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Yarahuan JKW, Lo HY, Bass L, Wright J, Hess LM. Design, Usability, and Acceptability of a Needs-Based, Automated Dashboard to Provide Individualized Patient-Care Data to Pediatric Residents. Appl Clin Inform 2022; 13:380-390. [PMID: 35294985 PMCID: PMC8926457 DOI: 10.1055/s-0042-1744388] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric residency programs are required by the Accreditation Council for Graduate Medical Education to provide residents with patient-care and quality metrics to facilitate self-identification of knowledge gaps to prioritize improvement efforts. Trainees are interested in receiving this data, but this is a largely unmet need. Our objectives were to (1) design and implement an automated dashboard providing individualized data to residents, and (2) examine the usability and acceptability of the dashboard among pediatric residents. METHODS We developed a dashboard containing individualized patient-care data for pediatric residents with emphasis on needs identified by residents and residency leadership. To build the dashboard, we created a connection from a clinical data warehouse to data visualization software. We allocated patients to residents based on note authorship and created individualized reports with masked identities that preserved anonymity. After development, we conducted usability and acceptability testing with 11 resident users utilizing a mixed-methods approach. We conducted interviews and anonymous surveys which evaluated technical features of the application, ease of use, as well as users' attitudes toward using the dashboard. Categories and subcategories from usability interviews were identified using a content analysis approach. RESULTS Our dashboard provides individualized metrics including diagnosis exposure counts, procedure counts, efficiency metrics, and quality metrics. In content analysis of the usability testing interviews, the most frequently mentioned use of the dashboard was to aid a resident's self-directed learning. Residents had few concerns about the dashboard overall. Surveyed residents found the dashboard easy to use and expressed intention to use the dashboard in the future. CONCLUSION Automated dashboards may be a solution to the current challenge of providing trainees with individualized patient-care data. Our usability testing revealed that residents found our dashboard to be useful and that they intended to use this tool to facilitate development of self-directed learning plans.
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Affiliation(s)
- Julia K W Yarahuan
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Huay-Ying Lo
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, United States
| | - Lanessa Bass
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, United States
| | - Jeff Wright
- Information Services, Texas Children's Hospital, Houston, Texas, United States
| | - Lauren M Hess
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, United States
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Rosenbluth G. Trainee and Program Director Perspectives on Meaningful Patient Attribution and Clinical Outcomes Data. J Grad Med Educ 2020; 12:295-302. [PMID: 32595849 PMCID: PMC7301928 DOI: 10.4300/jgme-d-19-00730.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/24/2020] [Accepted: 02/29/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education specifies that trainees must receive clinical outcomes and quality benchmark data at specific levels related to institutional patient populations. Program directors (PDs) are challenged to identify meaningful data and provide them in formats acceptable to trainees. OBJECTIVE We sought to understand what types of patients, data/metrics, and data delivery systems trainees and PDs prefer for supplying trainees with clinical outcomes data. METHODS Trainees (n = 21) and PDs (n = 12) from multiple specialties participated in focus groups during academic year 2017-2018. They described key themes for providing clinical outcomes data to trainees. RESULTS Trainees and PDs differed in how they identified patients for clinical outcomes data for trainees. Trainees were interested in encounters where they felt a sense of responsibility or had autonomy/independent decision-making opportunities, continuity, or learned something new; PDs used broader criteria including all patients cared for by their trainees. Both groups thought trainees should be given trainee-level metrics and consistently highlighted the importance of comparison to peers and/or benchmarks. Both groups found value in "push" and "pull" data systems, although trainees wanted both, while PDs wanted one or the other. Both groups agreed that trainees should review data with specific faculty. Trainees expressed concern about being judged based on their patients' clinical outcomes. CONCLUSIONS Trainee and PD perspectives on which patients they would like outcomes data for differed, but they overlapped for types of metrics, formats, and review processes for the data.
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Bowen JL, O'Brien BC, Ilgen JS, Irby DM, Ten Cate O. Chart stalking, list making, and physicians' efforts to track patients' outcomes after transitioning responsibility. MEDICAL EDUCATION 2018; 52:404-413. [PMID: 29383741 DOI: 10.1111/medu.13509] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/14/2017] [Accepted: 10/16/2017] [Indexed: 05/23/2023]
Abstract
CONTEXT Transitions of patient care responsibility occur frequently between physicians. Resultant discontinuities make it difficult for physicians to observe clinical outcomes. Little is known about what physicians do to overcome the practical challenges to learning these discontinuities create. This study explored physicians' activities in practice as they sought follow-up information about patients. METHODS Using a constructivist grounded theory approach, semi-structured interviews with 18 internal medicine hospitalist and resident physicians at a single tertiary care academic medical center explored participants' strategies when deliberately conducting follow-up after they transitioned responsibility for patients to other physicians. Following open coding, the authors used activity theory (AT) to explore interactions among the social, cultural and material influences related to follow-up. RESULTS The authors identified three themes related to follow-up: (i) keeping lists to track patients, (ii) learning to create tracking systems and (iii) conducting follow-up. Analysis of participants' follow-up processes as an activity system highlighted key tensions in the system and participants' work adaptations. Tension within functionality of electronic health records for keeping lists (tools) to find information about patients' outcomes (object) resulted in using paper lists as workarounds. Tension between paper lists (tools) and protecting patients' health information (rules) led to rule-breaking or abandoning activities of locating information. Finding time to conduct desired follow-up produced tension between this and other activity systems. CONCLUSION In clinical environments characterised by discontinuity, lists of patients served as tools for guiding patient care follow-up. The authors offer four recommendations to address the tensions identified through AT: (i) optimise electronic health record tracking systems to eliminate the need for paper lists; (ii) support physicians' skill development in developing and maintaining tracking systems for follow-up; (iii) dedicate time in physicians' work schedules for conducting follow-up; and (iv) engage physicians and patients in determining guidelines for longitudinal tracking that optimise physicians' learning and respect patients' privacy.
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Affiliation(s)
- Judith L Bowen
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California, San Francisco, California, USA
| | - Jonathan S Ilgen
- Department of Emergency Medicine, and Associate Director, Center for Leadership and Innovation in Medical Education, University of Washington, School of Medicine, Seattle, Washington, USA
| | - David M Irby
- Department of Medicine, University of California, San Francisco, California, USA
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Bowen JL, Ilgen JS, Irby DM, Ten Cate O, O'Brien BC. "You Have to Know the End of the Story": Motivations to Follow Up After Transitions of Clinical Responsibility. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:S48-S54. [PMID: 29065023 DOI: 10.1097/acm.0000000000001919] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Physicians routinely transition responsibility for patient care to other physicians. When transitions of responsibility occur before the clinical outcome is known, physicians may lose opportunities to learn from the consequences of their decision making. Sometimes curiosity about patients does not end with the transition and physicians continue to follow them. This study explores physicians' motivations to follow up after transitioning responsibilities. METHOD Using a constructivist grounded theory approach, the authors conducted 18 semistructured interviews in 2016 with internal medicine hospitalist and resident physicians at a single tertiary care academic medical center. Constant comparative methods guided the qualitative analysis, using motivation theories as sensitizing constructs. RESULTS The authors identified themes that characterized participants' motivations to follow up. Curiosity about patients' outcomes determined whether or not follow-up occurred. Insufficient curiosity about predictable clinical problems resulted in the choice to forgo follow-up. Sufficient curiosity due to clinical uncertainty, personal attachment to patients, and/or concern for patient vulnerability motivated follow-up to fulfill goals of knowledge building and professionalism. The authors interpret these findings through the lenses of expectancy-value (EVT) and self-determination (SDT) theories of motivation. CONCLUSIONS Participants' curiosity about what happened to their patients motivated them to follow up. EVT may explain how participants made choices in time-pressured work settings. SDT may help interpret how follow-up fulfills needs of relatedness. These findings add to a growing body of literature endorsing learning environments that consider task-value trade-offs and support basic psychological needs of autonomy, competency, and relatedness to motivate learning.
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Affiliation(s)
- Judith L Bowen
- J.L. Bowen is professor, Department of Medicine, Oregon Health & Science University, Portland, Oregon. J.S. Ilgen is associate professor, Division of Emergency Medicine, Department of Medicine, and associate director, Center for Leadership & Innovation in Medical Education, University of Washington, School of Medicine, Seattle, Washington. D.M. Irby is professor, Department of Medicine, University of California, San Francisco, San Francisco, California. O. ten Cate is professor, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands, and adjunct professor, Department of Medicine, University of California, San Francisco, San Francisco, California. B.C. O'Brien is associate professor, Department of Medicine, University of California, San Francisco, San Francisco, California
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Holmboe ES, Bowen JL, Green M, Gregg J, DiFrancesco L, Reynolds E, Alguire P, Battinelli D, Lucey C, Duffy D. Reforming internal medicine residency training. A report from the Society of General Internal Medicine's task force for residency reform. J Gen Intern Med 2005; 20:1165-72. [PMID: 16423110 PMCID: PMC1490285 DOI: 10.1111/j.1525-1497.2005.0249.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Revised: 07/26/2005] [Accepted: 07/26/2005] [Indexed: 11/26/2022]
Affiliation(s)
- Eric S Holmboe
- American Board of Internal Medicine, Philadelphia, PA 19106, USA.
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Sadosty AT, Stead LG, Boie ET, Goyal DG, Weaver AL, Decker WW. Evaluation of the Educational Utility of Patient Follow-up. Acad Emerg Med 2004. [DOI: 10.1111/j.1553-2712.2004.tb02422.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ziegelstein RC, Fiebach NH. "The mirror" and "the village": a new method for teaching practice-based learning and improvement and systems-based practice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2004; 79:83-88. [PMID: 14691003 DOI: 10.1097/00001888-200401000-00018] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE Practice-based learning and improvement (PBLI) and systems-based practice (SBP) may be conceptually difficult for both residents and faculty. Methods for introducing these concepts are needed if PBLI and SBP are to be incorporated into education and practice. METHOD In 2001, PBLI and SBP were introduced at Johns Hopkins Bayview Medical Center in Baltimore, Maryland, using the metaphors "the mirror" and "the village." PBLI was likened to residents' holding up a mirror to document, assess, and improve their practice. Specific tools for residents (e.g., weekly morbidity and mortality morning reports, continuity clinic chart self-audits, and resident learning portfolios) became the mirrors. SBP was introduced through specific training activities (e.g., multidisciplinary patient care rounds, nursing evaluations, and quality assessment-systems improvement exercises) using the metaphor of the village made famous by Hillary Clinton in the phrase: "It takes a village to raise a child." Residents completed a questionnaire in which they rated these initiatives' impact on their training. RESULTS The majority of residents who participated in specific activities agreed that quality assessment-systems improvement exercises (92.9%), multidisciplinary rounds (92.1%), morbidity and mortality morning reports (86.8%), clinic chart self-audits (76.4%), and nursing evaluations (52.8%) helped to improve their proficiency in specific aspects of PBLI and SBP. Residents' retrospective self-assessments of their PBLI abilities demonstrated significant improvement after the introduction of specific training activities. CONCLUSIONS PBLI and SBP can be introduced effectively in residency training by incorporating specific activities that use the metaphors of the mirror and the village.
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Affiliation(s)
- Roy C Ziegelstein
- Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.
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Abstract
Physicians play a critical role in controlling resource use in medicine. This paper describes an innovative, interdisciplinary conference that teaches housestaff and medical students about resource and information management in the hospital setting. The objectives are to help foster communication between physicians and other members of the health care team, to improve the understanding of hospital reimbursement, and to influence attitudes toward practicing cost effectiveness. The conference structure includes the following components: case presentation by the treating physician and follow-up information provided by the primary care physician, a review of the itemized hospital bill, discussion of coding issues, discussion of hospital reimbursement comparing case data to institutional and state averages, and a summary of key take-home points and lessons.
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Affiliation(s)
- S J Kravet
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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