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Loo JCY, Boot E, Corral M, Bassett AS. Personalized medical information card for adults with 22q11.2 deletion syndrome: An initiative to improve communication between patients and healthcare providers. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1534-1540. [PMID: 32407568 DOI: 10.1111/jar.12747] [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: 09/13/2019] [Revised: 03/02/2020] [Accepted: 04/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many individuals with intellectual disabilities and their caregivers struggle to provide accurate and complete information to healthcare providers. METHOD The present authors provided personal medical information cards (PMICs) containing contact and medical information to 52 Canadian adults with 22q11.2 deletion syndrome, a genetic condition associated with intellectual disability. The authors invited them and/or their caregivers to complete a user satisfaction survey concerning usage of the card. RESULTS Forty-eight (92%) patients or their caregivers completed the survey. Twenty-two (46%) respondents used the PMIC over a median of 8 months during encounters with doctors and other professionals, and a majority of these used it more than once. Users reported finding the PMIC "very helpful" (86%) or "helpful" (14%), providing necessary information, speeding up interactions with professionals and helping avoid repeat storytelling. CONCLUSION Providing a PMIC to individuals with intellectual disabilities and their caregivers could help improve patient safety and assist in advocacy.
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Affiliation(s)
- Joanne C Y Loo
- The Dalglish Family 22q Clinic, Toronto General Hospital, Toronto, ON, Canada
| | - Erik Boot
- The Dalglish Family 22q Clinic, Toronto General Hospital, Toronto, ON, Canada.,'s Heeren Loo Zorggroep, Amersfoort, The Netherlands
| | - Maria Corral
- The Dalglish Family 22q Clinic, Toronto General Hospital, Toronto, ON, Canada.,Department of Psychiatry, University Health Network, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Anne S Bassett
- The Dalglish Family 22q Clinic, Toronto General Hospital, Toronto, ON, Canada.,Department of Psychiatry, University Health Network, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Division of Cardiology, Toronto Congenital Cardiac Centre for Adults at the Peter Munk Cardiac Centre, Department of Medicine, and Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
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Sheaff R, Halliday J, Byng R, Øvretveit J, Exworthy M, Peckham S, Asthana S. Bridging the discursive gap between lay and medical discourse in care coordination. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:1019-1034. [PMID: 28349619 DOI: 10.1111/1467-9566.12553] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
For older people with multiple chronic co-morbidities, strategies to coordinate care depend heavily on information exchange. We analyse the information-sharing difficulties arising from differences between patients' oral narratives and medical sense-making; and whether a modified form of 'narrative medicine' might mitigate them. We systematically compared 66 general practice patients' own narratives of their health problems and care with the contents of their clinical records. Data were collected in England during 2012-13. Patients' narratives differed from the accounts in their medical record, especially the summary, regarding mobility, falls, mental health, physical frailty and its consequences for accessing care. Parts of patients' viewpoints were never formally encoded, parts were lost when clinicians de-coded it, parts supplemented, and sometimes the whole narrative was re-framed. These discrepancies appeared to restrict the patient record's utility even for GPs for the purposes of risk stratification, case management, knowing what other care-givers were doing, and coordinating care. The findings suggest combining the encoding/decoding theory of communication with inter-subjectivity and intentionality theories as sequential, complementary elements of an explanation of how patients communicate with clinicians. A revised form of narrative medicine might mitigate the discursive gap and its consequences for care coordination.
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Affiliation(s)
- Rod Sheaff
- School of Government, Plymouth University, UK
| | | | - Richard Byng
- School of Medicine and Dentistry, Plymouth University, UK
| | | | - Mark Exworthy
- Health Services Management Centre, University of Birmingham, UK
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Samal L, Dykes PC, Greenberg JO, Hasan O, Venkatesh AK, Volk LA, Bates DW. Care coordination gaps due to lack of interoperability in the United States: a qualitative study and literature review. BMC Health Serv Res 2016; 16:143. [PMID: 27106509 PMCID: PMC4841960 DOI: 10.1186/s12913-016-1373-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/01/2016] [Indexed: 12/22/2022] Open
Abstract
Background Health information technology (HIT) could improve care coordination by providing clinicians remote access to information, improving legibility, and allowing asynchronous communication, among other mechanisms. We sought to determine, from a clinician perspective, how care is coordinated and to what extent HIT is involved when transitioning patients between emergency departments, acute care hospitals, skilled nursing facilities, and home health agencies in settings across the United States. Methods We performed a qualitative study with clinicians and information technology professionals from six regions of the U.S. which were chosen as national leaders in HIT. We analyzed data through a two person consensus approach, assigning responses to each of nine care coordination activities. We also conducted a literature review of MEDLINE®, CINAHL®, and Embase, analyzing results of studies that examined interventions to improve information transfer during transitions of care. Results We enrolled 29 respondents from 17 organizations and conducted six focus groups. Respondents reported how HIT is currently used for care coordination activities. HIT is currently used to monitor patients and to align systems-level resources with population needs. However, we identified multiple areas where the lack of interoperability leads to inefficient processes and missing data. Additionally, the literature review identified ten intervention studies that address information transfer, seven of which employed HIT and three of which utilized other communication methods such as telephone calls, faxed records, and nurse case management. Conclusions Significant care coordination gaps exist due to the lack of interoperability across the United States. We must design, evaluate, and incentivize the use of HIT for care coordination. We should focus on the domains where we found the largest gaps: information transfer, systems to monitor patients, tools to support patients’ self-management goals, and tools to link patients and their caregivers with community resources. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1373-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lipika Samal
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St., Suite OBC-03-02V, Boston, MA, 02120, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Patricia C Dykes
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St., Suite OBC-03-02V, Boston, MA, 02120, USA.,Harvard Medical School, Boston, MA, USA
| | - Jeffrey O Greenberg
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St., Suite OBC-03-02V, Boston, MA, 02120, USA.,Harvard Medical School, Boston, MA, USA
| | - Omar Hasan
- American Medical Association, Chicago, IL, USA
| | | | | | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St., Suite OBC-03-02V, Boston, MA, 02120, USA.,Harvard Medical School, Boston, MA, USA.,Partners Healthcare System, Boston, MA, USA
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Vaks Y, Bensen R, Steidtmann D, Wang TD, Platchek TS, Zulman DM, Malcolm E, Milstein A. Better health, less spending: Redesigning the transition from pediatric to adult healthcare for youth with chronic illness. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2016; 4:57-68. [PMID: 27001100 PMCID: PMC4805882 DOI: 10.1016/j.hjdsi.2015.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 01/18/2023]
Abstract
Adolescents and young adults (AYA) with serious chronic illnesses face costly and dangerous gaps in care as they transition from pediatric to adult health systems. New, financially sustainable approaches to transition are needed to close these gaps. We designed a new transition model for adolescents and young adults with a variety of serious chronic conditions. Our explicit goal was to build a model that would improve the value of care for youth 15-25 years of age undergoing this transition. The design process incorporated a review, analysis, and synthesis of relevant clinical and health services research; stakeholder interviews; and observations of high-performing healthcare systems. We identified three major categories of solutions for a safer and lower cost transition to adult care: (1) building and supporting self-management during the critical transition; (2) engaging receiving care; and (3) providing checklist-driven guide services during the transition. We propose that implementation of a program with these interventions would have a positive impact on all three domains of the triple aim - improving health, improving the experience of care, and reducing per capita healthcare cost. The transition model provides a general framework as well as suggestions for specific interventions. Pilot tests to assess the model's ease of implementation, clinical effects, and financial impact are currently underway.
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Affiliation(s)
- Yana Vaks
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Loma Linda University Children's Hospital, United States.
| | - Rachel Bensen
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Stanford University School of Medicine, United States
| | - Dana Steidtmann
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Family Medicine, University of Colorado School of Medicine, United States
| | - Thomas D Wang
- Clinical Excellence Research Center, Stanford University School of Medicine, United States
| | - Terry S Platchek
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Stanford University School of Medicine, United States
| | - Donna M Zulman
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Division of General Medical Disciplines, Stanford University School of Medicine, United States; Center for Innovation to Implementation, VA Palo Alto Health Care System, United States
| | - Elizabeth Malcolm
- Clinical Excellence Research Center, Stanford University School of Medicine, United States
| | - Arnold Milstein
- Clinical Excellence Research Center, Stanford University School of Medicine, United States
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Medical History of Elderly Patients in the Emergency Setting: Not an Easy Point-of-Care Diagnostic Marker. Emerg Med Int 2015; 2015:490947. [PMID: 26421190 PMCID: PMC4573427 DOI: 10.1155/2015/490947] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/24/2015] [Indexed: 11/17/2022] Open
Abstract
Background. Medical histories are a crucially important diagnostic tool. Elderly patients represent a large and increasing group of emergency patients. Due to cognitive deficits, taking a reliable medical history in this patient group can be difficult. We sought to evaluate the medical history-taking in emergency patients above 75 years of age with respect to duration and completeness. Methods. Anonymous data of consecutive patients were recorded. Times for the defined basic medical history-taking were documented, as were the availability of other sources and times to assess these. Results. Data of 104 patients were included in the analysis. In a quarter of patients (25%, n = 26) no complete basic medical history could be obtained. In the group of patients where complete data could be gathered, only 16 patients were able to provide all necessary information on their own. Including other sources like relatives or GPs prolonged the time until complete medical history from 7.3 minutes (patient only) to 26.4 (+relatives) and 56.3 (+GP) minutes. Conclusions. Medical histories are important diagnostic tools in the emergency setting and are prolonged in the elderly, especially if additional documentation and third parties need to be involved. New technologies like emergency medical cards might help to improve the availability of important patient data but implementation of these technologies is costly and faces data protection issues.
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Ben-Assuli O, Leshno M. Using Electronic Medical Records in Admission Decisions: A Cost Effectiveness Analysis. DECISION SCIENCES 2013. [DOI: 10.1111/deci.12018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ofir Ben-Assuli
- Faculty of Business Administration, Ono Academic College & Faculty of Management; Tel-Aviv University; 104 Zahal Street; Kiryat Ono; Israel
| | - Moshe Leshno
- Faculty of Management & Faculty of Medicine; Tel-Aviv University; P.O. Box 39040; Tel Aviv 69978; Israel
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Ben-Assuli O, Shabtai I, Leshno M. The impact of EHR and HIE on reducing avoidable admissions: controlling main differential diagnoses. BMC Med Inform Decis Mak 2013; 13:49. [PMID: 23594488 PMCID: PMC3651728 DOI: 10.1186/1472-6947-13-49] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 02/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many medical organizations have invested heavily in electronic health record (EHR) and health information exchange (HIE) information systems (IS) to improve medical decision-making and increase efficiency. Despite the potential interoperability advantages of such IS, physicians do not always immediately consult electronic health information, and this decision may result in decreased level of quality of care as well as unnecessary costs. This study sought to reveal the effect of EHR IS use on the physicians' admission decisions. It was hypothesizing the using EHR IS will result in more accurate and informed admission decisions, which will manifest through reduction in single-day admissions and in readmissions within seven days. METHODS This study used a track log-file analysis of a database containing 281,750 emergency department (ED) referrals in seven main hospitals in Israel. Log-files were generated by the system and provide an objective and unbiased measure of system usage, Thus allowing us to evaluate the contribution of an EHR IS, as well as an HIE network, to decision-makers (physicians). This is done by investigating whether EHR IS lead to improved medical outcomes in the EDs, which are known for their tight time constraints and overcrowding. The impact of EHR IS and HIE network was evaluated by comparing decisions on patients classified by five main differential diagnoses (DDs), made with or without viewing the patients' medical history via the EHR IS. RESULTS The results indicate a negative relationship between viewing medical history via EHR systems and the number of possibly redundant admissions. Among the DDs, we found information viewed most impactful for gastroenteritis, abdominal pain, and urinary tract infection in reducing readmissions within seven days, and for gastroenteritis, abdominal pain, and chest pain in reducing the single-day admissions' rate. Both indices are key quality measures in the health system. In addition, we found that interoperability (using external information provided online by health suppliers) contributed more to this reduction than local files, which are available only in the specific hospital. Thus, reducing the rate of redundant admissions by using external information produced larger odds ratios (of the β coefficients; e.g. viewing external information on patients resulted in negative associations of 27.2% regarding readmissions within seven days, and 13% for single-day admissions as compared with viewing local information on patients respectively). CONCLUSIONS Viewing medical history via an EHR IS and using HIE network led to a reduction in the number of seven day readmissions and single-day admissions for all patients. Using external medical history may imply a more thorough patient examination that can help eliminate unnecessary admissions. Nevertheless, in most instances physicians did not view medical history at all, probably due to the limited resources available, combined with the stress of rapid turnover in ED units.
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Affiliation(s)
- Ofir Ben-Assuli
- Faculty of Business Administration, Ono Academic College, Zahal Street, Kiryat Ono, IL, Israel.
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Ben‐Assuli O, Leshno M. Efficient use of medical IS: diagnosing chest pain. JOURNAL OF ENTERPRISE INFORMATION MANAGEMENT 2012. [DOI: 10.1108/17410391211245865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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