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Rayan-Gharra N, Shadmi E, Tadmor B, Flaks-Manov N, Balicer RD. Patients' ratings of the in-hospital discharge briefing and post-discharge primary care follow-up: The association with 30-day readmissions. PATIENT EDUCATION AND COUNSELING 2019; 102:1513-1519. [PMID: 30987768 DOI: 10.1016/j.pec.2019.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE We examined whether patients' ratings of their in-hospital discharge briefing and their post-discharge Primary Care Physicians' (PCP) review of the discharge summary are associated with 30-day readmissions. METHODS A prospective study of 594 internal-medicine patients at a tertiary medical-center in Israel. The in-hospital baseline questionnaire included sociodemographic characteristics, physical, mental, and functional health status. Patients were surveyed by phone about the discharge and post-discharge processes. Clinical data and health-service use was retrieved from a central data-warehouse. Multivariate regressions modeled the relationship between in-hospital baseline characteristics, discharge briefing, PCP visit indicator, the PCP discharge summary review, and 30-day readmissions. RESULTS The extent of the PCPs' review of the hospital discharge summary at the post-discharge visit was rated higher than the in-hospital discharge briefing (3.46 vs. 3.17, p = 0.001) and was associated with lower odds of readmission (OR=0.35, 95% CI 0.26-0.45). The model that included this assessment performed better than the in-hospital baseline, the in-hospital discharge-briefing, and the PCP visit models (C-statistic = 0.87, compared with: 0.70, 0.81, 0.81, respectively). CONCLUSIONS Providing extensive post-discharge explanations by PCPs serves as a significant protective factor against readmissions. PRACTICE IMPLICATIONS PCPs should be encouraged to thoroughly review the discharge summary letter with the patient.
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Affiliation(s)
- Nosaiba Rayan-Gharra
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; The Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | | | | | - Ran D Balicer
- The Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
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Aelbrecht K, Hanssens L, Detollenaere J, Willems S, Deveugele M, Pype P. Determinants of physician-patient communication: The role of language, education and ethnicity. PATIENT EDUCATION AND COUNSELING 2019; 102:776-781. [PMID: 30527850 DOI: 10.1016/j.pec.2018.11.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 11/05/2018] [Accepted: 11/09/2018] [Indexed: 06/09/2023]
Abstract
AIM The value of patient-centredness, of which effective physician-patient communication is one key element, has been established within medicine. However, research shows social differences in medical communication according to the patient's social background. This study examines the role of the patient's ethnicity, educational background and language proficiency in relation to physician-patient interaction in 31 countries. METHOD More than fifty thousand patients were given a standardized questionnaire to gain insights into the professional behaviour of their family physician and their own expectations and actions. RESULTS While no effect of ethnicity was found, there was a significant effect of patients' language proficiency and educational level. Patients with lower language proficiencies were more likely to experience more negative interactions with their physicians. Second-generation migrants who did not fill in the questionnaire in an official language were more negative about the patient-physician interaction. Patients who had a greater chance of having a positive patient-physician interaction were more likely to be higher educated. CONCLUSION Despite the shift towards patient-centred care in medicine, physician-patient communication is still determined by the patient's educational background and language proficiency. PRACTICE IMPLICATION GPs should primarily be trained to tailor their communication styles to match patients' backgrounds.
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Affiliation(s)
- Karolien Aelbrecht
- Department of Public Health and Primary Care, Ghent University, Belgium.
| | - Lise Hanssens
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Jens Detollenaere
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Myriam Deveugele
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Belgium
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Rayan-Gharra N, Tadmor B, Balicer RD, Shadmi E. Multicultural Transitions: Caregiver Presence and Language-Concordance at Discharge. Int J Integr Care 2018; 18:9. [PMID: 30220892 PMCID: PMC6137623 DOI: 10.5334/ijic.3965] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/23/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Patients with low health literacy (HL) and minority patients encounter many challenges during hospital to community transitions. We assessed care transitions of minority patients with various HL levels and tested whether presence of caregivers and provision of language-concordant care are associated with better care transitions. METHODS A prospective cohort study of 598 internal medicine patients, Hebrew, Russian, or Arabic native speakers, at a tertiary medical center in central Israel, from 2013 to 2014.HL was assessed at baseline with the Brief Health Literacy Screen. A follow-up telephone survey was used to administer the Care Transition Measure [CTM] and to assess, caregiver presence and patient-provider language-concordance at discharge. RESULTS Patients with low HL and without language-concordance or caregiver presence had the lowest CTM scores (33.1, range 0-100). When language-concordance and caregivers were available, CTM scores did not differ between the medium-high and low HL groups (68.7 and 66.9, respectively, p = 0.118). The adjusted analysis, showed that language-concordance and caregiver presence during discharge moderate the relationship between HL and patients' care transition experience (p < 0.001). CONCLUSIONS Language-concordance care and caregiver presence are associated with higher patients' ratings of the transitional-care experience among patients with low HL levels and among minorities.
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Affiliation(s)
- Nosaiba Rayan-Gharra
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, IL
| | | | - Ran D. Balicer
- The Clalit Research Institute, Clalit Health Services, Tel Aviv, IL
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, IL
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Trenchard L, Mc Grath-Lone L, Ward H. Ethnic variation in cancer patients' ratings of information provision, communication and overall care. ETHNICITY & HEALTH 2016; 21:515-533. [PMID: 26853061 PMCID: PMC4940888 DOI: 10.1080/13557858.2015.1126561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/30/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Ethnic inequalities in cancer patient experience exist but variation within broad ethnic categories is under-explored. This study aimed to describe variation by ethnic sub-category in experiences of information provision and communication (key domains of patient experience) using National Cancer Patient Experience Survey (NCPES) data. DESIGN The NCPES 2012-2013 contained responses from 68,737 cancer patients treated at 155 NHS Trusts in England. Multivariate logistic regression was used to investigate associations between ethnicity and patients' ratings of overall care, information provision and communication. RESULTS Variation by and within broad ethnic categories was evident. Non-White patients (particularly Asian patients (ORadj:0.78; 95%CI:0.67-0.90, p=0.001)) were less likely than White patients to receive an understandable explanation of treatment side effects. Among Asian patients, those of Bangladeshi ethnicity were least likely to receive an understandable explanation. CONCLUSIONS Effective communication and information provision are important to ensure patients are well informed, receive the best possible care and have a positive patient experience. However, ethnic inequalities exist in cancer patients' experiences of information provision and communication with variation evident both between and within broad ethnic categories. Further work to understand the causes of this variation is required to address ethnic inequalities at practice and policy level.
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Affiliation(s)
- Lorna Trenchard
- School of Public Health, Imperial College London, London, UK
| | - Louise Mc Grath-Lone
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Helen Ward
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
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Sharabi IS, Levin A, Schiff E, Samuels N, Agour O, Tapiro Y, Lev E, Keinan-Boker L, Ben-Arye E. Quality of life-related outcomes from a patient-tailored integrative medicine program: experience of Russian-speaking patients with cancer in Israel. Support Care Cancer 2016; 24:4345-55. [PMID: 27169571 DOI: 10.1007/s00520-016-3274-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/05/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Complementary/integrative medicine (CIM) is increasingly being integrated with standard supportive cancer care. The effects of CIM on quality of life (QOL) during chemotherapy need to be examined in varied socio-cultural settings. We purpose to explore the impact of CIM on QOL-related outcomes among Russian-speaking (RS) patients with cancer. PATIENTS AND METHODS RS patients undergoing chemotherapy receiving standard supportive care were eligible. Patients in the treatment arm were seen by an integrative physician (IP) and treated within a patient-tailored CIM program. Symptoms and QOL were assessed at baseline, at 6, and at 12 weeks with the Edmonton Symptom Assessment Scale (ESAS), the Measure Yourself Concerns and Wellbeing (MYCAW) questionnaire, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). RESULTS Of 70 patients referred to the treatment arm, 50 (71.4 %) underwent IP assessment and CIM treatments. Of 51 referred to the control arm, 38 (76 %) agreed to participate. At 6 weeks, CIM-treated patients reported improved ESAS scores for fatigue (P = 0.01), depression (P = 0.048), appetite (P = 0.008), sleep (P < 0.0001), and general wellbeing (P = 0.004). No improvement was observed among controls. Between-group analysis found CIM-treated patients had improved sleep scores on ESAS (P = 0.019) and EORTC (P = 0.007) at 6 weeks. Social functioning improved between 6 and 12 weeks (EORTC, P = 0.02), and global health status/QOL scale from baseline to 12 weeks (EORTC, P = 0.007). CONCLUSION A patient-tailored CIM treatment program may improve QOL-related outcomes among RS patients undergoing chemotherapy. Integrating CIM in conventional supportive care needs to address cross-cultural aspects of care. TRIAL REGISTRATION The study protocol was registered at ClinicalTrials.gov ( https://clinicaltrials.gov/ct2/show/NCT01860365 ).
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Affiliation(s)
- Ilanit Shalom Sharabi
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Anna Levin
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Elad Schiff
- Department of Internal Medicine, and Integrative Medicine Service, Bnai-Zion Hospital, Haifa, Israel; The Department for Complementary Medicine, Law and Ethics, The International Center for Health, Law and Ethics, Haifa University, Haifa, Israel
| | - Noah Samuels
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel.,Tal Center for Integrative Medicine, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Olga Agour
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel.,Social-Work Service, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Yehudith Tapiro
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Efraim Lev
- Department of Eretz Israel Studies, University of Haifa, Haifa, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Israel Ministry of Health, Jerusalem, Israel.,School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel. .,Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. .,Clalit Health Services, Haifa and Western Galilee District, Israel. .,The Oncology Service, Lin Medical Center, 35 Rothschild St., Haifa, Israel.
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Rayan N, Admi H, Shadmi E. Transitions from hospital to community care: the role of patient-provider language concordance. Isr J Health Policy Res 2014; 3:24. [PMID: 25075273 PMCID: PMC4114088 DOI: 10.1186/2045-4015-3-24] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/26/2014] [Indexed: 11/19/2022] Open
Abstract
Background Cultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients’ discharge from hospital to community care, specifically examining the relationship between patient–provider language concordance and the quality of transitional care. Methods This was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0–100 scale)) and on the primary-care post-discharge visit. Results Overall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient–provider language concordance was present in 49% of minority patients’ discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P <0.001). Other aspects significantly associated with CTM scores: extent of discharge explanations (P <0.05), quality of discharge briefing (P <0.001), and post-discharge explanations by the primary care physician (P <0.01). Conclusion Language-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.
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Affiliation(s)
- Nosaiba Rayan
- School of Public Health, Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel
| | - Hanna Admi
- Rambam Medical Campus: Nursing Division, Haifa 31096, Israel
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel
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Abstract
The aim of this study was to review published studies on the cultural aspects of screening and care of Arab cancer patients living in Israel. The literature published from the beginning of recording, available up to December 2012, was systematically reviewed. Fifteen studies on perceptions of cancer screening and five studies on different aspects of coping with cancer were identified. Non-attendance of screening for early detection of breast or colorectal cancer was reported to be associated with higher personal barriers (the health belief model) and higher cultural and social barriers. Perceptions of cancer risk, causes, outcomes and personal responsibility were widespread from traditional to more modern biomedical views, and sometimes integrated. Among breast cancer patients, effects of a collective and family centred way of life and strong support by one's spouse were evident, followed by a change towards closer spousal relations. Religious coping strategies were the most prevalent among breast cancer patients and were related to better well-being. An integration of traditional and modern perceptions of cancer, attitudes towards screening and coping with cancer were evident. More research is needed in order to advance a culturally competent care of cancer patients and of interventions that encourage screening for the early detection of cancer.
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Affiliation(s)
- Miri Cohen
- a Faculty of Social Welfare and Health Sciences , University of Haifa , Mount Carmel , Haifa , Israel
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Hospital-community interface: a qualitative study on patients with cancer and health care providers' experiences. Eur J Oncol Nurs 2013; 17:528-35. [PMID: 23598074 DOI: 10.1016/j.ejon.2013.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 02/20/2013] [Accepted: 02/25/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Patients with cancer must deal with complex and fragmented healthcare systems in addition to coping with the burden of their illness. To improve oncology treatment along the care continuum, the barriers and facilitators for streamlined oncologic care need to be better understood. PURPOSE This study sought to gain insight into the hospital-community interface from the point of view of patients with cancer, their families, and health care providers on both sides of the interface i.e., the community and hospital settings. METHODS AND SAMPLE The sample comprised 37 cancer patients, their family members, and 40 multidisciplinary health care providers. Twelve participants were interviewed individually and 65 took part in 10 focus groups. Based on the grounded theory approach, theoretical sampling and constant comparative analyses were used. RESULTS Two major concepts emerged: "ambivalence and confusion" and "overcoming healthcare system barriers." Ambiguity was expressed regarding the roles of health care providers in the community and in the hospital. We identified three main strategies by which these patients and their families overcame barriers within the system: patients and families became their own case managers; patients and health care providers used informal routes of communication; and nurse specialists played a significant role in managing care. CONCLUSIONS The heavy reliance on informal routes of communication and integration by patients and providers emphasizes the urgent need for change in order to improve coordinating mechanisms for hospital-community oncologic care.
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Shadmi E. Quality of hospital to community care transitions: the experience of minority patients. Int J Qual Health Care 2013; 25:255-60. [PMID: 23571747 DOI: 10.1093/intqhc/mzt031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Care transitions are an especially vulnerable juncture in the course of patient care. Patients from ethnic minority populations face additional unique challenges during hospital to community care transitions due to language and cultural barriers, yet, this phenomenon is understudied. This study examines the quality of care transitions of minority patients (immigrants) versus the general population, and specifically assesses the association between in-hospital provider-patient communication and the quality of minority care transitions. DESIGN Prospective study of older hospitalized adults. SETTING A large teaching hospital. PARTICIPANTS Participants (n = 385) were patients hospitalized for non-disabling medical conditions, from one of the two groups: the general Israeli population (Hebrew speakers) or immigrants from the former Soviet Union (Russian speakers). MAIN OUTCOME MEASURES One-month phone follow-up assessed the quality of patients' transitional care using the care transitions measure. RESULTS Russian speakers rated their transitional care on average 10% lower than Hebrew speakers (54.4 versus 64.2, respectively, P = 0.002). On average, Russian speakers' ratings on the physician interpersonal-communication scale were significantly lower than Hebrew speakers' ratings. For Russian speakers, but not Hebrew speakers, the interpersonal physician communication scale was significantly positively associated with the quality of care transitions in multivariate analyses (P = 0.01), controlling for gender, education, economic status and length of stay. CONCLUSIONS Minority patients experience lower quality of care transitions than the general population. Interpersonal physician-patient communication during the hospital stay is associated with better care transitions of ethnic minority patients and should be considered in efforts to improve the quality of minority patients' care transition processes.
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Affiliation(s)
- Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 31905, Israel.
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Balicer RD, Shadmi E, Israeli A. Interventions for reducing readmissions - are we barking up the right tree? Isr J Health Policy Res 2013; 2:2. [PMID: 23343051 PMCID: PMC3570430 DOI: 10.1186/2045-4015-2-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/09/2013] [Indexed: 11/27/2022] Open
Abstract
Readmission reduction is at the focus of health care systems worldwide in efforts to improve efficiency across care settings. Yet, setting targets for readmission reduction is complicated due to inconsistencies in evidence pointing to effective organization-wide interventions and because of inverse incentives (such as maintaining high occupancy rates). Nonetheless, readmission reduction is one of the few quality measures that, if implemented properly, can serve as a catalyst for system integration. Appropriate mechanisms should be applied to hospitals as well as ambulatory settings to ensure that accountability is assigned to all stakeholders.
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Affiliation(s)
- Ran D Balicer
- Health Policy Planning department & Clalit Research Institute, Chief Physician Office, Clalit Health Services, Arlozorov 101, Tel Aviv, Israel.
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