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Webber AL, Toomey M, Keay L, Dai S, Gole GA, Newcomb D, McKinlay L. Building and maintaining interprofessional collaborative practice in eyecare: Learnings from the Queensland Paediatric Optometry Alignment Program. Ophthalmic Physiol Opt 2024; 44:52-70. [PMID: 38009804 DOI: 10.1111/opo.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE The Queensland Children's Hospital Paediatric Optometry Alignment Program commenced with a pilot phase to assess its feasibility, effectiveness and acceptability. This study identified the barriers that hinder effective interprofessional collaboration and the facilitators that contribute to its success, and assessed changes in optometrists' satisfaction since the pilot phase of the collaborative care programme. METHODS Qualitative deductive and inductive content analysis was applied to open-ended free-text survey responses collected in 2018 from the optometrists involved in the Program's pilot phase. The responses were coded using the Theoretical Domains Framework (TDF) to categorise barriers and facilitators into key themes. Key behavioural determinants were mapped to the COM-B (Capability, Opportunity, Motivation-Behaviour) elements of the Behaviour Change Wheel model to identify intervention strategies. Intervention recommendations were derived from behaviour change mapping and compared with programme quality improvement initiatives. A cross-sectional explanatory survey informed by the TDF was conducted within the current 2023 cohort, and a longitudinal comparative analysis was carried out using data from the 2018 survey. RESULTS Among the 97 surveys distributed in 2018, 44 respondents participated; from this group, 38 individuals contributed a total of 200 free-text responses. Facilitators (240 comments) outnumbered barriers (65 comments). Key facilitators were accessible and timely care, professional development, confidence and positive outcome beliefs. Barriers included communication, information handover, credibility, relationships and skill gaps. Optometrists actively engaged in the programme in 2023 reported heightened satisfaction with their involvement, increased confidence and greater engagement in paediatric eyecare delivery. However, challenges in clinical information transfer persist. CONCLUSION The interprofessional collaborative model of paediatric eyecare has contributed efficiencies within the health system by building paediatric care capacity in the community, fostering professional credibility and promoting interdisciplinary trust. Insights gained should prove valuable for other paediatric eyecare services exploring hospital-to-community care models.
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Affiliation(s)
- Ann L Webber
- School of Optometry and Vision Science, Queensland University of Queensland, Brisbane, Queensland, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Melinda Toomey
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Shuan Dai
- Children's Health Queensland, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Glen A Gole
- Children's Health Queensland, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Dana Newcomb
- General Practice Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lynne McKinlay
- Children's Health Queensland, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Tan VZ, Teo YH, Wu J, Ong PH. Care transition processes in the Singapore healthcare system: process mapping and perspectives of private primary care practitioners. Singapore Med J 2023:388832. [PMID: 37929563 DOI: 10.4103/singaporemedj.smj-2021-446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Varen Zhi Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jiaxuan Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pang Hao Ong
- Ministry of Health Office for Healthcare Transformation, Singapore
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Li E, Lounsbury O, Clarke J, Ashrafian H, Darzi A, Neves AL. Perceptions of chief clinical information officers on the state of electronic health records systems interoperability in NHS England: a qualitative interview study. BMC Med Inform Decis Mak 2023; 23:158. [PMID: 37573388 PMCID: PMC10423420 DOI: 10.1186/s12911-023-02255-8] [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: 12/12/2022] [Accepted: 08/02/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND In the era of electronic health records (EHR), the ability to share clinical data is a key facilitator of healthcare delivery. Since the introduction of EHRs, this aspect has been extensively studied from the perspective of healthcare providers. Less often explored are the day-to-day challenges surrounding the procurement, deployment, maintenance, and use of interoperable EHR systems, from the perspective of healthcare administrators, such as chief clinical information officers (CCIOs). OBJECTIVE Our study aims to capture the perceptions of CCIOs on the current state of EHR interoperability in the NHS, its impact on patient safety, the perceived facilitators and barriers to improving EHR interoperability, and what the future of EHR development in the NHS may entail. METHODS Semi-structured interviews were conducted between November 2020 - October 2021. Convenience sampling was employed to recruit NHS England CCIOs. Interviews were digitally recorded and transcribed verbatim. A thematic analysis was performed by two independent researchers to identify emerging themes. RESULTS Fifteen CCIOs participated in the study. Participants reported that limited EHR interoperability contributed to the inability to easily access and transfer data into a unified source, thus resulting in data fragmentation. The resulting lack of clarity on patients' health status negatively impacts patient safety through suboptimal care coordination, duplication of efforts, and more defensive practice. Facilitators to improving interoperability included the recognition of the need by clinicians, patient expectations, and the inherent centralised nature of the NHS. Barriers included systems usability difficulties, and institutional, data management, and financial-related challenges. Looking ahead, participants acknowledged that realising that vision across the NHS would require a renewed focus on mandating data standards, user-centred design, greater patient involvement, and encouraging inter-organisational collaboration. CONCLUSION Tackling poor interoperability will require solutions both at the technical level and in the wider policy context. This will involve demanding interoperability functionalities from the outset in procurement contracts, fostering greater inter-organisation cooperation on implementation strategies, and encouraging systems vendors to prioritise interoperability in their products. Only by comprehensively addressing these challenges would the full potential promised by the use of fully interoperable EHRs be realised.
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Affiliation(s)
- Edmond Li
- Institute of Global Health Innovation, National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK.
| | | | - Jonathan Clarke
- Institute of Global Health Innovation, National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
- Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, London, UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation, National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Ara Darzi
- Institute of Global Health Innovation, National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Ana Luisa Neves
- Institute of Global Health Innovation, National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Department of Community Medicine, Health Information and Decision, Center for Health Technology and Services Research, University of Porto, Porto, Portugal
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Perspectives of acute, post-acute, physician and community support providers on community collaborative efforts to improve transitions of care. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2023; 11:100673. [PMID: 36566518 DOI: 10.1016/j.hjdsi.2022.100673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Transitional care (TC) involves multiple organizations as patients transition from hospitals. Collaboration to reduce readmissions has been encouraged by government initiatives. As part of Project ACHIEVE, a comparative TC study, we sought provider perspectives on TC improvement efforts. METHODS We aimed to identify perceived problems that drove improvement efforts, influences on interventions implemented, facilitators or barriers to desired outcomes, and sustainability. Investigators interviewed 63 representatives from collaborative improvement efforts across 13 states in 2015. Directed content analysis was performed, with inductive coding as insights emerged. Data was also analyzed for differences in participant perceptions, such as the organization represented, geographic characteristics, and source of funding for interventions. RESULTS Participants in semi-structured interviews included physicians, nurses, care navigators, and administrators from hospitals, nursing facilities, community-based organizations, and medical practices. Participants reported that changing reimbursement practices and readmissions penalties drove TC efforts, and common problems they sought to address included insufficient inter-provider communication, medication management, and challenges related to chronic condition management. Solutions implemented were often adapted according to community and setting characteristics and population factors. Findings also suggest differences in the types of interventions implemented according to funding sources, which also impacted the ability to sustain these interventions. CONCLUSIONS Cross-site collaboration, communication, and partnership among stakeholders is essential to effective transitional care. Collaboration led to shared understanding among stakeholders of health care and support services available in the community. Coalition-based work also facilitated trust among partners which led to expansion and sustainment of TC efforts. Unmet social needs of patients are a barrier. IMPLICATIONS Opportunities exist for increased and improved collaboration among clinical providers with community-based and social services organizations. Increased involvement of primary care providers in such collaborations would improve communication with both the patient and involved providers. Communities with external funding were more likely to implement evidence-based interventions, while those relying on institutional support addressed identified problems with more targeted interventions.
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Montoya-Williams D, Fraiman YS, Peña MM, Burris HH, Pursley DM. Antiracism in the Field of Neonatology: A Foundation and Concrete Approaches. Neoreviews 2022; 23:e1-e12. [PMID: 34970665 PMCID: PMC8796312 DOI: 10.1542/neo.23-1-e1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Neonatal patients and families from historically marginalized and discriminated communities have long been documented to have differential access to health care, disparate health care, and as a result, inequitable health outcomes. Fundamental to these processes is an understanding of what race and ethnicity represent for patients and how different levels of racism act as social determinants of health. The NICU presents a unique opportunity to intervene with regard to the detrimental ways in which structural, institutional, interpersonal, and internalized racism affect the health of newborn infants. The aim of this article is to provide neonatal clinicians with a foundational understanding of race, racism, and antiracism within medicine, as well as concrete ways in which health care professionals in the field of neonatology can contribute to antiracism and health equity in their professional careers.
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Affiliation(s)
| | - Yarden S Fraiman
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michelle-Marie Peña
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Heather H Burris
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - DeWayne M Pursley
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
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Implementing a Care Pathway for Complex Chronic Patients from a Nursing Perspective: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126324. [PMID: 34207974 PMCID: PMC8296156 DOI: 10.3390/ijerph18126324] [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: 05/06/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022]
Abstract
A care pathway constitutes a complex care strategy for decision-making and the organization of processes in the care of complex chronic patients, avoiding the fragmentation of care. Health professionals play a decisive role in the implementation, development, and evaluation of care pathways. This study sought to explore nurses’ opinions on the care pathway for complex chronic patients three years after its implementation. The study participants were thirteen nurses with different roles who were involved in the care pathway. Thematic content analysis of the semi-structured interviews resulted in four major themes: (a) the strengths of the route; (b) the impact of the route on caregivers; (c) the weaknesses of the route; and (d) the future of the route. Overall, the pathway was positively valued for the benefits it provides to patients, the caregiver, and the administration of professional health care. Participants voiced their concerns regarding: communication and coordination difficulties among professionals across the different levels of care, the need for improved teamwork and consensus among professionals at the same center, and human and material resources. The ongoing evaluation and monitoring of facilitators and barriers is necessary throughout the implementation process, to ensure continuity and quality of care in the health system.
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Nurjono M, Shrestha P, Ang IYH, Shiraz F, Eh KX, Toh SAES, Vrijhoef HJM. Shifting care from hospital to community, a strategy to integrate care in Singapore: process evaluation of implementation fidelity. BMC Health Serv Res 2020; 20:452. [PMID: 32448283 PMCID: PMC7245814 DOI: 10.1186/s12913-020-05263-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 04/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background Accessibility to efficient and person-centered healthcare delivery drives healthcare transformation in many countries. In Singapore, specialist outpatient clinics (SOCs) are commonly congested due to increasing demands for chronic care. To improve this situation, the National University Health System (NUHS) Regional Health System (RHS) started an integrated care initiative,the Right-Site Care (RSC) program in 2014. Through collaborations between SOCs at the National University Hospital and primary and community care (PCC) clinics in the western region of the county, the program was designed to facilitate timely discharge and appropriate transition of patients, who no longer required specialist care, to the community. The aim of this study was to evaluate the implementation fidelity of the NUHS RHS RSC program using the modified Conceptual Framework for Implementation Fidelity (CFIF), at three distinct levels; providers, organizational, and system levels to explain outcomes of the program and to inform further development of (similar) programs. Methods A convergent parallel mixed methods study using the realist evaluation approach was used. Data were collected between 2016 and 2018 through non-participatory observations, reviews of medical records and program database, together with semi-structured interviews with healthcare providers. Triangulation of data streams was applied guided by the modified CFIF. Results Our findings showed four out of six program components were implemented with low level of fidelity, and 9112 suitable patients were referred to the program while 3032 (33.3%) declined to be enrolled. Moderating factors found to influence fidelity included: (i) complexity of program, (ii) evolving providers’ responsiveness, (iii) facilitation through synergistic partnership, training of PCC providers by specialists and supportive structures: care coordinators, guiding protocols, shared electronic medical record and shared pharmacy, (iv) lack of organization reinforcement, and (v) mismatch between program goals, healthcare financing and providers’ reimbursement. Conclusion Functional integration alone is insufficient for a successful right-site care program implementation. Improvement in relationships between providers, organizations, and patients are also warranted for further development of the program.
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Affiliation(s)
- Milawaty Nurjono
- Centre for Health Services Research and Policy Research, Saw Swee Hock School of Public Health National University of Singapore, National University Health System, Singapore, Singapore. .,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Pami Shrestha
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Ian Yi Han Ang
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Farah Shiraz
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Regional Health System Office, National University Health System, Singapore, Singapore
| | - Ke Xin Eh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sue-Anne Ee Shiow Toh
- Regional Health System Office, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Hubertus Johannes Maria Vrijhoef
- Department of Patient and Care, University Hospital Maastrich, Maastricht, the Netherlands.,Panaxea B.V., Amsterdam, the Netherlands
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Hospital-to-Homecare Videoconference Handoff: Improved Communication, Coordination of Care, and Patient/Family Engagement. Home Healthc Now 2020; 37:198-207. [PMID: 31274582 DOI: 10.1097/nhh.0000000000000755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transitions of care between settings and clinicians are a time of vulnerability for patients, and can result in fragmented care, medication errors, avoidable readmissions, and patient/nurse dissatisfaction. Through the use of technology and a structured face-to-face handoff, the patient and family can be engaged in the transition across settings. The purpose of this project was to determine the feasibility and effectiveness of videoconference handoffs between inpatient, case management, and home care nurses, and the patients/families during transitions of care from hospital to home care. Videoconferences were conducted for 2 months with patients transitioning from two pediatric inpatient units to the hospital-based home care agency. The nurses and patient/family connected through a secure cloud-based videoconferencing platform. Participants discussed the patient's status, safety concerns, ongoing plan of care, what the patient/family could expect at home, and the coordination of equipment/supply needs and postdischarge visits. Videoconference handoffs (n = 10) were found to be feasible and address gaps in communication, coordination of care, and patient/family engagement during transitions from hospital to home care. Postpilot, nurses agreed the videoconference handoffs should continue with minimal modifications.
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Low LL, Ab Rahim FI, Johari MZ, Abdullah Z, Abdul Aziz SH, Suhaimi NA, Jaafar N, Mohd Hanafiah AN, Kong YL, Mahmud SH, Zulkepli MZ, Perialathan K, Muharam N, Zainudin NH, Mohd Zin Z, Mohd Roslan N, Aris T, Murad S. Assessing receptiveness to change among primary healthcare providers by adopting the consolidated framework for implementation research (CFIR). BMC Health Serv Res 2019; 19:497. [PMID: 31311538 PMCID: PMC6636000 DOI: 10.1186/s12913-019-4312-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 07/01/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Amid the current burden of non-communicable (NCD) diseases in Malaysia, there is a growing demand for more efficient service delivery of primary healthcare. A complex intervention is proposed to improve NCD management in Malaysia. This exploratory study aimed to assess primary healthcare providers' receptiveness towards change prior to implementation of the proposed complex intervention. METHOD This study was conducted using an exploratory qualitative approach on purposely selected healthcare providers at primary healthcare clinics. Twenty focus group discussions and three in-depth interviews were conducted using a semi-structured interview guide. Consent was obtained prior to interviews and for audio-recordings. Interviews were transcribed verbatim and thematically analysed, guided by the Consolidated Framework for Implementation Research (CFIR), a framework comprised of five major domains promoting implementation theory development and verification across multiple contexts. RESULTS The study revealed via CFIR that most primary healthcare providers were receptive towards any proposed changes or intervention for the betterment of NCD care management. However, many challenges were outlined across four CFIR domains-intervention characteristics, outer setting, inner setting, and individual characteristics-that included perceived barriers to implementation. Perception of issues that triggered proposed changes reflected the current situation, including existing facilitating aspects that can support the implementation of any future intervention. The importance of strengthening the primary healthcare delivery system was also expressed. CONCLUSION Understanding existing situations faced at the primary healthcare setting is imperative prior to implementation of any intervention. Healthcare providers' receptiveness to change was explored, and using CFIR framework, challenges or perceived barriers among healthcare providers were identified. CFIR was able to outline the clinics' setting, individual behaviour and external agency factors that have direct impact to the organisation. These are important indicators in ensuring feasibility, effectiveness and sustainability of any intervention, as well as future scalability considerations.
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Affiliation(s)
- Lee Lan Low
- Institute for Health Systems Research, National Institute of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Fathullah Iqbal Ab Rahim
- Institute for Health Systems Research, National Institute of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Mohammad Zabri Johari
- Institute for Behavioural Research, National Institute of Health, Ministry of Health Malaysia, Block B3, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Zalilah Abdullah
- Institute for Health Systems Research, National Institute of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Siti Hajar Abdul Aziz
- Institute for Health Systems Research, National Institute of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Nur Ajeerah Suhaimi
- Institute for Health Systems Research, National Institute of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Norrafizah Jaafar
- Institute for Behavioural Research, National Institute of Health, Ministry of Health Malaysia, Block B3, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Ainul Nadziha Mohd Hanafiah
- Institute for Health Systems Research, National Institute of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Yuke Lin Kong
- Institute for Health Systems Research, National Institute of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Siti Haniza Mahmud
- Institute for Health Systems Research, National Institute of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Mohamad Zaidan Zulkepli
- Institute for Behavioural Research, National Institute of Health, Ministry of Health Malaysia, Block B3, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Komathi Perialathan
- Institute for Behavioural Research, National Institute of Health, Ministry of Health Malaysia, Block B3, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Norazlin Muharam
- Department of Statistics, Block C6, Complex C, Federal Government Administrative CentrE, 62514 Putrajaya, Malaysia
| | - Nur Hani Zainudin
- Institute for Health Systems Research, National Institute of Health, Ministry of Health Malaysia, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Zaikiah Mohd Zin
- Institute for Behavioural Research, National Institute of Health, Ministry of Health Malaysia, Block B3, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Norazilah Mohd Roslan
- Family Health Development Division, Putrajaya, Ministry of Health Malaysia, Block E1, E3, E7 & E10, Complex E, Federal Government Administrative Centre, 62590 Putrajaya, Malaysia
| | - Tahir Aris
- Institute for Public Health, National Institute of Health, Ministry of Health Malaysia, Block B5, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Shahnaz Murad
- Office of Deputy Director General of Health (Research and Technical Support), Ministry of Health Malaysia, Block E1, E3, E7 & E10, Complex E, Federal Government Administrative Centre, 62590 Putrajaya, Malaysia
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Tremoulet P, Krishnan R, Karavite D, Muthu N, Regli SH, Will A, Michel J. A Heuristic Evaluation to Assess Use of After Visit Summaries for Supporting Continuity of Care. Appl Clin Inform 2018; 9:714-724. [PMID: 30208496 DOI: 10.1055/s-0038-1668093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Outpatient providers often do not receive discharge summaries from acute care providers prior to follow-up visits. These outpatient providers may use the after-visit summaries (AVS) that are given to patients to obtain clinical information. It is unclear how effectively AVS support care coordination between clinicians. OBJECTIVES Goals for this effort include: (1) developing usability heuristics that may be applied both for assessment and to guide generation of medical documents in general, (2) conducting a heuristic evaluation to assess the use of AVS for communication between clinicians, and (3) providing recommendations for generating AVS that effectively support both patient/caregiver use and care coordination. METHODS We created a 17-item heuristic evaluation instrument for assessing usability of medical documents. Eight experts used the instrument to assess each of four simulated AVS. The simulations were created using examples from two hospitals and two pediatric patient cases developed by the National Institute of Standards and Technology. RESULTS Experts identified 224 unique usability problems ranging in severity from mild to catastrophic. Content issues (e.g., missing medical history, marital status of a 2-year-old) were rated as most severe, but widespread formatting and structural problems (e.g., inconsistent indentation, fonts, and headings; confusing ordering of information) were so distracting that they significantly reduced readers' ability to efficiently use the documents. Overall, issues in the AVS from Hospital 2 were more severe than those in the AVS from Hospital 1. CONCLUSION The new instrument allowed for quick, inexpensive evaluations of AVS. Usability issues such as unnecessary information, poor organization, missing information, and inconsistent formatting make it hard for patients, caregivers, and clinicians to use the AVS. The heuristics in the new instrument may be used as guidance to adapt electronic health record systems so that they generate more useful and usable medical documents.
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Affiliation(s)
- Patrice Tremoulet
- Health Devices Department, ECRI Institute, Plymouth Meeting, Pennsylvania, United States.,Department of Psychology, Rowan University, Glassboro, New Jersey, United States
| | - Ramya Krishnan
- Health Devices Department, ECRI Institute, Plymouth Meeting, Pennsylvania, United States
| | - Dean Karavite
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Naveen Muthu
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Division of General Pediatrics, Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Susan Harkness Regli
- Department of Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States
| | - Amy Will
- National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia, United States
| | - Jeremy Michel
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Division of General Pediatrics, Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,ECRI Institute Technology Assessment, Plymouth Meeting, Pennsylvania, United States
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11
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Leyenaar JK, Shieh MS, Lagu T, Pekow PS, Lindenauer PK. Hospital and Community Characteristics Associated With Pediatric Direct Admission to Hospital. Acad Pediatr 2018; 18:525-534. [PMID: 29111274 PMCID: PMC5924569 DOI: 10.1016/j.acap.2017.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/27/2017] [Accepted: 10/14/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES One quarter of pediatric hospitalizations begin as direct admissions, defined as hospitalization without receiving care in the hospital's emergency department (ED). Direct admission rates are highly variable across hospitals, yet previous studies have not examined reasons for this variation. We aimed to determine the relationships between hospital and community factors and pediatric direct admission rates, and to evaluate the degree to which these characteristics explain variation in risk-adjusted direct admission rates. METHODS We conducted a cross-sectional study of the Healthcare Cost and Utilization Project's Kids Inpatient Database, American Hospital Association Database, and Area Health Resource File, including children <18 years of age who were admitted for a medical hospitalization in states contributing data to all data sets. Using hierarchical generalized linear modeling, we generated risk-adjusted direct admission rates and used generalized linear models to assess the association of hospital and community characteristics with these risk-adjusted rates. RESULTS We included 211,458 children discharged from 933 hospitals and 26 states; 20.2% were admitted directly. One-fifth of the variance in risk-adjusted direct admission rates was attributed to observed hospital and community factors. The greatest proportion of this explained variance was related to ED volume (37%), volume of pediatric hospitalizations (27%), and size of the pediatrician workforce (12%). CONCLUSIONS Direct admission rates were associated with several hospital and community characteristics, but the majority of variation in hospitals' direct admission rates was not explained by these factors. These findings suggest opportunities for diverse hospital types to develop the infrastructure and communication systems necessary to support pediatric direct admissions.
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Affiliation(s)
- JoAnna K. Leyenaar
- Section of Pediatric Hospital Medicine, Department of Pediatrics
& The Dartmouth Institute for Health Policy and Clinical Practice,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03766,Graduate Program in Clinical and Translational Science, Sackler
School of Graduate Biomedical Sciences, Tufts University, Boston, MA 02111,
USA
| | - Meng-Shiou Shieh
- Instititute for Healthcare Delivery and Population Science and
Department of Medicine, University of Massachusetts Medical School –
Baystate 3601 Main Street, Springfield, MA, 01199
| | - Tara Lagu
- Instititute for Healthcare Delivery and Population Science and
Department of Medicine, University of Massachusetts Medical School –
Baystate 3601 Main Street, Springfield, MA, 01199;,Department of Quantitative Health Sciences, University of
Massachusetts Medical School Worcester, MA
| | - Penelope S. Pekow
- School of Public Health and Health Sciences, University of
Massachusetts, 715 N. Pleasant St., Amherst, MA 01003
| | - Peter K. Lindenauer
- Instititute for Healthcare Delivery and Population Science and
Department of Medicine, University of Massachusetts Medical School –
Baystate 3601 Main Street, Springfield, MA, 01199;,Department of Quantitative Health Sciences, University of
Massachusetts Medical School Worcester, MA
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Holleck JL, Gunderson CG, Antony SM, Gupta S, Chang JJ, Merchant N, Lin S, Federman DG. The “Hand-in” Project: Jump-starting Communication Between Inpatient and Outpatient Providers. South Med J 2017; 110:694-698. [DOI: 10.14423/smj.0000000000000724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Solan LG, Sherman SN, DeBlasio D, Simmons JM. Communication Challenges: A Qualitative Look at the Relationship Between Pediatric Hospitalists and Primary Care Providers. Acad Pediatr 2016; 16:453-459. [PMID: 26979780 DOI: 10.1016/j.acap.2016.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/26/2016] [Accepted: 03/07/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Primary care providers (PCPs) and hospitalists endorse the importance of effective communication yet studies illustrate critical communication problems between these 2 provider types. Our objective was to develop deeper insight into the dimensions of and underlying reasons for communication issues and determine ways to improve communication and remove barriers by eliciting the perspectives of pediatric PCPs and hospitalists. METHODS Using qualitative methods, 2 sets of focus groups were held: 1) mix of local PCPs serving diverse populations, and 2) hospitalists from a free-standing, pediatric institution. The open-ended, semistructured question guides included questions about communication experiences, patient care responsibilities, and suggestions for improvement. Using inductive thematic analysis, investigators coded the transcripts, and resolved differences through consensus. RESULTS Six PCP (n = 27) and 3 hospitalist (n = 15) focus groups were held. Fifty-six percent of PCPs and 14% of hospitalists had been practicing for >10 years. Five major themes were identified: problematic aspects of communication, perceptions of provider roles, push-pull, postdischarge responsibilities/care, and proposed solutions. Aspects of communication included specific problem areas with verbal and written communication. Perceptions of provider roles highlighted the issue of PCPs feeling devalued. Push-pull described conflicting expectations about a counterpart's role and responsibilities. Postdischarge responsibilities/care addressed unclear responsibilities related to patient follow-up. Proposed solutions were suggested for ways to improve communication. CONCLUSIONS Deficiencies in communication hinder successful collaboration and can cause tension between providers in inpatient and outpatient settings. Understanding specific issues that contribute to poor communication like perceptions about provider roles is critical to improving relationships and facilitating combined efforts to improve patient care.
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Affiliation(s)
- Lauren G Solan
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | | | - Dominick DeBlasio
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeffrey M Simmons
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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