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Lehan E, Briand P, O’Brien E, Hafeez AA, Mulder DJ. Synergistic patient factors are driving recent increased pediatric urgent care demand. PLOS DIGITAL HEALTH 2024; 3:e0000572. [PMID: 39172742 PMCID: PMC11340883 DOI: 10.1371/journal.pdig.0000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/04/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES We aimed to use the high fidelity urgent care patient data to model the factors that have led to the increased demand at our local pediatric urgent care centre. METHODS The dataset for this retrospective cohort study was obtained from our local healthcare centre's national reporting data for pediatric urgent care visits from 2006 to 2022. Variables analyzed included: basic patient demographics, chief complaint, triage urgency, date and time of registration/discharge, discharge diagnosis, and discharge destination. Statistical analysis of non-linear trends was summarized by locally estimated scatterplot smoothing splines. For machine learning, we used the tidymodels R package. Models were validated in training using k-fold cross validation with k = 5. We used univariate linear regression as a baseline model. After the data was standardized, correlation and homoscedasticity were evaluated between all parameter permutations. RESULTS This dataset consisted of 164,660 unique visits to our academic centre's pediatric urgent care. Over the study period, there was an overall substantial increase in the number of urgent care visits per day, with a rapid increase beyond previous levels in 2021 and further in 2022. The increased length of stay trend was consistent across presenting complaint categories. The proportion of patients without primary care in 2022 was 2.5 times higher than in 2013. A random forest machine learning model revealed the relative importance of features to predicting a visit in 2022 were: longer stay, later registration in the day, diagnosis of an infectious illness, and younger age. CONCLUSIONS This study identified a combination of declining primary care access, circulating viral infections, and shifting chief complaints as factors driving the recent increase in frequency and duration of visits to our urgent care service.
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Affiliation(s)
- Emily Lehan
- Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada
| | - Peyton Briand
- Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Department of Medicine, Gastrointestinal Diseases Research Unit, Queen’s University, Kingston, Ontario, Canada
| | - Eileen O’Brien
- Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Department of Medicine, Gastrointestinal Diseases Research Unit, Queen’s University, Kingston, Ontario, Canada
| | | | - Daniel J. Mulder
- Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Department of Medicine, Gastrointestinal Diseases Research Unit, Queen’s University, Kingston, Ontario, Canada
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Scichilone N, Whittamore A, White C, Nudo E, Savella M, Lombardini M. The patient journey in Chronic Obstructive Pulmonary Disease (COPD): a human factors qualitative international study to understand the needs of people living with COPD. BMC Pulm Med 2023; 23:506. [PMID: 38093262 PMCID: PMC10720133 DOI: 10.1186/s12890-023-02796-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common condition that causes irreversible airway obstruction. Fatigue and exertional dyspnoea, for example, have a detrimental impact on the patient's daily life. Current research has revealed the need to empower the patient, which can result in not only educated and effective decision-making, but also a considerable improvement in patient satisfaction and treatment compliance. The current study aimed to investigate the perspectives and requirements of people living with COPD to possibly explore new ways to manage their disease. METHODS Adults with COPD from 8 European countries were interviewed by human factor experts to evaluate their disease journey through the gathering of information on the age, performance, length, and impact of diagnosis, symptoms progression, and family and friends' reactions. The assessment of present symptoms, services, and challenges was performed through a 90-min semi-structured interview. To identify possible unmet needs of participants, a generic thematic method was used to explore patterns, themes, linkages, and sequences within the data collected. Flow charts and diagrams were created to communicate the primary findings. Following analysis, the data was consolidated into cohesive insights and conversation themes relevant to determining the patient's unmet needs. RESULTS The 62, who voluntarily accepted to be interviewed, were patients (61% females, aged 32-70 years) with a COPD diagnosis for at least 6 months with stable symptoms of different severity. The main challenges expressed by the patients were the impact on their lifestyle, reduced physical activity, and issues with their mobility. About one-fourth had challenges with their symptoms or medication including difficulty in breathing. Beyond finding a cure for COPD was the primary goal for patients, their main needs were to receive adequate information on the disease and treatments, and to have adequate support to improve physical activity and mobility, helpful both for patients and their families. CONCLUSIONS These results could aid in the creation of new ideas and concepts to improve our patient's quality of life, encouraging a holistic approach to people living with COPD and reinforcing the commitment to understanding their needs.
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Affiliation(s)
- Nicola Scichilone
- Division of Respiratory Medicine, Department PROMISE, "Giaccone" University Hospital, University of Palermo, Palermo, Italy.
| | | | | | - Elena Nudo
- Chiesi Farmaceutici S.P.A, Via Paradigna 131/A - 43122, Parma, Italy
| | - Massimo Savella
- Chiesi Farmaceutici S.P.A, Via Paradigna 131/A - 43122, Parma, Italy
| | - Marta Lombardini
- Chiesi Farmaceutici S.P.A, Via Paradigna 131/A - 43122, Parma, Italy
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Chen W, Flanagan A, Nippak PM, Nicin M, Sinha SK. Understanding the Experience of Geriatric Care Professionals in Using Telemedicine to Care for Older Patients in Response to the COVID-19 Pandemic: A Mixed-Methods Study. JMIR Aging 2022; 5:e34952. [PMID: 35830331 PMCID: PMC9369613 DOI: 10.2196/34952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Geriatric care professionals were forced to rapidly adopt the use of telemedicine technologies to ensure the continuity of care for their older patients in response to the COVID-19 pandemic. However, there is little current literature that describes how telemedicine technologies can best be used to meet the needs of geriatric care professionals in providing care to frail older patients, their caregivers, and their families. Objective This study aims to identify the benefits and challenges geriatric care professionals face when using telemedicine technologies with frail older patients, their caregivers, and their families and how to maximize the benefits of this method of providing care. Methods This was a mixed methods study that recruited geriatric care professionals to complete an online survey regarding their personal demographics and experiences with using telemedicine technologies and participate in a semistructured interview. Interview responses were analyzed using the Consolidated Framework for Implementation Research (CFIR). Results Quantitative and qualitative data were obtained from 30 practicing geriatric care professionals (22, 73%, geriatricians, 5, 17%, geriatric psychiatrists, and 3, 10%, geriatric nurse practitioners) recruited from across the Greater Toronto Area. Analysis of interview data identified 5 CFIR contextual barriers (complexity, design quality and packaging, patient needs and resources, readiness for implementation, and culture) and 13 CFIR contextual facilitators (relative advantage, adaptability, tension for change, available resources, access to knowledge, networks and communications, compatibility, knowledge and beliefs, self-efficacy, champions, external agents, executing, and reflecting and evaluating). The CFIR concept of external policy and incentives was found to be a neutral construct. Conclusions This is the first known study to use the CFIR to develop a comprehensive narrative to characterize the experiences of Ontario geriatric care professionals using telemedicine technologies in providing care. Overall, telemedicine can significantly enable most of the geriatric care that is traditionally provided in person but is less useful in providing specific aspects of geriatric care to frail older patients, their caregivers, and their families.
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Affiliation(s)
- Wenwen Chen
- School of Health Services Management, Ted Rogers School of Management, Toronto Metropolitan University, TRS 2-068350 Victoria Street, Toronto, CA
| | - Ashley Flanagan
- National Institute on Ageing, Toronto Metropolitan University, Toronto, CA
| | - Pria Md Nippak
- School of Health Services Management, Ted Rogers School of Management, Toronto Metropolitan University, TRS 2-068350 Victoria Street, Toronto, CA
| | - Michael Nicin
- National Institute on Ageing, Toronto Metropolitan University, Toronto, CA
| | - Samir K Sinha
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, CA.,National Institute on Ageing, Toronto Metropolitan University, Toronto, CA
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Appelbaum L, Kaplan ID, Palchuk MB, Kundrot S, Winer-Jones JP, Rinard M. Development and Experience with Cancer Risk Prediction Models Using Federated Databases and Electronic Health Records. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-federated-databases] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gartner JB, Abasse KS, Bergeron F, Landa P, Lemaire C, Côté A. Definition and conceptualization of the patient-centered care pathway, a proposed integrative framework for consensus: a Concept analysis and systematic review. BMC Health Serv Res 2022; 22:558. [PMID: 35473632 PMCID: PMC9040248 DOI: 10.1186/s12913-022-07960-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/13/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Confusion exists over the definition of the care pathway concept and existing conceptual frameworks contain various inadequacies which have led to implementation difficulties. In the current global context of rapidly changing health care systems, there is great need for a standardized definition and integrative framework that can guide implementation. This study aims to propose an accurate and up-to-date definition of care pathway and an integrative conceptual framework. METHODS An innovative hybrid method combining systematic review, concept analysis and bibliometric analysis was undertaken to summarize qualitative, quantitative, and mixed-method studies. Databases searched were PubMed, Embase and ABI/Inform. Methodological quality of included studies was then assessed. RESULTS Forty-four studies met the inclusion criteria. Using concept analysis, we developed a fine-grained understanding, an integrative conceptual framework, and an up-to-date definition of patient-centered care pathway by proposing 28 subcategories grouped into seven attributes. This conceptual framework considers both operational and social realities and supports the improvement and sustainable transformation of clinical, administrative, and organizational practices for the benefit of patients and caregivers, while considering professional experience, organizational constraints, and social dynamics. The proposed attributes of a fluid and effective pathway are (i) the centricity of patients and caregivers, (ii) the positioning of professional actors involved in the care pathway, (iii) the operation management through the care delivery process, (iv) the particularities of coordination structures, (v) the structural context of the system and organizations, (vi) the role of the information system and data management and (vii) the advent of the learning system. Antecedents are presented as key success factors of pathway implementation. By using the consequences and empirical referents, such as outcomes and evidence of care pathway interventions, we went beyond the single theoretical aim, proposing the application of the conceptual framework to healthcare management. CONCLUSIONS This study has developed an up-to-date definition of patient-centered care pathway and an integrative conceptual framework. Our framework encompasses 28 subcategories grouped into seven attributes that should be considered in complex care pathway intervention. The formulation of these attributes, antecedents as success factors and consequences as potential outcomes, allows the operationalization of this model for any pathway in any context.
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Affiliation(s)
- Jean-Baptiste Gartner
- Département de management, Faculté des sciences de l'administration, Université Laval, 2325 rue de la Terrasse, Québec, QC, G1V 0A6, Canada.
- Centre de recherche en gestion des services de santé, Université Laval, Québec, QC, Canada.
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada.
- Centre de recherche du CISSS de Chaudière-Appalaches, Québec, QC, Canada.
- VITAM, Centre de recherche en santé durable, Université Laval, Québec, QC, Canada.
| | - Kassim Said Abasse
- Département de management, Faculté des sciences de l'administration, Université Laval, 2325 rue de la Terrasse, Québec, QC, G1V 0A6, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
- VITAM, Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
| | - Frédéric Bergeron
- Bibliothèque-Direction des services-conseils, Université Laval, Québec, QC, Canada
| | - Paolo Landa
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
- Département d'opérations et systèmes de décision, Université Laval, Québec, QC, Canada
| | - Célia Lemaire
- Université de Strasbourg, EM Strasbourg-Business School, HuManiS, Strasbourg, France
| | - André Côté
- Département de management, Faculté des sciences de l'administration, Université Laval, 2325 rue de la Terrasse, Québec, QC, G1V 0A6, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Québec, QC, Canada
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
- Centre de recherche du CISSS de Chaudière-Appalaches, Québec, QC, Canada
- VITAM, Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
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Inefficiencies of Electronic Medical Record Use by Surgical Healthcare Providers. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Palojoki S, Saranto K, Reponen E, Skants N, Vakkuri A, Vuokko R. Classification of Electronic Health Record-Related Patient Safety Incidents: Development and Validation Study. JMIR Med Inform 2021; 9:e30470. [PMID: 34245558 PMCID: PMC8441612 DOI: 10.2196/30470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/10/2021] [Accepted: 07/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background It is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical health care system, but no international consensus exists on a standardized format for enhancing the collection, analysis, and interpretation of technology-induced errors. Objective This study aims to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). It also aims to validate the classification by using a data set of incidents during a 6-month period immediately after the implementation of a new EHR system. Methods The starting point of the classification development was the Finnish Technology-Induced Error Risk Assessment Scale tool, based on research on commonly recognized error types. A multiprofessional research team used iterative tests on consensus building to develop a classification system. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system and also to evaluate this classification’s characteristics and applicability for reporting incidents. Interrater agreement was applied. Results The number of EHR-related patient safety incidents during the implementation period (n=501) was five-fold when compared with the preimplementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for reporting patient safety incidents in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 (22.5%) incident reports, usability problems for 73 (17.1%), documentation problems for 60 (14.1%), and clinical workflow problems for 33 (7.7%). Altogether, 20.8% (89/427) of reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 14.8% (74/501) of reports of the original sample were rejected because of insufficient information, even though the reports were deemed to be related to EHRs. The interrater agreement during the blinded review was 97.7%. Conclusions This study presents a new classification for EHR-related patient safety incidents applicable to mature EHRs. The number of EHR-related patient safety incidents during the implementation period may reflect patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with the EHR development cycle.
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Affiliation(s)
- Sari Palojoki
- Department of Steering of Healthcare and Social Welfare, Ministry of Social Affairs and Health, Helsinki, Finland.,Department of Anesthesiology, Intensive Care and Pain Medicine, Peijas Hospital, Helsinki University Hospital, Vantaa, Finland
| | - Kaija Saranto
- Faculty of Social Sciences and Business Studies, University of Eastern Finland, Kuopio, Finland
| | - Elina Reponen
- Department of Anesthesiology, Intensive Care and Pain Medicine, Peijas Hospital, Helsinki University Hospital, Vantaa, Finland
| | - Noora Skants
- Department of Anesthesiology, Intensive Care and Pain Medicine, Peijas Hospital, Helsinki University Hospital, Vantaa, Finland
| | - Anne Vakkuri
- Department of Anesthesiology, Intensive Care and Pain Medicine, Peijas Hospital, Helsinki University Hospital, Vantaa, Finland
| | - Riikka Vuokko
- Department of Steering of Healthcare and Social Welfare, Ministry of Social Affairs and Health, Helsinki, Finland
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