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Penas-Prado M, Armstrong TS, Gilbert MR. Proposed Additions to the NCCN Guidelines for Adult Medulloblastoma. J Natl Compr Canc Netw 2020; 18:1579-1584. [DOI: 10.6004/jnccn.2020.7650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/02/2020] [Indexed: 11/17/2022]
Abstract
Medulloblastoma is a rare brain tumor that occurs in both children and adults, with patients aged 15 to 39 years accounting for 30% of all cases. In adults, guidelines for diagnosis and treatment are often based on retrospective data and extrapolated from the pediatric experience due to limited availability of prospective trials or registries involving adults. Importantly, adult patients differ from pediatric patients in many aspects, including the molecular features of the tumor and tolerance to treatment. In 2017, the NCI was granted support from the Cancer Moonshot initiative to address the challenges and unmet needs of adults with rare central nervous system (CNS) tumors through the NCI Comprehensive Oncology Network for Evaluating Rare CNS Tumors (NCI-CONNECT). On November 25, 2019, NCI-CONNECT convened a multidisciplinary workshop on adult medulloblastoma. Working groups identified unmet needs in clinical care and research and developed specific action items, including a proposal for inclusion of new items in the NCCN Guidelines for Adult Medulloblastoma, delineated in this review along with the evidence supporting their incorporation. Recommendations included facilitating referral of patients to centers of excellence; promoting patient participation in clinical trials or registries; encouraging use of DNA methylation for confirmation of diagnosis and subgrouping; offering counseling on contraception and fertility preservation; evaluating patients for symptoms and medical management of endocrine, vision, hearing, and neurocognitive deficits; providing psychosocial support and referral to neurorehabilitation; minimizing delays in therapy; and incorporating imaging standards and criteria for progression.
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Affiliation(s)
- Marta Penas-Prado
- 1Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Terri S. Armstrong
- 1Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Mark R. Gilbert
- 1Neuro-Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
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Elrod JK, Fortenberry JL. Advertising in health and medicine: using mass media to communicate with patients. BMC Health Serv Res 2020; 20:818. [PMID: 32928190 PMCID: PMC7491105 DOI: 10.1186/s12913-020-05599-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Advertising-a marketing communications method involving the paid use of mass media to deliver messages to desired audiences-represents one of the most common and effective avenues for engaging current and prospective patients. Although late to proliferate in the health services industry due to tradition, the medium of communication is now firmly established and routinely deployed by health and medical organizations far and wide. Despite widespread use, healthcare providers must take opportunities, when and where possible, to stay abreast of the latest details concerning advertising and its associated applications, increasing the likelihood of successful audience engagements. DISCUSSION Maintaining an awareness of current developments in health services advertising can be facilitated by acquiring operational perspectives and practices from peer institutions. Most any healthcare provider can benefit from experiential views as they can shape and hone advertising approaches. Gaining such insights can be difficult, given competitive sensitivities, but occasionally healthcare institutions are compelled to share knowledge in published accounts, with this particular article following suit. Specifically, insights and experiences from Willis-Knighton Health System's extensive and historic use of advertising are shared, bolstering the experiential accounts available in the literature and supplying operational guidance for health and medical providers. CONCLUSIONS Advertising, if well devised and deployed, offers healthcare providers opportunities to dramatically improve their fortunes by successfully engaging current and prospective patients, hastening exchange and building vital market share. In pursuit of advertising excellence, health and medical establishments can bolster associated endeavors by tapping into the experiences of other healthcare providers, permitting insights which might potentially be incorporated into communicative pathways. This account sheds light on the advertising operations of a major health system, supplying food for thought for the advancement of advertising acumen.
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Affiliation(s)
- James K Elrod
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA
| | - John L Fortenberry
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA. .,LSU Shreveport, 1 University Place, Shreveport, LA, 71115, USA.
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Elrod JK, Fortenberry JL. Personal selling in health and medicine: using sales agents to engage audiences. BMC Health Serv Res 2020; 20:819. [PMID: 32928197 PMCID: PMC7490869 DOI: 10.1186/s12913-020-05600-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Personal selling—the use of sales agents to personally deliver messages to target audiences—is often not the first conveyance pathway that comes to mind when thinking about marketing communications in the health services industry. This is not surprising given that sales force roles are not as public and prominent as other promotional avenues, such as advertising and public relations. Further, the titles held by those in sales-oriented roles in the health services industry are usually more discreet, carrying designations such as community liaison, business development officer, and the like. Regardless of title, sales roles involve personally interacting with desired audiences to compel some sort of action, adding a vital form of communication that bolsters engagement opportunities. Discussion Personal selling plays a critical role in the promotion of health services organizations. Perhaps most obviously, it is distinguished from its counterparts in the marketing communications mix by its use of people to deliver messages to desired audiences. Associated titles, duties, and expectations vary widely between and among those healthcare entities which make use of personal selling, as there is no pat formula for deployment within health services environments. To shed light on personal selling, this article presents an associated overview through the lens of Willis-Knighton Health System, sharing practical insights and experiences which can assist peer healthcare establishments in understanding, shaping, and honing sales roles within their own facilities. Conclusions Taking advantage of the utility afforded by direct, personal interactions with audiences, personal selling provides a helpful communications resource that better enables healthcare providers to connect proficiently with target markets. It supplements other forms of marketing communication, operating synergistically to help healthcare institutions achieve their conveyance goals. Prudent deployment of this unique marketing communications method affords health and medical institutions with a capable conveyance asset that can provide great assistance in achieving communicative ambitions.
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Affiliation(s)
- James K Elrod
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA
| | - John L Fortenberry
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA. .,LSU Shreveport, 1 University Place, Shreveport, LA, 71115, USA.
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Elrod JK, Fortenberry JL. Public relations in health and medicine: using publicity and other unpaid promotional methods to engage audiences. BMC Health Serv Res 2020; 20:821. [PMID: 32928186 PMCID: PMC7491107 DOI: 10.1186/s12913-020-05602-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Public relations—a marketing communications method involving the use of publicity and other unpaid promotional methods to deliver messages—historically has served as the communicative workhorse of the health services industry, representing the predominant pathway over many decades by which health and medical facilities conveyed stories to the public. While other components of the marketing communications mix, perhaps most notably that of advertising, have now captured a significant portion of interest, attention, and use by healthcare establishments, public relations remains a valuable communicative avenue when deployed properly. Discussion As an unpaid method of promotion, public relations is uniquely positioned among its counterparts in the marketing communications mix which require direct expenditures to reach audiences. Typically effected by preparing and submitting press releases to news media firms in hopes that they, in turn, will present given stories to their audiences, limitations are somewhat obvious as transmission control rests with external entities. But overcoming limitations is possible with prudent strategies. This article presents Willis-Knighton Health System’s associated strategies, along with a range of public relations insights from decades of deployment experience. Conclusions Prudently deployed and led by guiding strategies, public relations offers health and medical organizations opportunities to engage audiences in an efficient and highly credible manner. Courtesy of its unique properties, public relations capably can complement other marketing communications, operating synergistically to help healthcare institutions achieve their conveyance goals, fostering exchange and bolstering market share. Careful operationalization of this marketing communications avenue can help healthcare establishments realize their full communicative potential.
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Bardakjian TM, Klapper J, Carey A, Wood J, Pauly M, Gasper K, Lawler K, Tran B, Bell Y, Zwil A, Gonzalez-Alegre P. Addressing the Value of Multidisciplinary Clinical Care in Huntington's Disease: A Snapshot of a New Huntington's Disease Center. J Huntingtons Dis 2020; 8:501-507. [PMID: 31381522 DOI: 10.3233/jhd-190355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Clinical care for Huntington's disease (HD) is often provided in experienced centers that provide multidisciplinary care. However, the value of these centers and their uptake by HD families remain unknown. OBJECTIVE To describe the services provided by a new HD center, including estimates of capture of the population served. METHODS Retrospective review of a HD Center launched in 2015, including quantitative and qualitative data on clinic visits, demographic and clinical data. RESULTS We observed a rapid and ongoing growth on the annual number of clinic encounters, with high demand for in-clinic multidisciplinary care. Using census data and estimates of HD prevalence, we determined that we served about 20% of local patients with HD. Most HD patients received pharmacological treatment for psychiatric symptoms, and over half were treated for chorea. About 25% of new HD diagnoses were on patients without family history of HD. Finally, the demand for predictive testing in at risk individuals significantly increased following the press release reporting the successful completion of the Ionis-HTTRx (RG 6042) trial. CONCLUSIONS This report indicates a high demand for multidisciplinary care by HD families, supporting its value, providing a snapshot of the organization and function of a single center. Furthermore, it demonstrates how dissemination of news related to research advances influence clinical behavior. Reporting similar information from other HD centers to would provide us with a more global view of the status of HD care across multiple geographical areas.
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Affiliation(s)
- Tanya M Bardakjian
- Department of Neurology, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer Klapper
- Department of Neurology, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Adrianna Carey
- Dan Aaron Parkinson's Disease Rehabilitation Center, University of Pennsylvania Health System, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Julia Wood
- Dan Aaron Parkinson's Disease Rehabilitation Center, University of Pennsylvania Health System, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Meredith Pauly
- Dan Aaron Parkinson's Disease Rehabilitation Center, University of Pennsylvania Health System, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Kelly Gasper
- Dan Aaron Parkinson's Disease Rehabilitation Center, University of Pennsylvania Health System, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Kathy Lawler
- Department of Neurology, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Baochan Tran
- Department of Neurology, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Yuliis Bell
- Department of Neurology, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Alex Zwil
- Department of Psychiatry, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Pedro Gonzalez-Alegre
- Department of Neurology, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
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Trends in Incidence and Mortality by Hospital Teaching Status and Location in Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2020; 142:e253-e259. [PMID: 32599190 DOI: 10.1016/j.wneu.2020.06.180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/22/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Few studies have examined the impact of teaching status and location on outcomes in subarachnoid hemorrhage (SAH). The objective of the present study was to compare mortality and functional outcomes among urban teaching, urban nonteaching, and rural centers for hospitalizations with SAH. METHODS The National Inpatient Sample for years 2003-2016 was queried for hospitalizations with aneurysmal SAH from 2003 to 2017. Cohorts treated at urban teaching, urban nonteaching, and rural centers were compared with the urban teaching center cohort acting as the reference. The National Inpatient Sample Subarachnoid Hemorrhage Outcome Measure, a validated measure of SAH functional outcome, was used as a coprimary outcome with mortality. Multivariable models adjusted for age, sex, NIH-SSS score, hypertension, and hospital bed size. Trends in SAH mortality rates were calculated. RESULTS There were 379,716 SAH hospitalizations at urban teaching centers, 105,638 at urban nonteaching centers, and 17,165 at rural centers. Adjusted mortality rates for urban teaching centers were lower than urban nonteaching (21.90% vs. 25.00%, P < 0.0001) and rural (21.90% vs. 30.90%, P < 0.0001) centers. While urban teaching (24.74% to 21.22%) and urban nonteaching (24.78% to 23.68%) had decreases in mortality rates over the study period, rural hospitals showed increased mortality rates (25.67% to 33.38%). CONCLUSIONS Rural and urban nonteaching centers have higher rates of mortality from SAH than urban teaching centers. Further study is necessary to understand drivers of these differences.
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Nakov R, Sarafov S, Gospodinova M, Kirov A, Chamova T, Todorov T, Todorova A, Tournev I. Transthyretin amyloidosis: Testing strategies and model for center of excellence support. Clin Chim Acta 2020; 509:228-234. [PMID: 32564944 DOI: 10.1016/j.cca.2020.06.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
Appropriate testing strategies and strict model for Center Of Excellence (CoE) support are essential for the correct diagnosis, follow-up strategy and treatment plan for transthyretin (ATTR) amyloidosis. CoE is defined as a programme within a healthcare institution established to provide an exceptionally high concentration of expertise and related resources centred on a particular area of medicine, delivering associated care in a comprehensive, interdisciplinary fashion to afford the best patient outcome. Ideally, CoEs provide regular education and training for healthcare professionals and share knowledge and learning with other CoEs and specialists to ensure the highest standards of care. CoEs and testing strategies are of significant value to those with rare diseases and their families, as there is naturally low awareness among healthcare professionals, a phenomenon that potentially delays diagnosis and treatment. In this review, we focus on the importance of performing the most appropriate testing strategies for ATTR amyloidosis and establishing a CoE for this rare disease. We highlight our experience in establishing a CoE in Sofia, Bulgaria and define the fundamental steps needed to successfully launch a programme.
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Affiliation(s)
- Radislav Nakov
- Clinic of Gastroenterology, Tsaritsa Joanna University Hospital, Medical University - Sofia, Bulgaria.
| | - Stayko Sarafov
- Clinic of Nervous Diseases, Alexandrovska University Hospital, Medical University - Sofia, Bulgaria
| | - Mariana Gospodinova
- Clinic of Cardiology, Medical Institute of Ministry of Interior, Sofia, Bulgaria
| | - Andrey Kirov
- Genetic and Medico-diagnostic Laboratory "Genica", Sofia, Bulgaria; Department of Medical Chemistry and Biochemistry, Medical University - Sofia, Bulgaria
| | - Teodora Chamova
- Clinic of Gastroenterology, Tsaritsa Joanna University Hospital, Medical University - Sofia, Bulgaria
| | - Tihomir Todorov
- Genetic and Medico-diagnostic Laboratory "Genica", Sofia, Bulgaria
| | - Albena Todorova
- Genetic and Medico-diagnostic Laboratory "Genica", Sofia, Bulgaria; Department of Medical Chemistry and Biochemistry, Medical University - Sofia, Bulgaria
| | - Ivailo Tournev
- Clinic of Nervous Diseases, Alexandrovska University Hospital, Medical University - Sofia, Bulgaria; Department of Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria
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Li J, Burson RC, Clapp JT, Fleisher LA. Centers of excellence: Are there standards? Healthcare (Basel) 2020; 8:100388. [DOI: 10.1016/j.hjdsi.2019.100388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/19/2019] [Accepted: 10/06/2019] [Indexed: 11/25/2022] Open
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Parbhoo P. Biopsychosocial outcome indicators in traumatic brain injuries. NeuroRehabilitation 2020; 46:157-166. [PMID: 32083600 DOI: 10.3233/nre-192969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) remains a silent and global epidemic which creates an aftermath of convoluted dynamics. Despite significant incidence rates and increasing awareness over the long-term catastrophic implications, there remain marked contrasts between acute vs. post-acute rehabilitation processes in the United States. OBJECTIVE To explore existing research and highlight the complexity of TBIs to inform vital changes needed to reduce the significant differences and inconsistencies across post-acute treatment settings. To highlight how psychologists/neuropsychologists and other rehabilitation professionals maintain a prominent operational presence in post-acute settings resulting in key leadership opportunities to support a more efficient longitudinal continuation of care model. METHODS Literature search of various health science databases was completed for articles between 1987 to 2019 to explore the range and depth of post-acute treatment, model, and outcomes research. RESULTS Despite progressive medical advancements, translation of relevant rehabilitation research and practices into post-acute treatment settings remains inconsistent. CONCLUSIONS Significant barriers remain for objective and comprehensive evaluation(s) of post-acute program quality and purported patient outcomes in the United States. There remains a lack of consensually relevant and objective metrics. Further investigation is recommended for: consensus on longitudinal post-acute brain injury outcome measures; functional relevance of program accreditations/certifications; outcome differences based on team composition and program resources; and patient/stakeholder variables/input to support optimal post-acute service access and delivery.
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Affiliation(s)
- Pritesh Parbhoo
- NeuroInternational Healthcare, LLC, 1876 Barber Rd, Building A, Sarasota, FL 34240, USA. Tel.: +1 (813) 401 6728; E-mail:
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Asher AL, Devin CJ, Kerezoudis P, Nian H, Alvi MA, Khan I, Sivaganesan A, Harrell FE, Archer KR, Bydon M. Predictors of patient satisfaction following 1- or 2-level anterior cervical discectomy and fusion: insights from the Quality Outcomes Database. J Neurosurg Spine 2019; 31:835-843. [PMID: 31470402 DOI: 10.3171/2019.6.spine19426] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/17/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patient satisfaction with treatment outcome is gaining an increasingly important role in assessing the value of surgical spine care delivery. Nationwide data evaluating the predictors of patient satisfaction in elective cervical spine surgery are lacking. The authors sought to decipher the impacts of the patient, surgical practice, and surgeon on satisfaction with outcome following anterior cervical discectomy and fusion (ACDF). METHODS The authors queried the Quality Outcomes Database for patients undergoing 1- to 2-level ACDF for degenerative spine disease since 2013. Patient satisfaction with the surgical outcome as measured by the North American Spine Society (NASS) scale comprised the primary outcome. A multivariable proportional odds logistic regression model was constructed with adjustments for baseline patient characteristics and surgical practice and surgeon characteristics as fixed effects. RESULTS A total of 4148 patients (median age 54 years, 48% males) with complete 12-month NASS satisfaction data were analyzed. Sixty-seven percent of patients answered that "surgery met their expectations" (n = 2803), while 20% reported that they "did not improve as much as they had hoped but they would undergo the same operation for the same results" (n = 836). After adjusting for a multitude of patient-specific as well as hospital- and surgeon-related factors, the authors found baseline Neck Disability Index (NDI) score, US geographic region of hospital, patient race, insurance status, symptom duration, and Workers' compensation status to be the most important predictors of patient satisfaction. The discriminative ability of the model was satisfactory (c-index 0.66, overfitting-corrected estimate 0.64). CONCLUSIONS The authors' results found baseline NDI score, patient race, insurance status, symptom duration, and Workers' compensation status as well as the geographic region of the hospital to be the most important predictors of long-term patient satisfaction after a 1- to 2-level ACDF. The findings of the present analysis further reinforce the role of preoperative discussion with patients on setting treatment goals and realistic expectations.
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Affiliation(s)
- Anthony L Asher
- 1Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neurological Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Clinton J Devin
- 2Orthopaedics of Steamboat Springs, Steamboat Springs, Colorado
| | | | - Hui Nian
- 4Department of Biostatistics, Vanderbilt University School of Medicine, and Departments of
| | - Mohammed Ali Alvi
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and
| | | | | | - Frank E Harrell
- 4Department of Biostatistics, Vanderbilt University School of Medicine, and Departments of
| | - Kristin R Archer
- 6Orthopedic Surgery, and
- 7Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohamad Bydon
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and
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Michael P, Tran VT, Hopkins M, Berger I, Ziemba J, Bansal UK, Balasubramanian A, Chen J, Mayer W, Fang A, Rais-Bahrami S, James A, Harris A. Comparison of Urologic Transfers to Academic Medical Centers: A Multi-institutional Perspective. Urology 2019; 136:100-104. [PMID: 31751623 DOI: 10.1016/j.urology.2019.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/25/2019] [Accepted: 11/09/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine urologic transfers and rate of tertiary center interventions from 4 geographically distinct academic medical centers. METHODS Four academic medical centers were selected for this study including Baylor College of Medicine, University of Alabama at Birmingham, University of Kentucky, and University of Pennsylvania Hospital (Penn). Baylor College of Medicine and Penn primarily service large metropolitan city centers and University of Kentucky and University of Alabama at Birmingham primarily service large rural populations. Transfer logs were pulled for each institution over a 2-year period, and a retrospective chart review was performed to evaluate transfer diagnosis and need for procedural management upon admission. Date of transfer, transfer diagnosis, and interventions performed during tertiary center admission were extracted from the transfer log data sets. The transfer diagnosis was categorized into 1 of 11 mutually exclusive categories. RESULTS Overall, 984 urologic transfers were included. Sixty-nine percent (682/984) of patients were transferred to the 2 rural centers, and 30.7% (302/984) were transferred to the 2 metropolitan centers. The most common reason for transfer was nephrolithiasis at 26% (256 of 984 transfers). The overall surgical intervention rate for all urologic transfers in this study was 44.4% (437 of 984 total transfers). Rural center transfers had a lower rate of surgical intervention than metropolitan centers (42.7% vs 48.3%) as well as a markedly higher number of total transfers during the study period (682 vs 302). CONCLUSION Given that a majority of patients did not require surgical intervention, methods for avoiding unnecessary urologic transfers are warranted.
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Affiliation(s)
- Patrick Michael
- Department of Urology, University of Kentucky, Lexington, KY
| | - Vi T Tran
- Department of Urology, University of Kentucky, Lexington, KY.
| | - Marilyn Hopkins
- Department of Urology, University of Kentucky, Lexington, KY
| | - Ian Berger
- Department of Urology, University of Pennsylvania, Philadelphia, PA
| | - Justin Ziemba
- Department of Urology, University of Pennsylvania, Philadelphia, PA
| | - Utsav K Bansal
- Department of Urology, Baylor College of Medicine, Houston, TX
| | | | - Jessie Chen
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Wesley Mayer
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Andrew Fang
- Dept. of Urology, University of Alabama at Birmingham - Birmingham, Birmingham, AL
| | - Soroush Rais-Bahrami
- Dept. of Urology, University of Alabama at Birmingham - Birmingham, Birmingham, AL
| | - Andrew James
- Department of Urology, University of Kentucky, Lexington, KY
| | - Andrew Harris
- Department of Urology, University of Kentucky, Lexington, KY
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Sheha ED, Iyer S. Spine centers of excellence: applications for the ambulatory care setting. JOURNAL OF SPINE SURGERY 2019; 5:S133-S138. [PMID: 31656866 DOI: 10.21037/jss.2019.04.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Centers of excellence (COE) are designed to deliver high-quality, cost-effective healthcare by providing specialized and comprehensive multidisciplinary care for a given condition and have become attractive option to both insurers and healthcare providers given their promise of creating value. The criteria that constitute and define a COE may be delineated by a number of entities with a stake in value-based healthcare delivery including professional societies, the federal government, insurers and businesses seeking to control costs while guaranteeing outcomes for their employees. COEs accomplish this goal through a number of means, the first and most essential of which is centralization of organization wherein a variety of specialists are integrated under a single hospital system to improve communication between providers and decrease overall variability of care delivery. In this system, the patient is tracked throughout the entire spectrum of care from diagnosis, through non-operative or surgical intervention, and postoperative care. The centralized model in turn allows for standardization of protocols and multidisciplinary team input which helps to inform case selection, improve patient screening, make treatment more uniform and ultimately allow for dynamic and continual modification of best practices. This model lends itself particularly well to orthopedic subspecialties where patients often require specialized pre-, intra- and post-operative care from a variety of providers. However, despite their apparent benefits, studies evaluating outcomes after implementation of COEs have been less than favorable, and further research is needed in this area to support their widespread adoption. The growth of the ambulatory surgery center in orthopedics provides a new opportunity for the development, evaluation and evolution of spine COEs. Although the direct value of COEs is yet to be firmly established, they provide guidelines for best practices in outpatient spine surgery and a framework for how spine care can be transitioned safely and effectively to the outpatient setting.
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Affiliation(s)
- Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
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Hunger R, Mantke A, Herrmann C, Grimm AL, Ludwig J, Mantke R. Hospital volume and mortality in liver resections for colorectal metastasis using population‐based administrative data. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 26:548-556. [DOI: 10.1002/jhbp.680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Richard Hunger
- Department of General and Visceral Surgery Brandenburg Medical School Theodor Fontane Municipal Hospital Brandenburg Brandenburg a. d. Havel Germany
| | - Anne Mantke
- Department of General and Visceral Surgery Brandenburg Medical School Theodor Fontane Municipal Hospital Brandenburg Brandenburg a. d. Havel Germany
| | - Christian Herrmann
- Department of General and Visceral Surgery Brandenburg Medical School Theodor Fontane Municipal Hospital Brandenburg Brandenburg a. d. Havel Germany
| | - Alexis Leonhard Grimm
- Department of General and Visceral Surgery Brandenburg Medical School Theodor Fontane Municipal Hospital Brandenburg Brandenburg a. d. Havel Germany
| | - Juliane Ludwig
- Department of General and Visceral Surgery Brandenburg Medical School Theodor Fontane Municipal Hospital Brandenburg Brandenburg a. d. Havel Germany
| | - René Mantke
- Department of General and Visceral Surgery Brandenburg Medical School Theodor Fontane Municipal Hospital Brandenburg Brandenburg a. d. Havel Germany
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Cloney M, Hopkins B, Shlobin N, Dahdaleh NS. Online Ratings of Neurosurgeons: An Examination of Web Data and its Implications. Neurosurgery 2019; 83:1143-1152. [PMID: 29618127 DOI: 10.1093/neuros/nyy064] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/08/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patient satisfaction ratings are increasingly used for hospital rankings, referral base and physician reimbursement. As such, online physician rating websites (PRWs) are quickly becoming a topic of interest. OBJECTIVE To analyze the distribution of neurosurgeons' ratings on the 3 most widely used PRWs, and examine factors associated with positive and negative ratings. METHODS We used a key term search to identify board-certified neurosurgeons on 3 widely used PRWs: RateMD.com, Healthgrades.com, and Vitals.com. Data were collected on average rating and number of ratings. Demographic, training-related and practice-related data, as well as location of practice, and place of training were also collected. RESULTS Data was non-normally distributed (P < .001 for all 3). Having fewer reviews was associated with higher variance in ratings between PRWs for a given surgeon (odds ratio 0.99, P = .001). All surgeons below the 25th percentile with respect to the number of reviews that had been written about them were eliminated. Of the remaining surgeons (n = 3054), the median composite score was 4.11 out of 5, interquartile range (3.69, 4.44). Surgeons had higher median modified composite scores if they were fellowship-trained (P = .0001) or graduated from a top 25 medical school (P = .0117), but not if they graduated from a top 25 residency (P = .1056). Surgeons located in major cities had higher median composite scores (P = .0025). CONCLUSION Online ratings for neurosurgeons must be evaluated in context. Median ratings are generally high, but variable between websites. Median scores also vary among regions and practice settings. Higher scores were associated with ranking of medical school, recent graduation, and fellowship training completion.
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Affiliation(s)
- Michael Cloney
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Benjamin Hopkins
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Nathan Shlobin
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Elrod JK, Fortenberry JL. Catalyzing marketing innovation and competitive advantage in the healthcare industry: the value of thinking like an outsider. BMC Health Serv Res 2018; 18:922. [PMID: 30545368 PMCID: PMC6293865 DOI: 10.1186/s12913-018-3682-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Marketing arguably is the most critical administrative responsibility associated with the pursuit and realization of growth and prosperity, making prowess in the discipline essential for any healthcare institution, especially given the competitive intensity that characterizes the industry. But in order to truly gain an advantage, healthcare establishments must tap into innovative pathways that their competitors have yet to discover. Here, thinking like an outsider can pay tremendous dividends, as health and medical organizations tend to focus inwardly, limiting their exposure to externally-derived innovations and advancements which often can supply differentiation opportunities. DISCUSSION Some years ago, during a formative period in preparation for expanding its footprint, Willis-Knighton Health System opted to think like an outsider, peering beyond the walls of healthcare institutions in search of tools and techniques that would allow its growth ambitions to be realized. Associated pursuits and subsequent successes created a culture of challenging status quo perspectives, affording innovations and resulting competitive advantages. Marketing advancements, in particular, have been fueled by this outsider mentality, benefiting the institution and its patient populations. This article profiles several of these advancements, discusses the dangers of insular mindsets, and suggests avenues for encouraging broad perspectives. CONCLUSIONS Due to extreme competitive intensity and ever-increasing patient needs, health and medical establishments must perform at optimal levels, with marketing efforts playing a critical role in the achievement of such. By shedding status quo perspectives and peering beyond the walls of healthcare institutions, health and medical providers have opportunities to discover new and different marketing approaches for potential use in their own organizations, affording mutual benefits, including all-important competitive advantages.
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Affiliation(s)
- James K Elrod
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA
| | - John L Fortenberry
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA. .,LSU Shreveport, 1 University Place, Shreveport, LA, 71115, USA.
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Elrod JK, Fortenberry JL. Formulating productive marketing communications strategy: a major health system's experience. BMC Health Serv Res 2018; 18:926. [PMID: 30545343 PMCID: PMC6293486 DOI: 10.1186/s12913-018-3676-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Healthcare establishments serve as key community resources, bringing into locales a wealth of resources aimed at enhancing and improving health and wellness. Without effective communications, current and prospective patients will remain unaware of available offerings, foiling opportunities for mutually beneficial exchange. Today, healthcare organizations engage audiences by selecting from among the components of the marketing communications mix, but this wasn't always the case. There was a time not long ago when communications options were limited due to industry traditions, creating associated challenges. DISCUSSION Willis-Knighton Health System faced a communications dilemma in the 1970s when, as a small healthcare provider desirous of growth, it could not achieve a satisfactory media presence via the usual and customary route of the day: submitting press releases to news media organizations, requesting conveyance of associated stories to their audiences. This forced the institution to explore other possibilities, ultimately leading it to experiment with and embrace advertising at a time period when its use was generally shunned in the industry. Willis-Knighton Health System's pioneering deployment of advertising helped the institution achieve its intended promotions goals, supplying mutual benefits and affording insights which influence its communications approach to this day. CONCLUSIONS Deploying advertising years in advance of its widespread acceptance and use in the healthcare industry, Willis-Knighton Health System forged new pathways and acquired experience which fostered provider-patient engagement initiatives, affording an enduring marketing communications approach. Challenging situations are quite common in the healthcare industry and the one faced by Willis-Knighton Health System was no exception, but it supplied an immense opportunity to innovate, leading to communications prowess, resulting growth, informed audiences, and lasting mutual benefits.
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Affiliation(s)
- James K Elrod
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA
| | - John L Fortenberry
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA. .,LSU Shreveport, 1 University Place, Shreveport, LA, 71115, USA.
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Elrod JK, Fortenberry JL. Establishing Good Samaritan programs in healthcare institutions: a method for enhancing patient experiences and increasing loyalty. BMC Health Serv Res 2018; 18:927. [PMID: 30545346 PMCID: PMC6293488 DOI: 10.1186/s12913-018-3677-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Healthcare institutions deliver essential services that practically everyone needs at least periodically over the course of their lives. Hospital admissions, in particular, place patients in circumstances very foreign to them, with uncertain outcomes often being the case, causing stress for care recipients and their loved ones. Health and medical establishments must be very mindful of this and work toward supplying environments that are as comforting as possible for those in their care. Discussion One avenue for relieving patients and their loved ones of hardships that complicate already difficult situations involves the development and implementation of Good Samaritan programs. Termed in reference to the biblical Good Samaritan who attended to the physical and emotional needs of his neighbor, these programs supply aid and comfort over and above that which traditionally has been delivered to patients in healthcare delivery settings, fostering satisfaction, positive word-of-mouth communications, and loyalty. Willis-Knighton Health System operates a Good Samaritan program, notably including a patient concierge team, complimentary lodging, and free transportation, with the offering greatly improving the patient experience. This article profiles Willis-Knighton Health System’s Good Samaritan program and supplies a blueprint for establishing similar offerings in virtually any healthcare entity. Conclusions Good Samaritan programs provide significant support and assistance to care recipients and their loved ones at particularly difficult times. Willis-Knighton Health System has observed firsthand the many benefits afforded by its Good Samaritan program, relieving those served by the establishment of many burdens and endearing them to the institution for its associated investments which foster peace of mind.
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Affiliation(s)
- James K Elrod
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA
| | - John L Fortenberry
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA. .,LSU Shreveport, 1 University Place, Shreveport, LA, 71115, USA.
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Elrod JK, Fortenberry JL. Target marketing in the health services industry: the value of journeying off the beaten path. BMC Health Serv Res 2018; 18:923. [PMID: 30545349 PMCID: PMC6293495 DOI: 10.1186/s12913-018-3678-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Target marketing, a practice used to more effectively address the wants and needs of customers, involves three interrelated activities: market segmentation, targeting, and product positioning. The practice follows a perfectly logical process. For a given offering, healthcare institutions select a desired group to pursue and arrange service characteristics and related attributes in a manner to entice that particular group to forward patronage and become customers. Pursuits often focus on heavily-traveled routes teeming with competitors, but occasionally an off the beaten path can be identified to amplify target marketing efforts. DISCUSSION In an earlier chapter of its history, Willis-Knighton Health System identified and pursued an off the beaten path in its bid to capture market share in pediatric healthcare services. The direct route-targeting current and prospective parents-was heavily pursued by competitors, prompting the institution to seek a unique approach; a road less traveled which would reach the same audiences but do so via a different route. Children, as direct care recipients, supplied one such route, and while their ability to influence associated parental decisions was unclear, the institution viewed developing a bond with them to have great potential. Painstaking efforts yielded Willis-Knighton Health System's Pediatric Orientation Program, fostering an affinity between the institution and children, which in turn influenced parents, affording opportunities for enhanced patronage in pediatric medicine and beyond. CONCLUSIONS Willis-Knighton Health System's decision to look off the beaten path for an avenue capable of amplifying its target marketing initiatives resulted in a novel pursuit which distinguished the institution from its competitors and set the stage for achieving its goal of providing healthcare services for a greater percentage of children in the marketplace. Additional spillover effects bolstering share in other areas also were afforded. This unique initiative addressed desires to pursue an increasingly important road less traveled to reach prime audiences. When roads less traveled can be identified, opportunities abound for better connecting with customer groups, warranting investigation and pursuit.
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Affiliation(s)
- James K Elrod
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA
| | - John L Fortenberry
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA. .,LSU Shreveport, 1 University Place, Shreveport, LA, 71115, USA.
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Guarda AS, Wonderlich S, Kaye W, Attia E. A path to defining excellence in intensive treatment for eating disorders. Int J Eat Disord 2018; 51:1051-1055. [PMID: 30189103 DOI: 10.1002/eat.22899] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 12/16/2022]
Abstract
In the United States, the past decade has seen rapid growth in treatment centers providing specialty care to patients with eating disorders. Much of this growth has been in higher levels of care, including hospital-based and residential treatment. Despite this expansion, there remains lack of agreement regarding the most important components of care, such as staff training or specifics of treatment delivery. Additionally there is no consensus on how best to assess outcome and compare performance across programs. This leaves patients, families, public and private insurance programs, and policy makers with limited information to help facilitate treatment decisions. The present paper considers implications of these changes in the eating disorder treatment landscape and examines two ideas that, if implemented, may enhance the quality of eating disorder care. First, we explore the proposal to develop a network of centers of excellence in eating disorder treatment and the value this may have for improving overall treatment quality. This idea was discussed at an expert meeting held at SAMSHA in 2017 regarding issues important to the field following passage of the 21st Century Cures Act. Second, we consider the potential utility of a study using the Delphi method to promote expert consensus regarding clinical outcome assessments.
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Affiliation(s)
- Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Stephen Wonderlich
- Neuropsychiatric Research Institute, Fargo, North Dakota, U.S.A.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, U.S.A
| | - Walter Kaye
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Medical Center, New York, New York, U.S.A.,Department of Psychiatry Weill Cornell Medical College, New York, New York, U.S.A
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