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Holbrook A, Bowen JM, Patel H, O'Brien C, You JJ, Tahavori R, Doleweerd J, Berezny T, Perri D, Nieuwstraten C, Troyan S, Patel A. Process mapping evaluation of medication reconciliation in academic teaching hospitals: a critical step in quality improvement. BMJ Open 2016; 6:e013663. [PMID: 28039294 PMCID: PMC5223656 DOI: 10.1136/bmjopen-2016-013663] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Medication reconciliation (MedRec) has been a mandated or recommended activity in Canada, the USA and the UK for nearly 10 years. Accreditation bodies in North America will soon require MedRec for every admission, transfer and discharge of every patient. Studies of MedRec have revealed unintentional discrepancies in prescriptions but no clear evidence that clinically important outcomes are improved, leading to widely variable practices. Our objective was to apply process mapping methodology to MedRec to clarify current processes and resource usage, identify potential efficiencies and gaps in care, and make recommendations for improvement in the light of current literature evidence of effectiveness. METHODS Process engineers observed and recorded all MedRec activities at 3 academic teaching hospitals, from initial emergency department triage to patient discharge, for general internal medicine patients. Process maps were validated with frontline staff, then with the study team, managers and patient safety leads to summarise current problems and discuss solutions. RESULTS Across all of the 3 hospitals, 5 general problem themes were identified: lack of use of all available medication sources, duplication of effort creating inefficiency, lack of timeliness of completion of the Best Possible Medication History, lack of standardisation of the MedRec process, and suboptimal communication of MedRec issues between physicians, pharmacists and nurses. DISCUSSION MedRec as practised in this environment requires improvements in quality, timeliness, consistency and dissemination. Further research exploring efficient use of resources, in terms of personnel and costs, is required.
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Affiliation(s)
- Anne Holbrook
- Division of Clinical Pharmacology & Toxicology, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- St Joseph's Healthcare & Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - James M Bowen
- Department of Clinical Epidemiology & Biostatistics, McMaster University,Hamilton, Ontario, Canada
- St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Harsit Patel
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - John J You
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University,Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Roshan Tahavori
- Clinical Pharmacology & Toxicology, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | | | - Tim Berezny
- Doleweerd Consulting Inc., Orillia, Ontario, Canada
| | - Dan Perri
- Division of Clinical Pharmacology & Toxicology, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | | | - Sue Troyan
- Clinical Pharmacology & Toxicology, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Ameen Patel
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
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Lilly CM, Motzkus C, Rincon T, Cody SE, Landry K, Irwin RS. ICU Telemedicine Program Financial Outcomes. Chest 2016; 151:286-297. [PMID: 27932050 DOI: 10.1016/j.chest.2016.11.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 10/14/2016] [Accepted: 11/15/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND ICU telemedicine improves access to high-quality critical care, has substantial costs, and can change financial outcomes. Detailed information about financial outcomes and their trends over time following ICU telemedicine implementation and after the addition of logistic center function has not been published to our knowledge. METHODS Primary data were collected for consecutive adult patients of a single academic medical center. We compared clinical and financial outcomes across three groups that differed regarding telemedicine support: a group without ICU telemedicine support (pre-ICU intervention group), a group with ICU telemedicine support (ICU telemedicine group), and an ICU telemedicine group with added logistic center functions and support for quality-care standardization (logistic center group). The primary outcome was annual direct contribution margin defined as aggregated annual case revenue minus annual case direct costs (including operating costs of ICU telemedicine and its related programs). All monetary values were adjusted to 2015 US dollars using Producer Price Index for Health-Care Facilities. RESULTS Annual case volume increased from 4,752 (pre-ICU telemedicine) to 5,735 (ICU telemedicine) and 6,581 (logistic center). The annual direct contribution margin improved from $7,921,584 (pre-ICU telemedicine) to $37,668,512 (ICU telemedicine) to $60,586,397 (logistic center) due to increased case volume, higher case revenue relative to direct costs, and shorter length of stay. CONCLUSIONS The ability of properly modified ICU telemedicine programs to increase case volume and access to high-quality critical care with improved annual direct contribution margins suggests that there is a financial argument to encourage the wider adoption of ICU telemedicine.
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Affiliation(s)
- Craig M Lilly
- Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Department of Anesthesiology and Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Clinical and Population Health Research Program, UMass Memorial Medical Center, Worcester, MA; Graduate School of Biomedical Sciences, UMass Memorial Medical Center, Worcester, MA.
| | - Christine Motzkus
- Clinical and Population Health Research Program, UMass Memorial Medical Center, Worcester, MA
| | - Teresa Rincon
- Department of Nursing, UMass Memorial Medical Center, Worcester, MA
| | - Shawn E Cody
- UMass Memorial Health Care, UMass Memorial Medical Center, Worcester, MA; Department of Nursing, UMass Memorial Medical Center, Worcester, MA
| | - Karen Landry
- UMass Memorial Health Care, UMass Memorial Medical Center, Worcester, MA
| | - Richard S Irwin
- Department of Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA; Graduate School of Nursing Sciences, UMass Memorial Medical Center, Worcester, MA
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203
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Abstract
BACKGROUND Despite an increase in HIV Counselling and Testing (HCT), few young people have been tested. It has been suggested that they do not test because formal health services (where HCT is provided) are often not youth friendly. The World Health Organisation describes a youth-friendly health service (YFHS) as one which is accessible, equitable, acceptable, appropriate, and effective. A mobile school-based model has been implemented by a non-governmental organisation in Cape Town in an attempt to make HCT more youth friendly and accessible to young people. The objective of this study was to explore whether this mobile school-based HCT service is youth friendly. METHODS The study was descriptive, using three qualitative data collection methods: observation of the HCT site at two secondary schools; interviews with six service providers; and direct observation of 21 HCT counselling sessions. KEY RESULTS The mobile school-based HCT service fulfilled some of the criteria for being a YFHS. The service was equitable in that all students, irrespective of race, gender, age, or socio-economic status, were free to use the service. It was accessible in terms of location and cost, but students were not well informed to make decisions about using the service. The service was acceptable in that confidentiality was guaranteed and the service providers were friendly and non-judgemental, but it was not considered acceptable in that there was limited privacy. The service was appropriate in that HCT is recommended as an intervention for decreasing the transmission of HIV, based on evidence and expert opinion; however, in this case, HCT was provided as a stand-alone service rather than part of a full package of services. Moreover, studies have suggested that young people want to know their HIV status. The service was ineffective in that it identified students who are HIV positive; however, these students were not assisted to access care. CONCLUSION Providing HCT in the school setting may make HCT more accessible for students, but it needs to be provided in an equitable, accessible, acceptable, and effective way.
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Affiliation(s)
- Estelle Lawrence
- PhD student, School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Patricia Struthers
- PhD, Associate Professor at School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Geert Van Hove
- PhD, Professor at Department of Special Education, Ghent University, Ghent, Belgium
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Gillespie A, Reader TW. The Healthcare Complaints Analysis Tool: development and reliability testing of a method for service monitoring and organisational learning. BMJ Qual Saf 2016; 25:937-946. [PMID: 26740496 DOI: 10.1136/bmjqs-2015-004596/-/dc1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/22/2015] [Accepted: 10/25/2015] [Indexed: 05/26/2023]
Abstract
BACKGROUND Letters of complaint written by patients and their advocates reporting poor healthcare experiences represent an under-used data source. The lack of a method for extracting reliable data from these heterogeneous letters hinders their use for monitoring and learning. To address this gap, we report on the development and reliability testing of the Healthcare Complaints Analysis Tool (HCAT). METHODS HCAT was developed from a taxonomy of healthcare complaints reported in a previously published systematic review. It introduces the novel idea that complaints should be analysed in terms of severity. Recruiting three groups of educated lay participants (n=58, n=58, n=55), we refined the taxonomy through three iterations of discriminant content validity testing. We then supplemented this refined taxonomy with explicit coding procedures for seven problem categories (each with four levels of severity), stage of care and harm. These combined elements were further refined through iterative coding of a UK national sample of healthcare complaints (n= 25, n=80, n=137, n=839). To assess reliability and accuracy for the resultant tool, 14 educated lay participants coded a referent sample of 125 healthcare complaints. RESULTS The seven HCAT problem categories (quality, safety, environment, institutional processes, listening, communication, and respect and patient rights) were found to be conceptually distinct. On average, raters identified 1.94 problems (SD=0.26) per complaint letter. Coders exhibited substantial reliability in identifying problems at four levels of severity; moderate and substantial reliability in identifying stages of care (except for 'discharge/transfer' that was only fairly reliable) and substantial reliability in identifying overall harm. CONCLUSIONS HCAT is not only the first reliable tool for coding complaints, it is the first tool to measure the severity of complaints. It facilitates service monitoring and organisational learning and it enables future research examining whether healthcare complaints are a leading indicator of poor service outcomes. HCAT is freely available to download and use.
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Affiliation(s)
- Alex Gillespie
- Department of Social Psychology, London School of Economics, London, UK
| | - Tom W Reader
- Department of Social Psychology, London School of Economics, London, UK
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205
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Senay A, Delisle J, Giroux M, Laflamme GY, Leduc S, Malo M, Nguyen H, Ranger P, Fernandes JC. The impact of a standardized order set for the management of non-hip fragility fractures in a Fracture Liaison Service. Osteoporos Int 2016; 27:3439-3447. [PMID: 27368699 PMCID: PMC5118409 DOI: 10.1007/s00198-016-3669-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/13/2016] [Indexed: 01/05/2023]
Abstract
UNLABELLED We analysed the impact of a standardized order set empowering staff nurses to independently manage a Fracture Liaison Service over a 9-month period. Nurses identified between 30 and 70 % of non-hip fragility fractures to the unit in charge of management over time. The latter managed 58 % of referred patients. INTRODUCTION The main goal of this study was to evaluate the impact of a standardized order set empowering nurses to independently manage a fracture liaison service (FLS). METHODS Since November 2014, an order set allowed nurses of a Montreal hospital, Quebec, Canada to entirely manage an FLS on their own. Nurses followed an 6-h training program on-site. Emergency department (ED) and orthopaedic outpatient clinic (OC) nurses identified non-hip fragility fractures. Medical day treatment unit (MDTU) nurses were in charge of the management (investigation and treatment initiation). The list of patients, 50 years and older, with a fracture were retrieved for the period of November 2014 to July 2015. Performance was assessed with the rate of identification over time and the rate of management of non-hip fragility fractures. RESULTS Over the 9-month period, 346 patients of ≥50 years old were seen for a fracture, of which 190 met fragility criteria (excluding hip fractures). A sinusoid pattern of rates of identification between 30-70 % was observed over time. An average proportion of 58.1 % of fracture patients were managed by MDTU nurses. CONCLUSIONS A standardized order set legally allowing nurses to manage an FLS led to identification rates varying from 30-70 % and a management rate close to 60 % for referred patients over a 9-month period, which largely exceeds that of standard care. Identification was mostly compromised by difficulty integrating the order set into routine practice. Enforcement of the hospital policy on fragility fractures could help yield efficiency of identification of osteoporosis-related fractures by the staff.
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Affiliation(s)
- A Senay
- Université de Montréal, 2900 bl. Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
- Centre de Recherche de l' Hôpital du Sacré Coeur de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 bl. Gouin ouest, Montreal, Quebec, H4J 1C5, Canada
- Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada
| | - J Delisle
- Centre de Recherche de l' Hôpital du Sacré Coeur de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 bl. Gouin ouest, Montreal, Quebec, H4J 1C5, Canada
- Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada
| | - M Giroux
- Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada
| | - G Y Laflamme
- Centre de Recherche de l' Hôpital du Sacré Coeur de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 bl. Gouin ouest, Montreal, Quebec, H4J 1C5, Canada
- Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada
| | - S Leduc
- Centre de Recherche de l' Hôpital du Sacré Coeur de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 bl. Gouin ouest, Montreal, Quebec, H4J 1C5, Canada
- Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada
| | - M Malo
- Centre de Recherche de l' Hôpital du Sacré Coeur de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 bl. Gouin ouest, Montreal, Quebec, H4J 1C5, Canada
- Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada
| | - H Nguyen
- Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada
| | - P Ranger
- Centre de Recherche de l' Hôpital du Sacré Coeur de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 bl. Gouin ouest, Montreal, Quebec, H4J 1C5, Canada
- Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada
| | - J C Fernandes
- Université de Montréal, 2900 bl. Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada.
- Centre de Recherche de l' Hôpital du Sacré Coeur de Montréal, Hôpital du Sacré-Cœur de Montréal, 5400 bl. Gouin ouest, Montreal, Quebec, H4J 1C5, Canada.
- Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montreal, Quebec, H2E 1S6, Canada.
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Abstract
Objective. To conduct a systematic review of workplace stress management intervention studies that have incorporated process evaluation. Data Source. Electronic databases such as PsycINFO and MEDline were searched. Study Inclusion Criteria. The inclusion criteria included interventions published in the English language that were focused on either individual- or organizational-level stress management interventions at the workplace, with an outcome evaluation. Data Extraction. Each article was coded on key process-relevant variables, including context, recruitment, reach, dose delivered, dose received, fidelity, implementation, and participant's attitudes toward the intervention. Studies that reported on at least one of these process variables were also coded on the following study characteristics: Participants, setting, evaluation design, intervention content, intervention format, and study outcomes. Data Synthesis. Statistical Package for the Social Science was used to analyze the data with descriptive statistics. Results. Of the 84 studies identified that met the study inclusion criteria, 52 (61.9%) reported findings on at least one of the key relevant process-relevant variables. Variables most frequently included were recruitment (30%), intervention dose received (22%), participants' attitudes toward intervention (19%), and program reach (13%). Fewer than half of the studies presented any findings linking process evaluation and outcome evaluation. Conclusions. The incomplete reporting of information relevant to process evaluation makes it difficult to identify reliable determinants of effective intervention implementation or outcomes.
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Affiliation(s)
- Sheila Giardini Murta
- Universidade Católica de Goiás, Psychology (Psicologia), Avenida Universitária, Numero 1069, Setor Universitário, Goiânia, Goiás 7405010, Brazil.
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Kaphingst KA, Lobb R, Fay ME, Hunt MK, Suarez EG, Fletcher RH, Emmons KM. Impact of Intervention Dose on Cancer-Related Health Behaviors among Working-Class, Multiethnic, Community Health Center Patients. Am J Health Promot 2016; 21:262-6. [PMID: 17375492 DOI: 10.4278/0890-1171-21.4.262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To examine the relationship between intervention dose and health behavior change in Healthy Directions–Health Centers, an intervention designed to reduce cancer risk factors. Design. Analysis of intervention condition participant data from a randomized controlled trial. Setting. Community health centers in Massachusetts. Subjects. Patients residing in low-income, working-class, multiethnic neighborhoods. Intervention. Components were clinician endorsement, in-person counseling session and four telephone counseling sessions with a trained health advisor, and social-contextual tailored materials. Measures. Intervention dose was number of six possible intervention components completed by each participant. Changes in fruit and vegetable consumption, red meat consumption, physical activity, and multivitamin intake between baseline (n = 1088) and 8-month follow-up (n = 967; 89% of baseline sample) were determined. Analysis. Bivariate and multivariate associations between intervention dose and change in health behaviors were examined. Results. In multivariate analysis, the association between intervention dose and increase in multivitamin intake approached significance (p < .07). Seventy percent of participants completed all intervention activities. In bivariate analysis, completion of four telephone counseling calls was associated with decrease in red meat consumption (p < .05). Conclusion. These findings indicate that future studies should examine the number, content, and length of contacts needed for behavior change. The results also suggest that health centers are a channel for reaching diverse populations, as shown by the high level of intervention implementation.
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Affiliation(s)
- Kimberly A Kaphingst
- National Human Genome Research Institute, Social and Behavioral Research Branch, 2 Center Drive, MSC 0249, Building 2, Room 4E30, Bethesda, MD 20892, USA.
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Wainright JL, Klassen DK, Kucheryavaya AY, Stewart DE. Delays in Prior Living Kidney Donors Receiving Priority on the Transplant Waiting List. Clin J Am Soc Nephrol 2016; 11:2047-2052. [PMID: 27591296 PMCID: PMC5108186 DOI: 10.2215/cjn.01360216] [Citation(s) in RCA: 8] [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: 02/05/2016] [Accepted: 07/07/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Prior living donors (PLDs) receive very high priority on the Organ Procurement and Transplantation Network (OPTN) kidney waiting list. Program delays in adding PLDs to the waiting list, setting their status to active, and submitting requests for PLD priority can affect timely access to transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used the OPTN and the Centers for Medicare and Medicaid Services data to examine timing of (1) listing relative to start of dialysis, (2) activation on the waiting list, and (3) requests for PLD priority relative to listing date. There were 210 PLDs (221 registrations) added to the OPTN kidney waiting list between January 1, 2010 and July 31, 2015. RESULTS As of September 4, 2015, 167 of the 210 PLDs received deceased donor transplants, six received living donor transplants, two died, five were too sick to transplant, and 29 were still waiting. Median waiting time to deceased donor transplant for PLDs was 98 days. Only 40.7% of 221 PLD registrations (n=90) were listed before they began dialysis; 68.3% were in inactive status for <90 days, 17.6% were in inactive status for 90-365 days, 8.6% were in inactive status for 1-2 years, and 5.4% were in inactive status for >2 years. Median time of PLDs waiting in active status before receiving PLD priority was 2 days (range =0-1450); 67.4% of PLDs received PLD priority within 7 days after activation, but 15.4% waited 8-30 days, 8.1% waited 1-3 months, 4.1% waited 3-12 months, and 5.0% waited >1 year in active status for PLD priority. After receiving priority, most were transplanted quickly. Median time in active status with PLD priority before deceased donor transplant was 23 days. CONCLUSIONS Fewer than one half of listed PLDs were listed before starting dialysis. Most listed PLDs are immediately set to active status and receive PLD priority quickly, but a substantial number spends time in active status without PLD priority or a large amount of time in inactive status, which affects access to timely transplants.
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Affiliation(s)
| | - David K. Klassen
- Office of the Chief Medical Officer, United Network for Organ Sharing, Richmond, Virginia
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Bashshur RL, Krupinski EA, Thrall JH, Bashshur N. The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence. Telemed J E Health 2016; 22:868-898. [PMID: 27585301 PMCID: PMC5107673 DOI: 10.1089/tmj.2016.0149] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 07/07/2016] [Accepted: 07/10/2016] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. METHODS A selective review of the credible literature during the past decade (2005-2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. FINDINGS The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.
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Affiliation(s)
| | | | - James H. Thrall
- Department of Radiology, Massachusetts General Hospital, Harvard, Boston, Massachusetts
| | - Noura Bashshur
- University of Michigan Health System, Ann Arbor, Michigan
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210
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Saver C. Performance improvement teams can move the needle from ‘good’ to ‘great’. OR Manager 2016; 32:18-19. [PMID: 29978982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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211
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Guo L, Hariharan S. IS PROCESS IMPROVEMENT THE ULTIMATE SOLUTION? Physician Leadersh J 2016; 3:26-30. [PMID: 30571869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
If you think improving processes in a health care organization is the key to higher profitability, think again.
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212
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Kajonius PJ, Kazemi A. Safeness and Treatment Mitigate the Effect of Loneliness on Satisfaction With Elderly Care. Gerontologist 2016; 56:928-36. [PMID: 25628300 PMCID: PMC5019041 DOI: 10.1093/geront/gnu170] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/11/2014] [Indexed: 12/30/2022] Open
Abstract
UNLABELLED Maximizing satisfaction among the older persons is the goal of modern individualized elderly care and how to best achieve this is of relevance for people involved in planning and providing elderly care services. PURPOSE OF THE STUDY What predicts satisfaction with care among older persons can be conceived as a function of process (how care is performed) and the older person. Inspired by the long-standing person versus situation debate, the present research investigated the interplay between person- and process-related factors in predicting satisfaction with elderly care. DESIGN AND METHODS A nationwide sample was analyzed, based on a questionnaire with 95,000 individuals using elderly care services. RESULTS The results showed that person-related factors (i.e., anxiety, health, and loneliness) were significant predictors of satisfaction with care, although less strongly than process-related factors (i.e., treatment, safeness, and perceived staff and time availability). Among the person-related factors, loneliness was the strongest predictor of satisfaction among older persons in nursing homes. Interestingly, a path analysis revealed that safeness and treatment function as mediators in linking loneliness to satisfaction. IMPLICATIONS The results based on a large national sample demonstrate that the individual aging condition to a significant degree can be countered by a well-functioning care process, resulting in higher satisfaction with care among older persons.
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Affiliation(s)
- Petri J Kajonius
- Department of Psychology, University of Gothenburg, Sweden. School of Health and Education, University of Skövde, Sweden.
| | - Ali Kazemi
- School of Health and Education, University of Skövde, Sweden
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213
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Loor G, Shumway SJ, McCurry KR, Keshavamurthy S, Hussain S, Weide GD, Spratt JR, Al Salihi M, Koch CG. Process Improvement in Thoracic Donor Organ Procurement: Implementation of a Donor Assessment Checklist. Ann Thorac Surg 2016; 102:1872-1877. [PMID: 27659600 DOI: 10.1016/j.athoracsur.2016.06.083] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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] [Received: 02/23/2016] [Revised: 06/17/2016] [Accepted: 06/22/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Donor organs are often procured by junior staff in stressful, unfamiliar environments where a single adverse event can be catastrophic. A formalized checklist focused on preprocedural processes related to thoracic donor organ procurement could improve detection and prevention of near miss events. METHODS A checklist was developed centered on patient identifiers, organ compatibility and quality, and team readiness. It went through five cycles of feedback and revision using a panel of expert procurement surgeons. Educational in-service sessions were held on the use of the checklist as well as best organ assessment practices. Near miss events before the survey were tallied by retrospective review of 20 procurements, and near misses after checklist implementation were prospectively recorded. We implemented the checklist for 40 donor lung and heart procurements: 20 from Cleveland Clinic and 20 from the University of Minnesota. A final survey assessment was used to determine ease of use. RESULTS Nine near miss events were reported in 20 procurements before use of the checklist. Thirty-one near miss events of 40 organ procurements were identified and potentially prevented by the checklist. Eighty-seven percent of fellows found the checklist to be unobtrusive to work flow, and 100% believed its use should be mandatory. Mortality was the same before and after implementation of the checklist despite increased patient volumes. CONCLUSIONS Implementation of a simple checklist for use during thoracic organ procurement uncovered a substantial number of near miss events. A preprocedural checklist for all thoracic organ transplants in the United States and abroad is feasible and would likely reduce adverse events.
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Affiliation(s)
- Gabriel Loor
- Division of Cardiothoracic Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota.
| | - Sara J Shumway
- Division of Cardiothoracic Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Kenneth R McCurry
- Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Suresh Keshavamurthy
- Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Syed Hussain
- Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Garry D Weide
- Division of Cardiothoracic Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - John R Spratt
- Division of Cardiothoracic Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Mazin Al Salihi
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Colleen G Koch
- Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
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Liu H, Lindley R, Alim M, Felix C, Gandhi DBC, Verma SJ, Tugnawat DK, Syrigapu A, Ramamurthy RK, Pandian JD, Walker M, Forster A, Anderson CS, Langhorne P, Murthy GVS, Shamanna BR, Hackett ML, Maulik PK, Harvey LA, Jan S. Protocol for process evaluation of a randomised controlled trial of family-led rehabilitation post stroke (ATTEND) in India. BMJ Open 2016; 6:e012027. [PMID: 27633636 PMCID: PMC5030603 DOI: 10.1136/bmjopen-2016-012027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION We are undertaking a randomised controlled trial (fAmily led rehabiliTaTion aftEr stroke in INDia, ATTEND) evaluating training a family carer to enable maximal rehabilitation of patients with stroke-related disability; as a potentially affordable, culturally acceptable and effective intervention for use in India. A process evaluation is needed to understand how and why this complex intervention may be effective, and to capture important barriers and facilitators to its implementation. We describe the protocol for our process evaluation to encourage the development of in-process evaluation methodology and transparency in reporting. METHODS AND ANALYSIS The realist and RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) frameworks informed the design. Mixed methods include semistructured interviews with health providers, patients and their carers, analysis of quantitative process data describing fidelity and dose of intervention, observations of trial set up and implementation, and the analysis of the cost data from the patients and their families perspective and programme budgets. These qualitative and quantitative data will be analysed iteratively prior to knowing the quantitative outcomes of the trial, and then triangulated with the results from the primary outcome evaluation. ETHICS AND DISSEMINATION The process evaluation has received ethical approval for all sites in India. In low-income and middle-income countries, the available human capital can form an approach to reducing the evidence practice gap, compared with the high cost alternatives available in established market economies. This process evaluation will provide insights into how such a programme can be implemented in practice and brought to scale. Through local stakeholder engagement and dissemination of findings globally we hope to build on patient-centred, cost-effective and sustainable models of stroke rehabilitation. TRIAL REGISTRATION NUMBER CTRI/2013/04/003557.
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Affiliation(s)
- Hueiming Liu
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Richard Lindley
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Mohammed Alim
- George Institute for Global Health, Hyderabad, Telangana, India
| | | | | | | | | | | | | | | | | | | | - Craig S Anderson
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | | | | | | | - Maree L Hackett
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Pallab K Maulik
- George Institute for Global Health, Hyderabad, Telangana, India
- The George Institute for Global Health, Oxford University, Oxford, UK
| | - Lisa A Harvey
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Reeve J, Cooper L, Harrington S, Rosbottom P, Watkins J. Developing, delivering and evaluating primary mental health care: the co-production of a new complex intervention. BMC Health Serv Res 2016; 16:470. [PMID: 27600512 PMCID: PMC5012043 DOI: 10.1186/s12913-016-1726-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 08/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health services face the challenges created by complex problems, and so need complex intervention solutions. However they also experience ongoing difficulties in translating findings from research in this area in to quality improvement changes on the ground. BounceBack was a service development innovation project which sought to examine this issue through the implementation and evaluation in a primary care setting of a novel complex intervention. METHODS The project was a collaboration between a local mental health charity, an academic unit, and GP practices. The aim was to translate the charity's model of care into practice-based evidence describing delivery and impact. Normalisation Process Theory (NPT) was used to support the implementation of the new model of primary mental health care into six GP practices. An integrated process evaluation evaluated the process and impact of care. RESULTS Implementation quickly stalled as we identified problems with the described model of care when applied in a changing and variable primary care context. The team therefore switched to using the NPT framework to support the systematic identification and modification of the components of the complex intervention: including the core components that made it distinct (the consultation approach) and the variable components (organisational issues) that made it work in practice. The extra work significantly reduced the time available for outcome evaluation. However findings demonstrated moderately successful implementation of the model and a suggestion of hypothesised changes in outcomes. CONCLUSIONS The BounceBack project demonstrates the development of a complex intervention from practice. It highlights the use of Normalisation Process Theory to support development, and not just implementation, of a complex intervention; and describes the use of the research process in the generation of practice-based evidence. Implications for future translational complex intervention research supporting practice change through scholarship are discussed.
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Affiliation(s)
- Joanne Reeve
- Warwick Medical School, Warwick University, Coventry, CV4 7AL UK
- Division of Health Sciences Research, Liverpool University, Liverpool, L69 3GL UK
- http://www2.warwick.ac.uk/fac/med/staff/jreeve
| | - Lucy Cooper
- Division of Health Sciences Research, Liverpool University, Liverpool, L69 3GL UK
| | - Sean Harrington
- AiW Health, 38-44 Woodside Business Park, Birkenhead, Wirral CH41 1EL UK
| | - Peter Rosbottom
- AiW Health, 38-44 Woodside Business Park, Birkenhead, Wirral CH41 1EL UK
| | - Jane Watkins
- AiW Health, 38-44 Woodside Business Park, Birkenhead, Wirral CH41 1EL UK
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Abstract
Many who would like to improve patient safety in health care have advocated for the widespread adoption of computerized physician order entry and electronic medical records. However, unforeseen consequences of this new technology may put patients at greater risk of harm, not less. The authors present a clinical scenario that demonstrates system vulnerabilities in the interface between humans and such technology. Furthermore, the authors suggest that managers could anticipate these vulnerabilities by using techniques such as cause-and-effect analysis or failure mode and effect analysis, both before the installation of electronic medical records and as ongoing surveillance mechanisms. The case study demonstrates that adoption of technology is not a quick fix to the patient safety issue; proactive and ongoing efforts to address the human factors issues raised by the introduction of new technology will be required to prevent patient harm.
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Affiliation(s)
- Margaret Caudill-Slosberg
- VA National Quality Scholars Fellowship Program, 215 North Main Street, White River Junction, VT 05009, USA.
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Barnes CS, Ziemer DC, Miller CD, Doyle JP, Watkins C, Cook CB, Gallina DL, el-Kebbi I, Branch WT, Phillips LS. Little Time for Diabetes Management in the Primary Care Setting. Diabetes Educ 2016; 30:126-35. [PMID: 14999900 DOI: 10.1177/014572170403000120] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE This study was conducted to determine how time is allocated to diabetes care. METHODS Patients with type 2 diabetes who were receiving care from the internal medicine residents were shadowed by research nurses to observe the process of management. The amount of time spent with patients and the care provided were observed and documented. RESULTS The total time patients spent in the clinic averaged 2 hours and 26 minutes: 1 to 9 minutes waiting, 25 minutes with the resident, and 12 minutes with medical assistants and nurses. The residents spent an average of only 5 minutes on diabetes. Glucose monitoring was addressed in 70% of visits; a history of hypoglycemia was sought in only 30%. Blood pressure values were mentioned in 75% of visits; hemoglobin A1c (A1C) values were addressed in only 40%. The need for proper foot care was discussed in 55% of visits; feet were examined in only 40%. Although 65% of patients had capillary glucose levels greater than 150 mg/dL during the visit and their A1C averaged 8.9%, therapy was intensified for only 15% of patients. CONCLUSIONS During a routine office visit in a resident-staffed general medicine clinic, little time is devoted to diabetes management. Given the time pressures on the primary care practitioner and the need for better diabetes care, it is essential to teach an efficient but systematic approach to diabetes care.
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Affiliation(s)
- Catherine S Barnes
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
| | - David C Ziemer
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
| | - Chris D Miller
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
| | - Joyce P Doyle
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
| | - Clyde Watkins
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
| | - Curtiss B Cook
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
| | - Dan L Gallina
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
| | - Imad el-Kebbi
- Divisions of Endocrinology and Metabolism, and General Internal Medicine, Department of Medicine, Emory University School of Medicine, Grady Health Systems, Atlanta, Georgia, USA
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Wallace G, Bird V, Leamy M, Bacon F, Le Boutillier C, Janosik M, MacPherson R, Williams J, Slade M. Service user experiences of REFOCUS: a process evaluation of a pro-recovery complex intervention. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1275-84. [PMID: 27365099 DOI: 10.1007/s00127-016-1257-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/15/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Policy is increasingly focused on implementing a recovery-orientation within mental health services, yet the subjective experience of individuals receiving a pro-recovery intervention is under-studied. The aim of this study was to explore the service user experience of receiving a complex, pro-recovery intervention (REFOCUS), which aimed to encourage the use of recovery-supporting tools and support recovery-promoting relationships. METHODS Interviews (n = 24) and two focus groups (n = 13) were conducted as part of a process evaluation and included a purposive sample of service users who received the complex, pro-recovery intervention within the REFOCUS randomised controlled trial (ISRCTN02507940). Thematic analysis was used to analyse the data. RESULTS Participants reported that the intervention supported the development of an open and collaborative relationship with staff, with new conversations around values, strengths and goals. This was experienced as hope-inspiring and empowering. However, others described how the recovery tools were used without context, meaning participants were unclear of their purpose and did not see their benefit. During the interviews, some individuals struggled to report any new tasks or conversations occurring during the intervention. CONCLUSION Recovery-supporting tools can support the development of a recovery-promoting relationship, which can contribute to positive outcomes for individuals. The tools should be used in a collaborative and flexible manner. Information exchanged around values, strengths and goals should be used in care-planning. As some service users struggled to report their experience of the intervention, alternative evaluation approaches need to be considered if the service user experience is to be fully captured.
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Affiliation(s)
- Genevieve Wallace
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Victoria Bird
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, UK.
| | - Mary Leamy
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Faye Bacon
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Clair Le Boutillier
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Monika Janosik
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | | | - Julie Williams
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Mike Slade
- Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
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219
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Estep B, Kaminski B. Optimal Teams and Performance Feedback Drive Improvements in Processing Measures. ED Manag 2016; 28:104-107. [PMID: 29787654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The ED at ProMedica Toledo Hospital, a Level I trauma facility in Toledo, OH, has been able to chart impressive metrics on patient processing measures year after year. Administrators credit an overhaul in their triage process, a comprehensive approach to providing staff with regular feedback on their performance, and a system that relies on optimally sized teams to deliver care. Department leaders are hoping to boost patient satisfaction scores with an initiative that will leverage champions, fresh metrics, and a new mission statement to highlight the importance of the patient experience. Hospital administrators report that the median door-to-bed time in the ED is 23 minutes, and the median bed-to-physician time is eight minutes. The median length of stay for all ED patients stands at 121 minutes, and hospital administrators note that the ED's leave-without-being-seen rate tends to hover beneath 1%, far below the naticnal average. The ED uses a zone system that can adjust from two to five zones, depending on patient volume. The charge nurse is responsible for assigning patients to specific zones for care.
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Richter A, Meißner Y, Strangfeld A, Zink A. Primary and secondary patient data in contrast: the use of observational studies like RABBIT. Clin Exp Rheumatol 2016; 34:S79-S86. [PMID: 27762200] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
The study of secondary patient data, particularly represented by claims data, has increased in recent years. The strength of this approach involves easy access to data that have been generated for administrative purposes. By contrast, collection of primary data for research is time-consuming and may therefore appear outdated. Both administrative data and data collected prospectively in clinical care can address similar research questions concerning effectiveness and safety of treatments. Therefore, why should we invest the precious time of rheumatologists to generate primary patient data? This article will outline some features of primary patient data collection illustrated by the German biologics register RABBIT (Rheumatoid arthritis: observation of biologic therapy). RABBIT is a long-term observational cohort study that was initiated more than 15 years ago. We will discuss as quality indicators: (i) study design, (ii) type of documentation, standardisation of (iii) clinical and (iv) safety data, (v) monitoring of the longitudinal follow-up, (vi) losses to follow-up as well as (vii) the possibilities to link the data base. The impact of these features on interpretation and validity of results is illustrated using recent publications. We conclude that high quality and completeness of data prospectively-collected offers many advantages over large quantities of non-standardised data collected in an unsupervised manner. We expect the enthusiasm about the use of secondary patient data to decline with more awareness of their methodological limitations while studies with primary patient data like RABBIT will maintain and broaden their impact on daily clinical practice.
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Affiliation(s)
- Adrian Richter
- German Rheumatism Research Center, Epidemiology Unit, Berlin, Germany.
| | - Yvette Meißner
- German Rheumatism Research Center, Epidemiology Unit, Berlin, Germany
| | - Anja Strangfeld
- German Rheumatism Research Center, Epidemiology Unit, Berlin, Germany
| | - Angela Zink
- German Rheumatism Research Center, Epidemiology Unit, and Charité University Medicine, Berlin, Germany
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221
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Havermans BM, Schelvis RMC, Boot CRL, Brouwers EPM, Anema JR, van der Beek AJ. Process variables in organizational stress management intervention evaluation research: a systematic review. Scand J Work Environ Health 2016; 42:371-381. [PMID: 27168469 DOI: 10.5271/sjweh.3570] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 09/28/2023] Open
Abstract
OBJECTIVES This systematic review aimed to explore which process variables are used in stress management intervention (SMI) evaluation research. METHODS A systematic review was conducted using seven electronic databases. Studies were included if they reported on an SMI aimed at primary or secondary stress prevention, were directed at paid employees, and reported process data. Two independent researchers checked all records and selected the articles for inclusion. Nielsen and Randall's model for process evaluation was used to cluster the process variables. The three main clusters were context, intervention, and mental models. RESULTS In the 44 articles included, 47 process variables were found, clustered into three main categories: context (two variables), intervention (31 variables), and mental models (14 variables). Half of the articles contained no reference to process evaluation literature. The collection of process evaluation data mostly took place after the intervention and at the level of the employee. CONCLUSIONS The findings suggest that there is great heterogeneity in methods and process variables used in process evaluations of SMI. This, together with the lack of use of a standardized framework for evaluation, hinders the advancement of process evaluation theory development.
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Affiliation(s)
- Bo M Havermans
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, PO box 7057, 1007 MB, Amsterdam, The Netherlands.
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Abstract
OBJECTIVES Quality improvement projects to address transitions of care across care boundaries are increasingly common but meet with mixed success for reasons that are poorly understood. We aimed to characterise challenges in a project to improve transitions for older people between hospital and care homes. DESIGN Independent process evaluation, using ethnographic observations and interviews, of a quality improvement project. SETTING AND PARTICIPANTS An English hospital and two residential care homes for older people. DATA 32 hours of non-participant observations and 12 semistructured interviews with project members, hospital and care home staff. RESULTS A hospital-based improvement team sought to reduce unplanned readmissions from residential care homes using interventions including a community-based geriatric team that could be accessed directly by care homes and a communication tool intended to facilitate transfer of information between homes and hospital. Only very modest (if any) impacts of these interventions on readmission rates could be detected. The process evaluation identified multiple challenges in implementing interventions and securing improvement. Many of these arose because of lack of consensus on the nature of the problem and the proper solutions: while the hospital team was keen to reduce readmissions and saw the problems as lying in poor communication and lack of community-based support for care homes, the care home staff had different priorities. Care home staff were unconvinced that the improvement interventions were aligned with their needs or addressed their concerns, resulting in compromised implementation. CONCLUSIONS Process evaluations have a valuable role in quality improvement. Our study suggests that a key task for quality improvement projects aimed at transitions of care is that of developing a shared view of the problem to be addressed. A more participatory approach could help to surface assumptions, interpretations and interests and could facilitate the coproduction of solutions. This finding is likely to have broader applicability.
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Affiliation(s)
- Elizabeth Sutton
- Department of Health Sciences, Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, University of Leicester, Leicester, UK
| | - Mary Dixon-Woods
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Carolyn Tarrant
- Department of Health Sciences, Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, University of Leicester, Leicester, UK
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223
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Gadsby R, Young B, Cartwright C, Fargher L, Taylor B. National audit of diabetes: why it matters to general practice. Br J Gen Pract 2016; 66:398-9. [PMID: 27481959 PMCID: PMC4979921 DOI: 10.3399/bjgp16x686197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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224
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Musekamp G, Bengel J, Schuler M, Faller H. Improved self-management skills predict improvements in quality of life and depression in patients with chronic disorders. Patient Educ Couns 2016; 99:1355-1361. [PMID: 27050107 DOI: 10.1016/j.pec.2016.03.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 09/28/2015] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Self-management programs aim to improve patients' skills to manage their chronic condition in everyday life. Improvement in self-management is assumed to bring about improvements in more distal outcomes, such as quality of life. This study aimed to test the hypothesis that changes in self-reported self-management skills observed after participation in self-management programs predict changes in both quality of life and depressive symptoms three months later. METHODS Using latent change modeling, the relationship between changes in latent variables over three time points (start and end of rehabilitation, after three months) was analysed. The sample comprised 580 patients with different chronic conditions treated in inpatient rehabilitation clinics. The influence of additional predictor variables (age, sex, perceived social support) and type of disorder as a moderator variable was also tested. RESULTS Changes in self-reported self-management skills after rehabilitation predicted changes in both quality of life and depressive symptoms at the end of rehabilitation and the 3 months follow-up. These relationships remained significant after the inclusion of other predictor variables and were similar across disorders. CONCLUSION The findings provide support for the hypothesis that improvements in proximal outcomes of self-management programs may foster improvements in distal outcomes. Further studies should investigate treatment mechanisms.
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Affiliation(s)
- Gunda Musekamp
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany.
| | - Jürgen Bengel
- Institute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany.
| | - Michael Schuler
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany.
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany.
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225
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Saver C. Process improvements raise SPD standards and quality. OR Manager 2016; 32:1-15. [PMID: 30010268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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226
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Chen JY, Wan EY, Choi EP, Wong CK, Chan AK, Chan KH, Li PK, Lam CL. Clinical and patient-reported outcomes of Chinese patients undergoing haemodialysis in hospital or in the community: A 1-year longitudinal study. Nephrology (Carlton) 2016; 21:617-23. [PMID: 26616825 PMCID: PMC5129586 DOI: 10.1111/nep.12686] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 10/28/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 12/16/2022]
Abstract
AIM Little is known about the effect of haemodialysis (HD) setting on outcomes of patients with end stage renal disease (ESRD). The study aimed at comparing clinical outcomes and patient-reported outcomes (PRO) of patients on community-based (CBHD) and hospital-based haemodialysis (HBHD). METHODS A prospective cohort of Chinese ESRD patients receiving HBHD (n = 89) or CBHD (n = 117) in Hong Kong were followed up for 12 months. Subjects were assessed on clinical outcomes of dialysis adequacy (Kt/V) and blood haemoglobin and PRO of health-related quality of life (SF-12v2), general health condition (Global Rating Scale (GRS)) and confidence to cope with their illness (Patient Enablement Instrument (PEI)). Differences between groups were analyzed by independent t-tests for the SF-12v2, GRS and PEI scores. χ(2) tests were used to analyze the difference in proportion of patients reaching the targets of Kt/V and blood haemoglobin and with GRS > 0 and PEI > 0. Multiple linear and logistic regressions were performed to assess the adjusted difference-in-difference estimation. RESULTS The mean PEI and GRS scores of CBHD patients at 12 months were significantly higher than those of HBHD patients. CBHD patients had significantly greater improvement in self-efficacy and were more likely to be enabled after 12 months than the HBHD patients. CONCLUSION The study showed similar clinical outcomes and PRO between CBHD and HBHD but CBHD was more effective than HBHD in promoting patient enablement over a 12-month period. The results suggest added value for patients receiving CBHD and support the transfer of HD care from the hospital to the community.
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Affiliation(s)
- Julie Y Chen
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Eric Yf Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Edmond Ph Choi
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
| | - Carlos Kh Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Anca Kc Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Karina Hy Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Philip Kt Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Cindy Lk Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
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227
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Stirnkorb WJ. MR Safety and The Kanal Method. Radiol Manage 2016; 38:31-34. [PMID: 30508329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
* The Kanal Method is a scientific method of focusing and standardizing efforts in MR safety as it applies to each specific patient. Its value, along with the Ameri- can Board of Magnetic Resonance Safety (ABMRS) and the Magnetic Resonance Safety Officer (MRSO), Magnetic Resonance Medical Director (MRMD), Magnetic Resonance Safety Expert (MRSE)- board certifications, is demonstrated and in practice. * People learn the Kanal Method in the MRSO/ MRMD/ MRSE courses. Such certification helps to ensure a standard knowledge base and competency among those overseeing departmen- tal, organizational, and/or enterprise MR safety. * As with all patient care activities, the team approach is necessary for best practices and for more positive patient outcomes. With this methodology, technologists, physicists, and physicians can improve best practices for their patients.
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Schiepek G, Aas B, Viol K. The Mathematics of Psychotherapy: A Nonlinear Model of Change Dynamics. Nonlinear Dynamics Psychol Life Sci 2016; 20:369-399. [PMID: 27262423] [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: 06/05/2023]
Abstract
Psychotherapy is a dynamic process produced by a complex system of interacting variables. Even though there are qualitative models of such systems the link between structure and function, between network and network dynamics is still missing. The aim of this study is to realize these links. The proposed model is composed of five state variables (P: problem severity, S: success and therapeutic progress, M: motivation to change, E: emotions, I: insight and new perspectives) interconnected by 16 functions. The shape of each function is modified by four parameters (a: capability to form a trustful working alliance, c: mentalization and emotion regulation, r: behavioral resources and skills, m: self-efficacy and reward expectation). Psychologically, the parameters play the role of competencies or traits, which translate into the concept of control parameters in synergetics. The qualitative model was transferred into five coupled, deterministic, nonlinear difference equations generating the dynamics of each variable as a function of other variables. The mathematical model is able to reproduce important features of psychotherapy processes. Examples of parameter-dependent bifurcation diagrams are given. Beyond the illustrated similarities between simulated and empirical dynamics, the model has to be further developed, systematically tested by simulated experiments, and compared to empirical data.
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Affiliation(s)
- Gunter Schiepek
- Paracelsus Medical University Salzburg, Austria and Ludwig Maximilians University Munich, Germany
| | - Benjamin Aas
- Paracelsus Medical University Salzburg, Austria and Ludwig Maximilians University Munich, Germany
| | - Kathrin Viol
- Paracelsus Medical University Salzburg, Austria and Ludwig Maximilians University Munich, Germany
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Baysari MT, Jackson N, Ramasamy S, Santiago P, Xiong J, Westbrook J, Omari A, Day RO. Exploring sub-optimal use of an electronic risk assessment tool for venous thromboembolism. Appl Ergon 2016; 55:63-69. [PMID: 26995037 DOI: 10.1016/j.apergo.2016.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/18/2015] [Revised: 12/03/2015] [Accepted: 01/11/2016] [Indexed: 06/05/2023]
Abstract
International guidelines and consensus groups recommend using a risk assessment tool (RAT) to assess Venous Thromboembolism (VTE) risk prior to the prescription of prophylaxis. We set out to examine how an electronic RAT was being used (i.e. if by the right clinician, at the right time, for the right purpose) and to identify factors influencing utilization of the RAT. A sample of 112 risk assessments was audited and 12 prescribers were interviewed. The RAT was used as intended in only 40 (35.7%) cases (i.e. completed by a doctor within 24 h of admission, prior to the prescription of prophylaxis). We identified several reasons for sub-optimal use of the RAT, including beliefs about the need for a RAT, poor awareness of the tool, and poor RAT design. If a user-centred approach had been adopted, it is likely that a RAT would not have been implemented or that problematic design issues would have been identified.
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Affiliation(s)
- Melissa T Baysari
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia.
| | - Nicola Jackson
- Vascular Medicine, St Vincent's Hospital, Sydney, Australia
| | - Sheena Ramasamy
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
| | - Priscila Santiago
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
| | - Juan Xiong
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Johanna Westbrook
- Centre for Health Systems & Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Abdullah Omari
- Vascular Medicine, St Vincent's Hospital, Sydney, Australia
| | - Richard O Day
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, UNSW Medicine, UNSW, Sydney, Australia
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Hunt MK, Lederman R, Stoddard AM, LaMontagne AD, McLellan D, Combe C, Barbeau E, Sorensen G. Process Evaluation of an Integrated Health Promotion/Occupational Health Model in WellWorks-2. Health Educ Behav 2016; 32:10-26. [PMID: 15642751 DOI: 10.1177/1090198104264216] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Disparities in chronic disease risk by occupation call for newapproaches to health promotion. Well Works-2 was a randomized, controlled study comparing the effectiveness of a health promotion/occupational health program (HP/OHS) with a standard intervention (HP). Interventions in both studies were based on the same theoretical foundations. Results from process evaluation revealed that a similar number of activities were offered in both conditions and that in the HP/OHS condition there were higher levels of worker participation using three measures: mean participation per activity (HP: 14.2% vs. HP/OHS: 21.2%), mean minutes of worker exposure to the intervention/site (HP: 14.9 vs. HP/OHS: 33.3), and overall mean participation per site (HP: 34.4% vs. HP/ OHS: 45.8%). There were a greater number of contacts with management (HP: 8.8 vs. HP/OHS: 24.9) in the HP/ OHS condition. Addressing occupational health may have contributed to higher levels of worker and management participation and smoking cessation among blue-collar workers.
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Affiliation(s)
- Mary Kay Hunt
- Dana-Farber Cancer Institute, Center for Community Based Research, Boston, MA, USA.
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231
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Abstract
A research agenda for investigating the impact of team-work training on patient safety in the perioperative environment is presented. The current status of teamwork training is reviewed briefly, and conclusions based on existing research are presented. We present a roadmap for future research on how teamwork training should be structured, delivered, and evaluated to optimize patient safety in the operating room. For teamwork skills to be assessed and have credibility, team performance measures must be grounded in team theory, account for individual and team-level performance, capture team process and outcomes, adhere to standards for reliability and validity, and address real or perceived barriers to measurement. The interdisciplinary nature of work in the perioperative environment and the necessity of cooperation among team members play an important role in enabling patient safety and avoiding errors. Teams make fewer mistakes than do individuals, especially when each team member knows his or her responsibilities, as well as those of other team members. However, simply installing a team structure without addressing the organizational context of care—the culture—does not automatically ensure it will operate effectively. Factors associated with the design of teamwork training, measures of training effectiveness, and the assessment process that should be explored in near-term work (1 to 2 years) are addressed. We also address the impact of the organizational environment, including the role of institutional support and culture, that need to be explored in longer term research (3 to 5 years).
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232
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Abstract
This study examined whether patients discharged from inpatient psychiatric care would improve rates of follow-up appointments when designated staff (ie, care coordinators) were assigned to coordinate care after hospital discharge. Data were collected from 1313 psychiatric discharges in 2003 and 1804 psychiatric discharges in 2004, principally from hospitals in the Northeast states. Patients' health care was managed by Anthem Behavioral Health-Northeast. Appointment verification was made through Health Plan Employer Data and Information Set methodology. Of the 1804 psychiatric discharges, 71.6% kept an outpatient appointment within 7 days of discharge, and 88.3% kept an outpatient appointment within 30 days of discharge. These rates were a statistically significant improvement ( P>.001) from the prior year's rates of 66.6% and 84.0%, respectively, when care coordinators were not used.
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Affiliation(s)
- Michael J Orlosky
- Yale Department of Psychiatry, Behavioral Health Operations, WellPoint Behavioral Health, North Haven, CT 06473, USA.
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233
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Abstract
Process evaluation is now a core component of health promotion program evaluations. Over the past decade, considerable attention and resources were devoted to developing sensitive and collaborative process evaluation methodologies. These efforts share the broad commitments that process evaluation should (a) support program goals and objectives, (b) lead to program improvement, and (c) whenever possible, develop evaluation capacity among participants. This article describes dialogue boxes, a process evaluation tool that has proven extremely useful in diverse health promotion program and planning efforts. The tool itself is described, along with eight lessons learned about the power of this seemingly simple evaluation method, comments about the challenges of this type of process evaluation, and tips for using dialogue boxes in health promotion planning and programs.
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Affiliation(s)
- Kathleen Roe
- Health Science Department, San Jose State University, San Jose, California, USA
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234
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Landman KZ, Kinabo GD, Schimana W, Dolmans WM, Swai ME, Shao JF, Crump JA. Capacity of health-care facilities to deliver HIV treatment and care services, Northern Tanzania, 2004. Int J STD AIDS 2016; 17:459-62. [PMID: 16820075 DOI: 10.1258/095646206777689134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/18/2022]
Abstract
Few data exist on the current capacity of Tanzanian health-care facilities to deliver antiretroviral therapy (ART). We evaluated this capacity among Northern Zone facilities in 2004 using a questionnaire that addressed human resources, clinical facilities and services, and laboratory capacity. Of 19 facilities surveyed, nine (47%) had staff trained to manage ART and three (16%) prescribed ART. Two (11%) offered CD4 counts, five (26%) offered liver function tests, 16 (84%) offered chest radiography, and 18 (95%) offered acid-fast sputum staining. Of 12 (67%) facilities offering outpatient HIV/AIDS services, 12 (100%) provided co-trimoxazole to outpatients and six (50%) provided isoniazid (INH). All 19 (100%) facilities offered rapid HIV tests and full blood pictures. Overall in 2004, facilities needed strengthening to increase staff training in ART management and to implement INH for treatment of latent tuberculosis. Laboratory facilities for ART monitoring were inadequate, and outpatient ART was limited.
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Affiliation(s)
- Keren Z Landman
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Box 3867, Durham, NC 27710, USA
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McLeod D, Morgan S, McKinlay E, Dew K, Cumming J, Dowell A, Love T. Use of, and attitudes to, clinical priority assessment criteria in elective surgery in New Zealand. J Health Serv Res Policy 2016; 9:91-9. [PMID: 15099456 DOI: 10.1258/135581904322987508] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 11/18/2022]
Abstract
Objectives: To describe the ways patients access elective surgery in New Zealand, and to understand the use of, and attitudes to, clinical priority assessment criteria (CPAC) in determining access to publicly funded elective surgery. Methods: A qualitative study in selected New Zealand localities. A purposive sample of general practitioners, surgeons and administrators in publicly funded hospitals were interviewed. Data were analysed by a process of thematic analysis. Results: Sixty-five interviews were completed. General practitioners had a key role in determining which patients were seen in the public sector and, by utilising strategies to actively advocate for patients, influenced both waiting times for first assessment by surgeons and for surgery. CPAC had been developed as decision support guides with the intention that they would provide transparency and equity in determining access. However, there was variation in the way CPAC were being used both in score construction and in the influence of the score on access to surgery. The management of the hospital system also limited the extent to which CPAC could be used to prioritise patients for surgery. Conclusions: Variability in the use of CPAC tools meant that at the time of the study they did not provide a transparent and equitable method of determining access to surgery. This highlights the difficulties in developing and implementing CPAC and suggests that further development is difficult in the absence of evidence to identify patients who will benefit the most from surgery.
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Affiliation(s)
- Deborah McLeod
- Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
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236
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Affiliation(s)
- Pieter Degeling
- Centre for Clinical Management Development, University of Durham, UK
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237
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Abstract
Objective: A single visual analogue scale is used in New Zealand to prioritise patients for elective general surgery. Although it reflects clinical judgement, it has been criticised for its lack of transparency. We wished to elicit generic criteria used by surgeons for prioritisation of patients for elective general surgery in order to improve the transparency of the visual analogue scale. Methods: Semi-structured interviews were undertaken with 15 general surgeons. Using the repertory grid method, surgeons were asked to explain their rationale for distinguishing between patients they considered a high, medium or low priority for treatment. Interviews were audiotaped, transcribed and analysed for themes. The accuracy of the thematic analysis was checked using a five-point Likert scale to assess surgeons' agreement with the identified themes. Further testing to check for face, content and construct validity was undertaken with a purposive sample of six surgeons prioritising patient vignettes. Results: Eight major themes were deduced: diagnosis; treatment; patient characteristics; symptomatology and sequelae to date; future complications; quality of life; psychological/emotional impact; and socio-political/logistic factors. The utilisation of these themes by surgeons was confirmed. Tests of collinearity indicated good content validity. Factor analysis confirmed the hypothesis of one underlying construct, namely priority. Conclusion: Seven of the themes became the basis for a new clinical priority assessment criteria tool using visual analogue scales to determine priority of patients for elective general surgery. Further testing of reliability and validity is needed.
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Affiliation(s)
- Andrew MacCormick
- Divison of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1001, New Zealand
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238
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Abstract
Objective Emergency Department (ED) patient volumes are unpredictable, which can result in service delays and patients leaving without care. We initiated a programme of emergency physician (EP) telepresence in the ED with the objectives of assessing feasibility, safety, patient and provider acceptance, and throughput time. Methods This was a prospective convenience study. Patients presenting to the ED during operation of the study who were planned for placement in the waiting room were considered for enrolment. A faculty EP conducted patient evaluations via telepresence with confirmatory evaluation by the onsite faculty EP prior to disposition. Patient care was either taken to completion by the telemedicine EP or initiated and handed off to the onsite team. Measures included patient demographics, triage class (ESI 1-5), throughput time and a single question satisfaction survey (rating 1-5, 5 most favourable) completed by patients, registered nurses and EPs. Patients were called within 3 days and the electronic health record reviewed at 7 days looking for unscheduled visits and adverse events. Results In total, 130 patients were enrolled. Mean triage class was 3.9 with a median throughput of 150 minutes (IQR = 116.5, 206). Non-telemedicine patients during the same time period with similar triage classes had a median throughput of 287 minutes (IQR = 199, 408). Mean satisfaction scores were: patient 4.91, nurse 4.75, onsite EP 4.47 and telemedicine EP 4.79. There was one potential misdiagnosis and no adverse events. Conclusion Patient evaluation by EP via telepresence is feasible, safe, readily accepted by patients and providers and associated with reduced throughput time.
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Affiliation(s)
- Vaishal Tolia
- UCSD Health System, Department of Emergency Medicine, San Diego, California, USA
| | - Eddie Castillo
- UCSD Health System, Department of Emergency Medicine, San Diego, California, USA
| | - David Guss
- UCSD Health System, Department of Emergency Medicine, San Diego, California, USA
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Scali ST, Runge SJ, Feezor RJ, Giles KA, Fatima J, Berceli SA, Huber TS, Beck AW. Outcomes after endovascular aneurysm repair conversion and primary aortic repair for urgent and emergency indications in the Society for Vascular Surgery Vascular Quality Initiative. J Vasc Surg 2016; 64:338-347. [PMID: 27288102 DOI: 10.1016/j.jvs.2016.02.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/02/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Open conversion after endovascular aortic aneurysm repair (EVAR-c) is performed nonelectively in up to 60% of cases. EVAR-c has been reported to have significantly greater risk of postoperative morbidity and mortality than primary aortic repair, but few data exist on outcomes for symptomatic or ruptured presentations. This study determined outcomes and identified predictors of postoperative major adverse cardiac events (MACEs) and mortality for patients undergoing nonelective EVAR-c compared with nonelective primary aortic repair (PAR) in the Vascular Quality Initiative (VQI). METHODS All VQI patients undergoing urgent/emergency EVAR-c or urgent/emergency PAR from 2002 to 2014 were reviewed. Urgent presentation was defined by repair ≤24 hours of a nonelective admission, and emergency operations had clinical or radiographic evidence, or both, of rupture. End points included in-hospital MACE (myocardial infarction, dysrhythmia, congestive heart failure) and 30-day mortality. Possible covariates identified on univariate analysis (P < .2) were entered into a multivariable model, and stepwise elimination identified the best subset of predictors. Generalized estimating equations logistic regression analysis was used to determine the relative effect of EVAR-c compared with PAR on outcomes. RESULTS During the study interval, we identified 277 EVAR-c, and 118 (43%) underwent urgent/emergency repair. nonelective PAR was performed in 1388 of 6152 total (23%). EVAR-c patients were older (75 ± 9 vs 71 ± 10 years; P < .0001), more likely to be male (84% vs 74%; P = .02), and had a higher prevalence of hypertension (88% vs 79%; P = .02) and coronary artery disease (38% vs 27%; P = .01). No differences in MACE (EVAR-c, 31% [n = 34] vs PAR, 30% [n = 398]) or any major postoperative complication (EVAR-c, 57% [n = 63] vs PAR, 55% [n = 740]; P = .8) were found; however, 30-day mortality was significantly greater in EVAR-c (37% [n = 41]) than in (PAR, 24% [n = 291]; P = .003), with an odds ratio (OR) of 2.2 (95% confidence interval [CI], 1.04-4.77; P = .04) for EVAR-c. Predictors of any MACE included age (OR, × 1.03 for each additional year; 95% CI, 1.01-1.03; P = .0002), male gender (OR, 1.3; 95% CI, 1.03-1.67; P = .03), body mass index ≤20 kg/m2 (OR, 1.8; 95% CI, 1.13-2.87; P = .01), chronic obstructive pulmonary disease (OR, 1.2; 95% CI, 0.86-1.80; P = .25), congestive heart failure (OR, 1.5; 95% CI, 0.98-2.34; P = .06), preoperative chronic β-blocker use (OR, 1.3; 95% CI, 0.97-1.63; P = .09), and emergency presentation (OR, 2.3; 95% CI, 1.8-3.01; area under the curve, 0.70; P < .0001). Significant predictors for 30-day mortality were age (OR × 1.07 for each additional year; 95% CI, 1.05-1.09; P < .0001), female gender (OR, 1.6; 95% CI, 1.01-2.46; P = .04), preoperative creatinine >1.8 mg/dL (OR, 1.6; 95% CI, 1.04-2.35; P = .03), an emergency presentation (OR, 4.8; 95% CI, 2.93-7.93; P < .0001), and renal/visceral ischemia (OR, × 1.1 for each unit increase log (time-minutes); 95% CI, 1.02-1.22; area under the curve, 0.84; P = .01). CONCLUSIONS Nonelective EVAR-c patients are older and have higher prevalence of cardiovascular risk factors than PAR patients. Similar rates of postoperative complications occur; however, urgent/emergency EVAR-c has a significantly higher risk of 30-day mortality than nonelective PAR. Several variables are identified that predict outcomes after these repairs and may help risk stratify patients to further inform clinical decision making when patients present nonelectively with EVAR failure.
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Affiliation(s)
- Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla.
| | - Sara J Runge
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
| | - Robert J Feezor
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
| | - Kristina A Giles
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
| | - Javairiah Fatima
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
| | - Scott A Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
| | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
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Manning M, Purrington K, Penner L, Duric N, Albrecht TL. Between-race differences in the effects of breast density information and information about new imaging technology on breast-health decision-making. Patient Educ Couns 2016; 99:1002-10. [PMID: 26847421 PMCID: PMC4988060 DOI: 10.1016/j.pec.2016.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/02/2016] [Accepted: 01/15/2016] [Indexed: 05/08/2023]
Abstract
OBJECTIVES Some US states have mandated that women be informed when they have dense breasts; however, little is known about how general knowledge about breast density (BD) affects related health decision-making. We examined the effects of BD information and imaging technology information on 138 African-American (AA) and European-American (EA) women's intentions to discuss breast cancer screening with their physicians. METHODS Women were randomly assigned to receive BD information and/or imaging technology information via 2 by 2 factorial design, and completed planned behavior measures (e.g., attitudes, intentions) related to BC screening. RESULTS Attitudes mediated the effects of BD information, and the mediation was stronger for AA women compared to EA women. Effects were more robust for BD information compared to imaging technology information. Results of moderator analyses revealed suppressor effects of injunctive norms that were moderated by imaging technology information. CONCLUSION Information about BD favorably influences women's intentions to engage in relevant breast health behaviors. Stronger attitude mediated-effects for AA women suggest greater scrutiny of BD information. PRACTICE IMPLICATIONS Since BD information may influence women's intentions to discuss BC screening, strategies to effectively present BD information to AA women should be investigated given the likelihood of their increased scrutiny of BD information.
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Affiliation(s)
- Mark Manning
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States.
| | - Kristen Purrington
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Louis Penner
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Neb Duric
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
| | - Terrance L Albrecht
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, United States
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241
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DeSorcy DR, Olver ME, Wormith JS. Working Alliance and Its Relationship With Treatment Outcome in a Sample of Aboriginal and Non-Aboriginal Sexual Offenders. Sex Abuse 2016; 28:291-313. [PMID: 25381308 DOI: 10.1177/1079063214556360] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The relationship that develops between a client and therapist is arguably one of the most important factors toward achieving positive outcomes from therapy. The present study examined the therapeutic alliance, as measured by Horvath and Greenberg's Working Alliance Inventory (WAI), as a function of Aboriginal ancestry and the relationship of alliance to important program outcomes, in a Canadian correctional sample of 423 treated sexual offenders. The men rated their primary therapists on the WAI 3 months into treatment. Higher self-report ratings on the WAI and its Task, Bond, and Goal subscales were associated with lower rates of treatment non-completion and longer stay in treatment. Aboriginal men scored significantly lower on the WAI's Bond subscale (i.e., the emotional connection between client and therapist) than non-Aboriginal men, although by and large, the offender sample as a whole otherwise registered fairly high mean scores on the tool. Aboriginal men scoring below the median on WAI total score had the highest rates of treatment non-completion. WAI total score and scores on the three subscales were unrelated to post-program recidivism in the community. Cultural implications for correctional client engagement and service delivery within the context of the risk-needs-responsivity model are discussed.
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Affiliation(s)
| | - Mark E Olver
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Strutton R, Du Chemin A, Stratton IM, Forster AS. System-level and patient-level explanations for non-attendance at diabetic retinopathy screening in Sutton and Merton (London, UK): a qualitative analysis of a service evaluation. BMJ Open 2016; 6:e010952. [PMID: 27194319 PMCID: PMC4874146 DOI: 10.1136/bmjopen-2015-010952] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES Non-attendance at diabetic retinopathy screening has financial implications for screening programmes and potential clinical costs to patients. We sought to identify explanations for why patients had never attended a screening appointment (never attendance) in one programme. DESIGN Qualitative analysis of a service evaluation. SETTING One South London (UK) diabetic eye screening programme. PARTICIPANTS AND PROCEDURE Patients who had been registered with one screening programme for at least 18 months and who had never attended screening within the programme were contacted by telephone to ascertain why this was the case. Patients' general practices were also contacted for information about why each patient may not have attended. Framework analysis was used to interpret responses. RESULTS Of the 296 patients, 38 were not eligible for screening and of the 258 eligible patients, 159 were not contactable (31 of these had phone numbers that were not in use). We obtained reasons from patients/general practices/clinical notes for non-attendance for 146 (57%) patients. A number of patient-level and system-level factors were given to explain non-attendance. Patient-level factors included having other commitments, being anxious about screening, not engaging with any diabetes care and being misinformed about screening. System-level factors included miscommunication about where the patient lives, their clinical situation and practical problems that could have been overcome had their existence been shared between programmes. CONCLUSIONS This service evaluation provides unique insight into the patient-level and system-level reasons for never attendance at diabetic retinopathy screening. Improved sharing of relevant information between providers has the potential to facilitate increased uptake of screening. Greater awareness of patient-level barriers may help providers offer a more accessible service.
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Affiliation(s)
- R Strutton
- Sutton and Merton Diabetic Eye Screening Programme, London, UK
| | - A Du Chemin
- NHS England (London), London, UK
- Sutton and Merton Diabetic Eye Screening Programme, London, UK
| | - I M Stratton
- Gloucestershire Retinal Research Group, Gloucester Hospitals NHS Foundation Trust, Cheltenham, UK
| | - A S Forster
- Health Behaviour Research Centre, London, UK
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
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Xydakis MS, Fravell MD, Nasser KE, Casler JD. Analysis of Battlefield Head and Neck Injuries in Iraq and Afghanistan. Otolaryngol Head Neck Surg 2016; 133:497-504. [PMID: 16213918 DOI: 10.1016/j.otohns.2005.07.003] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVE: At the time of this study, the 1st place that an injured or ill American soldier in Iraq or Afghanistan would have been evaluated by an ENT–head and neck surgeon was at a tertiary care medical center as a result of air evacuation out of theater: Landstuhl Regional Medical Center (LRMC), Ramstein, Germany. By examining the ENT-related diagnoses of all air evacuations from downrange, we were able to match the patients classified as having battle injuries to determine the percentage with head and neck trauma. STUDY DESIGN: A prospective review of 11,287 soldiers air-evacuated from Afghanistan and Iraq, representing the 1st year of combat operations. A new, computerized patient-tracking system was created by our team to merge several disparate databases to generate and compile our data. RESULTS: The ENT–head and neck surgery department evaluated and primarily managed 8.7% of all patients evacuated out of theater by air to Germany. Other medical and surgical services managed 7.3% of all patients evacuated out of theater with overlapping ENT diagnoses. The number of potential ENT patients increased to 16% when one looked at all head and neck pathology instances seen by all medical and surgical departments hospital-wide. Of all patients air-evacuated and classified as having battle injuries, 21% presented with at least 1 head and neck trauma code. CONCLUSIONS: This is the 1st paper focusing on the role of the ENT–head and neck surgeon in treating a combat population and also the patterns of illness and head and neck injuries in a deployed force in our modern military. Improved soldier body armor has resulted in distinctly new patterns of combat injuries. Unprotected areas of the body account for the majority of injuries. SIGNIFICANCE: These findings should be used to improve the planning and delivery of combat medical care.
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Affiliation(s)
- Michael S Xydakis
- 435 Medical Group at Landstuhl Regional Medical Center of the US Air Force, MacDill AFB, Tampa, Florida, USA.
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244
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Abstract
We examined population-based surveillance data from the Tennessee Emerging Infections Program to determine whether neighborhood socioeconomic status was associated with influenza hospitalization rates. Hospitalization data collected during October 2007-April 2014 were geocoded (N = 1,743) and linked to neighborhood socioeconomic data. We calculated age-standardized annual incidence rates, relative index of inequality, and concentration curves for socioeconomic variables. Influenza hospitalizations increased with increased percentages of persons who lived in poverty, had female-headed households, lived in crowded households, and lived in population-dense areas. Influenza hospitalizations decreased with increased percentages of persons who were college educated, were employed, and had health insurance. Higher incidence of influenza hospitalization was also associated with lower neighborhood socioeconomic status when data were stratified by race.
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245
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Millman AJ, Reed C, Kirley PD, Aragon D, Meek J, Farley MM, Ryan P, Collins J, Lynfield R, Baumbach J, Zansky S, Bennett NM, Fowler B, Thomas A, Lindegren ML, Atkinson A, Finelli L, Chaves SS. Improving Accuracy of Influenza-Associated Hospitalization Rate Estimates. Emerg Infect Dis 2016; 21:1595-601. [PMID: 26292017 PMCID: PMC4550134 DOI: 10.3201/eid2109.141665] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Adjusting for diagnostic test sensitivity enables more accurate and timely comparisons over time. Diagnostic test sensitivity affects rate estimates for laboratory-confirmed influenza–associated hospitalizations. We used data from FluSurv-NET, a national population-based surveillance system for laboratory-confirmed influenza hospitalizations, to capture diagnostic test type by patient age and influenza season. We calculated observed rates by age group and adjusted rates by test sensitivity. Test sensitivity was lowest in adults >65 years of age. For all ages, reverse transcription PCR was the most sensitive test, and use increased from <10% during 2003–2008 to ≈70% during 2009–2013. Observed hospitalization rates per 100,000 persons varied by season: 7.3–50.5 for children <18 years of age, 3.0–30.3 for adults 18–64 years, and 13.6–181.8 for adults >65 years. After 2009, hospitalization rates adjusted by test sensitivity were ≈15% higher for children <18 years, ≈20% higher for adults 18–64 years, and ≈55% for adults >65 years of age. Test sensitivity adjustments improve the accuracy of hospitalization rate estimates.
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246
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Magill SS, Dumyati G, Ray SM, Fridkin SK. Evaluating Epidemiology and Improving Surveillance of Infections Associated with Health Care, United States. Emerg Infect Dis 2016; 21:1537-42. [PMID: 26291035 PMCID: PMC4550137 DOI: 10.3201/eid2109.150508] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
This national resource provides much-needed data on pathogens, infections, and antimicrobial drug use. The Healthcare-Associated Infections Community Interface (HAIC), launched in 2009, is the newest major activity of the Emerging Infections Program. The HAIC activity addresses population- and laboratory-based surveillance for Clostridium difficile infections, candidemia, and multidrug-resistant gram-negative bacilli. Other activities include special projects: the multistate Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey and projects that evaluate new approaches for improving surveillance. The HAIC activity has provided information about the epidemiology and adverse health outcomes of health care–associated infections and antimicrobial drug use in the United States and informs efforts to improve patient safety through prevention of these infections.
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247
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Patel A, Parikh R, Poddar KL, Ellis SG, Tuzcu EM, Kapadia SR. Frequency and factors associated with inappropriate for intervention cardiac catheterization laboratory activation. Cardiovasc Revasc Med 2016; 17:219-24. [PMID: 27150501 DOI: 10.1016/j.carrev.2016.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/06/2016] [Accepted: 03/11/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Current guidelines emphasize timely coronary intervention with a door to balloon time of ≤90min for favorable survival impact after STEMI. Efforts to achieve these targets may result in unnecessary emergent angiography for inappropriate activations. OBJECTIVE Evaluate the frequency, trend and factors which are significantly associated with inappropriate for intervention cardiac catheterization laboratory (CCL) activation. METHODS We analyzed 1764 consecutive emergent CCL activation for possible ST segment elevation myocardial infarction (STEMI) between 7/2005 and 8/2013. Inappropriate for intervention activation was defined as negative STEMI (incorrect diagnosis: insignificant coronary lesion, not requiring any intervention) and inappropriate patients (true STEMI but poor CCL candidacy). RESULTS Inappropriate for intervention CCL activation occurred in 317 patients (17.9%): 292 incorrect diagnosis (negative STEMI diagnosis), 25 inappropriate patients, with no difference in the frequency based on time of the day (18.6% regular hours vs. 17.6% off-hours, p=0.6). On multivariable analysis, female gender (OR 1.9 [1.2-3.0]), African American race (OR 1.9[1.3-2.7]), and prior coronary artery bypass graft surgery (OR 3.6 [2.3-5.5]) were significantly associated with incorrect diagnosis (negative STEMI diagnosis) (all p<0.005) and hyperlipidemia (OR 0.2 [0.1-0.3]), tobacco use (OR 0.2 [0.1-0.3]), and stroke/TIA (OR 0.2 [0.1-0.4]) had a significant inverse association (all p<0.001). ST Elevation with no reciprocal depression and pericarditis/myocarditis were the most common ECG finding and etiology respectively. CONCLUSION Inappropriate for intervention CCL activation is not uncommon and should be closely monitored to maximize resource utilization. Females, African American patients with few or no risk factors and patients presenting ST elevation but no reciprocal depression constitute a population that may require attention.
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Affiliation(s)
- Apurva Patel
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Roosha Parikh
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Kanhaiya L Poddar
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Stephen G Ellis
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH.
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248
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Qualls LG, Hammill BG, Maciejewski ML, Curtis LH, Jones WS. Low-density lipoprotein cholesterol level and statin use among Medicare beneficiaries with diabetes mellitus. Diab Vasc Dis Res 2016; 13:244-6. [PMID: 26802221 DOI: 10.1177/1479164115620980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
At the time of this study, guidelines recommended a primary goal of low-density lipoprotein cholesterol level less than 100 mg/dL for all patients, an optional goal of low-density lipoprotein cholesterol less than 70 mg/dL for patients with overt cardiovascular disease and statins for patients with diabetes and overt cardiovascular disease and patients 40 years and older with diabetes and at least one risk factor for cardiovascular disease. This study examined statin use and achievement of lipid goals among 111,730 Medicare fee-for-service beneficiaries 65 years and older in 2011. Three-quarters of patients met the low-density lipoprotein cholesterol goal of less than 100 mg/dL. Patients with cardiovascular disease were more likely to meet the goal than those without, not controlling for other differences. Patients on a statin were more likely to meet the goal. There is considerable opportunity for improvement in cholesterol management in high-risk patients with diabetes mellitus.
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MESH Headings
- Aged
- Aged, 80 and over
- Biomarkers/blood
- Cardiovascular Diseases/epidemiology
- Cardiovascular Diseases/prevention & control
- Cholesterol, LDL/blood
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/therapy
- Dyslipidemias/blood
- Dyslipidemias/diagnosis
- Dyslipidemias/drug therapy
- Dyslipidemias/epidemiology
- Female
- Humans
- Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
- Male
- Medicare
- Prevalence
- Process Assessment, Health Care
- Risk Assessment
- Risk Factors
- Time Factors
- Treatment Outcome
- United States/epidemiology
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Affiliation(s)
| | | | - Matthew L Maciejewski
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Lesley H Curtis
- Duke Clinical Research Institute, Durham, NC, USA Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - W Schuyler Jones
- Duke Clinical Research Institute, Durham, NC, USA Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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249
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Tibor LC, Schultz SR, Cravath JL, Rein RR, Krecke KN. Improving Patient Flow Utilizing a Collaborative Learning Model. Radiol Manage 2016; 38:19-28. [PMID: 27514106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This initiative utilized a collaborative learning approach to increase knowledge and experience in process improvement and systems thinking while targeting improved patient flow in seven radiology modalities. Teams showed improvements in their project metrics and collectively streamlined the flow for 530 patients per day by improving patient lead time, wait time, and first case on-time start rates. In a post-project survey of 50 project team members, 82% stated they had more effective solutions as a result of the process improvement methodology, 84% stated they will be able to utilize the process improvement tools again in the future, and 98% would recommend participating in another project to a colleague.
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250
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Castañón-González JA, Barrientos-Fortes T, Polanco-González C. [Reflections concerning the care process in the emergency medical services]. Rev Med Inst Mex Seguro Soc 2016; 54:376-379. [PMID: 27100984] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In this paper we share some reflections regarding the care process in the emergency medical services, as well as some of the challenges with which these fundamental services deal. We highlight the increasing amount of patients and the complexity of some of the clinical cases, which are some of the causes that lead to the overcrowding of these services.
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