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Dowzicky PM, Shah AA, Barg FK, Eriksen WT, McHugh MD, Kelz RR. An Assessment of Patient, Caregiver, and Clinician Perspectives on the Post-discharge Phase of Care. Ann Surg 2021; 273:719-724. [PMID: 31356271 DOI: 10.1097/sla.0000000000003479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We sought to elicit patients', caregivers', and health care providers' perceptions of home recovery to inform care personalization in the learning health system. SUMMARY BACKGROUND DATA Postsurgical care has shifted from the hospital into the home. Daily care responsibilities fall to patients and their caregivers, yet stakeholder concerns in these heterogeneous environments, especially as they relate to racial inequities, are poorly understood. METHODS Surgical oncology patients, caregivers, and clinicians participated in freelisting; an open-ended interviewing technique used to identify essential elements of a domain. Within 2 weeks after discharge, participants were queried on 5 domains: home independence, social support, pain control, immediate, and overall surgical impact. Salience indices, measures of the most important words of interest, were calculated using Anthropac by domain and group. RESULTS Forty patients [20 whites and 20 African-Americans (AAs)], 30 caregivers (17 whites and 13 AAs), and 20 providers (8 residents, 4 nurses, 4 nurse practitioners, and 4 attending surgeons) were interviewed. Patients and caregivers attended to the personal recovery experience, whereas providers described activities and individuals associated with recovery. All groups defined surgery as life-changing, with providers and caregivers discussing financial and mortality concerns. Patients shared similar thoughts about social support and self-care ability by race, whereas AA patients described heterogeneous pain management and more hopeful recovery perceptions. AA caregivers expressed more positive responses than white caregivers. CONCLUSIONS Patients live the day-to-day of recovery, whereas caregivers and clinicians also contemplate more expansive concerns. Incorporating relevant perceptions into traditional clinical outcomes and concepts could enhance the surgical experience for all stakeholders.
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Affiliation(s)
- Phillip M Dowzicky
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Arnav A Shah
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Frances K Barg
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Whitney T Eriksen
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Rachel R Kelz
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Keddem S, Barg FK, Frasso R. Practical Guidance for Studies Using Freelisting Interviews. Prev Chronic Dis 2021. [DOI: 10.5888/pcd18.200355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Shimrit Keddem
- Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Frances K. Barg
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rosemary Frasso
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
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Keddem S, Barg FK, Frasso R. Practical Guidance for Studies Using Freelisting Interviews. Prev Chronic Dis 2021; 18:E04. [PMID: 33444525 PMCID: PMC7845553 DOI: 10.5888/pcd17.200355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Freelisting is a qualitative interviewing technique that has recently grown in popularity. It is an excellent tool for rapidly exploring how groups of people think about and define a particular health-related domain and is well suited for engaging communities and identifying shared priorities. In this article, we outline 7 practical considerations for conducting freelisting studies summarized from 16 articles conducted by the authors at the University of Pennsylvania and Thomas Jefferson University in partnership with community-based organizations and students. Our recommendations can inform study design, data collection, and data analysis for investigators who are interested in using freelisting interviews in their research.
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Affiliation(s)
- Shimrit Keddem
- Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.,Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Frances K Barg
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rosemary Frasso
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania.,College of Population Health, Thomas Jefferson University, 901 Walnut St,10th Floor, Philadelphia, PA 19107.
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Worsley D, Barrios E, Shuter M, Pettit AR, Doupnik SK. Adolescents' Experiences During "Boarding" Hospitalization While Awaiting Inpatient Psychiatric Treatment Following Suicidal Ideation or Suicide Attempt. Hosp Pediatr 2019; 9:827-833. [PMID: 31653656 PMCID: PMC7307268 DOI: 10.1542/hpeds.2019-0043] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Two million adolescents experience suicidal ideation (SI) or suicide attempt (SA) annually, and they frequently present to emergency departments. Delays in transfer to inpatient psychiatric units increasingly lead to "boarding" in emergency departments and inpatient medical units. We sought to understand adolescents' perspectives during boarding hospitalizations to gain insight into helpful practices and targets for improvement. METHODS Using convenience sampling, we conducted semistructured interviews with 27 adolescents hospitalized for SI or SA while they were awaiting transfer to an inpatient psychiatric facility. Interviews were recorded and transcribed, and the thematic analysis was organized using NVivo 11. RESULTS Eight themes emerged: (1) supportive clinical interactions, (2) information needs, (3) repetitive inquiries, (4) safety, (5) previous hospital experiences, (6) activities and boredom, (7) physical comfort, and (8) emotions. Adolescents expressed appreciation for compassionate clinicians and for receiving information about what to expect, experienced the hospital as a safe environment, emphasized the value of staying occupied and of physical comfort, and were relieved to be receiving help to reduce their suicidal thoughts or behaviors. Reports of embarrassment and discomfort about repeated inquiries from the clinical team, comparisons with previous hospital experiences, and unanswered questions about what would occur during the planned inpatient psychiatric hospitalization were common. CONCLUSIONS The perspectives of adolescents seeking care for SI or SA are an important source of information for health care systems seeking to improve hospital care. Clinicians can relieve distress of adolescents awaiting psychiatric hospitalization by focusing on compassionate connection, minimizing repeated inquiries, and providing complete and concrete information about treatment plans.
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Affiliation(s)
- Diana Worsley
- Center for Pediatric Clinical Effectiveness, PolicyLab, and Division of General Pediatrics and
| | - Emily Barrios
- Center for Pediatric Clinical Effectiveness, PolicyLab, and Division of General Pediatrics and
| | - Marie Shuter
- Department of Nursing, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | - Stephanie K Doupnik
- Center for Pediatric Clinical Effectiveness, PolicyLab, and Division of General Pediatrics and
- Leonard Davis Institute of Health Economics and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Samuels-Kalow ME, Rhodes KV, Henien M, Hardy E, Moore T, Wong F, Camargo CA, Rizzo CT, Mollen C. Development of a Patient-centered Outcome Measure for Emergency Department Asthma Patients. Acad Emerg Med 2017; 24:511-522. [PMID: 28146297 PMCID: PMC5426977 DOI: 10.1111/acem.13165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/26/2016] [Accepted: 01/14/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Measuring outcomes of emergency care is of key importance, but current metrics, such as 72-hour return visit rates, are subject to ascertainment bias, incentivize overtesting and overtreatment at initial visit, and do not reflect the full burden of disease and morbidity experienced at home following ED care. There is increasing emphasis on including patient-reported outcomes, but the existing patient-reported measures have limited applicability to emergency care. OBJECTIVE The objective was to identify concepts for inclusion in a patient-reported outcome measure for ED care and assess differences in potential concepts by health literacy. METHODS A three-phase qualitative study was completed using freelisting and semistructured interviewing for concept identification, member checking for concept ranking, and cognitive interviewing for question development. Participants were drawn from three tertiary care EDs. Parents of patients (pediatric) or patients (adult) with asthma completed a demographic survey and an assessment of health literacy. Phase 1 participants also completed a freelisting exercise and qualitative interview regarding the definition of success following ED discharge. Phase 2 participants completed a member checking survey based on concepts identified in Phase 1. Phase 3 was a pilot of trial questions based on the highest-ranked concepts from Phase 2. RESULTS Phase 1 enrolled 22 adult patients and 37 parents of pediatric patients. Phase 2 enrolled 41 adult patients and 200 parents. Phase 3 involved 15 parents. Across all demographic/literacy groups, Phase 1 participants reported return to usual activity and lack of asthma symptoms as the most important markers of success. In Phase 2, symptom improvement, medication use and access, and asthma knowledge were identified as the most important components of the definition of post-ED discharge success. Phase 3 resulted in five questions for the proposed measure. CONCLUSIONS A stepwise qualitative process can identify, rank, and formulate questions based on patient-identified concepts for inclusion in a patient-reported outcome measure for ED discharge. The four key concepts identified for inclusion: symptom improvement, medication access, correct medication use, and asthma knowledge are not measured by existing quality metrics.
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Affiliation(s)
| | - Karin V Rhodes
- Office of Population Health, Hofstra Northwell School of Medicine, Great Neck, NY
| | - Mira Henien
- Drexel University College of Medicine, Philadelphia, PA
| | - Emily Hardy
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Thomas Moore
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Caroline T Rizzo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Cynthia Mollen
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
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Auriemma CL, Lyon SM, Strelec LE, Kent S, Barg FK, Halpern SD. Defining the Medical Intensive Care Unit in the Words of Patients and Their Family Members: A Freelisting Analysis. Am J Crit Care 2015; 24:e47-55. [PMID: 26134339 DOI: 10.4037/ajcc2015717] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND No validated conceptual framework exists for understanding the outcomes of patient- and family-centered care in critical care. OBJECTIVE To explore the meaning of intensive care unit among patients and their families by using freelisting. METHODS The phrase intensive care unit was used to prompt freelisting among intensive care unit patients and patients' family members. Freelisting is an anthropological technique in which individuals define a domain by listing all words that come to mind in response to a topic. Salience scores, derived from the frequency with which a word was mentioned, the order in which it was mentioned, and the length of each list, were calculated and analyzed. RESULTS Among the 45 participants, many words were salient to both patients and patients' family members. Words salient solely for patients included consciousness, getting better, noisy, and personal care. Words salient solely for family members included sadness, busy, professional, and hope. The words suffering, busy, and team were salient solely for family members of patients who lived, whereas sadness, professionals, and hope were salient solely for family members of patients who died. The words caring and death were salient for both groups. CONCLUSIONS Intensive care unit patients and their families define intensive care unit by using words to describe sickness, caring, medical staff, emotional states, and physical qualities of the unit. The results validate the importance of these topics among patients and their families in the intensive care unit and illustrate the usefulness of freelisting in critical care research.
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Affiliation(s)
- Catherine L Auriemma
- Catherine L. Auriemma is a resident physician in internal medicine, University of California San Francisco and a research trainee with the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, University of Pennsylvania, Philadelphia. Sarah M. Lyon is an instructor of medicine in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pennsylvania Perelman School of Medicine. Lauren E. Strelec and Saida Kent are research assistants with the FIELDS Program, University of Pennsylvania. Frances K. Barg is an associate professor in the Department of Family Medicine and Community Health and the Department of Anthropology, University of Pennsylvania School of Arts and Sciences. Scott D. Halpern is director of the FIELDS Program and an associate professor in the Departments of Medicine, Epidemiology, and Medical Ethics and Health Policy, as well as senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania Perelman School of Medicine
| | - Sarah M Lyon
- Catherine L. Auriemma is a resident physician in internal medicine, University of California San Francisco and a research trainee with the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, University of Pennsylvania, Philadelphia. Sarah M. Lyon is an instructor of medicine in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pennsylvania Perelman School of Medicine. Lauren E. Strelec and Saida Kent are research assistants with the FIELDS Program, University of Pennsylvania. Frances K. Barg is an associate professor in the Department of Family Medicine and Community Health and the Department of Anthropology, University of Pennsylvania School of Arts and Sciences. Scott D. Halpern is director of the FIELDS Program and an associate professor in the Departments of Medicine, Epidemiology, and Medical Ethics and Health Policy, as well as senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania Perelman School of Medicine
| | - Lauren E Strelec
- Catherine L. Auriemma is a resident physician in internal medicine, University of California San Francisco and a research trainee with the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, University of Pennsylvania, Philadelphia. Sarah M. Lyon is an instructor of medicine in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pennsylvania Perelman School of Medicine. Lauren E. Strelec and Saida Kent are research assistants with the FIELDS Program, University of Pennsylvania. Frances K. Barg is an associate professor in the Department of Family Medicine and Community Health and the Department of Anthropology, University of Pennsylvania School of Arts and Sciences. Scott D. Halpern is director of the FIELDS Program and an associate professor in the Departments of Medicine, Epidemiology, and Medical Ethics and Health Policy, as well as senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania Perelman School of Medicine
| | - Saida Kent
- Catherine L. Auriemma is a resident physician in internal medicine, University of California San Francisco and a research trainee with the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, University of Pennsylvania, Philadelphia. Sarah M. Lyon is an instructor of medicine in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pennsylvania Perelman School of Medicine. Lauren E. Strelec and Saida Kent are research assistants with the FIELDS Program, University of Pennsylvania. Frances K. Barg is an associate professor in the Department of Family Medicine and Community Health and the Department of Anthropology, University of Pennsylvania School of Arts and Sciences. Scott D. Halpern is director of the FIELDS Program and an associate professor in the Departments of Medicine, Epidemiology, and Medical Ethics and Health Policy, as well as senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania Perelman School of Medicine
| | - Frances K Barg
- Catherine L. Auriemma is a resident physician in internal medicine, University of California San Francisco and a research trainee with the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, University of Pennsylvania, Philadelphia. Sarah M. Lyon is an instructor of medicine in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pennsylvania Perelman School of Medicine. Lauren E. Strelec and Saida Kent are research assistants with the FIELDS Program, University of Pennsylvania. Frances K. Barg is an associate professor in the Department of Family Medicine and Community Health and the Department of Anthropology, University of Pennsylvania School of Arts and Sciences. Scott D. Halpern is director of the FIELDS Program and an associate professor in the Departments of Medicine, Epidemiology, and Medical Ethics and Health Policy, as well as senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania Perelman School of Medicine
| | - Scott D Halpern
- Catherine L. Auriemma is a resident physician in internal medicine, University of California San Francisco and a research trainee with the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, University of Pennsylvania, Philadelphia. Sarah M. Lyon is an instructor of medicine in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pennsylvania Perelman School of Medicine. Lauren E. Strelec and Saida Kent are research assistants with the FIELDS Program, University of Pennsylvania. Frances K. Barg is an associate professor in the Department of Family Medicine and Community Health and the Department of Anthropology, University of Pennsylvania School of Arts and Sciences. Scott D. Halpern is director of the FIELDS Program and an associate professor in the Departments of Medicine, Epidemiology, and Medical Ethics and Health Policy, as well as senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania Perelman School of Medicine.
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Kaplanoglu M, Kaplanoglu D, Usman MG. Postpartum contraception in adolescents: data from a single tertiary clinic in southeast of Turkey. Glob J Health Sci 2014; 7:80-6. [PMID: 25716393 PMCID: PMC4796411 DOI: 10.5539/gjhs.v7n2p80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/04/2014] [Indexed: 12/03/2022] Open
Abstract
Aim: We aimed to evaluate the postpartum contraception preferences of adolescent women in this study. Material and Method: This descriptive study was prepared after a retrospective analysis of file records of primigravida women who had given birth at the Adiyaman University School of Medicine Training and Research Hospital Department of Obstetric and Gynecology between January 2010 and June 2012. More than 12 months had passed after birth. The adolescents who were included in the study and the control group women were called by phone and invited to our clinic. A total of 506 adolescents and 1,046 control group women came to the clinic and were evaluated. The control group was formed of women between the age of 20-35 years who gave given birth in our clinic during the same period and were randomly selected. Postpartum obstetric history, contraception methods and data of these patients were recorded. Results: The mean age was 18.3±0.4 years and 28.2±4.9 years in the adolescent group and control group respectively. No contraception other than lactation amenorrhea was used by 256 women of the adolescent group (50.6%) and 345 women of the control group (33%). The most commonly used contraceptive method in both groups other than lactation amenorrhea was condoms (160 women (64%) and 230 women (32.8%) respectively). The annual contraceptive failure rate was 3.95% in the adolescent group and 1.72% in the control group. The highest failure rate was with lactation amenorrhea in both groups. Discussion: Adolescent women mostly use contraceptive methods with low reliability such as lactation amenorrhea and the calendar method in the postpartum period. Providing adequate contraceptive education is therefore important. On the other hand, starting such training starting in the early postnatal period will prevent recurring adolescent pregnancies with a short pregnancy interval.
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