Santiago de Compostela, A Coruña 15706, Spain
| | - Ana M Formenti
- Institute of Endocrinology, Università Vita-Salute San Raffaele, Via Olgettina Milano, 58, Milano, Milan 20132, Italy
| | - Miguel A Martinez-Olmos
- Division of Endocrinology, Complejo Hospitalario Universitario de Santiago (USC/SERGAS), Instituto de Investigacion Sanitaria de Santiago (IDIS), Rúa da Choupana, S/N, Santiago de Compostela, A Coruña 15706, Spain; CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Andrea Giustina
- Institute of Endocrinology, Università Vita-Salute San Raffaele, Via Olgettina Milano, 58, Milano, Milan 20132, Italy
| | - Felipe F Casanueva
- Division of Endocrinology, Complejo Hospitalario Universitario de Santiago (USC/SERGAS), Instituto de Investigacion Sanitaria de Santiago (IDIS), Rúa da Choupana, S/N, Santiago de Compostela, A Coruña 15706, Spain; CIBER Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.
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Abstract
INTRODUCTION Severe asthma is a debilitating, life-threatening disease associated with substantial global morbidity, mortality, and health care resource utilization. Patients may not receive guideline-directed medical care for severe asthma. Moreover, viable precision-based assessment tools and newer preventive therapies that can reduce the frequency of exacerbations and associated functional impact are underused. As a result, high rates of poorly controlled severe asthma persist, and patient health-related quality of life suffers. METHODS In 2019, the Improve Access to Better Care Task Force of the PRECISION Steering Committee set out to develop a global template on quality standards for severe asthma care to support improved access to and delivery of quality care. This Quality Standard is grounded in the vast body of published evidence available for severe asthma care, published clinical guidelines (i.e., from the Global Initiative for Asthma in 2019 and the European Respiratory Society/American Thoracic Society in 2014), and the 2018 PRECISION-supported Charter to Improve Patient Care in Severe Asthma. RESULTS The Quality Standard developed emphasizes four key elements aimed at optimizing clinical care and outcomes in severe asthma: (1) organization of services, (2) timely identification and referral for suspected severe asthma, (3) specialized assessment and management of severe asthma to optimize outcomes, and (4) patient-centric care and shared decision-making that is reflective of the patient's expectations, priorities, and values. Four key Quality Statements are provided, along with quality metrics and strategies for local adaptation to optimize implementation. CONCLUSION This Global Quality Standard is intended to mobilize policymakers, health care providers, and patient advocacy groups to build consensus on the definition and expectations of quality care in severe asthma, to promote patient-centric care, to identify gaps in care and areas for improvement, and systematically implement improvement measures and outcomes and to reduce the burden of illness for patients with severe asthma.
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Affiliation(s)
- John Haughney
- Glasgow Clinical Research Facility, Queen Elizabeth University Hospital, Glasgow, UK.
| | | | | | - Pascal Chanez
- Aix Marseille Université, Clinique des bronches, Allergie Et Sommeil/APHM, Marseille C2VN Center INSERM INRA UMR1062, Marseille, France
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John JR, Tannous WK, Jones A. Changes in health-related quality of life before and after a 12-month enhanced primary care model among chronically ill primary care patients in Australia. Health Qual Life Outcomes 2020; 18:288. [PMID: 32831086 PMCID: PMC7445903 DOI: 10.1186/s12955-020-01539-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/17/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Evidence suggests that Patient-centred Medical Home (PCMH) model facilitates person-centred care and improves health-related quality of life for patients with chronic illness. This study aims to evaluate changes in health-related quality of life (HRQoL), before and after enrolment into a 12-month integrated care program called 'WellNet'. METHODS This study includes 616 eligible consented patients aged 40 years and above with one or more chronic conditions from six general practices across Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and clinical coordinators (CCs) providing patient-tailored care plans configured to individual risk and complexity. HRQoL was recorded using the validated EuroQol five dimensions five levels (EQ-5D-5L) instrument at baseline and 12 months. Additionally, patients diagnosed with osteoarthritis also reported HRQoL using short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOSjr and HOOSjr). A case-series study design with repeated measures analysis of covariance (ANCOVA) was used to assess changes in mean differences of EQ-5D index scores after controlling for baseline covariates. Additionally, backward stepwise multivariable linear regression models were conducted to determine significant predictors of EQ-5D index scores at follow-up. RESULTS Out of 616 patients, 417 (68%) reported EQ-5D scores at follow-up. Almost half (48%) of the WellNet patients reported improved EQ-5D index scores at follow-up. After controlling for baseline covariates, the adjusted mean difference was statistically significant whilst also meeting the bare minimal clinically important difference (MCID) with a change of 0.03 (95% CI 0.01, 0.05). The multivariable regression models determined that baseline EQ-5D scores and positive diagnosis of a respiratory illness were significant predictors of HRQoL at follow-up. There were significant improvements across both KOOS and HOOS assessments, specifically, the pain and symptom scores in both scales met statistical significance in addition to meeting the MCID. CONCLUSION Patient-tailored chronic disease management (CDM) plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.
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Affiliation(s)
- James Rufus John
- Translational Health Research Institute, Western Sydney University, Campbelltown, Sydney, NSW 2560 Australia
- Rozetta Institute (formerly Capital Markets Cooperative Research Centre), The Rocks, Sydney, NSW 2000 Australia
| | - W. Kathy Tannous
- Translational Health Research Institute, Western Sydney University, Campbelltown, Sydney, NSW 2560 Australia
- School of Business, Western Sydney University, Parramatta, NSW 2150 Australia
| | - Amanda Jones
- Sonic Clinical Services, The Rocks, Sydney, NSW 2000 Australia
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Dorough A, Forfang D, Murphy SL, Mold JW, Kshirsagar AV, DeWalt DA, Flythe JE. Development of a person-centered interdisciplinary plan-of-care program for dialysis. Nephrol Dial Transplant 2020; 35:1426-1435. [PMID: 32083669 PMCID: PMC7825473 DOI: 10.1093/ndt/gfaa018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/23/2019] [Accepted: 01/08/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Dialysis care often focuses on outcomes that are of lesser importance to patients than to clinicians. There is growing international interest in individualizing care based on patient priorities, but evidence-based approaches are lacking. The objective of this study was to develop a person-centered dialysis care planning program. To achieve this objective we performed qualitative interviews, responsively developed a novel care planning program and then assessed program content and burden. METHODS We conducted 25 concept elicitation interviews with US hemodialysis patients, care partners and care providers, using thematic analysis to analyze transcripts. Interview findings and interdisciplinary stakeholder panel input informed the development of a new care planning program, My Dialysis Plan. We then conducted 19 cognitive debriefing interviews with patients, care partners and care providers to assess the program's content and face validities, comprehensibility and burden. RESULTS We identified five themes in concept elicitation interviews: feeling boxed in by the system, navigating dual lives, acknowledging an evolving identity, respecting the individual as a whole person and increasing individualization to enhance care. We then developed a person-centered care planning program and supporting materials that underwent 32 stakeholder-informed iterations. Data from subsequent cognitive interviews led to program revisions intended to improve contextualization and understanding, decrease burden and facilitate implementation. CONCLUSIONS My Dialysis Plan is a content-valid, person-centered dialysis care planning program that aims to promote care individualization. Investigation of the program's capacity to improve patient experiences and outcomes is needed.
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Affiliation(s)
- Adeline Dorough
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC, USA
| | | | - Shannon L Murphy
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC, USA
| | | | - Abhijit V Kshirsagar
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC, USA
| | - Darren A DeWalt
- Division of General Internal Medicine and Clinical Epidemiology, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, USA
| | - Jennifer E Flythe
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
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Šuc L, Švajger A, Bratun U. Goal Setting Among Experienced and Novice Occupational Therapists in a Rehabilitation Center. Can J Occup Ther 2020; 87:287-297. [PMID: 32696653 DOI: 10.1177/0008417420941979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND. Collaborative goal setting is an important part of client-centered occupational therapy. However, not all therapists have comparable skills when it comes to setting goals. PURPOSE. The aim of our study was to explore the experiences of novice and expert occupational therapists who use the Canadian Occupational Performance Measure in the process of goal setting. METHOD. This study followed a focused ethnography approach. Four beginners and four experienced occupational therapists were interviewed about their experiences with goal setting. We also observed them during a goal setting session. Data were analyzed using thematic analysis. FINDINGS. The four main themes that emerged from the analysis showed both similarities and differences between novice and experienced therapists, especially in the areas of communication, guidance, and flexibility, as well as dilemmas they were facing. IMPLICATIONS. Our findings challenge the client-centeredness of the participants and the relevance of work experience when it comes to collaborative goal setting.
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Baillieu R, Hoang H, Sripipatana A, Nair S, Lin SC. Impact of health information technology optimization on clinical quality performance in health centers: A national cross-sectional study. PLoS One 2020; 15:e0236019. [PMID: 32667953 PMCID: PMC7363086 DOI: 10.1371/journal.pone.0236019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 06/26/2020] [Indexed: 01/14/2023] Open
Abstract
Background Delivery of preventive care and chronic disease management are key components of a high functioning primary care practice. Health Centers (HCs) funded by the Health Resources and Services Administration (HRSA) have been delivering affordable and accessible primary health care to patients in underserved communities for over fifty years. This study examines the association between health center organization’s health information technology (IT) optimization and clinical quality performance. Methods and findings Using 2016 Uniform Data System (UDS) data, we performed bivariate and multivariate analyses to study the association of Meaningful Use (MU) attestation as a proxy for health IT optimization, patient centered medical home (PCMH) recognition status, and practice size on performance of twelve electronically specified clinical quality measures (eCQMs). Bivariate analysis demonstrated performance of eleven out of the twelve preventive and chronic care eCQMs was higher among HCs attesting to MU Stage 2 or above. Multivariate analysis demonstrated that Stage 2 MU or above, PCMH status, and larger practice size were positively associated with performance on cancer screening, smoking cessation counseling and pediatric weight assessment and counseling eCQMs. Conclusions Organizational advancement in MU stages has led to improved quality of care that augments HCs patient care capacity for disease prevention, health promotion, and chronic care management. However, rapid technological advancement in health care acts as a potential source of disparity, as considerable resources needed to optimize the electronic health record (EHR) and to undertake PCMH transformation are found more commonly among larger HCs practices. Smaller practices may lack the financial, human and educational assets to implement and to maintain EHR technology. Accordingly, targeted approaches to support small HCs practices in leveraging economies of scale for health IT optimization, clinical decision support, and clinical workflow enhancements are critical for practices to thrive in the dynamic value-based payment environment.
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Affiliation(s)
- Robert Baillieu
- Robert Graham Center for Policy Studies in Primary Care Washington, Washington, DC, United States of America
| | - Hank Hoang
- US Department of Health and Human Service, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
| | - Alek Sripipatana
- US Department of Health and Human Service, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
| | - Suma Nair
- US Department of Health and Human Service, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
| | - Sue C. Lin
- US Department of Health and Human Service, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
- * E-mail:
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Yamane SS, De Gagne JC, Riggs A, Kimberly GD, Holye M. Assessment of a patient-centered initiative to improve hypertension management for adults with comorbid type 2 diabetes at a free clinic in the rural south. Nurs Forum 2020; 55:348-355. [PMID: 32034778 DOI: 10.1111/nuf.12434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 06/10/2023]
Abstract
BACKGROUND Hypertension is the most modifiable risk factor for cardiovascular disease. Low levels of adherence to medication regimens, positive health behaviors, and ideal metric goals are associated with low rates of morbidity and mortality, impaired physical function, and frailty. AIM This quality improvement study sought to assess whether a program of patient and provider education, combined with a decision aid (DA) designed to increase shared decision making, would improve (a) patient knowledge about hypertension management, (b) provider adherence to prescription guidelines for the management of hypertension, (c) medication adherence for the management of hypertension by the patient, and (d) communication between provider and patient. SETTING Free clinic in the United States rural south. PARTICIPANTS Twenty-four patients with comorbid hypertension and type 2 diabetes. METHODS A pretest/posttest design utilizing a provider education, pre-encounter quiz, focused patient education, and DA was used to evaluate the intervention. RESULTS A significant increase in pretest/posttest scores 60% (SD = 29%) to 93% (SD = 15%), P < .001 about hypertension and its management was observed. Adherence to guideline-based medication use increased angiotensin-converting enzyme inhibitors 38% to 64%, angiotensin II receptor blockers 17% to 29%, dihydropyridine calcium channel blockers 29% to 43%, beta-blockers 8% to 25%, statins 65% to 83%, and diuretics 38% to 46%. CONCLUSIONS The intervention was an efficient method to provide patient-centered education that increased patient knowledge about medication and lifestyle management of hypertension.
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Affiliation(s)
- Sandra S Yamane
- Department of Nursing, Catawba College, Salisbury, North Carolina
| | | | - Alysse Riggs
- Davie County Health Department, Mocksville, North Carolina
| | | | - Martha Holye
- Storehouse for Jesus, Mocksville, North Carolina
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Gupta N, Thiele CM, Daum JI, Egbert LK, Chiang JS, Kilgore AE, Johnson CD. Building Patient-Physician Trust: A Medical Student Perspective. Acad Med 2020; 95:980-983. [PMID: 32079958 DOI: 10.1097/acm.0000000000003201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Public trust in physicians has declined over the last 50 years. Future physicians will need to mend the patient-physician trust relationship. In conjunction with the American Medical Association's Accelerating Change in Medical Education initiative, the Mayo Clinic Alix School of Medicine implemented the Science of Health Care Delivery (SHCD) curriculum-a 4-year curriculum that emphasizes interdisciplinary training across population-centered care; person-centered care; team-based care; high-value care; leadership; and health policy, economics, and technology-in 2015. In this medical student perspective, the authors highlight how the SHCD curriculum has the potential to address issues that have eroded patient-physician trust. The curriculum reaches this aim through didactic and/or experiential teachings in health equity, cultural humility and competence, shared decision making, patient advocacy, and safety and quality of care. It is the authors' hope that novel medical education programs such as the SHCD curriculum will allow the nation's future physicians to own their role in rebuilding and fostering public trust in physicians and the health care system.
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Affiliation(s)
- Nikita Gupta
- N. Gupta is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. C.M. Thiele is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. J.I. Daum is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. L.K. Egbert is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. J.S. Chiang is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. A.E. Kilgore Jr is a second-year medical student, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona. C.D. Johnson is a consultant, Department of Radiology, Mayo Clinic Hospital, Scottsdale, Arizona
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Weiner S, Schwartz A, Altman L, Ball S, Bartle B, Binns-Calvey A, Chan C, Falck-Ytter C, Frenchman M, Gee B, Jackson JL, Jordan N, Kass B, Kelly B, Safdar N, Scholcoff C, Sharma G, Weaver F, Wopat M. Evaluation of a Patient-Collected Audio Audit and Feedback Quality Improvement Program on Clinician Attention to Patient Life Context and Health Care Costs in the Veterans Affairs Health Care System. JAMA Netw Open 2020; 3:e209644. [PMID: 32735338 PMCID: PMC7395234 DOI: 10.1001/jamanetworkopen.2020.9644] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Evidence-based care plans can fail when they do not consider relevant patient life circumstances, termed contextual factors, such as a loss of social support or financial hardship. Preventing these contextual errors can reduce obstacles to effective care. OBJECTIVE To evaluate the effectiveness of a quality improvement program in which clinicians receive ongoing feedback on their attention to patient contextual factors. DESIGN, SETTING, AND PARTICIPANTS In this quality improvement study, patients at 6 Department of Veterans Affairs outpatient facilities audio recorded their primary care visits from May 2017 to May 2019. Encounters were analyzed using the Content Coding for Contextualization of Care (4C) method. A feedback intervention based on the 4C coded analysis was introduced using a stepped wedge design. In the 4C coding schema, clues that patients are struggling with contextual factors are termed contextual red flags (eg, sudden loss of control of a chronic condition), and a positive outcome is prospectively defined for each encounter as a quantifiable improvement of the contextual red flag. Data analysis was performed from May to October 2019. INTERVENTIONS Clinicians received feedback at 2 intensity levels on their attention to patient contextual factors and on predefined patient outcomes at 4 to 6 months. MAIN OUTCOMES AND MEASURES Contextual error rates, patient outcomes, and hospitalization rates and costs were measured. RESULTS The patients (mean age, 62.0 years; 92% male) recorded 4496 encounters with 666 clinicians. At baseline, clinicians addressed 413 of 618 contextual factors in their care plans (67%). After either standard or enhanced feedback, they addressed 1707 of 2367 contextual factors (72%), a significant difference (odds ratio, 1.3; 95% CI, 1.1-1.6; P = .01). In a mixed-effects logistic regression model, contextualized care planning was associated with a greater likelihood of improved outcomes (adjusted odds ratio, 2.5; 95% CI, 1.5-4.1; P < .001). In a budget analysis, estimated savings from avoided hospitalizations were $25.2 million (95% CI, $23.9-$26.6 million), at a cost of $337 242 for the intervention. CONCLUSIONS AND RELEVANCE These findings suggest that patient-collected audio recordings of the medical encounter with feedback may enhance clinician attention to contextual factors, improve outcomes, and reduce hospitalizations. In addition, the intervention is associated with substantial cost savings.
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Affiliation(s)
- Saul Weiner
- Department of Medicine, University of Illinois at Chicago, Chicago
- Center of Innovation for Complex Chronic Healthcare, Jesse Brown VA Chicago Health Care System, Chicago, Illinois
| | - Alan Schwartz
- Department of Medical Education, University of Illinois at Chicago, Chicago
| | - Lisa Altman
- Office of Healthcare Transformation, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Sherry Ball
- Research Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Brian Bartle
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois
| | - Amy Binns-Calvey
- Department of Medicine, University of Illinois at Chicago, Chicago
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois
| | - Carolyn Chan
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Meghana Frenchman
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Bryan Gee
- Department of Medicine, Edward Hines Jr VA Hospital, Hines, Illinois
| | - Jeffrey L. Jackson
- General Medicine Division, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Neil Jordan
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois
- Department of Psychiatry and Behavioral Sciences and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Benjamin Kass
- Department of Medicine, University of Illinois at Chicago, Chicago
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois
| | - Brendan Kelly
- Department of Medicine, University of Illinois at Chicago, Chicago
- Center of Innovation for Complex Chronic Healthcare, Jesse Brown VA Chicago Health Care System, Chicago, Illinois
| | - Nasia Safdar
- Research Services, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Cecilia Scholcoff
- General Medicine Division, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Gunjan Sharma
- Department of Medicine, University of Illinois at Chicago, Chicago
- Center of Innovation for Complex Chronic Healthcare, Jesse Brown VA Chicago Health Care System, Chicago, Illinois
| | - Frances Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr VA Hospital, Hines, Illinois
- Department of Public Health Sciences, Loyola University Chicago, Chicago, Illinois
| | - Maria Wopat
- Pharmacy Services, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
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Okunrintemi V, Nasir K. Optimizing Patient-Reported Experiences for Cardiovascular Disease: Current Landscape and Future Opportunities. Methodist Debakey Cardiovasc J 2020; 16:220-224. [PMID: 33133358 PMCID: PMC7587317 DOI: 10.14797/mdcj-16-3-220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/08/2022] Open
Abstract
Improving patient experience is a fundamental component of patient-centered care and one of the key strategies for improving health care quality, delivery, and outcomes. Several studies have described the association between improved patient experience and better health outcomes among individuals with cardiovascular disease. These findings are important given that cardiovascular disease is a leading cause of morbidity and mortality in the United States and globally. This review summarizes the findings on patient-reported health care experiences and discusses how optimizing these experiences may be a tool to improve health outcomes among individuals with cardiovascular disease.
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Affiliation(s)
| | - Khurram Nasir
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
- YALE SCHOOL OF MEDICINE, NEW HAVEN, CONNECTICUT
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Englander R, Holmboe E, Batalden P, Caron RM, Durham CF, Foster T, Ogrinc G, Ercan-Fang N, Batalden M. Coproducing Health Professions Education: A Prerequisite to Coproducing Health Care Services? Acad Med 2020; 95:1006-1013. [PMID: 31876565 DOI: 10.1097/acm.0000000000003137] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In 2016, Batalden et al proposed a coproduction model for health care services. Starting from the argument that health care services should demonstrate service-dominant rather than goods-dominant logic, they argued that health care outcomes are the result of the intricate interaction of the provider and patient in concert with the system, community, and, ultimately, society. The key notion is that the patient is as much an expert in determining outcomes as the provider, but with different expertise. Patients come to the table with expertise in their lived experiences and the context of their lives.The authors posit that education, like health care services, should follow a service-dominant logic. Like the relationship between patients and providers, the relationship between learner and teacher requires the integrated expertise of each nested in the context of their system, community, and society to optimize outcomes. The authors then argue that health professions learners cannot be educated in a traditional, paternalistic model of education and then expected to practice in a manner that prioritizes coproductive partnerships with colleagues, patients, and families. They stress the necessity of adapting the health care services coproduction model to health professions education. Instead of asking whether the coproduction model is possible in the current system, they argue that the current system is not sustainable and not producing the desired kind of clinicians.A current example from a longitudinal integrated clerkship highlights some possibilities with coproduced education. Finally, the authors offer some practical ways to begin changing from the traditional model. They thus provide a conceptual framework and ideas for practical implementation to move the educational model closer to the coproduction health care services model that many strive for and, through that alignment, to set the stage for improved health outcomes for all.
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Affiliation(s)
- Robert Englander
- R. Englander is associate dean, undergraduate medical education, and professor, pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota. E. Holmboe is chief, research, milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. P. Batalden is emeritus professor, Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. R.M. Caron is professor, Department of Health Management and Policy, College of Health and Human Services, University of New Hampshire, Durham, New Hampshire. C.F. Durham is professor and director, interprofessional education and practice, and director, education-innovation-simulation learning environment, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. T. Foster is professor of obstetrics and gynecology and of community and family medicine, Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. G. Ogrinc is senior associate dean for medical education and professor of medicine, Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. N. Ercan-Fang is associate director for medical education for primary and specialty care services, co-director, the VA longitudinal integrated clerkship, and associate professor of medicine, Minneapolis VA Health Care System and the University of Minnesota Medical School, Minneapolis, Minnesota. M. Batalden is interim chief quality officer, Cambridge Health Alliance, and assistant professor of medicine, Harvard Medical School, Boston, Massachusetts
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Rising KL, Powell RE, Cameron KA, Salzman DH, Papanagnou D, Doty AM, Latimer L, Piserchia K, McGaghie WC, McCarthy DM. Development of the Uncertainty Communication Checklist: A Patient-Centered Approach to Patient Discharge From the Emergency Department. Acad Med 2020; 95:1026-1034. [PMID: 32101919 PMCID: PMC7302334 DOI: 10.1097/acm.0000000000003231] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Clear communication with patients upon emergency department (ED) discharge is important for patient safety during the transition to outpatient care. Over one-third of patients are discharged from the ED with diagnostic uncertainty, yet there is no established approach for effective discharge communication in this scenario. From 2017 to 2019, the authors developed the Uncertainty Communication Checklist for use in simulation-based training and assessment of emergency physician communication skills when discharging patients with diagnostic uncertainty. This development process followed the established 12-step Checklist Development Checklist framework and integrated patient feedback into 6 of the 12 steps. Patient input was included as it has potential to improve patient-centeredness of checklists related to assessment of clinical performance. Focus group patient participants from 2 clinical sites were included: Thomas Jefferson University Hospital, Philadelphia, PA, and Northwestern University Hospital, Chicago, Illinois.The authors developed a preliminary instrument based on existing checklists, clinical experience, literature review, and input from an expert panel comprising health care professionals and patient advocates. They then refined the instrument based on feedback from 2 waves of patient focus groups, resulting in a final 21-item checklist. The checklist items assess if uncertainty was addressed in each step of the discharge communication, including the following major categories: introduction, test results/ED summary, no/uncertain diagnosis, next steps/follow-up, home care, reasons to return, and general communication skills. Patient input influenced both what items were included and the wording of items in the final checklist. This patient-centered, systematic approach to checklist development is built upon the rigor of the Checklist Development Checklist and provides an illustration of how to integrate patient feedback into the design of assessment tools when appropriate.
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Affiliation(s)
- Kristin L. Rising
- K.L. Rising is associate professor and director of acute care transitions, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rhea E. Powell
- R.E. Powell is associate professor, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, and senior researcher, Mathematica, Princeton, New Jersey
| | - Kenzie A. Cameron
- K.A. Cameron is research professor, Department of Medical Education and Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David H. Salzman
- D.H. Salzman is associate professor, Department of Emergency Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dimitrios Papanagnou
- D. Papanagnou is associate professor and vice chair for education, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amanda M.B. Doty
- A.M.B. Doty is a research coordinator, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lori Latimer
- L. Latimer is a research coordinator, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Katherine Piserchia
- K. Piserchia is a clinical research coordinator, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William C. McGaghie
- W.C. McGaghie is professor, Department of Medical Education, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Danielle M. McCarthy
- D.M. McCarthy is associate professor, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Abstract
Introduction: Matching available mental health services to patients' preferences, as well as is possible, may increase patient satisfaction and help increase adherence to certain treatments. This study systematically reviewed discrete-choice experiments (DCEs) on patients' preferences for treatment of depressive and anxiety disorders and assessed the relative importance of outcome, process and cost attributes to improve the current and future treatment situations.Methods: A systematic literature review using PubMed, EMBASE and PsychInfo was conducted to retrieve all relevant DCEs published up to 15 April 2019, eliciting patient preferences for treatment of depressive and anxiety disorders. Data were extracted using an extraction sheet, and attributes were classified into outcome, process and cost attributes. The relative importance of each attribute category was then assessed, and studies were evaluated according to their reporting quality, using validated checklists.Results: A total of 11 studies were identified for qualitative analysis. All studies received an aggregate score of 4 on the five-point PREFS checklist (Purpose, Respondents, Explanation, Findings and Significance). Most attributes were outcome related (52%), followed by process (42%) and cost (6%) attributes. Comparing the attribute categories and summing up the relative importance weights for each category within the studies, process attributes were ranked as most important, followed by cost and outcome attributes.Conclusions: In this systematic review, heterogeneous results were observed regarding the inclusion and framing of different attributes across studies. Overall, patients considered process and cost attributes to be more important than outcome attributes. Outcomes and process are important for patients, and thus clinicians should be particularly aware of this and take patients' preferences into account, although the attribute importance may depend on chosen attributes and related levels.
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Affiliation(s)
- Maike Tünneßen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI - Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Vera Vennedey
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
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Palmer Kelly E, Meara A, Hyer M, Payne N, Pawlik TM. Characterizing Perceptions Around the Patient-Oncologist Relationship: a Qualitative Focus Group Analysis. J Cancer Educ 2020; 35:447-453. [PMID: 30772927 DOI: 10.1007/s13187-019-1481-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of the current study was to characterize the experiences of cancer patients and their caregiver/family members around their relationship with their oncologist, health care team, and the hospital environment. Participants were recruited from The Ohio State University Comprehensive Cancer Center. Participant sociodemographic factors were assessed. Focus groups were moderated and recorded by two members of the research team using a semi-structured interview format. The audio recordings were transcribed and uploaded to NViVO 11 for analyses. Four focus groups were conducted with 25 participants. The mean age of participants was 58.4 years (SD = 15.1, range 26.0-76.0). Participants who were identified as patients (84%) reported different malignancy types including breast (56%), gynecologic (16%), skin (6%) oral (6%), and non-Hodgkin's lymphoma (6%). Three major themes that emerged around the patient-oncologist relationship, include (1) choosing a physician and health care location, (2) relationship with the physician, health care team, and hospital environment; and (3) patient engagement and decision-making. Subthemes highlighted the importance of the flexible communication behaviors and trustworthiness of the oncologist, and the impact of other health care team members. Patients also reported the desire to be engaged in making treatment-related decisions and to include the caregiver/spouse in all stages of cancer care. Understanding the experience of cancer patients in a relationship with their oncologist in the context of the health care team and health care environment will be an important area of future research to provide optimal, tailored patient-centered cancer care.
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Affiliation(s)
| | - Alexa Meara
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nicolette Payne
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Ajam AA, Tahir S, Makary MS, Longworth S, Lang EV, Krishna NG, Mayr NA, Nguyen XV. Communication and Team Interactions to Improve Patient Experiences, Quality of Care, and Throughput in MRI. Top Magn Reson Imaging 2020; 29:131-134. [PMID: 32568975 DOI: 10.1097/rmr.0000000000000242] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Patients undergoing MRI may experience fear, claustrophobia, or other anxiety manifestations due to the typically lengthy, spatially constrictive, and noisy MRI acquisition process and in some cases are not able to tolerate completion of the study. This article discusses several patient-centered aspects of radiology practice that emphasize interpersonal interactions. Patient education and prescan communication represent 1 way to increase patients' awareness of what to expect during MRI and therefore mitigate anticipatory anxiety. Some patient interaction strategies to promote relaxation or calming effects are also discussed. Staff teamwork and staff training in communication and interpersonal skills are also described, along with literature evidence of effectiveness with respect to patient satisfaction and productivity endpoints. Attention to how radiologists, nurses, technologists, and other members of the radiology team interact with patients before or during the MRI scan could improve patients' motivation and ability to cooperate with the MRI scanning process as well as their subjective perceptions of the quality of their care. The topics discussed in this article are relevant not only to MRI operations but also to other clinical settings in which patient anxiety or motion represent impediments to optimal workflow.
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Affiliation(s)
- Amna A Ajam
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sandra Longworth
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Nidhi G Krishna
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nina A Mayr
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA
| | - Xuan V Nguyen
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
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Denadai R, Lo LJ. Building a virtuous cycle of surgical cleft-craniofacial care by combining surgeon centered outcome and patient reported outcome measures. J Plast Reconstr Aesthet Surg 2020; 73:1174-1205. [PMID: 32113961 DOI: 10.1016/j.bjps.2020.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/17/2020] [Accepted: 02/08/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Sao Paulo, Brazil.
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Abstract
The Christie NHS Foundation Trust is a leader in adapting patient care in response to treatment advances and new patient-centred care/efficiency initiatives. Due to extended waiting times in cancer clinics, The Christie developed an at-home treatment service to help reduce the pressure on clinics and improve patient experience. This article provides a detailed examination of the requirements necessary to successfully develop a home service for the delivery of systemic anticancer treatment. The authors discuss the criteria used to identify suitable at-home treatments, as well as necessary resources and equipment. The success of the Christie at Home service was examined using a patient survey to assess the standard of this care. Details are given regarding the challenges of implementing a homecare service and potential future challenges. As an example, systemic treatment with eribulin as a 'Christie at Home' therapy demonstrates the practicalities of introduction of new therapies in a homecare service.
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Affiliation(s)
- Victoria Burns
- SACT Outreach Manager, The Christie NHS Foundation Trust, Manchester
| | - Vivek Misra
- Consultant Clinical Oncologist, The Christie NHS Foundation Trust, Manchester
| | - Nina Paton
- Homecare Pharmacist, The Christie NHS Foundation Trust, Manchester
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Findlay M, Rankin NM, Shaw T, White K, Boyer M, Milross C, De Abreu Lourenço R, Brown C, Collett G, Beale P, Bauer JD. Best Evidence to Best Practice: Implementing an Innovative Model of Nutrition Care for Patients with Head and Neck Cancer Improves Outcomes. Nutrients 2020; 12:nu12051465. [PMID: 32438607 PMCID: PMC7284331 DOI: 10.3390/nu12051465] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/31/2022] Open
Abstract
Malnutrition is prevalent in patients with head and neck cancer (HNC), impacting outcomes. Despite publication of nutrition care evidence-based guidelines (EBGs), evidence–practice gaps exist. This study aimed to implement and evaluate the integration of a patient-centred, best-practice dietetic model of care into an HNC multidisciplinary team (MDT) to minimise the detrimental sequelae of malnutrition. A mixed-methods, pre–post study design was used to deliver key interventions underpinned by evidence-based implementation strategies to address identified barriers and facilitators to change at individual, team and system levels. A data audit of medical records established baseline adherence to EBGs and clinical parameters prior to implementation in a prospective cohort. Key interventions included a weekly Supportive Care-Led Pre-Treatment Clinic and a Nutrition Care Dashboard highlighting nutrition outcome data integrated into MDT meetings. Focus groups provided team-level evaluation of the new model of care. Economic analysis determined system-level impact. The baseline clinical audit (n = 98) revealed barriers including reactive nutrition care, lack of familiarity with EBGs or awareness of intensive nutrition care needs as well as infrastructure and dietetic resource limitations. Post-implementation data (n = 34) demonstrated improved process and clinical outcomes: pre-treatment dietitian assessment; use of a validated nutrition assessment tool before, during and after treatment. Patients receiving the new model of care were significantly more likely to complete prescribed radiotherapy and systemic therapy. Differences in mean percentage weight change were clinically relevant. At the system level, the new model of care avoided 3.92 unplanned admissions and related costs of $AUD121K per annum. Focus groups confirmed clear support at the multidisciplinary team level for continuing the new model of care. Implementing an evidence-based nutrition model of care in patients with HNC is feasible and can improve outcomes. Benefits of this model of care may be transferrable to other patient groups within cancer settings.
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Affiliation(s)
- Merran Findlay
- Cancer Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia;
- Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia; (M.B.); (C.M.)
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Camperdown, NSW 2050, Australia; (N.M.R.); (T.S.); (K.W.)
- Correspondence: ; Tel.: +61-(0)411-779-420
| | - Nicole M. Rankin
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Camperdown, NSW 2050, Australia; (N.M.R.); (T.S.); (K.W.)
- Research in Implementation Science and eHealth, Faculty of Health Sciences, University of Sydney, Camperdown, NSW 2006, Australia
| | - Tim Shaw
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Camperdown, NSW 2050, Australia; (N.M.R.); (T.S.); (K.W.)
- Research in Implementation Science and eHealth, Faculty of Health Sciences, University of Sydney, Camperdown, NSW 2006, Australia
| | - Kathryn White
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Camperdown, NSW 2050, Australia; (N.M.R.); (T.S.); (K.W.)
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia;
| | - Michael Boyer
- Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia; (M.B.); (C.M.)
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Camperdown, NSW 2050, Australia; (N.M.R.); (T.S.); (K.W.)
| | - Christopher Milross
- Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia; (M.B.); (C.M.)
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Camperdown, NSW 2050, Australia; (N.M.R.); (T.S.); (K.W.)
| | - Richard De Abreu Lourenço
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, NSW 2000, Australia;
| | - Chris Brown
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Camperdown, NSW 2050, Australia;
| | - Gemma Collett
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia;
| | - Philip Beale
- Cancer Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia;
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Camperdown, NSW 2050, Australia; (N.M.R.); (T.S.); (K.W.)
| | - Judith D. Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Brisbane, QLD 4072, Australia;
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Simons M, Rapport F, Zurynski Y, Cullis J, Davidson A. What are the links between evidence-based medicine and shared decision-making in training programs for junior doctors? A scoping review protocol. BMJ Open 2020; 10:e037225. [PMID: 32404397 PMCID: PMC7228528 DOI: 10.1136/bmjopen-2020-037225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Patient-centred care is pivotal to clinical practice and medical education. The practice of evidence-based medicine (EBM) and shared decision-making (SDM) are complementary aspects of patient-centred care, but they are frequently taught and reported as independent entities. To effectively perform all steps of EBM, clinicians need to include patients in SDM conversations, however, the uptake of this has been slow and inconsistent. A solution may be the incorporation of SDM into EBM training programmes, but such programmes do not routinely include SDM skills development. This scoping review will survey the literature on the kinds of EBM and SDM educational programmes that exist for recently qualified doctors, programmes that incorporate the teaching of both EBM and SDM skills, as well as identifying research gaps in the literature. METHODS AND ANALYSIS Literature searches will be conducted in the databases Medline, Embase, Scopus and Cochrane Library. Bibliographies of key articles and their citing references will also be hand-searched and assessed for inclusion. Selected grey literature will be included. Papers must be written in English, or provide English abstracts, and date from 1996 to the present day.Two independent reviewers will screen titles and abstracts, check full texts of selected papers for eligibility and extract the data. Any disagreement will be resolved, and consensus reached, if necessary, with the assistance of a third reviewer. Qualitative and quantitative studies that address educational interventions for either EBM, SDM or both will be included. Data extraction tables will present bibliographic information, populations, interventions, context and outcomes. Data will be summarised using tables and figures and a description of findings. ETHICS AND DISSEMINATION This review will synthesise information from publicly available publications and does not require ethics approval. The results will be disseminated via conference presentations and publications in medical journals.
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Affiliation(s)
- Mary Simons
- Library, Macquarie University, North Ryde, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeremy Cullis
- Library, Macquarie University, North Ryde, New South Wales, Australia
| | - Andrew Davidson
- Library, Macquarie University, North Ryde, New South Wales, Australia
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Burrows J, Dall'Alba G, La Caze A. We are all patient-centred now, aren't we? Lessons from new pharmacy graduates. Curr Pharm Teach Learn 2020; 12:508-516. [PMID: 32336446 DOI: 10.1016/j.cptl.2020.01.017] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/27/2019] [Accepted: 01/13/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Patient-centredness is considered integral to the delivery of modern healthcare. This qualitative, longitudinal study explored the meaning and development of the practice of pharmacy graduates, leading to a focus on patient-centredness. The approach adopted in this study aligned with the principles of hermeneutic phenomenology. METHODS Twelve pharmacy graduates (seven females) from The University of Queensland were observed at work and interviewed about their experiences of pharmacy practice every six months for two years following graduation. RESULTS These 12 graduates initially understood and enacted pharmacy practice in a range of ways. A distinguishing characteristic related to how patients/customers featured in their practice. For some, ensuring the efficient supply or administration of correct and safe medicines with instructions was the focus, with patients viewed as source and recipient of information. For others, the focus was communicating effectively with patients/customers to provide individualised advice to avoid medication-related problems. A third group focused on achieving a broader goal, to provide individualised care to optimise health outcomes from medicines. Initial understanding of patient-centredness remained largely unchanged for most participants over the two years, despite the passage of time and experience gained. CONCLUSIONS This study calls into question an assumption of a common meaning for patient-centredness. The findings highlight the need to question and debate what patient-centredness means in contemporary pharmacy practice, rather than simply being an aspirational or theoretical concept. It is important that pharmacists and educators appreciate the centrality of understanding of practice for development, to optimally facilitate the development of patient-centred pharmacists.
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Affiliation(s)
- Judith Burrows
- School of Education, The University of Queensland, St Lucia, Brisbane, Queensland 4072, Australia; School of Pharmacy, 20 Cornwall St, Woolloongabba, Brisbane, Queensland 4102, Australia.
| | - Gloria Dall'Alba
- School of Education, The University of Queensland, St Lucia, Brisbane, Queensland 4072, Australia
| | - Adam La Caze
- School of Pharmacy, 20 Cornwall St, Woolloongabba, Brisbane, Queensland 4102, Australia
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50
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Abstract
Older adults, particularly those late in life, are at higher risk for medication misadventure, yet bear the burden of increasing polypharmacy. It is incumbent on practitioners who care for this vulnerable population to use one or more approaches to deprescribe medications that impose a greater burden than benefit, including medically futile medications. It is essential that health care providers use compassionate communication skills when explaining these interventions with patients and families, pointing out that this is a positive, patient-centric intervention.
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Affiliation(s)
- Shaida Talebreza
- Geriatric and Academic Palliative Medicine, Division of Geriatrics, University of Utah School of Medicine, George E. Wahlen Salt Lake City Veterans Affairs Medical Center, 30 North 1900 East SOM AB193, Salt Lake City, UT 84132-0001, USA
| | - Mary Lynn McPherson
- Advanced Post-Graduate Education in Palliative Care, Online Master of Science in Palliative Care, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy Baltimore, 20 North Pine Street, S405, Baltimore, MD 21201, USA.
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