Knowledge management in the era of digital medicine: A programmatic approach to optimize patient care in an academic medical center

Conceptual framework for management or transmission of knowledge in companies: A systematic review

The literature on knowledge management as a broad area, typically studied under the scope of business management, and on knowledge transmission as a process, often studied under the scope of work psychology and ergonomics, although extensive, lacks a synthesis regarding the dimensions involved in knowledge management or transmission practices in workplaces. Thus, this study aims to systematize the existing programs for management or transmission of knowledge in workplaces and to develop a conceptual framework to support their design and implementation in this context. Thereto, the study resorts to the main scientific approaches that address knowledge management and knowledge transmission (business management and work psychology/ergonomics). The methodology followed a systematic review to identify and analyse the programs concerning the management or transmission of knowledge implemented in professional contexts, nearly from the beginning of the 21st century, considering the two scientific approaches. The analysis of the 28 articles shows what defines the implemented practices, their impact, and the role assumed by HR. The results demonstrate differences and similarities between the two approaches which guided the dimensions included in the conceptual framework. This study makes advances for both the scientific field, bringing different scientific discourses closer together by acknowledging their strengths; and for practitioners, through the possibility of improving the understanding of the application scope of the concepts of knowledge management and knowledge transmission, as well as supporting their action in workplaces.

How health systems facilitate patient-centered care and care coordination: a case series analysis to identify best practices

Large- and small-scale transformation of healthcare delivery toward improved patient experience through promotion of patient-centered and coordinated care continues to be at the forefront of health system efforts in the United States. As part of a Quality Improvement (QI) project at a large, midwestern health system, a case series of high-performing organizations was explored with the goal of identifying best practices in patient-centered care and/or care coordination (PCC/CC). Identification of best practices was done through rapid realist review of peer-reviewed literature supporting three PCC/CC interventions per case. Mechanisms responsible for successful intervention outcomes and associated institutional-level facilitators were evaluated, and cross-case analysis produced high-level focus items for health system leadership, including (1) institutional values surrounding PCC/CC, (2) optimization of IT infrastructure to enhance performance and communication, (3) pay structures and employment models that enhance accountability, and (4) organizing bodies to support implementation efforts. Health systems may use this review to gain insight into how institutional-level factors may facilitate small-scale PCC/CC behaviors, or to conduct similar assessments in their own QI projects. Based on our analysis, we recommend health systems seeking to improve PCC/CC at any level or scale to evaluate how IT infrastructure affects provider-provider and provider-patient communication, and the extent to which institutional prioritization of PCC/CC is manifest and held accountable in performance feedback, incentivization, and values shared among departments and settings. Ideally, this evaluation work should be performed and/or supported by cross-department organizing bodies specifically devoted to PCC/CC implementation work.

Hands-On Workshops Improve Emergency Department Physicians' Self-Reported Understanding of Pediatric Hand Injuries

OBJECTIVES

The aims of this study were to assess emergency department (ED) physician perception of hand injuries and improve their understanding and confidence in treating these injuries.

METHODS

Combined didactic and hands-on workshops for ED physicians were developed and run by a team of medical students, plastic surgeons, and ED physicians. The workshops consisted of a short review by a hand surgeon followed by hands-on sessions involving radiograph assessment, administration of local anesthetic, closed reduction, and splinting. Two sessions, 6 months apart, were provided. The workshops were evaluated using preworkshop and postworkshop questionnaires to assess the following domains: confidence and competence in treating hand injuries, knowledge of basic hand injury care, and feedback on the intervention itself.

RESULTS

Fifty physicians participated in the workshops. After the workshops, physician recognition of hand fracture reduction as a critical skill increased. Self-efficacy ratings of fracture assessment, administration of local anesthetic, performing a reduction, and applying postreduction immobilization increased. Median scores on knowledge-testing questions also increased postintervention from 73.3% (95% confidence interval, 70.2-78.5) to 86.7% (95% confidence interval, 79.3-86.2) (P < 0.05). Finally, physicians reported that they found the intervention educational, useful, and important, and approximately 90% of participants indicated they intended to change their practice based on this intervention.

CONCLUSIONS

Knowledge sharing between specialists and generalists through combined didactic and hands-on workshops is an effective and well-received method of refining physician knowledge and increasing confidence in treating subspecialty-specific clinical presentations.

Developing an Ophthalmology Clinical Decision Support System to Identify Patients for Low Vision Rehabilitation

Purpose

The purpose of this study was to develop and evaluate an electronic health record (EHR) clinical decision support system to identify patients meeting criteria for low vision rehabilitation (LVR) referral.

Methods

In this quality improvement project, we applied a user-centered design approach to develop an interactive electronic alert for LVR referral within the Johns Hopkins Wilmer Eye Institute. We invited 15 ophthalmology physicians from 8 subspecialties to participate in the design and implementation, and to provide user experience feedback. The three project phases incorporated development evaluation, feedback analysis, and system refinement. We report on the final alert design, firing accuracy, and user experiences.

Results

The alert was designed as physician-centered and patient-specific. Alert firing relied on visual acuity and International Classification of Diseases (ICD)-10 diagnosis (hemianopia/quadrantanopia) criteria. The alert suppression considerations included age < 5 years, recent surgeries, prior LVR visit, and related alert actions. False positive rate (firing when alert should have been suppressed or when firing criteria not met) was 0.2%. The overall false negative rate (alert not firing when visual acuity or encounter diagnosis criteria met) was 5.6%. Of the 13 physicians who completed the survey, 8 agreed that the alert is easy to use, and 12 would consider ongoing usage.

Conclusions

This EHR-based clinical decision support system shows reliable firing metrics in identifying patients with vision impairment and promising acceptance by ophthalmologist users to facilitate care and LVR referral.

Translational Relevance

The use of real-time data offers an opportunity to translate ophthalmic guidelines and best practices into systematic action for clinical care and research purposes across subspecialties.

An Examination of the Statistical Laws of Semantic Change in Clinical Notes

Natural language is continually changing. Given the prevalence of unstructured, free-text clinical notes in the healthcare domain, understanding the aspects of this change is of critical importance to clinical Natural Language Processing (NLP) systems. In this study, we examine two previously described semantic change laws based on word frequency and polysemy, and analyze how they apply to the clinical domain. We also explore a new facet of change: whether domain-specific clinical terms exhibit different change patterns compared to general-purpose English. Using a corpus spanning eighteen years of clinical notes, we find that the previously described laws of semantic change hold for our data set. We also find that domain-specific biomedical terms change faster compared to general English words.

Mind the Gap: Putting Evidence into Practice in the Era of Learning Health Systems

Due to the increasing amount of available published evidence and the continual need to apply and update evidence in practice, we propose a shift in the way evidence generated by learning health systems can be integrated into more traditional evidence reviews. This paper discusses two main mechanisms to close the evidence-to-practice gap: (1) integrating Learning Health System (LHS) results with existing systematic review evidence and (2) providing this combined evidence in a standardized, computable data format. We believe these efforts will better inform practice, thereby improving individual and population health.