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Salmi LR, Roberts T, Renaud T, Buffeteau S, Cueille S, Fourneyron E, Gaillard A, Abraham M, Arditi N, Castry M, Daniel F, N'gom NF, Guéry O, L'Horty Y, Pincemail S, Purgues S, Thiessard F, Ramel V, Langlois E, Saillour-Glénisson F, Sibé M, Wittwer J. An evaluation of five regional health information technology-based programmes to improve health and social care coordination: A quasi-experimental controlled before/after mixed design. J Health Serv Res Policy 2022; 27:122-132. [DOI: 10.1177/13558196211065704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Health information technology (HIT) can help coordinate health and social actors involved in patients’ pathways. We assess five regional HIT-based programmes (‘ Territoires de Soins Numériques’ or TSN) introduced in France, covering the period 2012–2018. Methods This was a quasi-experimental controlled before/after mixed design. We used data from the French National Health Insurance database, qualitative and quantitative surveys, and information extracted from project documents and databases. We assessed the impact of TSN using four main impact indicators: emergency room visits, unplanned hospitalizations, avoidable hospitalizations and rehospitalization within 30 days. We also collected qualitative and secondary quantitative data covering perceived needs, knowledge, use, satisfaction, adoption and understanding of projects, pathway experience, impact on professional practices and appropriateness of hospitalizations. Results TSN implemented a heterogeneous mix of HIT. Implementation was slower than expected and was not well documented. Users perceived the HIT as having a positive but weak overall effect. There were no significant differences in trends for the main impact indicators, nor on the appropriateness of hospitalizations, but favourable trends on secondary polypharmacy indicators. Conclusions If similar innovations take place in future, they should be based on a logical framework that defines causal, measurable links between services provided and expected impacts.
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Affiliation(s)
- Louis-Rachid Salmi
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux, France
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Tamara Roberts
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Thomas Renaud
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Sophie Buffeteau
- Fédération nationale des observatoires de la santé, Paris, France
| | | | - Emmanuelle Fourneyron
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Aurélie Gaillard
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Maelys Abraham
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Nora Arditi
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Mathieu Castry
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Fabien Daniel
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - N'deye Fatou N'gom
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Orlane Guéry
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Yannick L'Horty
- Fédération nationale des observatoires de la santé, Paris, France
| | - Stéphane Pincemail
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Sonia Purgues
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Franz Thiessard
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux, France
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Viviane Ramel
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Emmanuel Langlois
- Univ. Bordeaux/Sciences Po Bordeaux, Centre Emile Durkheim, Bordeaux, France
| | - Florence Saillour-Glénisson
- CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, Bordeaux, France
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Matthieu Sibé
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Jérôme Wittwer
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
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Improving delirium screening and recognition in UK hospitals: results of a multi-centre quality improvement project. Age Ageing 2022; 51:6535927. [PMID: 35212730 PMCID: PMC8876302 DOI: 10.1093/ageing/afab243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 10/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND delirium is an acute severe neuropsychiatric condition associated with adverse outcomes, particularly in older adults. However, it is frequently under-recognised. METHODS this multi-centre quality improvement project utilised a collaborative approach to implementation of changes at sites, with the aim to improve delirium screening, recognition and documentation on discharge summaries. Resources, including delirium guidelines and presentations, were shared between sites, and broad details of local interventions were collected. Three timepoints of data collection (14 March 2018, 14 September 2018 and 13 March 2019) were conducted to assess screening, recognition and documentation of delirium in unscheduled admissions of adults aged ≥65 years old. The impact of local interventions and site-specific factors was assessed using logistic regression analysis, adjusting for patient factors. RESULTS a total of 3,013 patients (mean age 80.2, 53.8% females) were recruited across the three timepoints. Screening for delirium was associated with increased odds of recognition (aOR 4.75, CI 2.98-7.56; P < 0.001); this was not affected by grade/profession of screener. Rates of screening, recognition and discharge documentation improved across the three timepoints of data collection. The presence of a local delirium specialist team was associated with increased rates of screening for delirium (aOR 1.75, CI 1.41-2.18; P < 0.001), and the presence of a geriatric medicine team embedded into the admissions unit was associated with increased recognition rates (aOR 1.78, CI 1.09-2.92; P = 0.022). CONCLUSION delirium screening is associated with improved recognition. Interventions that strive to improve screening within a culture of delirium awareness are encouraged.
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Affiliation(s)
- Geriatric Medicine Research Collaborative
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Address correspondence to: Carly Welch.
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153
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Wright JR, Koch-Hanes T, Cortney C, Lutjens K, Raines K, Shan G, Young D. Planning for Safe Hospital Discharge by Identifying Patients Likely to Fall After Discharge. Phys Ther 2022; 102:6448020. [PMID: 34935968 DOI: 10.1093/ptj/pzab264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/15/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Acute care physical therapists recommend discharge locations and services in part to help prevent falls during post-discharge recovery. Therapists may use standardized tests to inform their recommendation decisions, but evidence linking test scores with fall risk after discharge is lacking. The primary purpose of this study was to explore the associations between Tinetti Performance-Oriented Mobility Assessment (POMA) and Activity Measure for Post-Acute Care Inpatient Mobility Short Form (AM-PAC IMSF) scores and falls in the first 30 days after hospital discharge. Anticipating that agreement between therapist recommendations and discharge locations and services (discharge agreement), age, and sex could impact those associations, these factors were included in this investigation. METHODS In this observational cohort study, 258 hospitalized patients consented to medical record data extraction and answered a phone survey 30 days after discharge to report whether they had experienced a fall since leaving the hospital. POMA and AM-PAC IMSF tests were administered for every patient. Participants' age, sex, diagnosis, last POMA score, last AM-PAC IMSF score, physical therapist discharge recommendations, actual discharge location and services, discharge date, and phone number were collected from their medical records. RESULTS When analyzed alone, higher POMA scores were associated with lower odds of falling, but the association was not significant after adjustment for other factors. Neither AM-PAC IMSF scores, age, nor sex were associated with falls. Discharge agreement, however, was associated with 59% lower odds of falling after adjustment for other factors. CONCLUSION Participants, who were discharged to the location with the services recommended by their physical therapist, were less likely to fall. Tinetti POMA and AM-PAC IMSF scores did not discriminate well participants who would fall. IMPACT Findings in this study inform those involved in discharge planning on the value of implementing physical therapist recommendations in reducing fall risk after hospital discharge. LAY SUMMARY If physical therapist discharge recommendations are implemented, patients are less likely to fall during the month after hospital discharge. Balance and mobility test scores may provide therapists valuable information, but they are limited in their ability to identify who will fall after discharge.
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Affiliation(s)
- Jonathan R Wright
- Doctor of Physical Therapy Program, Rocky Mountain University of Health Professions, Provo, Utah, USA
| | - Trisha Koch-Hanes
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ciera Cortney
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Kathryn Lutjens
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Kristopher Raines
- Physical Therapist Assistant Program, Carrington College, Las Vegas, Nevada, USA
| | - Guogen Shan
- Epidemiology and Biostatistics Program, School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Daniel Young
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
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154
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Diehl TM, Barrett JR, Abbott DE, Cherney Stafford LM, Hanlon BM, Yang Q, Van Doorn R, Weber SM, Voils CI. Protocol for the MobiMD trial: A randomized controlled trial to evaluate the effect of a self-monitoring mobile app on hospital readmissions for complex surgical patients. Contemp Clin Trials 2022; 113:106658. [PMID: 34954099 PMCID: PMC8844087 DOI: 10.1016/j.cct.2021.106658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hospital readmissions are estimated to cost $17.4 billion per year in the Medicare population alone, with readmission rates as high as 30% for patients undergoing complex abdominal surgery. Improved transitional care and self-monitoring may reduce preventable readmissions for such high-risk populations. In this study, we will conduct a single-institution randomized controlled trial (RCT) to assess the effect of a novel transitional care mobile app, MobiMD, on hospital readmission in complex abdominal surgery patients. METHODS Three hundred patients will be randomized 1:1 to standard of care (SOC) versus SOC plus MobiMD app in a parallel, single-blinded, two-arm RCT. Eligible patients are those who undergo complex abdominal surgery in the division of Surgical Oncology, Colorectal Surgery or Transplant Surgery. The MobiMD app provides push notification reminders directly to the patient's smart device, prompting them to enter clinical data and patient-reported outcomes. Clinical data collected via the MobiMD app include vital signs, red flag symptoms, daily wound and surgical drain images, ostomy output, drain output, medication compliance, and wound care compliance. These data are reviewed daily by a physician. The primary outcome is the proportion of participants readmitted to the hospital within 30 days of surgery. Secondary outcomes are 90-day hospital readmission, emergency department and urgent care visits, complication severity, and total readmission cost. DISCUSSION If effective, mobile health apps such as MobiMD could be routinely integrated into surgical transitional care programs to minimize unnecessary hospital readmissions, emergency department visits and healthcare resource utilization. Clinical trials identifier: NCT04540315.
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Affiliation(s)
- Thomas M Diehl
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - James R Barrett
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Daniel E Abbott
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Linda M Cherney Stafford
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Bret M Hanlon
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA; Department of Biostatistics and Medical Informatics, University of Wisconsin, WARF Room 201, 610 Walnut Street, Madison, WI 53726, USA.
| | - Qiuyu Yang
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA; Department of Biostatistics and Medical Informatics, University of Wisconsin, WARF Room 201, 610 Walnut Street, Madison, WI 53726, USA.
| | - Rachel Van Doorn
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Sharon M Weber
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Corrine I Voils
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA; William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace (151), Madison, WI 53705, USA.
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155
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I R Jenkinson J, Strike C, Hwang SW, Di Ruggiero E. Legal, geographic and organizational contexts that shape knowledge sharing in the hospital discharge process for people experiencing homelessness in Toronto, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e377-e387. [PMID: 33105525 DOI: 10.1111/hsc.13206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
People experiencing homelessness use acute healthcare at higher rates than the general population, yet hospitals frequently discharge them to the streets or emergency shelters. Available literature on the hospital discharge process for people experiencing homelessness identifies knowledge sharing as an important and challenging part of the discharge process; however, it does little to explain what generates these challenges or what might support knowledge sharing. In this study, we explain under which contexts certain mechanisms are triggered to facilitate knowledge sharing between hospitals and shelters during the discharge process. Between September 2018 and April 2019, we interviewed 33 participants: hospital workers on general medicine wards across three hospitals; shelter workers; researchers, policy advisors or advocates working at the intersection of homelessness and healthcare in Toronto. We find that within the legal context of health information protection, the concept of "circle of care" has created barriers to knowledge sharing between hospitals and shelters by excluding shelter workers from discharge planning. We note, however, that the degree to which hospital workers have navigated these barriers and brought shelter workers into the discharge process varies across hospitals. We explore this variation and find that certain geographic and organisational contexts have activated the development of institutional- and individual-level relationships between hospitals and shelters or their workers, respectively. We suggest that these relationships generate increased trust and communication and have led to knowledge sharing between hospitals and shelters. These findings are applicable in most urban centres with hospitals and where people experiencing homelessness live. Understanding the role of context is imperative for developing appropriate and effective interventions to improve hospital discharge processes. The development and implementation of more effective discharge processes can contribute to improved post-discharge care and recovery for this patient population and contribute to addressing health equity.
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Affiliation(s)
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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156
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Alqassim MY, Kresnye KC, Siek KA, Lee J, Wolters MK. The miscarriage circle of care: towards leveraging online spaces for social support. BMC Womens Health 2022; 22:23. [PMID: 35090452 PMCID: PMC8800293 DOI: 10.1186/s12905-022-01597-1] [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] [Received: 05/26/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Lack of social support during and after miscarriage can greatly affect mental wellbeing. With miscarriages being a common experience, there remains a discrepancy in the social support received after a pregnancy is lost. Method 42 people who had experienced at least one miscarriage took part in an Asynchronous Remote Community (ARC) study. The study involved 16 activities (discussions, creative tasks, and surveys) in two closed, secret Facebook groups over eight weeks. Descriptive statistics were used to analyse quantitative data, and content analysis was used for qualitative data. Results There were two main miscarriage care networks, formal (health care providers) and informal (friends, family, work colleagues). The formal care network was the most trusted informational support source, while the informal care network was the main source of tangible support. However, often, participants’ care networks were unable to provide sufficient informational, emotional, esteem, and network support. Peers who also had experienced miscarriage played a crucial role in addressing these gaps in social support. Technology use varied greatly, with smartphone use as the only common denominator. While there was a range of online support sources, participants tended to focus on only a few, and there was no single common preferred source. Discussion We propose a Miscarriage Circle of Care Model (MCCM), with peer advisors playing a central role in improving communication channels and social support provision. We show how the MCCM can be used to identify gaps in service provision and opportunities where technology can be leveraged to fill those gaps.
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Affiliation(s)
- Mona Y Alqassim
- School of Informatics, University of Edinburgh, 10 Crichton St, Edinburgh, UK.
| | - K Cassie Kresnye
- School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN, USA
| | - Katie A Siek
- School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN, USA
| | - John Lee
- School of Informatics, University of Edinburgh, 10 Crichton St, Edinburgh, UK
| | - Maria K Wolters
- School of Informatics, University of Edinburgh, 10 Crichton St, Edinburgh, UK.,The Alan Turing Institute for Data Science and Artificial Intelligence, London, UK.,Institute of Design Informatics, School of Informatics, University of Edinburgh, 10 Crichton St, Edinburgh, UK
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157
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O'Neal MA, Zecavati N, Yu M, Spain R, Friedenberg SM, El Husseini N, Torres-Russotto DR, Feliciano B, Spears R, Baca C. Effects of Fragmentation and the Case for Greater Cohesion in Neurologic Care Delivery. Neurology 2022; 98:146-153. [PMID: 34795048 DOI: 10.1212/wnl.0000000000013079] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 11/04/2021] [Indexed: 11/15/2022] Open
Abstract
GOALS To define fragmentation in neurologic care delivery, explain the positive and negative drivers in neurologic practice that contribute to fragmentation, illustrate situations that increase fragmentation risk, emphasize the costs and impact on both patients and providers, and propose solutions that allow for more cohesive care. WORK GROUP The Transforming Leaders Program (TLP) class of 2020 was tasked by American Academy of Neurology (AAN) leadership to identify the leading trends in inpatient and outpatient neurology and to predict their effects on future neurologic practice. METHODS Research material included AAN databases, PubMed searches, discussion with topic experts, and AAN leadership. RESULTS Trends in care delivery are driven by changes in the work force, shifts in health care delivery, care costs, changes in evidence-based care, and patient factors. These trends can contribute to care fragmentation. Potential solutions to these problems are proposed based on care models developed in oncology and medicine. LIMITATIONS This article shares our opinions as there is a lack of evidence-based guidelines for optimal neurologic care delivery.
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Affiliation(s)
- Mary A O'Neal
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO.
| | - Nassim Zecavati
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Melissa Yu
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Rebecca Spain
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Scott M Friedenberg
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Nada El Husseini
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Diego R Torres-Russotto
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Briseida Feliciano
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Roderick Spears
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
| | - Christine Baca
- From the Brigham and Women's Hospital (M.A.O.N.), Boston, MA; Children's Hospital of Richmond (N.Z.), Richmond, VA; Baylor College of Medicine (M.Y.), Houston, TX; Oregon Health Sciences University (Rebecca Spain), Portland, OR; Geisinger Medical Center (S.M.F.), Danville, PA; Duke University Medical Center (N.E.H.), Durham, NC; University of Nebraska Medical Center (D.R.T.-R.), Omaha, NE; None (B.F.); University of Pennsylvania (Roderick Spears), Philadelphia, PA; and University of Colorado Medical Center (C.B.), Denver, CO
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158
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McFadden NR, Gosdin MM, Jurkovich GJ, Utter GH. Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study. Trauma Surg Acute Care Open 2022; 7:e000800. [PMID: 35128068 PMCID: PMC8772453 DOI: 10.1136/tsaco-2021-000800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Trauma and acute care surgery (TACS) patients face complex barriers associated with hospitalization discharge that hinder successful recovery. We sought to better understand the challenges in the discharge transition of care, which might suggest interventions that would optimize it. METHODS We conducted a qualitative study of patient and clinician perceptions about the hospital discharge process at an urban level 1 trauma center. We performed semi-structured interviews that we recorded, transcribed, coded both deductively and inductively, and analyzed thematically. We enrolled patients and clinicians until we achieved data saturation. RESULTS We interviewed 10 patients and 10 clinicians. Most patients (70%) were male, and the mean age was 57±16 years. Clinicians included attending surgeons, residents, nurse practitioners, nurses, and case managers. Three themes emerged. (1) Communication (patient-clinician and clinician-clinician): clinicians understood that the discharge process malfunctions when communication with patients is not clear. Many patients discussed confusion about their discharge plan. Clinicians lamented that poorly written discharge summaries are an inadequate means of communication between inpatient and outpatient clinicians. (2) Discharge teaching and written instructions: patients appreciated discharge teaching but found written discharge instructions to be overwhelming and unhelpful. Clinicians preferred spending more time teaching patients and understood that written instructions contain too much jargon. (3) Outpatient care coordination: patients and clinicians identified difficulties with coordinating ongoing outpatient care. Both identified the patient's primary care physician and insurance coverage as important determinants of the outpatient experience. CONCLUSION TACS patients face numerous challenges at hospitalization discharge. Clinicians struggle to effectively help their patients with this stressful transition. Future interventions should focus on improving communication with patients, active communication with a patient's primary care physician, repurposing, and standardizing the discharge summary to serve primarily as a means of care coordination, and assisting the patient with navigating the transition. LEVEL OF EVIDENCE III-descriptive, exploratory study.
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Affiliation(s)
- Nikia R McFadden
- Department of Surgery, Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of California Davis, Davis, California, USA
| | - Melissa M Gosdin
- Center for Healthcare Policy and Research, University of California Davis, Davis, California, USA
| | - Gregory J Jurkovich
- Department of Surgery, Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of California Davis, Davis, California, USA
- Department of Surgery Outcomes Research Group, University of California Davis, Davis, California, USA
| | - Garth H Utter
- Department of Surgery, Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of California Davis, Davis, California, USA
- Center for Healthcare Policy and Research, University of California Davis, Davis, California, USA
- Department of Surgery Outcomes Research Group, University of California Davis, Davis, California, USA
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159
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Banker SL, Lakhaney D, Hooe BS, McCann TA, Kostacos C, Lane M. A Quality Improvement Approach to Improving Discharge Documentation. Pediatr Qual Saf 2022; 7:e428. [PMID: 38586219 PMCID: PMC10997293 DOI: 10.1097/pq9.0000000000000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/31/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Accurate discharge documentation is critical to ensuring a safe and effective transition of care following hospitalization, yet many discharge summaries do not meet consensus standards for content. A local needs assessment demonstrated gaps in documentation of 3 essential elements: discharge diagnosis, discharge medications, and follow-up appointments. This study aimed to increase the completion of three discharge elements from a baseline of 45% by 20 percentage points over 16 months for patients discharged from the general pediatrics service. Methods Ten discharge summaries were randomly selected and analyzed during each successive 2-week time period. Plan-Do-Study-Act cycles aimed to improve provider knowledge of essential discharge summary content, clarify communication during rounds, and create electronic health record shortcuts and quick-reference tools. Results The percentage of discharge summaries containing all 3 required elements increased from 45% to 73%. Specifically, documentation increased for discharge diagnosis (65%-87%), discharge medications (71%-90%), and follow-up appointments (88%-93%). There was no significant delay in discharge summary completion. Conclusions Discharge summaries are meaningfully and sustainably improved through provider education, workflows for clear communication, and electronic health record optimization.
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Affiliation(s)
- Sumeet L. Banker
- From the Division of Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York, N.Y
| | - Divya Lakhaney
- From the Division of Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York, N.Y
| | - Benjamin S. Hooe
- From the Division of Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York, N.Y
| | - Teresa A. McCann
- From the Division of Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York, N.Y
| | - Connie Kostacos
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, N.Y
| | - Mariellen Lane
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, N.Y
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160
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Written discharge communication of diagnostic and decision-making information for persons living with dementia during hospital to skilled nursing facility transitions. Geriatr Nurs 2022; 45:215-222. [PMID: 35569425 PMCID: PMC9327092 DOI: 10.1016/j.gerinurse.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 01/26/2023]
Abstract
Hospital-to-skilled nursing facility (SNF) transitions constitute a vulnerable point in care for people with dementia and often precede important care decisions. These decisions necessitate accurate diagnostic/decision-making information, including dementia diagnosis, power of attorney for health care (POAHC), and code status; however, inter-setting communication during hospital-to-SNF transitions is suboptimal. This retrospective cohort study examined omissions of diagnostic/decision-making information in written discharge communication during hospital-to-SNF transitions. Omission rates were 22% for dementia diagnosis, 82% and 88% for POAHC and POAHC activation respectively, and 70% for code status. Findings highlight the need to clarify and intervene upon causes of hospital-to-SNF communication gaps.
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161
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Morath B, Lampert A, Glaß FE, Metzner M, Study Team DISCHARGE, Haefeli WE, Seidling HM. Changing the medication documentation process for discharge: impact on clinical routine and documentation quality-a process analysis. Eur J Hosp Pharm 2022; 29:33-39. [PMID: 34930792 PMCID: PMC8717803 DOI: 10.1136/ejhpharm-2019-002027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES In 2017, an in-house best-practice process for medication documentation was developed and implemented to meet the new German legal requirements concerning the management of patient discharge from the hospital. Because this law regulates the common steps of good discharge practices (eg, specification of discharge mediation documentation), we used its implementation to assess the impact of such a measure on the quality of medication documentation and related workflows in clinical routine. METHODS By observing workflows and interviewing the affected employees, we analysed the medication workflow processes from admission to discharge of seven representative departments of a large university hospital before and early after implementation of a newly defined best-practice process. To investigate the implementation impact, following measures were determined overall and for five key process steps: quality of medication documentation as measured by predefined criteria, the adherence to the best-practice process (range 0%-100%), workload and potential shifts in responsibilities. RESULTS Already early after implementation, all departments met the legal requirements and the quality of the medication documentation increased from low to high quality in most departments. Mean adherence to the best-practice process was 77% (range 60%-100%) with strictest adherence of 100% in one department. Thereby, the number of process steps and hence, likely also the workload increased in all departments. New tasks were mainly performed by physicians and in one department by pharmacists. CONCLUSIONS The new lawful best-practice process led to a higher quality in medication documentation at the cost of a higher workload for physicians, potentially limiting time for other care tasks. Therefore, it could be important to define areas of the medication documentation process in which physicians could be supported by other professions or new tools facilitating accurate medication documentation as the basis of continuity of care.
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Affiliation(s)
- Benedict Morath
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Anette Lampert
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Franziska Elisabeth Glaß
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Michael Metzner
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | | | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
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162
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Shapiro MH, Goodman DM, Rodriguez VA. The Perfect Discharge: A Framework for High-Quality Hospital Discharges. Hosp Pediatr 2022; 12:108-117. [PMID: 34961884 DOI: 10.1542/hpeds.2021-006100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Matthew H Shapiro
- Department of Pediatrics, School of Medicine, University of California, Irvine, Irvine, California.,Children's Hospital of Orange County, Orange, California
| | - Denise M Goodman
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Victoria A Rodriguez
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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163
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Lea M, Hofmann BM. Dediagnosing - a novel framework for making people less ill. Eur J Intern Med 2022; 95:17-23. [PMID: 34417089 DOI: 10.1016/j.ejim.2021.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 01/06/2023]
Abstract
Diagnosing constitutes a substantial part of healthcare work and triggers a wide range of actions including the prescription of medicines. Dediagnosing is proposed as a novel framework for removing diagnoses that do not contribute to the reduction of persons' suffering and should be introduced to make people less ill. Dediagnosing comes together with other efforts to reduce overuse, such as deimplementation, deprescribing, decommissioning, and disinvestment. Because diagnoses may influence identity construction and social rights, dediagnosing must be conducted in close collaboration with the patient.
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Affiliation(s)
- Marianne Lea
- Department of Pharmacy, Section for Pharmacology and Pharmaceutical Biosciences, University of Oslo, Oslo, Norway; Oslo Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Norway.
| | - Bjørn Morten Hofmann
- Department for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway; Centre of Medical Ethics, University of Oslo, PO Box 1130, Blindern, N-0318 Oslo, Norway
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Development of an evidence-based reference framework for care coordination with a focus on the micro level of integrated care: A mixed method design study combining scoping review of reviews and nominal group technique. Health Policy 2022; 126:245-261. [DOI: 10.1016/j.healthpol.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
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165
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Li L, Kulp W, Krieg H, Aptaker D, Klink B, Knox D, Pincus HA. An Initiative to Improve Performance on a National Transition of Care Measure and to Reduce Readmissions in an Academic Psychiatric Hospital. Jt Comm J Qual Patient Saf 2022; 48:205-213. [DOI: 10.1016/j.jcjq.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/22/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
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Amin AN, Cornelison S, Woods JA, Hanania NA. Managing hospitalized patients with a COPD exacerbation: the role of hospitalists and the multidisciplinary team. Postgrad Med 2021; 134:152-159. [PMID: 34913814 DOI: 10.1080/00325481.2021.2018257] [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: 10/19/2022]
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with high rates of hospitalizations, costs, and morbidity. Therefore, hospitalists and the multidisciplinary team (hospital team) need to take a proactive approach to ensure patients are effectively managed from hospital admission to postdischarge. Comprehensive screening and diagnostic testing of patients at admission will enable an accurate diagnosis of COPD exacerbations, and severity, as well as other factors that may impact the length of hospital stay. Depending on the exacerbation severity and cause, pharmacotherapies may include short-acting bronchodilators, systemic corticosteroids, and antibiotics. Oxygen and/or ventilatory support may benefit patients with demonstrable hypoxemia. In preparation for discharge, the hospital team should ensure that patients receive the appropriate maintenance therapy, are counseled on their medications including inhalation devices, and proactively discuss smoking cessation and vaccinations. For follow-up, effective communication can be achieved by transferring discharge summaries to the primary care physician via an inpatient case manager. An inpatient case manager can support both the hospitalist and the patient in scheduling follow-up appointments, sending patient reminders, and confirming that a first outpatient visit has occurred. A PubMed search (prior to 26 January 2021) was conducted using terms such as: COPD, exacerbation, hospitalization. This narrative review focuses on the challenges the hospital team encounters in achieving optimal outcomes in the management of patients with COPD exacerbations. Additionally, we propose a novel simplified algorithm that may help the hospital team to be more proactive in the diagnosis and management of patients with COPD exacerbations.
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Affiliation(s)
- Alpesh N Amin
- Department of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Sharon Cornelison
- Department of Pulmonary and Cardiac Rehabilitation, J. Paul Sticht Center on Aging and Rehabilitation, Wake Forest Baptist Health, Medical Center Boulevard, Winston Salem, NC, USA
| | - J Andrew Woods
- Wingate University School of Pharmacy, and Atrium Health, Carolinas Medical Center Main, Charlotte, NC, USA
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
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167
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Jeffries M, Keers RN, Belither H, Sanders C, Gallacher K, Alqenae F, Ashcroft DM. Understanding the implementation, impact and sustainable use of an electronic pharmacy referral service at hospital discharge: A qualitative evaluation from a sociotechnical perspective. PLoS One 2021; 16:e0261153. [PMID: 34936661 PMCID: PMC8694480 DOI: 10.1371/journal.pone.0261153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/28/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction The transition of patients across care settings is associated with a high risk of errors and preventable medication-related harm. Ensuring effective communication of information between health professionals is considered important for improving patient safety. A National Health Service(NHS) organisation in the North West of England introduced an electronic transfer of care around medicines (TCAM) system which enabled hospital pharmacists to send information about patient’s medications to their nominated community pharmacy. We aimed to understand the adoption, and the implications for sustainable use in practice of the TCAM service Methods We evaluated the TCAM service in a Clinical Commissioning Group (CCG) and NHS Foundation Trust in Salford, United Kingdom (UK). Participants were opportunistically recruited to take part in qualitative interviews through stakeholder networks and during hospital admission, and included hospital pharmacists, hospital pharmacy technicians, community pharmacists, general practice-based pharmacists, patients and their carers. A thematic analysis, that was iterative and concurrent with data collection, was undertaken using a template approach. The interpretation of the data was informed by broad sociotechnical theory. Results Twenty-three interviews were conducted with health care professionals patients and carers. The ways in which the newly implemented TCAM intervention was adopted and used in practice and the perceptions of it from different stakeholders were conceptualised into four main thematic areas: The nature of the network and how it contributed to implementation, use and sustainability; The material properties of the system; How work practices for medicines safety were adapted and evolved; and The enhancement of medication safety activities. The TCAM intervention was perceived as effective in providing community pharmacists with timely, more accurate and enhanced information upon discharge. This allowed for pharmacists to enhance clinical services designed to ensure that accurate medication reconciliation was completed, and the correct medication was dispensed for the patient. Conclusions By providing pharmacy teams with accurate and enhanced information the TCAM intervention supported healthcare professionals to establish and/or strengthen interprofessional networks in order to provide clinical services designed to ensure that accurate medication reconciliation and dispensing activities were completed. However, the intervention was implemented into a complex and at times fragmented network, and we recommend opportunities be explored to fully integrate this network to involve patients/carers, general practice pharmacists and two-way communication between primary and secondary care to further enhance the reach and impact of the TCAM service.
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Affiliation(s)
- Mark Jeffries
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- * E-mail:
| | - Richard N. Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- Pharmacy Department, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | | | - Caroline Sanders
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- Division of Population Health, Health Services Research & Primary Care University of Manchester, Manchester, United Kingdom
| | - Kay Gallacher
- Patient and Public Involvement, NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
| | - Fatema Alqenae
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
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Direct phone communication to primary care physician to plan discharge from hospital: feasibility and benefits. BMC Health Serv Res 2021; 21:1352. [PMID: 34922549 PMCID: PMC8684651 DOI: 10.1186/s12913-021-07398-w] [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] [Received: 09/04/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The discharge summary is the main vector of communication at the time of hospital discharge, but it is known to be insufficient. Direct phone contact between hospitalist and primary care physician (PCP) at discharge could ensure rapid transmission of information, improve patient safety and promote interprofessional collaboration. The objective of this study was to evaluate the feasibility and benefit of a phone call from hospitalist to PCP to plan discharge. METHODS This study was a prospective, single-center, cross-sectional observational study. It took place in an acute medicine unit of a French university hospital. The hospitalist had to contact the PCP by telephone within 72 h prior discharge, making a maximum of 3 call attempts. The primary endpoint was the proportion of patients whose primary care physician could be reached by telephone at the time of discharge. The other criteria were the physicians' opinions on the benefits of this contact and its effect on readmission rates. RESULTS 275 patients were eligible. 8 hospitalists and 130 PCPs gave their opinion. Calls attempts were made for 71% of eligible patients. Call attempts resulted in successful contact with the PCP 157 times, representing 80% of call attempts and 57% of eligible patients. The average call completion rate was 47%. The telephone contact was perceived by hospitalist as useful and providing security. The PCPs were satisfied and wanted this intervention to become systematic. Telephone contact did not reduce the readmission rate. CONCLUSIONS Despite the implementation of a standardized process, the feasibility of the intervention was modest. The main obstacle was hospitalists lacking time and facing difficulties in reaching the PCPs. However, physicians showed desire to communicate directly by telephone at the time of discharge. TRIAL REGISTRATION French C.N.I.L. registration number 2108852. Registration date October 12, 2017.
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169
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de Mooij MJ, Ahayoun I, Leferink J, Kooij MJ, Karapinar-Çarkit F, Van den Berg-Vos RM. Transition of care in stroke patients discharged home: a single-center prospective cohort study. BMC Health Serv Res 2021; 21:1350. [PMID: 34922534 PMCID: PMC8684677 DOI: 10.1186/s12913-021-07347-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 11/16/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction Approximately two-thirds of the patients admitted to the hospital with an ischemic stroke are discharged directly home. Discontinuity of care may result in avoidable patient harm, re-admissions and even death. We hypothesized that the transfer of information is most essential in this patient group since any future care for these patients relies solely on the information that is available to the care provider responsible at that time. Aim The objective of this study was to evaluate the continuity of transmural care in ischemic stroke patients by assessing 1) the transfer of clinical information through discharge letters to general practitioners (GPs), 2) subsequent documentation of this information and early follow-up by GPs and 3) the documentation of medication-related information in discharge letters, at GPs and community pharmacies (CPs). Methods This prospective cohort study was conducted from September 2019 through March 2020 in OLVG, Amsterdam, the Netherlands, in patients with a first stroke discharged directly home. Outcome measures were derived from national guidelines and regional agreements. Results were analyzed using descriptive analysis. Results A total of 33 patients were included. Discharge letters (n = 33) and outpatient clinic letters (n = 24) to GPs contained most of the essential items, but 16% (n = 9) of the letters were sent in time. GPs (n = 31) infrequently adhered to guidelines since 10% (n = 3) of the diagnoses were registered using the correct code and 55% (n = 17) of the patients received follow-up shortly after discharge. Medication overviews were inaccurately communicated to GPs since 62% (n = 150) of all prescriptions (n = 243) were correctly noted in the discharge letter. Further loss of information was seen as only 39% (n = 95) of all prescriptions were documented correctly in GP overviews. We found that 59% (n = 144) of the prescriptions were documented correctly in CP overviews. Conclusion In this study, we found that discontinuity of care occurred to a varying extent throughout transmural care in patients with a first stroke who were discharged home.
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Affiliation(s)
- M J de Mooij
- Department of Neurology, OLVG, Jan Tooropstraat 164, Amsterdam, 1061, the Netherlands
| | - I Ahayoun
- Department of Clinical Pharmacy, OLVG, Amsterdam, the Netherlands
| | - J Leferink
- General Practitioner practice Rustenburg, Amsterdam, the Netherlands
| | - M J Kooij
- Community Pharmacy Koning, Amsterdam, the Netherlands
| | | | - R M Van den Berg-Vos
- Department of Neurology, OLVG, Jan Tooropstraat 164, Amsterdam, 1061, the Netherlands. .,Department of Neurology, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands.
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170
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Implementation of a shared medication list in primary care - a controlled pre-post study of medication discrepancies. BMC Health Serv Res 2021; 21:1335. [PMID: 34903215 PMCID: PMC8670071 DOI: 10.1186/s12913-021-07346-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
Background Access to medicines information is important when treating patients, yet discrepancies in medication records are common. Many countries are developing shared medication lists across health care providers. These systems can improve information sharing, but little is known about how they affect the need for medication reconciliation. The aim of this study was to investigate whether an electronically Shared Medication List (eSML) reduced discrepancies between medication lists in primary care. Methods In 2018, eSML was tested for patients in home care who received multidose drug dispensing (MDD) in Oslo, Norway. We followed this transition from the current paper-based medication list to an eSML. Medication lists from the GP, home care service and community pharmacy were compared 3 months before the implementation and 18 months after. MDD patients in a neighbouring district in Oslo served as a control group. Results One hundred eighty-nine patients were included (100 intervention; 89 control). Discrepancies were reduced from 389 to 122 (p < 0.001) in the intervention group, and from 521 to 503 in the control group (p = 0.734). After the implementation, the share of mutual prescription items increased from 77 to 94%. Missing prescriptions for psycholeptics, analgesics and dietary supplements was reduced the most. Conclusions The eSML greatly decreases discrepancies between the GP, home care and pharmacy medication lists, but does not eliminate the need for medication reconciliation.
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171
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Sauers-Ford HS, Aboagye JB, Henderson S, Marcin JP, Rosenthal JL. Disconnection in Information Exchange During Pediatric Trauma Transfers: A Qualitative Study. J Patient Exp 2021; 8:23743735211056513. [PMID: 34869838 PMCID: PMC8640298 DOI: 10.1177/23743735211056513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pediatric patients experiencing an emergency department (ED) visit for a traumatic injury often transfer from the referring ED to a pediatric trauma center. This qualitative study sought to evaluate the experience of information exchange during pediatric trauma visits to referring EDs from the perspectives of parents and referring and accepting clinicians through semi-structured interviews. Twenty-five interviews were conducted (10 parents and 15 clinicians) and analyzed through qualitative thematic analysis. A 4-person team collaboratively identified codes, wrote memos, developed major themes, and discussed theoretical concepts. Three interdependent themes emerged: (1) Parents’ and clinicians’ distinct experiences result in a disconnect of information exchange needs; (2) systems factors inhibit effective information exchange and amplify the disconnect; and (3) situational context disrupts the flow of information contributing to the disconnect. Individual-, situational-, and systems-level factors contribute to disconnects in the information exchanged between parents and clinicians. Understanding how these factors’ influence information disconnect may offer avenues for improving patient–clinician communication in trauma transfers.
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172
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Schusselé Filliettaz S, Moiroux S, Marchand G, Gilles I, Peytremann-Bridevaux I. Transitional shared decision-making processes for patients with complex needs: A feasibility study. J Eval Clin Pract 2021; 27:1326-1334. [PMID: 33742747 DOI: 10.1111/jep.13561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Shared decision-making (SDM) processes, combining patients' and professionals' perspectives, are especially necessary for patients with complex needs (CNs) during their care transitions. In 2016, we started implementing interprofessional and interinstitutional SDM processes (IIPs) for patients admitted to a short-stay unit (SSU) for inpatient care and then followed-up by primary care providers. Two types of IIPs were identified: (a) iterative IIPs, and (b) meeting IIPs. These differed in terms of the timing of SDM processes: whereas the former were multilateral and iterative, meeting IIPs were simultaneous. However, the two processes had similar outcomes and participants had similar characteristics. The intervention included other components, such as CNs assessment and a care coordinator position. The present study aimed to assess the feasibility of the intervention's implementation. METHODS The intervention's feasibility was assessed using fidelity and coverage indicators. We collected data from the patients' records on (a) patients' and professionals' characteristics, (b) the fidelity (CNs evaluations and occurrences of IIPs), and (c) the intervention's coverage (types of IIPs, participants). RESULTS The study included 453 patients between September 2017 and February 2019: mean age of 82.3 years, 65.6% women and 61.1% considered to have CNs. For patients with CNs, iterative IIPs and meeting IIPs occurred in 78.3% and 23.8% of cases, respectively. 35.1% of iterative IIPs and 8.8% of meeting IIPs for patients with CNs involved patients or their informal caregivers, inpatient professionals, primary care physicians and homecare professionals. DISCUSSION These results showed that an intervention targeting the implementation of formalized IIPs for SDM in transitional care was feasible. However, to improve the evaluation of such interventions, other methods should be used to measure their appropriateness and acceptability. Additionally, assessing the effects of IIPs would legitimize their funding, supporting their sustainability and generalisability.
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Affiliation(s)
- Séverine Schusselé Filliettaz
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Association for the Promotion of Integrated Patient Care Networks (PRISM), Geneva, Switzerland
| | | | | | - Ingrid Gilles
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Rieger EY, Kushner JNS, Sriram V, Klein A, Wiklund LO, Meltzer DO, Tang JW. Primary care physician involvement during hospitalisation: a qualitative analysis of perspectives from frequently hospitalised patients. BMJ Open 2021; 11:e053784. [PMID: 34853107 PMCID: PMC8638455 DOI: 10.1136/bmjopen-2021-053784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To explore frequently hospitalised patients' experiences and preferences related to primary care physician (PCP) involvement during hospitalisation across two care models. DESIGN Qualitative study embedded within a randomised controlled trial. Semistructured interviews were conducted with patients. Transcripts were analysed using qualitative template analysis. SETTING In the Comprehensive Care Programme (CCP) Study, in Illinois, USA, Medicare patients at increased risk of hospitalisation are randomly assigned to: (1) care by a CCP physician who serves as a PCP across both inpatient and outpatient settings or (2) care by a PCP as outpatient and by hospitalists as inpatients (standard care). PARTICIPANTS Twelve standard care and 12 CCP patients were interviewed. RESULTS Themes included: (1) Positive attitude towards PCP; (2) Longitudinal continuity with PCP valued; (3) Patient preference for PCP involvement in hospital care; (4) Potential for in-depth involvement of PCP during hospitalisation often unrealised (involvement rare in standard care; in CCP, frequent interaction with PCP fostered patient involvement in decision making); and (5) PCP collaboration with hospital-based providers frequently absent (no interaction for standard care patients; CCP patients emphasising PCP's role in interdisciplinary coordination). CONCLUSION Frequently hospitalised patients value PCP involvement in the hospital setting. CCP patients highlighted how an established relationship with their PCP improved interdisciplinary coordination and engagement with decision making. Inpatient-outpatient relational continuity may be an important component of programmes for frequently hospitalised patients. Opportunities for enhancing PCP involvement during hospitalisation should be considered.
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Affiliation(s)
| | - Josef N S Kushner
- Department of Medicine, Lenox Hill Hospital, New York City, New York, USA
| | - Veena Sriram
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Abbie Klein
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Lauren O Wiklund
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - David O Meltzer
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Joyce W Tang
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
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174
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Marques Cavalcante-Santos L, Carvalho Silvestre C, Andrade Macêdo L, Mônica Machado Pimentel D, Dias de Oliveira-Filho A, Manias E, Pereira de Lyra D. Written communication about the use of medications in medical records in a Brazilian hospital. Int J Clin Pract 2021; 75:e14990. [PMID: 34710266 DOI: 10.1111/ijcp.14990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 09/23/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Effective communication regarding the use of medications in hospital environments is a process that contributes to patient safety. Despite its importance, written communication about the medication use process in medical records remains insufficiently investigated. AIM To describe the documentation in medical records regarding the medication use process by pharmacists, physicians and nurses on admission, during the hospital stay, and at hospital discharge. METHOD A retrospective cross-sectional chart review study was carried out in medical records of patients admitted to a teaching hospital in Northeast Brazil. The study considered all patients admitted between December 2016 and February 2017, aged 18 or older and hospitalised for at least 48 hours. Clinical notes made by pharmacists, physicians and nurses were examined at three transition points of care. Data were collected using a questionnaire relating to the use of medications prior to hospital admission, changes in the prescribed medications during the hospital stay and discharge, as well as prescription non-conformities. Communication failures between the three healthcare professional groups were analysed and classified. The study was authorised by the Hospital's Board of Directors and approved by the Research Ethics Committee of the Federal University of Sergipe. RESULTS This study included 202 medical records of patients with a mean age of 51.48 (SD 6.42, range: 19-97) years. There was no record of a patient or relative interview on allergies and adverse drug reactions in 54 (26.8%) physician notes, 44 (21.9%) nursing notes, and 9 (25.0%) pharmacist notes. Moreover, 1,588 changes in prescriptions were identified during data collection, and 1,198 (75.4%) of these were unjustified. CONCLUSION Medication-related information in medical records was incomplete and inconsistent in the clinical notes of the three studied professions, especially in pharmacists' documentation. Future studies should focus on investigating the consequences of interprofessional communication in patient care.
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Affiliation(s)
- Lincoln Marques Cavalcante-Santos
- Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Carina Carvalho Silvestre
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
- Department of Pharmacy, Life Sciences Institute, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Luana Andrade Macêdo
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | | | | | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Divaldo Pereira de Lyra
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
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175
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Jaakkimainen L, Chung H, Lu H, Pinzaru B, Candido E. The receipt of information by family physicians about their patient's emergency department visits: a record linkage study of electronic medical records to health administrative data. BMC FAMILY PRACTICE 2021; 22:235. [PMID: 34802416 PMCID: PMC8607703 DOI: 10.1186/s12875-021-01582-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022]
Abstract
Background Canadians are known to be frequent users of emergency department (ED) care. However, the exchange of information from ED visits to family physicians (FPs) is not well known. Our objectives were to determine whether Canadian FPs received information about their patient’s ED visit and the patient characteristics related to the receipt of ED information. Methods This study was a descriptive record linkage study of FP Electronic Medical Record (EMR) data linked to health administrative data. Our study cohort included patients who had at least one ED visit in 2010 or 2015 in Ontario, Canada. An ED visit could include a transfer to or from another ED. The receipt of information from an ED note was examined in relation to patient age, sex, neighbourhood income quintiles, rurality and comorbidity. Results There were 26,609 patients in 2010 and 50,541 patients in 2015 with at least one ED visit. In 2010, 53.3% of FPs received an ED note for patients having a single ED visit compared to 41.0% in 2015. For patients with multiple ED visits, 58.2% of FPs received an ED note in 2010 compared to 45.7% in 2015. FPs were more likely to receive an ED note for patients not living in low income neighbourhoods, older patients, patients living in small urban areas and for patients having moderate comorbidity. FPs were less likely to receive a note for patients living in rural areas. Conclusions Community-based FPs are more likely to get information after an ED visit for their older and sicker patients. However, FPs do not receive any information from EDs for over half their patients. Electronic health record technologies and their adoption by ED providers need to improve the seamless transfer of information about the care provided in EDs to FPs in the community.
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Affiliation(s)
- Liisa Jaakkimainen
- Primary Care and Health Systems, ICES, 2075 Bayview Ave, G Wing, Toronto, M4N 3M5, Canada. .,Department of Family and Community Medicine, University of Toronto, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.
| | - Hannah Chung
- Primary Care and Health Systems, ICES, 2075 Bayview Ave, G Wing, Toronto, M4N 3M5, Canada
| | - Hong Lu
- Primary Care and Health Systems, ICES, 2075 Bayview Ave, G Wing, Toronto, M4N 3M5, Canada
| | - Bogdan Pinzaru
- Primary Care and Health Systems, ICES, 2075 Bayview Ave, G Wing, Toronto, M4N 3M5, Canada
| | - Elisa Candido
- Primary Care and Health Systems, ICES, 2075 Bayview Ave, G Wing, Toronto, M4N 3M5, Canada
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176
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Cooper A, Carson-Stevens A, Cooke M, Hibbert P, Hughes T, Hussain F, Siriwardena A, Snooks H, Donaldson LJ, Edwards A. Learning from diagnostic errors to improve patient safety when GPs work in or alongside emergency departments: incorporating realist methodology into patient safety incident report analysis. BMC Emerg Med 2021; 21:139. [PMID: 34794381 PMCID: PMC8601096 DOI: 10.1186/s12873-021-00537-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing demand on emergency healthcare systems has prompted introduction of new healthcare service models including the provision of GP services in or alongside emergency departments. In England this led to a policy proposal and £100million (US$130million) of funding for all emergency departments to have co-located GP services. However, there is a lack of evidence for whether such service models are effective and safe. We examined diagnostic errors reported in patient safety incident reports to develop theories to explain how and why they occurred to inform potential priority areas for improvement and inform qualitative data collection at case study sites to further refine the theories. METHODS We used a mixed-methods design using exploratory descriptive analysis to identify the most frequent and harmful sources of diagnostic error and thematic analysis, incorporating realist methodology to refine theories from an earlier rapid realist review, to describe how and why the events occurred and could be mitigated, to inform improvement recommendations. We used two UK data sources: Coroners' reports to prevent future deaths (30.7.13-14.08.18) and National Reporting and Learning System (NRLS) patient safety incident reports (03.01.05-30.11.15). RESULTS Nine Coroners' reports (from 1347 community and hospital reports, 2013-2018) and 217 NRLS reports (from 13 million, 2005-2015) were identified describing diagnostic error related to GP services in or alongside emergency departments. Initial theories to describe potential priority areas for improvement included: difficulty identifying appropriate patients for the GP service; under-investigation and misinterpretation of diagnostic tests; and inadequate communication and referral pathways between the emergency and GP services. High-risk presentations included: musculoskeletal injury, chest pain, headache, calf pain and sick children. CONCLUSION Initial theories include the following topics as potential priority areas for improvement interventions and evaluation to minimise the risk of diagnostic errors when GPs work in or alongside emergency departments: a standardised initial assessment with streaming guidance based on local service provision; clinical decision support for high-risk conditions; and standardised computer systems, communication and referral pathways between emergency and GP services. These theories require refinement and testing with qualitative data collection from case study (hospital) sites.
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Affiliation(s)
- Alison Cooper
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
| | - Andrew Carson-Stevens
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | - Faris Hussain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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177
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de Witt A, Matthews V, Bailie R, Valery PC, Adams J, Garvey G, Martin JH, Cunningham FC. Aboriginal and Torres Strait Islander patients' cancer care pathways in Queensland: Insights from health professionals. Health Promot J Austr 2021; 33:701-710. [PMID: 34767657 DOI: 10.1002/hpja.556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To identify points for improvements within the health system where Aboriginal and Torres Strait Islander cancer patients may experience a lack of continuity in their cancer care. The optimal care pathway for Aboriginal and Torres Strait Islander people with cancer (OCP) framework was utilised as a tool in this work. METHODS Semi-structured interviews were conducted with health professionals at the primary health care (PHC) and hospital setting. Data were categorised into six steps using the OCP framework. RESULTS This study identified multiple time-points in the cancer pathways that could be strengthened to increase the continuity of cancer care for these patients. In addition, the provision of person-centred care and adequate education tailored to patients' and health professionals' needs can help minimise the likelihood of patients experiencing a lack of continuity in their cancer care. Participants were recruited from an urban hospital (n = 9) and from six Aboriginal Community Controlled Health Services (n = 17) across geographical locations in Queensland. The provision of culturally competent care, effective communication, coordination and collaboration between services along the cancer pathway from prevention and early diagnosis through to end-of-life care were highlighted as important to enhance care continuity for Indigenous Australians. CONCLUSION The implementation of recommendations outlined in the OCP framework may help with improving cancer care continuity for Indigenous patients with cancer. SUMMARY Aboriginal and Torres Strait Islander people can sometimes find cancer care pathways complex and difficult to navigate. This study identified points in the cancer pathways that could be strengthened to increase the continuity of cancer care for these patients which could potentially lead to improved outcomes.
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Affiliation(s)
- Audra de Witt
- Menzies School of Health Research, Brisbane QLD, Charles Darwin University, Darwin, NT, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Veronica Matthews
- University Centre for Rural Health, University of Sydney, Sydney, NSW, Australia
| | - Ross Bailie
- University Centre for Rural Health, University of Sydney, Sydney, NSW, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Southside Clinical School, University of Queensland, Brisbane, QLD, Australia
| | - Jon Adams
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Gail Garvey
- Menzies School of Health Research, Brisbane QLD, Charles Darwin University, Darwin, NT, Australia
| | - Jennifer H Martin
- Southside Clinical School, University of Queensland, Brisbane, QLD, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Frances C Cunningham
- Menzies School of Health Research, Brisbane QLD, Charles Darwin University, Darwin, NT, Australia
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178
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Cam H, Kempen TGH, Eriksson H, Abdulreda K, Franzon K, Gillespie U. Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review. BMC Geriatr 2021; 21:618. [PMID: 34724895 PMCID: PMC8561898 DOI: 10.1186/s12877-021-02564-5] [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] [Received: 06/07/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The discharge of older hospitalised patients is critical in terms of patient safety. Inadequate transfer of information about medications to the next healthcare provider is a known problem, but there is a lack of understanding of this problem in settings where shared electronic health records are used. The aims of this study were to evaluate the prevalence of patients for whom hospitals sent adequate requests for medication-related follow-up at discharge, the proportion of patients with unplanned hospital revisits because of inadequate follow-up requests, and the association between medication reviews performed during hospitalisation and adequate or inadequate follow-up requests. METHODS We conducted a retrospective chart review. The study population was randomly selected from a cluster-randomised crossover trial which included patients 65 years or older who had been admitted to three hospitals in Sweden with shared electronic health records between hospital and primary care. Each patient was assessed with respect to the adequacy of the request for follow-up. For patients where the hospitals sent inadequate requests, data about any unplanned hospital revisits were collected, and we assessed whether the inadequate requests had contributed to the revisits. The association between medication reviews and adequate or inadequate requests was analysed with a Chi-square test. RESULTS A total of 699 patients were included. The patients' mean age was 80 years; an average of 10 medications each were prescribed on hospital admission. The hospitals sent an adequate request for 418 (60%) patients. Thirty-eight patients (14%) had a hospital revisit within six months of discharge which was related to an inadequate request. The proportion of adequate or inadequate requests did not differ between patients who had received a medication review during hospitalisation and those who had not (p = 0.83). CONCLUSIONS The prevalence of patients for whom the hospitals sent adequate follow-up requests on discharge was low. More than one in every ten who had an inadequate request revisited hospital within six months of discharge for reasons related to the request. Medication reviews conducted during hospitalisation did not affect the proportion of adequate or inadequate requests sent. A communication gap still exists despite the usage of a shared electronic health record between primary and secondary care levels.
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Affiliation(s)
- Henrik Cam
- Hospital Pharmacy Department, Uppsala University Hospital, SE-751 85, Uppsala, Sweden. .,Department of Pharmacy, Uppsala University, Uppsala, Sweden.
| | - Thomas Gerardus Hendrik Kempen
- Department of Pharmacy, Uppsala University, Uppsala, Sweden.,Academic Primary Health Care Centre, Region Uppsala, Uppsala, Sweden
| | | | | | - Kristin Franzon
- Geriatric Department, Uppsala University Hospital, Uppsala, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ulrika Gillespie
- Hospital Pharmacy Department, Uppsala University Hospital, SE-751 85, Uppsala, Sweden.,Department of Pharmacy, Uppsala University, Uppsala, Sweden
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179
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med 2021; 49:e1063-e1143. [PMID: 34605781 DOI: 10.1097/ccm.0000000000005337] [Citation(s) in RCA: 964] [Impact Index Per Article: 321.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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180
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Staples JA, Liu G, Brubacher JR, Karimuddin A, Sutherland JM. Physician Financial Incentives to Reduce Unplanned Hospital Readmissions: an Interrupted Time Series Analysis. J Gen Intern Med 2021; 36:3431-3440. [PMID: 33948803 PMCID: PMC8606373 DOI: 10.1007/s11606-021-06803-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 04/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2012, the Ministry of Health in British Columbia, Canada, introduced a $75 incentive payment that could be claimed by hospital physicians each time they produced a written post-discharge care plan for a complex patient at the time of hospital discharge. OBJECTIVE To examine whether physician financial payments incentivizing enhanced discharge planning reduce subsequent unplanned hospital readmissions. DESIGN Interrupted time series analysis of population-based hospitalization data. PARTICIPANTS Individuals with one or more eligible hospitalizations occurring in British Columbia between 2007 and 2017. MAIN MEASURES The proportion of index hospital discharges with subsequent unplanned hospital readmission within 30 days, as measured each month of the 11-year study interval. We used interrupted time series analysis to determine if readmission risk changed after introduction of the incentive payment policy. KEY RESULTS A total of 40,588 unplanned hospital readmissions occurred among 409,289 eligible index hospitalizations (crude 30-day readmission risk, 9.92%). Policy introduction was not associated with a significant step change (0.393%; 95CI, - 0.190 to 0.975%; p = 0.182) or change-in-trend (p = 0.317) in monthly readmission risk. Policy introduction was associated with significantly fewer prescription fills for potentially inappropriate medications among older patients, but no improvement in prescription fills for beta-blockers after cardiovascular hospitalization and no change in 30-day mortality. Incentive payment uptake was incomplete, rising from 6.4 to 23.5% of eligible hospitalizations between the first and last year of the post-policy interval. CONCLUSION The introduction of a physician incentive payment was not associated with meaningful changes in hospital readmission rate, perhaps in part because of incomplete uptake by physicians. Policymakers should consider these results when designing similar interventions elsewhere. TRIAL REGISTRATION ClinicalTrials.gov ID, NCT03256734.
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Affiliation(s)
- John A. Staples
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences (CHÉOS), Vancouver, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research (CHSPR), School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jeffrey R. Brubacher
- Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Ahmer Karimuddin
- Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Jason M. Sutherland
- Centre for Health Evaluation & Outcome Sciences (CHÉOS), Vancouver, Canada
- Centre for Health Services and Policy Research (CHSPR), School of Population and Public Health, University of British Columbia, Vancouver, Canada
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181
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Alshammari H, Al-Saeed E, Ahmed Z, Aslanpour Z. Reviewing Potentially Inappropriate Medication in Hospitalized Patients Over 65 Using Explicit Criteria: A Systematic Literature Review. Drug Healthc Patient Saf 2021; 13:183-210. [PMID: 34764701 PMCID: PMC8572741 DOI: 10.2147/dhps.s303101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022] Open
Abstract
Potentially inappropriate medication (PIM) is a primary health concern affecting the quality of life of patients over 65. PIM is associated with adverse drug reactions including falls, increased healthcare costs, health services utilization and hospital admissions. Various strategies, clinical guidelines and tools (explicit and implicit) have been developed to tackle this health concern. Despite these efforts, evidence still indicates a high prevalence of PIM in the older adult population. This systematic review explored the practice of using explicit tools to review PIM in hospitalized patients and examined the outcomes of PIM reduction. A literature search was conducted in several databases from their inception to 2019. Original studies that had an interventional element using explicit criteria detecting PIM in hospitalized patients over 65 were included. Descriptive narrative synthesis was used to analyze the included studies. The literature search yielded 6116 articles; 25 quantitative studies were included in this systematic literature review. Twenty were prospective studies and five were retrospective. Approximately, 15,500 patients were included in the review. Various healthcare professionals were involved in reviewing PIM including physicians and hospital pharmacists. Several tools were used to review PIM for hospitalized patients over 65, most frequently Beer’s criteria and the STOPP/START tool. The reduction of PIM ranged from 3.5% up to 87%. The most common PIM were benzodiazepines and antipsychotics. This systematic review showed promising outcomes in terms of improving patient outcomes. However, the reduction of PIM varied in the studies, raising the question of the variance between hospitals in the explicit tools used for review. Additional studies need to be conducted to further investigate the outcomes of reviewing PIM at different levels, as well as assessing the cost-effectiveness of using explicit tools in reducing PIM.
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Affiliation(s)
- Hesah Alshammari
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Correspondence: Hesah Alshammari Email
| | - Eman Al-Saeed
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Zamzam Ahmed
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Zoe Aslanpour
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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182
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Engel M, van der Padt-Pruijsten A, Huijben AMT, Kuijper TM, Leys MBL, Talsma A, van der Heide A. Quality of hospital discharge letters for patients at the end of life: A retrospective medical record review. Eur J Cancer Care (Engl) 2021; 31:e13524. [PMID: 34697850 PMCID: PMC9285046 DOI: 10.1111/ecc.13524] [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] [Received: 12/10/2020] [Revised: 06/29/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
Objective For patients who are discharged to go home after a hospitalisation, timely and adequately informing their general practitioner is important for continuity of care, especially at the end of life. We studied the quality of the hospital discharge letter for patients who were hospitalised in their last year of life. Methods A retrospective medical record review was performed. Included patients had been admitted to the hospital during the period 1 January to 1 July 2017 and had died within a year after discharge. Results Data were collected from records of 108 patients with cancer or other diseases. For 57 patients (53%), the discharge letter included information that related to their limited life expectancy (e.g., agreements about treatment limitations), whereas the patient's limited life expectancy was addressed in the medical record in 76 cases (70%). We found related information in discharge letters for 36 patients (66%) who died <3 months compared to 21 patients (40%) who died 3–12 months after hospitalisation (p < 0.01). Conclusion For patients with a limited life expectancy going home after a hospitalisation, one out of two hospital discharge letters lacked any information addressing their limited life expectancy. Specific guidelines for medical information exchange between care settings are needed.
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Affiliation(s)
- Marijanne Engel
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Auke M T Huijben
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Maria B L Leys
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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183
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Schusselé Filliettaz S, Moiroux S, Marchand G, Gilles I, Peytremann-Bridevaux I. Realist evaluation of a pilot intervention implementing interprofessional and interinstitutional processes for transitional care. Home Health Care Serv Q 2021; 40:302-323. [PMID: 34689706 DOI: 10.1080/01621424.2021.1989356] [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: 10/20/2022]
Abstract
In 2016, in Switzerland, we implemented transitional interprofessional and interinstitutional shared decision-making processes (IIPs) between a short-stay inpatient care unit (SSU) and primary care professionals. Between 2018 and 2019, we evaluated this intervention using a realist design to answer the following questions: for whom, with whom, in which context and how have IIPs been implemented? Our initial theory was tested via interviews with patients, primary care professionals and staff from the SSU. Results showed that a patient's stay at the SSU, with actors committed to facilitating IIPs, reinforced the perceived appropriateness and implementation of those IIPs. However, this appropriateness varied according to different contextual elements, such as the complexity of needs, preexisting collaborative practices and the purpose of the inpatient stay. Since IIPs occurred in a context of fragmented practices, proactive and sustained efforts are required of the actors implementing them and the organizations supporting them.
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Affiliation(s)
- Séverine Schusselé Filliettaz
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.,Association for the Promotion of Integrated Patient Care Networks (PRISM), Geneva, Switzerland
| | | | | | - Ingrid Gilles
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Li J, Clouser JM, Brock J, Davis T, Jack B, Levine C, Mays GP, Mittman B, Nguyen H, Sorra J, Stromberg A, Du G, Dai C, Adu A, Vundi N, Williams MV. Effects of Different Transitional Care Strategies on Outcomes after Hospital Discharge-Trust Matters, Too. Jt Comm J Qual Patient Saf 2021; 48:40-52. [PMID: 34764025 DOI: 10.1016/j.jcjq.2021.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/08/2021] [Accepted: 09/21/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND As health systems shift toward value-based care, strategies to reduce readmissions and improve patient outcomes become increasingly important. Despite extensive research, the combinations of transitional care (TC) strategies associated with best patient-centered outcomes remain uncertain. METHODS Using an observational, prospective cohort study design, Project ACHIEVE sought to determine the association of different combinations of TC strategies with patient-reported and postdischarge health care utilization outcomes. Using purposive sampling, the research team recruited a diverse sample of short-term acute care and critical access hospitals in the United States (N = 42) and analyzed data on eligible Medicare beneficiaries (N = 7,939) discharged from their medical/surgical units. Using both hospital- and patient-reported TC strategy exposure data, the project compared patients "exposed" to each of five overlapping groups of TC strategies to their "control" counterparts. Primary outcomes included 30-day hospital readmissions, 7-day postdischarge emergency department (ED) visits and patient-reported physical and mental health, pain, and participation in daily activities. RESULTS Participants averaged 72.3 years old (standard deviation =10.1), 53.4% were female, and most were White (78.9%). Patients exposed to one TC group (Hospital-Based Trust, Plain Language, and Coordination) were less likely to have 30-day readmissions (risk ratio [RR], 0.72; 95% confidence interval [CI] = 0.57-0.92, p < 0.001) or 7-day ED visits (RR, 0.72; 95% CI, 0.55-0.93, p < 0.001) and more likely to report excellent physical and mental health, greater participation in daily activities, and less pain (RR ranged from 1.11 to 1.15, p < 0.01). CONCLUSION In concert with care coordination activities that bridge the transition from hospital to home, hospitals' clear communication and fostering of trust with patients were associated with better patient-reported outcomes and reduced health care utilization.
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185
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Griebe KM, Hencken LN, Efta J, Patel N, Stine JJ, Bott B, El-Khoury C, MacDonald NC. An electronic tool for health systems to assess and communicate discharge medication access. Am J Health Syst Pharm 2021; 79:477-485. [PMID: 34636856 DOI: 10.1093/ajhp/zxab390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE The purpose of this study was to describe how the discharge medication cost inquiry (DMCI) consult order and workflow were created and used to communicate transition of care needs and medication access barriers before discharge. SUMMARY Health-system pharmacists collaborated with the information technology department to develop the DMCI consult order and workflow. This institutional review board-approved retrospective case study evaluated use of the DMCI consult order throughout the health system. Outcomes that could not be retrieved electronically were collected for every third patient encounter using manual chart review. The DMCI consult order was used at each hospital in the health system. Physicians placed the most DMCI consult orders; however, pharmacists at the large academic tertiary hospital utilized the DMCI consult order the most. The DMCI consult order was sent most frequently for anticoagulants. Although most medications were covered by insurance, the tool and workflow identified barriers to medication access. Almost 90% of the patients with a DMCI consult order had at least one prescription generated on discharge. CONCLUSION The DMCI consult order is a novel electronic tool to aid in communicating discharge medication needs. When incorporated into care transition planning, the DMCI consult order and workflow provide a model to ensure patients have access to medications. It can also be used to document and evaluate the role of pharmacy in transitions of care in the health system.
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Affiliation(s)
- Kristin M Griebe
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA
| | - Laura N Hencken
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA
| | - Jessica Efta
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA
| | - Nisha Patel
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA
| | - John J Stine
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA
| | - Brandon Bott
- Community Care Services, Ambulatory Pharmacy, Henry Ford Hospital, Detroit, MI, USA
| | - Caren El-Khoury
- Community Care Services, Ambulatory Pharmacy, Henry Ford Health System, Detroit, MI, USA
| | - Nancy C MacDonald
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA
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186
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Tangiisuran B, Rajendran V, Sha'aban A, Daud NAA, Nawi SNM. Physicians' perceived barriers and enablers for deprescribing among older patients at public primary care clinics: a qualitative study. Int J Clin Pharm 2021; 44:201-213. [PMID: 34642869 DOI: 10.1007/s11096-021-01336-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
Background Increased harmful effects of medication resulting from polypharmacy, especially among older patients, is a significant concern globally. Hence, continuous medication review and withdrawal of inappropriate medications are essential to improve patient safety. Objective To explore physicians' perceived barriers and enablers of deprescribing among older patients in the public primary healthcare setting. Setting Public primary care clinics in the northern states of Malaysia. Methods A semi-structured, face-to-face interview was conducted among physicians working in eight primary care clinics in northern Malaysia using a purposive sampling approach. Interviews were conducted using validated topic guides. All the responses were recorded, transcribed verbatim, validated, and analysed for the emerging themes using thematic analysis. Main outcome measure Physicians perceived barriers and enablers of deprescribing among geriatric patients. Results A total of eleven physicians were interviewed. Seven emerging themes were identified, which are categorised under barriers and enablers of deprescribing. The barriers were patient-specific, prescriber-specific, and healthcare provision and system. Prescriber deprescribing competencies, medication-specific outcomes, availability of empirical evidence, and pharmacist's role were the enablers identified. Conclusion Patient-specific barriers were identified as a significant challenge for deprescribing. Improving competencies on deprescribing was the repeatedly adduced enabler by physicians. The development of targeted educational training can help to reduce the obstacles faced by prescribers.
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Affiliation(s)
- Balamurugan Tangiisuran
- National Poison Centre, Universiti Sains Malaysia, 11800 USM, Pulau Pinang, Malaysia. .,School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Pulau Pinang, Malaysia.
| | - Vijitha Rajendran
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Pulau Pinang, Malaysia
| | - Abubakar Sha'aban
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Pulau Pinang, Malaysia.,Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Nur Aizati Athirah Daud
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Pulau Pinang, Malaysia
| | - Siti Nurbaya Mohd Nawi
- School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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187
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Coghlan A, Turner S, Coverdale S. Danger in discharge summaries: Abbreviations create confusion for both author and recipient. Intern Med J 2021; 53:550-558. [PMID: 34636114 DOI: 10.1111/imj.15582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/26/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The transition from hospital inpatient care to medical care in the community is a high-risk period for adverse events. Inadequate communication, including low quality or unavailable discharge summaries, has been shown to impact patient care. AIMS Assess use of abbreviations in clinical handover documents from inpatient hospital teams to general practitioners (GPs), and the interpretation of these abbreviations by GPs and hospital-based junior doctors. METHODS Retrospective audit of 802 discharge summaries completed during a one-week period in 2017 by a Queensland regional health service. GPs and local junior doctors then attempted interpretation of twenty relevant abbreviations. RESULTS 99% (794) discharge summaries included abbreviations. 1612 different abbreviations were used on 16 327 occasions. The median number of abbreviations per discharge summary was 17 (range 0-86). 254 GPs and 62 junior doctors responded to a survey which found that no abbreviation was interpreted the same by all respondents. GPs and junior doctors were unable to offer any interpretation in 17.9% and 15.2% of cases respectively. GPs offered a greater range of interpretations than junior doctors, with a median of 9 and 3 different interpretations per abbreviation respectively. 94% (239) of GPs felt that the use of abbreviations in discharge summaries had the potential to impact patient care. 152 (60%) GPs felt that time spent clarifying abbreviations in discharge summaries could be excessive. CONCLUSIONS Abbreviations are often used in discharge summaries, yet poorly understood. This has the potential to impact patient care in the transition period after hospitalisation This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anna Coghlan
- Sunshine Coast Hospital and Health Service, 6 Doherty St, Birtinya QLD AUS 4575.,Fernlands Radius Medical Centre, 10 Woodhill Road, Ferny Hills QLD AUS 4055.,University of Queensland Faculty of Medicine, Herston QLD AUS 4006, Australia
| | - Sophie Turner
- Sunshine Coast Hospital and Health Service, 6 Doherty St, Birtinya QLD AUS 4575.,Metro North Hospital and Health Service, 7 Butterfield St, Herston QLD AUS 4006, Australia.,University of Queensland Faculty of Medicine, Herston QLD AUS 4006, Australia
| | - Steven Coverdale
- School of Medicine, Sunshine Coast, Griffith University, 6, Doherty St, BIRTINYA, QLD 4575, Australia
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188
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How can communication to GPs at hospital discharge be improved? A systems approach. BJGP Open 2021; 6:BJGPO.2021.0148. [PMID: 34620598 PMCID: PMC8958742 DOI: 10.3399/bjgpo.2021.0148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 11/05/2022] Open
Abstract
Background Poor communication to GPs at hospital discharge threatens patient safety and continuity of care, with reliance on discharge summaries that are commonly written by the most junior doctors. Previous quality improvement efforts have largely focused on adherence to standardised templates, with limited success. A lack of understanding has been identified as a cause of the issue’s resistance to decades of improvement work. Aim To understand the system of communication to GPs at hospital discharge, with a view to identifying potential routes to improvement. Design & setting A qualitative exploration of the secondary-to-primary care communication system surrounding a large UK hospital. Method A systems approach, recently defined for the healthcare domain, was used to structure and thematically analyse interviews (n = 18) of clinical and administrative staff from both sides of the primary–secondary care interface, and a subsequent focus group. Results The largely one-way communication system structure and the low level of hospital stakeholder insight into recipient GP needs emerged as consistent hindrances to system performance. More open lines of communication and shared records might enable greater collaboration to share feedback and resolve informational deficits. Teaching sessions and assessments for medical students and junior doctors led by GPs could help to instil the importance of detail and nuance when using standardised communication templates. Conclusion Facilitating the sharing of performance insights between stakeholder groups emerged as the key theme of how communication might be improved. The empirical measures proposed have the potential to mitigate the safety risks of key barriers to performance such as patient complexity.
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189
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Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, Mcintyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Doi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Møller MH, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47:1181-1247. [PMID: 34599691 PMCID: PMC8486643 DOI: 10.1007/s00134-021-06506-y] [Citation(s) in RCA: 1576] [Impact Index Per Article: 525.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/05/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Laura Evans
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.
| | - Andrew Rhodes
- Adult Critical Care, St George's University Hospitals NHS Foundation Trust & St George's University of London, London, UK
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Massimo Antonelli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Flávia R Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, Hospital of São Paulo, São Paulo, Brazil
| | | | | | - Hallie C Prescott
- University of Michigan and VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | | | - Steven Simpson
- University of Kansas Medical Center, Kansas City, KS, USA
| | - W Joost Wiersinga
- ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, Emirates University, Al Ain, United Arab Emirates
| | - Derek C Angus
- University of Pittsburgh Critical Care Medicine CRISMA Laboratory, Pittsburgh, PA, USA
| | - Yaseen Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Luciano Azevedo
- School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | | | | | | | - Lisa Burry
- Mount Sinai Hospital & University of Toronto (Leslie Dan Faculty of Pharmacy), Toronto, ON, Canada
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy.,Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - John Centofanti
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Angel Coz Yataco
- Lexington Veterans Affairs Medical Center/University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Kent Doi
- The University of Tokyo, Tokyo, Japan
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Beijing, China
| | - Elisa Estenssoro
- Hospital Interzonal de Agudos San Martin de La Plata, Buenos Aires, Argentina
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | | | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Morten Hylander Møller
- Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Shevin Jacob
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Michael Klompas
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Younsuck Koh
- ASAN Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Anand Kumar
- University of Manitoba, Winnipeg, MB, Canada
| | - Arthur Kwizera
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Suzana Lobo
- Intensive Care Division, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil
| | - Henry Masur
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | | | | | - Yatin Mehta
- Medanta the Medicity, Gurugram, Haryana, India
| | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Nunnally
- New York University School of Medicine, New York, NY, USA
| | - Simon Oczkowski
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tiffany Osborn
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Michael Puskarich
- University of Minnesota/Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jason Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | | | | | | | - Charles L Sprung
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Tobias Welte
- Medizinische Hochschule Hannover and German Center of Lung Research (DZL), Hannover, Germany
| | - Janice Zimmerman
- World Federation of Intensive and Critical Care, Brussels, Belgium
| | - Mitchell Levy
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island & Rhode Island Hospital, Providence, RI, USA
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190
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Goodrich N, Dolter S, Snow J, Stoolman S, Kerns E, McCulloh R. Quality Improvement of Primary Care Provider Communication on Hospital Discharge. Hosp Pediatr 2021; 11:1050-1056. [PMID: 34531302 DOI: 10.1542/hpeds.2020-004804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Effective communication between inpatient and primary care providers (PCPs) is important for safe transition of care for hospitalized patients. In 2017, communication with PCPs was prioritized for the pediatric hospital medicine division. Our primary aim was to improve documented attempted communication with PCPs within 72 hours of discharge from 41% to at least 60% by January 1, 2018, and maintain this performance through 2019. METHODS This study included all inpatient encounters discharged by a pediatric hospital medicine provider from March 2017 to April 2020. An electronic health record phrase debuted March 2017. Successful documentation was defined as any attempt to contact the PCP, regardless of whether actual communication occurred. Group and individual audit and feedback occurred in July 2017 to April 2020. Provider communication was financially incentivized in July 2018 to June 2019. An annotated P-chart for the proportion of encounters with documented PCP communication occurring within 72 hours was established. Special-cause variation was determined by using Shewhart rules. RESULTS The mean proportion of encounters with documented PCP communication increased from 41% at baseline (March 2017 through July 2017) to 60% in August 2017 and 66% in December 2017. After the financial incentive was removed in July 2019, documentation decreased to 54%. Phone calls with clinic staff were the most common communication method (40% to 71%). Direct conversations with the PCP occurred rarely (0% to 3%). CONCLUSIONS Even when coupled with audit and feedback with EHR interventions, our work suggests that shifting to external financial motivation may hinder sustainability of behavior change to improve attempted documented PCP communication.
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Affiliation(s)
- Nathaniel Goodrich
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, Nebraska
| | - Stephen Dolter
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, Nebraska
| | - Joseph Snow
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, Nebraska
| | - Sharon Stoolman
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, Nebraska
| | - Ellen Kerns
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, Nebraska
| | - Russell McCulloh
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, Nebraska
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191
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Clark NA, Simmons J, Etzenhouser A, Pallotto EK. Improving Outpatient Provider Communication for High-Risk Discharges From the Hospitalist Service. Hosp Pediatr 2021; 11:1033-1048. [PMID: 34526327 DOI: 10.1542/hpeds.2020-005421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Patients are at risk for adverse events during inpatient-to-outpatient transitions of care. Previous improvement work has been targeted at this care transition, but gaps in discharge communication still exist. We aimed to increase documentation of 2-way communication between hospitalists and primary care providers (PCPs) for high-risk discharges from pediatric hospital medicine (PHM) services from 7% to 60% within 30 months. METHODS A3 improvement methodology was used. A list of high-risk discharge communication criteria was developed through engagement of PCPs and hospitalists. A driver diagram guided interventions. The outcome measure was documentation of successful 2-way communication with the PCP. Any documented 2-way discharge communication attempt was the process measure. Via a survey, hospitalist satisfaction with the discharge communication expectation served as the balancing measure. All patients discharged from PHM services meeting ≥1 high-risk criterion were included. Statistical process control charts were used to assess changes over time. RESULTS There were 3241 high-risk discharges (442 baseline: November 2017 to January 2018; 2799 intervention and sustain: February 2018 to June 2020). The outcome measure displayed iterative special cause variation from a mean baseline of 7% to peak of 39% but regressed and was sustained at 27%. The process measure displayed iterative special cause variation from a 13% baseline mean to a 64% peak, with regression to 41%. The balancing measure worsened from baseline of 5% dissatisfaction to 13%. Interventions temporally related to special cause improvements were education, division-level performance feedback, standardization of documentation, and offloading the task of communication coordination from hospitalists to support staff. CONCLUSIONS Improvement methodology resulted in modestly sustained improvements in PCP communication for high-risk discharges from the PHM services.
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Affiliation(s)
- Nicholas A Clark
- Division of Hospital Medicine
- School of Medicine, University of Missouri-Kansas City
| | - Julia Simmons
- Mercy Children's Hospital St Louis, St Louis, Missouri
| | - Angela Etzenhouser
- Division of Hospital Medicine
- School of Medicine, University of Missouri-Kansas City
- Graduate Medical Education, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Eugenia K Pallotto
- Division of Neonatology, Department of Pediatrics, Atrium Health Levine Children's Hospital, Charlotte, North Carolina
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192
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Sorita A, Robelia PM, Kattel SB, McCoy CP, Keller AS, Almasri J, Murad MH, Newman JS, Kashiwagi DT. The Ideal Hospital Discharge Summary: A Survey of U.S. Physicians. J Patient Saf 2021; 17:e637-e644. [PMID: 28885382 DOI: 10.1097/pts.0000000000000421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospital discharge summaries enable communication between inpatient and outpatient physicians. Despite existing guidelines for discharge summaries, they are frequently suboptimal. OBJECTIVE The aim of this study was to assess physicians' perspectives about discharge summaries and the differences between summaries' authors (hospitalists) and readers (primary care physicians [PCPs]). METHODS A national survey of 1600 U.S. physicians was undertaken. Primary measures included physicians' preferences in discharge summary standardization, content, format, and audience. RESULTS A total of 815 physicians responded (response rate = 51%). Eighty-nine percent agreed that discharge summaries "should have a standardized format." Most agreed that summaries should "document everything that was done, found, and recommended in the hospital" (64%) yet "only include details that are highly pertinent to the hospitalization" (66%). Although 74% perceived patients as an important audience of discharge summaries, only 43% agreed that summaries "should be written in language that patients…can easily understand," and 68% agreed that it "should be written solely for provider-to-provider communication." Compared with hospitalists, PCPs preferred comprehensive summaries (68% versus 59%, P = 0.002). More PCPs agreed that separate summaries should be created for patients and for provider-to-provider communication than hospitalists (60% versus 47%, P < 0.001). Compared with PCPs, more hospitalists believe that "hospitalists are too busy to prepare a high-quality discharge summary" (44% versus 23%, P < 0.001) and "PCPs have insufficient time to read an entire discharge summary" (60% versus 38%, P < 0.001). CONCLUSIONS Physicians believe that discharge summaries should have a standardized format but do not agree on how comprehensive or in what format they should be. Efforts are necessary to build consensus toward the ideal discharge summary.
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Affiliation(s)
| | | | - Sharma B Kattel
- Department of Hospital Medicine, Mayo Clinic Health System, Albert Lea
| | | | | | - Jehad Almasri
- Division of Health Care Policy and Research, Department of Health Sciences Research
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193
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Desai AV, Agarwal R, Epstein AS, Kuperman GJ, Michael CL, Mittelstaedt H, Connor M, Bernal C, Lynch KA, Ostroff JS, Katz B, Corrigan KL, Kramer D, Davis ME, Nelson JE. Needs and Perspectives of Cancer Center Stakeholders for Access to Patient Values in the Electronic Health Record. JCO Oncol Pract 2021; 17:e1524-e1536. [PMID: 33555928 PMCID: PMC9810135 DOI: 10.1200/op.20.00644] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE High-quality cancer care must incorporate patients' personal values in decision making throughout illness. Unfortunately, patient values are neither consistently elicited nor easily accessible in the electronic health record (EHR). Memorial Sloan Kettering Cancer Center is deploying a major EHR innovation, called the Patient Values Tab, which provides ready access to patients' values and personhood. To inform the Tab's design, we interviewed a large, diverse group of institutional stakeholders to understand their user needs for this Tab. METHODS Qualitative data were collected through semistructured, audio-recorded, in-person, individual interviews. An interdisciplinary team of four coders conducted a process of thematic content analysis. Thematic saturation was achieved, and member checking was performed. RESULTS A total of 110 stakeholders were approached and interviewed. Participants comprised a wide range of disciplines or professions and others involved in hospital and/or clinic administration. Analysis revealed the following themes related to important Tab content: personhood, support system or resources, social history, communication preferences, future planning, end of life, and illness and treatment understanding. Participants also discussed implementation considerations, the Tab's potential to improve communication, and privacy implications. CONCLUSION This study focused on a major EHR innovation to centralize information about values and personhood of patients with cancer. We elicited views of over 100 institutional stakeholders through in-depth interviews that were rigorously analyzed, yielding themes related to content and format that helped guide the Tab's design. The interviews generated a sense of ownership and enthusiasm for the Tab among future users. The Tab's introduction advances the use of the EHR as a driver of the delivery of patient-centered care.
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Affiliation(s)
- Anjali V. Desai
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Weill Cornell Medical College, New York, NY,Anjali V. Desai, MD, MSCE, 1275 York Avenue, New York, NY 10065; e-mail:
| | - Rajiv Agarwal
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew S. Epstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Weill Cornell Medical College, New York, NY
| | - Gilad J. Kuperman
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Chelsea L. Michael
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Haley Mittelstaedt
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - MaryAnn Connor
- Department of Nursing Informatics, Memorial Sloan Kettering Cancer Center, New York, NY,New York University, New York, NY
| | - Camila Bernal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kathleen A. Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jamie S. Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brittany Katz
- Weill Cornell Medical College, New York, NY,Department of Medicine, New York-Presbyterian Hospital, New York, NY
| | - Kelsey L. Corrigan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Dana Kramer
- Department of Advanced Practice Providers, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Judith E. Nelson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Weill Cornell Medical College, New York, NY
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194
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Osorio SN, Gage S, Mallory L, Soung P, Satty A, Abramson EL, Provost L, Cooperberg D. Factorial Analysis Quantifies the Effects of Pediatric Discharge Bundle on Hospital Readmission. Pediatrics 2021; 148:peds.2021-049926. [PMID: 34593650 DOI: 10.1542/peds.2021-049926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Factorial design of a natural experiment was used to quantify the benefit of individual and combined bundle elements from a 4-element discharge transition bundle (checklist, teach-back, handoff to outpatient providers, and postdischarge phone call) on 30-day readmission rates (RRs). METHODS A 24 factorial design matrix of 4 bundle element combinations was developed by using patient data (N = 7725) collected from January 2014 to December 2017 from 4 hospitals. Patients were classified into 3 clinical risk groups (CRGs): no chronic disease (CRG1), single chronic condition (CRG2), and complex chronic condition (CRG3). Estimated main effects of each bundle element and their interactions were evaluated by using Study-It software. Because of variation in subgroup size, important effects from the factorial analysis were determined by using weighted effect estimates. RESULTS RR in CRG1 was 3.5% (n = 4003), 4.1% in CRG2 (n = 1936), and 17.6% in CRG3 (n = 1786). Across the 3 CRGs, the number of subjects in the factorial groupings ranged from 16 to 674. The single most effective element in reducing RR was the checklist in CRG1 and CRG2 (reducing RR by 1.3% and 3.0%) and teach-back in CRG3 (by 4.7%) The combination of teach-back plus a checklist had the greatest effect on reducing RR in CRG3 by 5.3%. CONCLUSIONS The effect of bundle elements varied across risk groups, indicating that transition needs may vary on the basis of population. The combined use of teach-back plus a checklist had the greatest impact on reducing RR for medically complex patients.
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Affiliation(s)
- Snezana Nena Osorio
- Department of Pediatrics, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - Sandra Gage
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin.,Department of Child Health, College of Medicine-Phoenix, University of Arizona and Phoenix Children's Hospital, Phoenix, Arizona
| | - Leah Mallory
- Department of Pediatrics, School of Medicine, Tufts University and The Barbara Bush Children's Hospital, Portland, Maine
| | - Paula Soung
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Alexandra Satty
- Department of Pediatrics, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - Erika L Abramson
- Department of Pediatrics, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
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195
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Chen J, Wijesundara JG, Patterson A, Cutrona SL, Aiello S, McManus DD, McKee MD, Wang B, Houston TK. Facilitators and barriers to post-discharge pain assessment and triage: a qualitative study of nurses' and patients' perspectives. BMC Health Serv Res 2021; 21:1021. [PMID: 34583702 PMCID: PMC8480104 DOI: 10.1186/s12913-021-07031-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/11/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND After hospital discharge, patients can experience symptoms prompting them to seek acute medical attention. Early evaluation of patients' post-discharge symptoms by healthcare providers may improve appropriate healthcare utilization and patient safety. Post-discharge follow-up phone calls, which are used for routine transitional care in U.S. hospitals, serve as an important channel for provider-patient communication about symptoms. This study aimed to assess the facilitators and barriers to evaluating and triaging pain symptoms in cardiovascular patients through follow-up phone calls after their discharge from a large healthcare system in Central Massachusetts. We also discuss strategies that may help address the identified barriers. METHODS Guided by the Practical, Robust, Implementation and Sustainability Model (PRISM), we completed semi-structured interviews with 7 nurses and 16 patients in 2020. Selected nurses conducted (or supervised) post-discharge follow-up calls on behalf of 5 clinical teams (2 primary care; 3 cardiology). We used thematic analysis to identify themes from interviews and mapped them to the domains of the PRISM model. RESULTS Participants described common facilitators and barriers related to the four domains of PRISM: Intervention (I), Recipients (R), Implementation and Sustainability Infrastructure (ISI), and External Environment (EE). Facilitators include: (1) patients being willing to receive provider follow-up (R); (2) nurses experienced in symptom assessment (R); (3) good care coordination within individual clinical teams (R); (4) electronic health record system and call templates to support follow-up calls (ISI); and (5) national and institutional policies to support post-discharge follow-up (EE). Barriers include: (1) limitations of conducting symptom assessment by provider-initiated follow-up calls (I); (2) difficulty connecting patients and providers in a timely manner (R); (3) suboptimal coordination for transitional care among primary care and cardiology providers (R); and (4) lack of emphasis on post-discharge follow-up call reimbursement among cardiology clinics (EE). Specific barriers for pain assessment include: (1) concerns with pain medication misuse (R); and (2) no standardized pain assessment and triage protocol (ISI). CONCLUSIONS Strategies to empower patients, facilitate timely patient-provider communication, and support care coordination regarding pain evaluation and treatment may reduce the barriers and improve processes and outcomes of pain assessment and triage.
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Affiliation(s)
- Jinying Chen
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Jessica G Wijesundara
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Angela Patterson
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | | | - David D McManus
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - M Diane McKee
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Thomas K Houston
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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196
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Imfeld-Isenegger TL, Studer H, Ceppi MG, Rosen C, Bodmer M, Beeler PE, Boeni F, Häring AP, Hersberger KE, Lampert ML. Detection and resolution of drug-related problems at hospital discharge focusing on information availability - a retrospective analysis. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 166:18-26. [PMID: 34538579 DOI: 10.1016/j.zefq.2021.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/22/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospital stays are often associated with medication changes, which may lead to drug-related problems (DRPs). Medication reconciliation and medication reviews are strategies to detect and resolve DRPs. METHODS A descriptive cohort study was conducted using DRPs collected during routine pharmacist-led medication reconciliation and medication reviews in the hospital's community pharmacy at discharge (Zug Cantonal Hospital, Switzerland). In a simulation experiment, we retrospectively analysed the detection and resolution possibilities of these DRPs and their dependency on different information sources. RESULTS Overall, 6,087 prescriptions were filled in the hospital's community pharmacy (between June 2016 and May 2019). Among 1,352 prescriptions (with ≥ 1 documented DRP) a total of 1,876 DRPs were detected. The retrospective assessment showed that 1,115 DRPs could have been detected by performing simple medication reviews (based on the discharge prescription and the medication history), whereas in the remaining cases, additional clinical and/or patient-specific information would have been needed. In 944 (84.7 %) DRPs, which are detectable by simple medication reviews, the pharmacist would need to consult the prescriber for resolution. CONCLUSION The detection of DRPs is strongly influenced by the information available. These results support models with pre-discharge medication reconciliation and pharmacist-led medication review procedures enabling both comprehensive detection and facilitated resolution of DRPs.
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Affiliation(s)
- Tamara L Imfeld-Isenegger
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
| | - Helene Studer
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland; Clinical Pharmacy, Institute of Hospital Pharmacy, Solothurner Spitäler AG, Olten, Switzerland
| | - Marco G Ceppi
- Hospital Pharmacy, Zuger Kantonsspital AG, Baar, Switzerland; Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Christoph Rosen
- Hospital Pharmacy, Zuger Kantonsspital AG, Baar, Switzerland
| | - Michael Bodmer
- Internal Medicine, Zuger Kantonsspital AG, Baar, Switzerland
| | - Patrick E Beeler
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich & University Hospital Zurich, Zurich, Switzerland
| | - Fabienne Boeni
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland; Clinical Pharmacy, Institute of Hospital Pharmacy, Solothurner Spitäler AG, Olten, Switzerland
| | - Armella P Häring
- Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Kurt E Hersberger
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Markus L Lampert
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland; Clinical Pharmacy, Institute of Hospital Pharmacy, Solothurner Spitäler AG, Olten, Switzerland
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197
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Kaissi M, Solan LG. Staying Connected: Using Quality Improvement to Bridge the Communication Gap Between Pediatric Hospitalists and Primary Care Providers. Hosp Pediatr 2021; 11:e263-e265. [PMID: 34531303 DOI: 10.1542/hpeds.2021-006188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Maha Kaissi
- University of Rochester Golisano Children's Hospital, Rochester, New York
| | - Lauren G Solan
- University of Rochester Golisano Children's Hospital, Rochester, New York
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198
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Perrault-Sequeira L, Torti J, Appleton A, Mathews M, Goldszmidt M. Discharging the complex patient - changing our focus to patients' networks of care providers. BMC Health Serv Res 2021; 21:950. [PMID: 34507571 PMCID: PMC8431846 DOI: 10.1186/s12913-021-06841-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
Background A disconnect exists between the idealized model of every patient having a family physician (FP) who acts as the central hub for care, and the reality of health care where patients must navigate a network of different providers. This disconnect is particularly evident when hospitalized multimorbid patients transition back into the community. These discharges are identified as high-risk due to lapses in care continuity. The aim of this study was to identify and explore the networks of care providers in a sample of hospitalized, complex patients, and better understand the nature of their attachments to these providers as a means of discovering novel approaches for improving discharge planning. Methods This was a constructivist grounded theory study. Data included interviews from 30 patients admitted to an inpatient internal medicine service of a midsized academic hospital in Ontario, Canada. Analysis and data collection proceeded iteratively with sampling progressing from purposive to theoretical. Results We identified network of care configurations commonly found in patients with multiple medical comorbidities receiving care from multiple different providers admitted to an internal medicine service. FPs and specialists form the network’s scaffold. The involvement of physicians in the network dictated not only how patients experienced transitions in care but the degree of reliance on social supports and personal capacities. The ideal for the multimorbid patient is an optimally involved FP that remains at the centre, even when patients require more subspecialized care. However, in cases where a rostered FP is non-existent or inadequate, increased involvement and advocacy from specialists is crucial. Conclusions Our results have implications for transition planning in hospitalized complex patients. Recognizing salient network features can help identify patients who would benefit from enhanced discharge support. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06841-2.
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Affiliation(s)
| | - Jacqueline Torti
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Centre for Education Research & Innovation - Western University, London, ON, Canada
| | - Andrew Appleton
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Maria Mathews
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Mark Goldszmidt
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Centre for Education Research & Innovation - Western University, London, ON, Canada
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199
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Improving Communication Between Hospital and Outpatient Psychiatric Providers. Adv Emerg Nurs J 2021; 43:237-246. [PMID: 34397502 DOI: 10.1097/tme.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients suffering from mental illness are often less likely to engage in treatment at an outpatient level. Lack of communication and coordination of care between providers has negative results for the health system and the patient. Improved communication has shown improved satisfaction of providers in health care. Using prior research, an electronic reminder and standardized documentation of communication was added to the health system's electronic health record. The aim of this quality improvement (QI) project was to compare pre-/postintervention communication and satisfaction between emergency department and outpatient psychiatric providers. The QI project was conducted on a convenience sample of 13 outpatient psychiatric providers at a large academic medical center. Using a pre-/postintervention design, QI project data were collected via chart reviews and pre-/postsurveys. The chart review results revealed the communication rate increased significantly from pre (22%) to post (85%), p < .001. The survey results revealed overall satisfaction had statistically significant increase from pre- (Mdn = 3, neutral) to postintervention (Mdn = 5, very satisfied), Z = -2.21, p =.027. The survey results revealed a statistically significant increase in frequency of direct communication from pre- (21%-40%) to postintervention (81%-100%), Z = -2.06, p = .039. The QI project documents an increase in both provider satisfaction and communication post-intervention.
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200
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Griffiths S, Stephen G, Kiran T, Okrainec K. "She knows me best": a qualitative study of patient and caregiver views on the role of the primary care physician follow-up post-hospital discharge in individuals admitted with chronic obstructive pulmonary disease or congestive heart failure. BMC FAMILY PRACTICE 2021; 22:176. [PMID: 34488652 PMCID: PMC8421240 DOI: 10.1186/s12875-021-01524-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/18/2021] [Indexed: 11/23/2022]
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are at high-risk of readmission after hospital discharge. There is conflicting evidence however on whether timely follow-up with a primary care provider reduces that risk. The objective of this study is to understand the perspectives of patients with COPD and CHF, and their caregivers, on the role of primary care provider follow-up after hospital discharge. Methods A qualitative study design with semi-structured interviews was conducted among patients or their family caregivers admitted with COPD or CHF who were enrolled in a randomized controlled study at three acute care hospitals in Ontario, Canada. Participants were interviewed between December 2017 to January 2019, the majority discharged from hospital at least 30 days prior to their interview. Interviews were analyzed independently by three authors using a deductive directed content analysis, with the fourth author cross-comparing themes. Results Interviews with 16 participants (eight patients and eight caregivers) revealed four main themes. First, participants valued visiting their primary care provider after discharge to build upon their longitudinal relationship. Second, primary care providers played a key role in coordinating care. Third, there were mixed views on the ideal time for follow-up, with many participants expressing a desire to delay follow-up to stabilize following their acute hospitalization. Fourth, the link between the post-discharge visit and preventing hospital readmissions was unclear to participants, who often self-triaged based on their symptoms when deciding on the need for emergency care. Conclusions Patients and caregivers valued in-person follow-up with their primary care provider following discharge from hospital because of the trust established through pre-existing longitudinal relationships. Our results suggest policy makers should focus on improving rates of primary care provider attachment and systems supporting informational continuity. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01524-7.
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Affiliation(s)
- Sarah Griffiths
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Gaibrie Stephen
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Tara Kiran
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Karen Okrainec
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. .,Department of Medicine, University Health Network, Toronto, ON, Canada. .,Toronto Western Hospital, 399 Bathurst Street, 8EW-408, Toronto, ON, M5T 2S8, Canada.
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