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Belostotsky V, Roy M, Mikrogianakis A. Patient triage to specialist outpatient clinics—time to standardize terminology. Paediatr Child Health 2022; 27:291-296. [PMID: 36016590 PMCID: PMC9394629 DOI: 10.1093/pch/pxab086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The objectives of this study were to evaluate existing nomenclature used for outpatient referrals triage and propose a system, which meets the needs of McMaster Children’s Hospital and can be modified for use in other hospitals.
Methods
We reviewed triage practices in the Department of Pediatrics, McMaster Children Hospital, Hamilton, Ontario and conducted a literature search to assess terminology used for outpatient referrals triage at other institutions.
Results
There is lack of unified terminology for triaging outpatient referrals. Existing systems are not widely accepted, lack uniformity, and often miss recording the true acuity of the referral. We developed a system that covers most outpatient triage scenarios, allocates either flexible or precise visit timelines to referrals and plans for logistics of the patient’s visit. Triage categories are iMMediate (MM), Acute (A) (1 to 14 days), Semi-Acute (S) (1 to 3 months), Timetabled (T) (next available appointment slot), Evaluated (E) (used for either forwarding to another provider or requesting additional information), and Rejected (R) categories—McMASTER triage system. Several numbered subcategories are used in each category to define precise timelines, if needed. Visit logistics categories are the following: Hub (H) (place to see the patient), How to notify patient and referring provider (HP) and (HD), need to Start with tests prior to appointment (S), and need to Complete (C) other relevant local processes—HHSC logistics system. Both these systems may be adapted for local use in other institutions.
Conclusion
This is the first publication that proposes terminology standardization in triaging outpatient referrals for specialist paediatric services.
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Affiliation(s)
- Vladimir Belostotsky
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, McMaster Children’s Hospital, Hamilton Health Sciences , Hamilton, Ontario , Canada
| | - Madan Roy
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, McMaster Children’s Hospital, Hamilton Health Sciences , Hamilton, Ontario , Canada
| | - Angelo Mikrogianakis
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, McMaster Children’s Hospital, Hamilton Health Sciences , Hamilton, Ontario , Canada
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2
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Lim Y, Lee H, Woodby B, Valacchi G. Ozonated Oils and Cutaneous Wound Healing. Curr Pharm Des 2020; 25:2264-2278. [PMID: 31267858 DOI: 10.2174/1381612825666190702100504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022]
Abstract
Wound tissue repair is a complex and dynamic process of restoring cellular structures and tissue layers. Improvement in this process is necessary to effectively treat several pathologies characterized by a chronic delayed wound closure, such as in diabetes, and the investigation of new approaches aimed to ameliorate the wound healing process is under continuous evolution. Recently, the usage of vegetable matrices in the form of ozonated oils has been proposed, and several researchers have shown positive effects on wound healing, due to the bactericidal, antiviral, and antifungal properties of these ozonated oils. In the present review, we intend to summarize the actual state of the art of the topical usage of ozonated oil in cutaneous wounds with special emphasis to the importance of the ozonated degree of the oil.
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Affiliation(s)
- Yunsook Lim
- Department of Food and Nutrition, Kyung Hee University, Seoul 02447, Korea
| | - Heaji Lee
- Department of Food and Nutrition, Kyung Hee University, Seoul 02447, Korea
| | - Brittany Woodby
- Plant for Human Health Institute, Kannapolis Research Center, North Carolina State University, 28081, NC, United States
| | - Giuseppe Valacchi
- Department of Food and Nutrition, Kyung Hee University, Seoul 02447, Korea.,Plant for Human Health Institute, Kannapolis Research Center, North Carolina State University, 28081, NC, United States.,Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara 44121, Italy
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3
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El-Atem N, Irvine KM, Valery PC, Wojcik K, Horsfall L, Johnson T, Janda M, McPhail SM, Powell EE. Identifying areas of need relative to liver disease: geographic clustering within a health service district. AUST HEALTH REV 2019; 41:407-418. [PMID: 27509003 DOI: 10.1071/ah15225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 06/20/2016] [Indexed: 12/19/2022]
Abstract
Background Many people with chronic liver disease (CLD) are not detected until they present to hospital with advanced disease, when opportunities for intervention are reduced and morbidity is high. In order to build capacity and liver expertise in the community, it is important to focus liver healthcare resources in high-prevalence disease areas and specific populations with an identified need. The aim of the present study was to examine the geographic location of people seen in a tertiary hospital hepatology clinic, as well as ethnic and sociodemographic characteristics of these geographic areas. Methods The geographic locations of hepatology out-patients were identified via the out-patient scheduling database and grouped into statistical area (SA) regions for demographic analysis using data compiled by the Australian Bureau of Statistics. Results During the 3-month study period, 943 individuals from 71 SA Level 3 regions attended clinic. Nine SA Level 3 regions accounted for 55% of the entire patient cohort. Geographic clustering was seen especially for people living with chronic hepatitis B virus. There was a wide spectrum of socioeconomic advantage and disadvantage in areas with high liver disease prevalence. Conclusions The geographic area from which people living with CLD travel to access liver health care is extensive. However, the greatest demand for tertiary liver disease speciality care is clustered within specific geographic areas. Outreach programs targeted to these areas may enhance liver disease-specific health service resourcing. What is known about the topic? The demand for tertiary hospital clinical services in CLD is rising. However, there is limited knowledge about the geographic areas from which people living with CLD travel to access liver services, or the ethnic, socioeconomic and education characteristics of these areas. What does this paper add? The present study demonstrates that a substantial proportion of people living with CLD and accessing tertiary hospital liver services are clustered within specific geographic areas. The most striking geographic clustering was seen for people living with chronic hepatitis B, in regions with a relatively high proportion of people born in Vietnam and China. In addition to ethnicity, the data show an apparent ecological association between liver disease and both socioeconomic and educational and/or occupational disadvantage. What are the implications for practitioners? Identifying where demand for clinical services arises is an important step for service planning and preparing for potential outreach programs to optimise community-based care. It is likely that outreach programs to engage and enhance primary care services in geographic areas from which the greatest demand for tertiary liver disease speciality care arises would yield greater relative return on investment than non-targeted outreach programs.
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Affiliation(s)
- Nathan El-Atem
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Qld 4059, Australia.
| | - Katharine M Irvine
- Centre for Liver Disease Research, The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Qld 4102, Australia.
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute. 300 Herston Road, Herston, Qld 4006, Australia. Email
| | - Kyle Wojcik
- Centre for Liver Disease Research, The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Qld 4102, Australia.
| | - Leigh Horsfall
- Centre for Liver Disease Research, The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Qld 4102, Australia.
| | - Tracey Johnson
- Inala Primary Care, 64 Wirraway Parade, Inala, Qld 4077, Australia. Email
| | - Monika Janda
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Qld 4059, Australia.
| | - Steven M McPhail
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Qld 4059, Australia.
| | - Elizabeth E Powell
- Centre for Liver Disease Research, The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Qld 4102, Australia.
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4
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Patel PJ, Banh X, Horsfall LU, Hayward KL, Hossain F, Johnson T, Stuart KA, Brown NN, Saad N, Clouston A, Irvine KM, Russell AW, Valery PC, Williams S, Powell EE. Underappreciation of non-alcoholic fatty liver disease by primary care clinicians: limited awareness of surrogate markers of fibrosis. Intern Med J 2018; 48:144-151. [PMID: 29083080 DOI: 10.1111/imj.13667] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/19/2017] [Accepted: 10/23/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a common cause of incidental liver test abnormalities. General practitioners (GP) have a key role in identifying people with NAFLD at risk of significant liver disease. Recent specialist guidelines emphasise the use of fibrosis algorithms or serum biomarkers rather than routine liver tests, to assess advanced fibrosis. AIM To evaluate primary care clinicians' current approach to diagnosis, management and referral of NAFLD. METHODS A cross-sectional survey of primary care clinicians was undertaken through a structured questionnaire about NAFLD. A convenience sample of general practice clinics and general practice conferences in Metropolitan Brisbane and regional south east Queensland was selected. RESULTS A total of 108 primary care clinicians completed the survey (participation rate 100%). Fifty-one percent of respondents considered the prevalence of NAFLD in the general population to be ≤10%. Twenty-four percent of respondents felt that liver enzymes were sufficiently sensitive to detect underlying NAFLD. Most respondents were unsure whether the Fibrosis 4 score (62.7% unsure) or Enhanced Liver Fibrosis score (63.7% unsure) could help to identify advanced fibrosis or cirrhosis. Although 47% of respondents said they would refer a patient to a Gastroenterologist/Hepatologist if they suspect the patient has NAFLD, 44.1% do not make any referrals. Of concern, 70.6% of clinicians said they were unlikely to refer a patient to Hepatology unless liver function tests are abnormal. CONCLUSION Our findings demonstrate that many primary care clinicians underestimate the prevalence of NAFLD and under-recognise the clinical spectrum of NAFLD and how this is assessed.
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Affiliation(s)
- Preya J Patel
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Xuan Banh
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Leigh U Horsfall
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Kelly L Hayward
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia.,School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | | | | | - Katherine A Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nigel N Brown
- Pathology Queensland, Brisbane, Queensland, Australia
| | - Nivene Saad
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrew Clouston
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Katharine M Irvine
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia.,Mater Research, Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Anthony W Russell
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Patricia C Valery
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Elizabeth E Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia
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5
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Hingwala J, Wojciechowski P, Hiebert B, Bueti J, Rigatto C, Komenda P, Tangri N. Risk-Based Triage for Nephrology Referrals Using the Kidney Failure Risk Equation. Can J Kidney Health Dis 2017; 4:2054358117722782. [PMID: 28835850 PMCID: PMC5555495 DOI: 10.1177/2054358117722782] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/03/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In some jurisdictions, routine reporting of the estimated glomerular filtration rate (eGFR) has led to an increase in nephrology referrals and wait times. OBJECTIVE We describe the use of the Kidney Failure Risk Equation (KFRE) as part of a triage process for new nephrology referrals for patients with chronic kidney disease stages 3 to 5 in a Canadian province. DESIGN A quasi-experimental study design was used. SETTING This study took place in Manitoba, Canada. MEASUREMENTS Demographics, laboratory values, referral numbers, and wait times were compared between periods. METHODS In 2012, we adopted a risk-based cutoff of 3% over 5 years using the KFRE as a threshold for triage of new referrals. Referrals who did not meet other prespecified criteria (such as pregnancy, suspected glomerulonephritis, etc) and had a kidney failure risk of <3% over 5 years were returned to primary care with recommendations based on diabetes and hypertension guidelines. The average wait time and number of consults seen between the pretriage (January 1, 2011, to December 31, 2011) and posttriage period (January 1, 2013, to December 31, 2013) were compared using a general linear model. RESULTS In the pretriage period, the median number of referrals was 68/month (range: 44-76); this increased to 94/month (range: 61-147) in the posttriage period. In the posttriage period, 35% of referrals were booked as urgent, 31% as nonurgent, and 34% of referrals were not booked. The median wait times improved from 230 days (range: 126-355) in the pretriage period to 58 days (range: 48-69) in the posttriage period. LIMITATIONS We do not have long-term follow-up on patients triaged as low risk. Our study may not be applicable to nephrology teams operating under capacity without wait lists. We did not collect detailed information on all referrals in the pretriage period, so any differences in our pretriage and posttriage patient groups may be unaccounted for. CONCLUSIONS Our risk-based triage scheme is an effective health policy tool that led to improved wait times and access to care for patients at highest risk of progression to kidney failure.
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Affiliation(s)
- Jay Hingwala
- Department of Internal Medicine, Section of Nephrology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Peter Wojciechowski
- Department of Medicine and Department of Community Health Sciences, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada
| | - Brett Hiebert
- St. Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Joe Bueti
- Department of Internal Medicine, Section of Nephrology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Claudio Rigatto
- Department of Internal Medicine, Section of Nephrology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Medicine and Department of Community Health Sciences, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada
| | - Paul Komenda
- Department of Internal Medicine, Section of Nephrology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Medicine and Department of Community Health Sciences, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada
| | - Navdeep Tangri
- Department of Internal Medicine, Section of Nephrology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Medicine and Department of Community Health Sciences, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada
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6
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El-Atem NA, Wojcik K, Horsfall L, Irvine KM, Johnson T, McPhail SM, Powell EE. Patterns of service utilisation within Australian hepatology clinics: high prevalence of advanced liver disease. Intern Med J 2017; 46:420-6. [PMID: 26762655 DOI: 10.1111/imj.13008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/20/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Liver diseases in Australia are estimated to affect 6 million people with a societal cost of $51 billion annually. Information about utilisation of specialist hepatology care is critical in informing policy makers about the requirements for delivery of hepatology-related healthcare. AIMS This study examined the aetiology and severity of liver disease seen in a tertiary hospital hepatology clinic, as well as the resource utilisation patterns. METHODS A longitudinal cohort study included consecutive patients booked in hepatology outpatient clinics during a 3-month period. Subsequent outpatient appointments for these patients over the following 12 months were then recorded. RESULTS During the initial 3-month period, 1471 appointments were scheduled with a hepatologist, 1136 of which were attended. Twenty-one per cent of patients were 'new cases'. Hepatitis B virus (HBV) was the most common disease aetiology for new cases (37%). Advanced disease at presentation varied between aetiology; only 5% of HBV cases had advanced liver disease at presentation, in contrast with HCV, NAFLD and ALD, in which advanced disease was identified at presentation in 31%, 46% and 72% of cases, respectively. Most patients (83%) attended multiple hepatology appointments, and a range of referral patterns for procedures, investigations and other specialty assessments were observed. CONCLUSIONS There is a high prevalence of HBV in new case referrals. Patients with HCV infection, NAFLD and ALD have a high prevalence of advanced liver disease at referral, requiring ongoing surveillance for development of decompensated liver disease and liver cancer. These findings that describe the patterns of health service utilisation among patients with liver disease provide useful information for planning sustainable health service provision for this clinical population.
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Affiliation(s)
- N A El-Atem
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - K Wojcik
- Centre for Liver Disease Research, The University of Queensland, Brisbane, Queensland, Australia
| | - L Horsfall
- Centre for Liver Disease Research, The University of Queensland, Brisbane, Queensland, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - K M Irvine
- Centre for Liver Disease Research, The University of Queensland, Brisbane, Queensland, Australia
| | - T Johnson
- Inala Primary Care, Brisbane, Queensland, Australia
| | - S M McPhail
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - E E Powell
- Centre for Liver Disease Research, The University of Queensland, Brisbane, Queensland, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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7
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Hendrickson CD, Saini S, Pothuloori A, Mecchella JN. ASSESSING REFERRALS AND IMPROVING INFORMATION AVAILABILITY FOR CONSULTATIONS IN AN ACADEMIC ENDOCRINOLOGY CLINIC. Endocr Pract 2016; 23:190-198. [PMID: 27849384 DOI: 10.4158/ep161514.or] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Outpatient specialty consultations rely on the timeliness and completeness of referral information to facilitate a valuable patient-specialist interaction. This project aimed to increase essential diagnostic information availability at the initial consultation for patients referred for common endocrine conditions frequently lacking such data-diabetes mellitus, thyroid nodule, thyrotoxicosis, and hypercalcemia. METHODS At an endocrinology clinic at an academic medical center in rural New England, providers see several thousand new patients annually, the majority of whom are referred by providers external to the clinic's healthcare system. Through consensus, endocrinology clinic providers agreed on the two or three data elements essential for a meaningful initial consultation for each. A quality improvement team employed a planned series of interventions based on previously published methods and an innovative approach: dissemination of a referral guideline, an assessment of referral adequacy in the endocrinology clinic workflow, coupled with focused requests for missing items, and a pre-visit lab appointment. RESULTS Between April 2015 and March 2016, 762 referrals were reviewed. At baseline for the four conditions, referrals contained all essential elements only 27.5% (22 of 80) of the time. Over a 7-month period, the team implemented the interventions, with subsequent referrals containing all essential elements increasing to 75.5% (P<.0001), largely attributable to the pre-visit lab appointment. CONCLUSION Incoming referrals that lack essential information are a significant problem in specialty care and may adversely affect patient experience, provider satisfaction, and clinic efficiency. Improvement may require innovative approaches, such as the potentially transferable and generalizable ones employed here. ABBREVIATIONS DHMC = Dartmouth-Hitchcock Medical Center EHR = electronic health record PDSA = Plan-Do-Study-Act.
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8
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Hendrickson CD, Lacourciere SL, Zanetti CA, Donaldson PC, Larson RJ. Interventions to Improve the Quality of Outpatient Specialty Referral Requests. Am J Med Qual 2016; 31:454-62. [DOI: 10.1177/1062860615587741] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Chase D. Hendrickson
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Stacy L. Lacourciere
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Cole A. Zanetti
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Concord Hospital, Concord, NH
| | - Patrick C. Donaldson
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Tuck School of Business at Dartmouth, Hanover, NH
| | - Robin J. Larson
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Veteran’s Affairs Medical Center, White River Junction, VT
- Geisel School of Medicine at Dartmouth, Hanover, NH
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9
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Valery PC, Powell E, Moses N, Volk ML, McPhail SM, Clark PJ, Martin J. Systematic review: unmet supportive care needs in people diagnosed with chronic liver disease. BMJ Open 2015; 5:e007451. [PMID: 25854973 PMCID: PMC4390721 DOI: 10.1136/bmjopen-2014-007451] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE People with chronic liver disease, particularly those with decompensated cirrhosis, experience several potentially debilitating complications that can have a significant impact on activities of daily living and quality of life. These impairments combined with the associated complex treatment mean that they are faced with specific and high levels of supportive care needs. We aimed to review reported perspectives, experiences and concerns of people with chronic liver disease worldwide. This information is necessary to guide development of policies around supportive needs screening tools and to enable prioritisation of support services for these patients. DESIGN Systematic searches of PubMed, MEDLINE, CINAHL and PsycINFO from the earliest records until 19 September 2014. Data were extracted using standardised forms. A qualitative, descriptive approach was utilised to analyse and synthesise data. RESULTS The initial search yielded 2598 reports: 26 studies reporting supportive care needs among patients with chronic liver disease were included, but few of them were patient-reported needs, none used a validated liver disease-specific supportive care need assessment instrument, and only three included patients with cirrhosis. Five key domains of supportive care needs were identified: informational or educational (eg, educational material, educational sessions), practical (eg, daily living), physical (eg, controlling pruritus and fatigue), patient care and support (eg, support groups), and psychological (eg, anxiety, sadness). CONCLUSIONS While several key domains of supportive care needs were identified, most studies included hepatitis patients. There is a paucity of literature describing the supportive care needs of the chronic liver disease population likely to have the most needs--namely those with cirrhosis. Assessing the supportive care needs of people with chronic liver disease have potential utility in clinical practice for facilitating timely referrals to support services.
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Affiliation(s)
- Patricia C Valery
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Powell
- Centre for Liver Disease Research, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Neta Moses
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Michael L Volk
- Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Steven M McPhail
- Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - Paul J Clark
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Jennifer Martin
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia
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10
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Scott I, Phelps G, Dalton S. Arise the systems physician. Intern Med J 2014; 44:1251-6. [DOI: 10.1111/imj.12608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 09/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- I. Scott
- Department of Internal Medicine and Clinical Epidemiology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - G. Phelps
- Internal Medicine; Ballarat Health Services; Ballarat Victoria Australia
| | - S. Dalton
- Department of Health; The Clinical Excellence Commission; Sydney New South Wales Australia
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Abstract
PURPOSE OF REVIEW This article examines recent health services and policy research studies in hepatology and liver transplantation. RECENT FINDINGS Critical issues include access to medical care, timeliness of referral and consultation, resource utilization in clinical practice, comparative effectiveness research, and the evaluation of care delivery models. Despite policymaking efforts, there continues to be unwarranted variation in access to subspecialty care and liver transplantation services based on race and geographic location. Variations in primary care and specialist awareness of practice guidelines for liver disease contribute to disparities in appropriateness and timeliness of treatments. Defining the cost-effectiveness of increased resource utilization for novel antiviral therapies and liver transplantation continues to stimulate controversy. Few comparative effectiveness studies in hepatology exist to date, yet a growing number of analyses using national datasets will help inform policy in this arena. Identifying care delivery models that demonstrate high value for populations with chronic liver disease is critical in the context of recent healthcare reform efforts. SUMMARY Health services and policy research is a growing field of investigation in hepatology and liver transplantation. Further emphasis on research training and workforce development in this area will be critical for understanding and improving patient-centered outcomes for this population.
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