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McDowell JM, Kohut SH, Betts D. Extrapolation errors in Liu et al.'s CAM integrative review of health care professionals in New Zealand. BMC Complement Med Ther 2024; 24:187. [PMID: 38741124 DOI: 10.1186/s12906-023-04259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/14/2023] [Indexed: 05/16/2024] Open
Abstract
This letter is to highlight errors made by Liu et al. in their 2020 paper in BMC Complementary Medicine and Therapies, "Complementary and alternative medicine-practice, attitudes, and knowledge among healthcare professionals in New Zealand: an integrative review". Substantial errors in their citation of the recent research and methodology by McDowell, Kohut & Betts (2019) pertaining to the practice of acupuncture in New Zealand by physiotherapists are presented. The actual results of McDowell et al.'s work and the true state of acupuncture use by their sample group is reported.
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Affiliation(s)
| | - Susan Heather Kohut
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Debra Betts
- New Zealand School of Acupuncture and Traditional Chinese Medicine, Wellington, New Zealand
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Mamataz T, Virani SA, McDonald M, Edgell H, Grace SL. Heart failure clinic inclusion and exclusion criteria: cross-sectional study of clinic's and referring provider's perspectives. BMJ Open 2024; 14:e076664. [PMID: 38485484 PMCID: PMC10941180 DOI: 10.1136/bmjopen-2023-076664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES There are substantial variations in entry criteria for heart failure (HF) clinics, leading to variations in whom providers refer for these life-saving services. This study investigated actual versus ideal HF clinic inclusion or exclusion criteria and how that related to referring providers' perspectives of ideal criteria. DESIGN, SETTING AND PARTICIPANTS Two cross-sectional surveys were administered via research electronic data capture to clinic providers and referrers (eg, cardiologists, family physicians and nurse practitioners) across Canada. MEASURES Twenty-seven criteria selected based on the literature and HF guidelines were tested. Respondents were asked to list any additional criteria. The degree of agreement was assessed (eg, Kappa). RESULTS Responses were received from providers at 48 clinics (37.5% response rate). The most common actual inclusion criteria were newly diagnosed HF with reduced or preserved ejection fraction, New York Heart Association class IIIB/IV and recent hospitalisation (each endorsed by >74% of respondents). Exclusion criteria included congenital aetiology, intravenous inotropes, a lack of specialists, some non-cardiac comorbidities and logistical factors (eg, rurality and technology access). There was the greatest discordance between actual and ideal criteria for the following: inpatient at the same institution (κ=0.14), congenital heart disease, pulmonary hypertension or genetic cardiomyopathies (all κ=0.36). One-third (n=16) of clinics had changed criteria, often for non-clinical reasons. Seventy-three referring providers completed the survey. Criteria endorsed more by referrers than clinics included low blood pressure with a high heart rate, recurrent defibrillator shocks and intravenous inotropes-criteria also consistent with guidelines. CONCLUSIONS There is considerable agreement on the main clinic entry criteria, but given some discordance, two levels of clinics may be warranted. Publicising evidence-based criteria and applying them systematically at referral sources could support improved HF patient care journeys and outcomes.
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Affiliation(s)
- Taslima Mamataz
- Faculty of Health, York University, Keele Campus, Toronto, Ontario, Canada
| | - Sean A Virani
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Michael McDonald
- Peter Munk Cardiac Centre, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Heather Edgell
- Faculty of Health, York University, Keele Campus, Toronto, Ontario, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Keele Campus, Toronto, Ontario, Canada
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Haddad D, Yu V, Chow R, Yanez D, Rajput K. A Survey Study of Surgeons and Anesthesiologists Regarding Perioperative Multimodal Analgesia for Opioid-Tolerant Patients. J Perianesth Nurs 2024; 39:87-92. [PMID: 37855765 DOI: 10.1016/j.jopan.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Perioperative pain management of opioid-tolerant patients can be challenging. Although regional anesthesia and multimodal analgesics may be beneficial, these modalities are often underused. It is unclear whether practice patterns for perioperative pain management are determined by the knowledge, attitudes, and beliefs of surgeons and anesthesiologists. DESIGN Descriptive survey. METHODS Using a Qualtrics survey, we polled a randomly selected group of 25 surgeons and 25 anesthesiologists regarding their knowledge, attitudes, beliefs, and practices for pain management in an opioid-tolerant patient. FINDINGS Of 25, 23 anesthesiologists and 18/25 surgeons responded to the survey. Demographics were similar between the 2 groups. Most of the participant surgeons and anesthesiologists believed that pain management may be challenging in an opioid-tolerant patient. However, only 56% of surgeons would recommend a preoperative pain consultation. Most surgeons and anesthesiologists believed in the efficacy of regional anesthetics. However, 43% of surgeons would not advocate for a regional block, perhaps due to their perception of the added perioperative time. Multimodal analgesics were widely accepted by both surgeons and anesthesiologists. CONCLUSIONS There is an urgent need to reinforce the importance of patient-centered care, with a specific focus on addressing knowledge gaps and improving perceptions for all the members of the team, including surgeons, anesthesiologists, and perioperative nursing teams, if optimal outcomes are to be achieved for our patients.
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Affiliation(s)
- Daniel Haddad
- Department of Anesthesiology and Pain Medicine, Yale University School of Medicine, New Haven, CT
| | - Victor Yu
- Department of Anesthesiology and Pain Medicine, Yale University School of Medicine, New Haven, CT
| | - Robert Chow
- Department of Anesthesiology and Pain Medicine, Yale University School of Medicine, New Haven, CT
| | - David Yanez
- Department of Anesthesiology and Pain Medicine, Yale University School of Medicine, New Haven, CT
| | - Kanishka Rajput
- Department of Anesthesiology and Pain Medicine, Yale University School of Medicine, New Haven, CT.
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Mamataz T, Lee DS, Turk-Adawi K, Hajaj A, Code J, Grace SL. Factors Affecting Healthcare Provider Referral to Heart Function Clinics: A Mixed-Methods Study. J Cardiovasc Nurs 2024; 39:18-30. [PMID: 37669639 DOI: 10.1097/jcn.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
BACKGROUND Heart failure (HF) care providers are gatekeepers for patients to appropriately access lifesaving HF clinics. OBJECTIVE The aim of this study was to investigate referring providers' perceptions regarding referral to HF clinics, including the impact of provider specialty and the coronavirus disease pandemic. METHODS An exploratory, sequential design was used in this mixed-methods study. For the qualitative stage, semistructured interviews were performed with a purposive sample of HF providers eligible to refer (ie, nurse practitioners, cardiologists, internists, primary care and emergency medicine physicians) in Ontario. Interviews were conducted via Microsoft Teams. Transcripts were analyzed concurrently by 2 researchers independently using NVivo, using a deductive-thematic approach. Then, a cross-sectional survey of similar providers across Canada was undertaken via REDCap (Research Electronic Data Capture), using an adapted version of the Provider Attitudes toward Cardiac Rehabilitation and Referral scale. RESULTS Saturation was achieved upon interviewing 7 providers. Four themes arose: knowledge about clinics and their characteristics, providers' clinical expertise, communication and relationship with their patients, and clinic referral process and care continuity. Seventy-three providers completed the survey. The major negative factors affecting referral were skepticism regarding clinic benefit (4.1 ± 0.9/5), a bad patient experience and believing they are better equipped to manage the patient (both 3.9). Cardiologists more strongly endorsed clarity of referral criteria, referral as normative and within-practice referral supports as supporting appropriate referral versus other professionals ( P s < .02), among other differences. One-third (n = 13) reported the pandemic impacted their referral practices (eg, limits to in-person care, patient concerns). CONCLUSION Although there are some legitimate barriers to appropriate clinic referral, greater provider education and support could facilitate optimal patient access.
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Pereira DE, Kamara E, Krueger CA, Courtney PM, Austin MS, Rana A, Hannon CP. Prior Authorization in Total Joint Arthroplasty: A Survey of the American Association of Hip and Knee Surgeons Membership. J Arthroplasty 2023:S0883-5403(23)00042-6. [PMID: 36708936 DOI: 10.1016/j.arth.2023.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study surveyed the impact that prior authorization has on the practices of total joint arthroplasty (TJA) members of the American Association of Hip and Knee Surgeons (AAHKS). METHODS A 24-question survey was approved by the AAHKS Advocacy Committee and distributed to all 2,802 board-certified members of AAHKS. RESULTS There were 353 survey responses (13%). Ninety-five percent of surgeons noted a 5-year increase in prior authorization. A majority (71%) of practices employ at least 1 staff member to exclusively work on prior authorization. Average time spent on prior authorization was 15 h/wk (range, 1 to 125) and average number of claims peer week was 18 (range, 1 to 250). Surgeries (99%) were the most common denial. These were denied because nonoperative treatment had not been tried (71%) or had not been attempted for enough time (67%). Most (57%) prior authorization processes rarely/never changed the treatment provided. Most (56%) indicated that prior authorization rarely/never followed evidence-based guidelines. A majority (93%) expressed high administrative burden as well as negative clinical outcomes (87%) due to prior authorization including delays to access care (96%) at least sometimes. DISCUSSION Prior authorization has increased in the past 5 years resulting in high administrative burden. Prior authorizations were most common for TJA surgeries because certain nonoperative treatments were not attempted or not attempted for enough time. Surgeons indicated that prior authorization may be detrimental to high-value care and lead to potentially harmful delays in care without ultimately changing the management of the patient.
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Affiliation(s)
- Daniel E Pereira
- Department of Orthopaedic Surgery, Washington University, Saint Louis, Missouri
| | - Eli Kamara
- Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York
| | - Chad A Krueger
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - P Maxwell Courtney
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew S Austin
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Adam Rana
- Maine Medical Partners Orthopedics and Sports Medicine, South Portland, Maine
| | - Charles P Hannon
- Department of Orthopaedic Surgery, Washington University, Saint Louis, Missouri
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Rai A, Keil M, Choi H, Mindel V. Understanding how physician perceptions of job demand and process benefits evolve during CPOE implementation. Health Syst (Basingstoke) 2022; 12:98-122. [PMID: 36926371 PMCID: PMC10013386 DOI: 10.1080/20476965.2022.2113343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 08/03/2022] [Indexed: 10/14/2022] Open
Abstract
We examine how physicians' perceptions of two computerized provider order entry (CPOE) capabilities, standardisation of care protocols and documentation quality, are associated with their perceptions of turnaround time, medical error, and job demand at three phases of CPOE implementation: pre-go-live, initial use, and continued use. Through a longitudinal study at a large urban hospital, we find standardisation of care protocols is positively associated with turnaround time reduction in all phases but positively associated with job demand increase only in the initial use phase. Standardisation also has a positive association with medical error reduction in the initial use phase, but later this effect becomes fully mediated through turnaround time reduction in the continued use phase. Documentation quality has a positive association with medical error reduction in the initial use phase and this association strengthens in the continued use phase. Our findings provide insights to effectively manage physicians' response to CPOE implementation.
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Affiliation(s)
- Arun Rai
- Georgia State University, Atlanta, Georgia, United States
| | - Mark Keil
- Georgia State University, Atlanta, Georgia, United States
| | - Hyoungyong Choi
- Hankuk University of Foreign Studies, Dongdaemun-gu, Seoul, Korea
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Poole M, Fasola L, Zevin B. Management of Complications After Bariatric Surgery: a Survey of Comfort and Educational Needs of General Surgeons in Ontario, Canada. Obes Surg 2022; 32:2407-2416. [PMID: 35503158 PMCID: PMC9063615 DOI: 10.1007/s11695-022-06095-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 12/01/2022]
Abstract
Purpose Approximately 10% of patients develop complications after bariatric surgery. These patients often present to their local general surgeon rather than the hospital where the primary bariatric operation was performed. The objective of this study was to conduct a survey of general surgeons in Ontario, Canada, to explore their confidence and educational needs regarding management of surgical complications post-bariatric surgery. Materials and Methods A 40-item survey was created and piloted with community and academic general surgeons. It was disseminated by mail in August 2020 to general surgeons in Ontario who take acute care surgery call. Bariatric surgeons and surgeons who do not take acute care surgery call were excluded. Results A total of 138/715 (19.3%) eligible surgeons completed the survey. Of the respondents, 63/112 (54.3%) had no exposure to bariatric surgery during residency or fellowship. A total of 72/108 (66.7%) respondents agreed that management of complications after bariatric surgery should be within the skillset of a general surgeon; however, 28/108 (25.9%) were not confident managing these complications. Seventy-one of 108 (65.7%) respondents were interested in additional continuing professional development (CPD) resources regarding management of these complications. Hands-on workshops, online resources, and live webinars were the most preferred educational formats for such CPD resources, with 67.1% of participants willing to commit 1–3 h and 42.9% willing to pay >$100 for such CPD resources. Conclusions One-quarter of general surgeons in Ontario, Canada, were not comfortable managing complications after bariatric surgery; however, the majority of surgeons were interested in additional CPD resources on this topic. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-022-06095-9.
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Affiliation(s)
- Meredith Poole
- Department of Surgery, Juravinski Hospital, McMaster University, Room B3-143, 711 Concession Street East, Hamilton, Ontario, L8V 1C3, Canada
| | - Laurie Fasola
- Department of Surgery, Kingston General Hospital, Queen's University, 76 Stuart Street, Burr 2, Kingston, ON, K7L 2V7, Canada
| | - Boris Zevin
- Department of Surgery, Kingston General Hospital, Queen's University, 76 Stuart Street, Burr 2, Kingston, ON, K7L 2V7, Canada.
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Forner D, Noel CW, Grant A, Hong P, Corsten M, Wu V, Taylor SM, Trites JRB, Rigby MH. Management of Peritonsillar Abscesses in Adults: Survey of Otolaryngologists in Canada and the United States. OTO Open 2021; 5:2473974X211044081. [PMID: 34541442 PMCID: PMC8445538 DOI: 10.1177/2473974x211044081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022] Open
Abstract
Objective The management of peritonsillar abscess (PTA) has evolved over time. We sought to define contemporary practice patterns for the diagnosis and treatment of PTA. Study Design Cross-sectional survey. Setting The 15-question survey was distributed to members of the Canadian Society of Otolaryngology–Head and Neck Surgery (CSO) and the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS). Methods An iterative, consensus-based process was used for survey development. Primary outcomes were to determine methods of diagnosis and first-line treatments for PTA. Exploratory, secondary outcomes were analyzed using multivariable logistic regression models. Results The survey response rate was 12.6% (n = 1176). Most participants were attending staff (86%) in a community hospital setting (60%) and had been in practice for more than 20 years (38%). Most respondents (78%) indicated that at least half of the time, cross-sectional imaging had already been performed before they were consulted. Half of respondents (49%) indicated that they perform incision and drainage of the abscess as first-line treatment, while few (16%) provide medical management alone. In exploratory analysis, participants from the AAO-HNS had higher odds of imaging already being performed before consultation (odds ratio [OR], 11.7; 95% CI, 4.6-29.4) and increased odds of using medical management alone as a first-line treatment (OR, 2.4; 95% CI, 1.3-4.2) compared to respondents from the CSO. Conclusion There is wide practice variation in the diagnosis and management of acute, uncomplicated PTA among otolaryngologists in Canada and the United States. The use of cross-sectional imaging and medical management alone may differ between countries of practice.
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Affiliation(s)
- David Forner
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.,Maritime SPOR (Strategy for Patient-Oriented Research) Support Unit (MSSU), Halifax, Nova Scotia, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amy Grant
- Maritime SPOR (Strategy for Patient-Oriented Research) Support Unit (MSSU), Halifax, Nova Scotia, Canada
| | - Paul Hong
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.,Maritime SPOR (Strategy for Patient-Oriented Research) Support Unit (MSSU), Halifax, Nova Scotia, Canada.,IWK Health Center, Halifax, Nova Scotia, Canada
| | - Martin Corsten
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - S Mark Taylor
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan R B Trites
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew H Rigby
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
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Aspinall EE, Hunt SL, Theis-Mahon NR, Chew KV, Olawsky E. Addressing Disparities in Physician Access to Information in Support of Evidence-based Practice. HEALTH COMMUNICATION 2021; 36:900-908. [PMID: 32041438 DOI: 10.1080/10410236.2020.1723049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this study is to determine if Minnesota physicians have access to information resources needed to support evidence-based practice (EBP), which supports a culture of safety and patient-centered care. A survey was used to determine Minnesota physicians' need for, and access to, evidence-based clinical information. A total of 877 responses (6.4% response rate) were included in the data analysis. Participants spent 24 min daily seeking answers to clinical questions and averaged 4.41 questions per day that could not be immediately answered. Physicians reported high levels of information needs met (85.8%), though they reported limited access to drug resources, citation databases, systematic reviews, and full-text books and articles. Results also showed use of unreliable sources to support decision-making. A key finding was the extent to which workplace affiliation broadens disparities in information access. National and regional approaches can work to support EBP by reducing the information gap caused by workplace affiliation and other barriers. Further research should be done to identify partnerships, funding, infrastructure, and support to address these gaps.
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Affiliation(s)
| | | | | | | | - Evan Olawsky
- School of Public Health, Division of Biostatistics, University of Minnesota
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Wong KH, Yang LCM, Woo KWR, Wong OF, Kwong WY, Tse CF, Lam SKT, Ma HM, Lit CHA, Ho HF, Shih YN. Attitudes and educational needs of emergency doctors providing palliative and end-of-life care in Hong Kong: a cross-sectional analysis based on a self-report study. BMC Palliat Care 2021; 20:48. [PMID: 33757502 PMCID: PMC7988912 DOI: 10.1186/s12904-021-00742-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 03/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background Due to the ageing population in Hong Kong, the importance and need of palliative care and end-of-life (EOL) care are coming under the spotlight. The objectives of this study were to evaluate the attitudes of emergency doctors in providing palliative and EOL care in Hong Kong, and to investigate the educational needs of emergency doctors in these areas. Methods A questionnaire was used to study the attitudes of ED doctors of six different hospitals in Hong Kong. The questionnaire recorded the attitudes of the doctors towards the role of palliative and EOL care in EDs, the specific obstacles faced, their comfort level and further educational needs in providing such care. The attitudes of emergency doctors of EDs with EOL care services were compared with those of EDs without such services. Results In total, 145 emergency doctors completed the questionnaire, of which 60 respondents were from EDs with EOL care services. A significant number of participants recognized that the management of the dying process was essential in ED. Providing palliative and EOL care is also accepted as an important competence and responsibility, but the role and priority of palliative and EOL care in ED are uncertain. Lack of time and access to palliative care specialists/ teams were the major barriers. Doctors from EDs with EOL care services are more comfortable in providing such care and discuss it with patients and their relatives. Further educational needs were identified, including the management of physical complaints, communication skills, and EOL care ethics. Conclusions The study identified obstacles in promoting palliative and EOL care in the EDs Hong Kong. With the combination of elements of routine ED practice and a basic palliative medicine skill set, it would promote the development of palliative and EOL care in Emergency Medicine in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00742-1.
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Affiliation(s)
- Kwun Hang Wong
- Accident and Emergency Department, North Lantau Hospital, 8 Chung Yan Road, Tung Chun, Lantau, Hong Kong
| | - Li Chuan Marc Yang
- Fong Tam Yuen Leung Emergency Medicine Centre, The Chinese University of Hong Kong Medical Centre, 9 Chak Cheung Street, Shatin, New Territories, Hong Kong. .,Accident and Emergency Department, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
| | - Kam Wing Raymond Woo
- Department of Medicine and Geriatrics, Caritas Medical Centre, 111 Wing Hong Street, Sham Shui Po, Kowloon, Hong Kong
| | - Oi Fung Wong
- Accident and Emergency Department, North Lantau Hospital, 8 Chung Yan Road, Tung Chun, Lantau, Hong Kong
| | - Wing Yan Kwong
- Accident and Emergency Department, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| | - Choi Fung Tse
- Accident and Emergency Department, Tin Shui Wai Hospital, 11 Tin Tan Street, Tin Shui Wai, New Territories, Hong Kong
| | - Shing Kit Tommy Lam
- Accident and Emergency Department, Poh Oi Hospital, Au Tau, Yuen Long, New Territories, Hong Kong
| | - Hing Man Ma
- Accident and Emergency Department, North Lantau Hospital, 8 Chung Yan Road, Tung Chun, Lantau, Hong Kong
| | - Chau Hung Albert Lit
- Accident and Emergency Department, North Lantau Hospital, 8 Chung Yan Road, Tung Chun, Lantau, Hong Kong
| | - Hiu Fai Ho
- Accident and Emergency Department, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| | - Yau Ngai Shih
- Accident and Emergency Department, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
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Maes-Carballo M, Martín-Díaz M, Mignini L, Khan KS, Trigueros R, Bueno-Cavanillas A. Evaluation of the Use of Shared Decision Making in Breast Cancer: International Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2128. [PMID: 33671649 PMCID: PMC7926688 DOI: 10.3390/ijerph18042128] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess shared decision-making (SDM) knowledge, attitude and application among health professionals involved in breast cancer (BC) treatment. MATERIALS AND METHODS A cross-sectional study based on an online questionnaire, sent by several professional societies to health professionals involved in BC management. There were 26 questions which combined demographic and professional data with some items measured on a Likert-type scale. RESULTS The participation (459/541; 84.84%) and completion (443/459; 96.51%) rates were high. Participants strongly agreed or agreed in 69.57% (16/23) of their responses. The majority stated that they knew of SDM (mean 4.43 (4.36-4.55)) and were in favour of its implementation (mean 4.58 (4.51-4.64)). They highlighted that SDM practice was not adequate due to lack of resources (3.46 (3.37-3.55)) and agreed on policies that improved its implementation (3.96 (3.88-4.04)). The main advantage of SDM for participants was patient satisfaction (38%), and the main disadvantage was the patients' paucity of knowledge to understand their disease (24%). The main obstacle indicated was the lack of time and resources (40%). CONCLUSIONS New policies must be designed for adequate training of professionals in integrating SDM in clinical practice, preparing them to use SDM with adequate resources and time provided.
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Affiliation(s)
- Marta Maes-Carballo
- Unidad de Patología Mamaria del Servicio de Cirugía General, Complexo Universitario Hospitalario de Ourense, 32005 Ourense, Spain;
- Department of Preventive Medicine and Public Health, University of Granada, 18014 Granada, Spain; (K.S.K.); (A.B.-C.)
| | | | - Luciano Mignini
- Unidad de Mastología del Grupo Oroño, 2000 Rosario, Argentina;
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, 18014 Granada, Spain; (K.S.K.); (A.B.-C.)
- CIBER of Epidimiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Rubén Trigueros
- Department of Language and Education, University of Antonio de Nebrija, 28015 Madrid, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, 18014 Granada, Spain; (K.S.K.); (A.B.-C.)
- CIBER of Epidimiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Instituto de Investigación Biosanitaria (IBS), 18012 Granada, Spain
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Delnevo CD, Singh B. The effect of a web-push survey on physician survey responses rates: a randomized experiment. ACTA ACUST UNITED AC 2021; 14. [PMID: 33604202 DOI: 10.29115/sp-2021-0001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Achieving a high response rate for physicians has been challenging, and with response rates declining in recent years, innovative methods are needed to increase rates. An emerging concept in survey methodology has been web-push survey delivery. With this delivery method, contact is made by mail to request a response by web. This study explored the feasibility of a web-push survey on a national sample of physicians. Methods A total of 1,000 physicians across six specialties were randomly assigned to a mail-only or web-push survey delivery. Each mode consisted of four contacts including an initial mailing, reminder postcard, and two additional follow-ups. Response rates were calculated using the American Association for Public Opinion Research's response rate 3 calculation. Data collection occurred between Febuary and April 2018; data were analyzed March 2019. Results Overall reponse rates for the mail-only versus web-push survey delivery were comparable (51.2% vs. 52.8%). Higher response rates across all demographics were seen in the web-push delivery, with the exception of pulmonary/critical care and physicians over the age of 65. The web-push survey yielded a greater response after the first mailing, requiring fewer follow-up contacts resulting in a more cost-effective delivery. Conclusions A web-push mail survey is effective in achieving a comparable response rate to traditional mail-only delivery for physicians. The web-push survey was more efficient in terms of cost and in receiving responses in a more timely manner. Future research should explore the efficiency of a web-push survey delivery across various health care provider populations.
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Affiliation(s)
| | - Binu Singh
- Center for Tobacco Studies, Rutgers University New Brunswick
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Santry HP, Strassels SA, Ingraham AM, Oslock WM, Ricci KB, Paredes AZ, Heh VK, Baselice HE, Rushing AP, Diaz A, Daniel VT, Ayturk MD, Kiefe CI. Identifying the fundamental structures and processes of care contributing to emergency general surgery quality using a mixed-methods Donabedian approach. BMC Med Res Methodol 2020; 20:247. [PMID: 33008294 PMCID: PMC7532630 DOI: 10.1186/s12874-020-01096-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute Care Surgery (ACS) was developed as a structured, team-based approach to providing round-the-clock emergency general surgery (EGS) care for adult patients needing treatment for diseases such as cholecystitis, gastrointestinal perforation, and necrotizing fasciitis. Lacking any prior evidence on optimizing outcomes for EGS patients, current implementation of ACS models has been idiosyncratic. We sought to use a Donabedian approach to elucidate potential EGS structures and processes that might be associated with improved outcomes as an initial step in designing the optimal model of ACS care for EGS patients. METHODS We developed and implemented a national survey of hospital-level EGS structures and processes by surveying surgeons or chief medical officers regarding hospital-level structures and processes that directly or indirectly impacted EGS care delivery in 2015. These responses were then anonymously linked to 2015 data from the American Hospital Association (AHA) annual survey, Medicare Provider Analysis and Review claims (MedPAR), 17 State Inpatient Databases (SIDs) using AHA unique identifiers (AHAID). This allowed us to combine hospital-level data, as reported in our survey or to the AHA, to patient-level data in an effort to further examine the role of EGS structures and processes on EGS outcomes. We describe the multi-step, iterative process utilizing the Donabedian framework for quality measurement that serves as a foundation for later work in this project. RESULTS Hospitals that responded to the survey were primarily non-governmental and located in urban settings. A plurality of respondent hospitals had fewer than 100 inpatient beds. A minority of the hospitals had medical school affiliations. DISCUSSION Our results will enable us to develop a measure of preparedness for delivering EGS care in the US, provide guidance for regionalized care models for EGS care, tiering of ACS programs based on the robustness of their EGS structures and processes and the quality of their outcomes, and formulate triage guidelines based on patient risk factors and severity of EGS disease. CONCLUSIONS Our work provides a template for team science applicable to research efforts combining primary data collection (i.e., that derived from our survey) with existing national data sources (i.e., SIDs and MedPAR).
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Affiliation(s)
- Heena P. Santry
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W 12th Ave, Suite 614, Columbus, OH 43210 USA
| | - Scott A. Strassels
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Angela M. Ingraham
- Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI USA
| | - Wendelyn M. Oslock
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Kevin B. Ricci
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Anghela Z. Paredes
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Victor K. Heh
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Holly E. Baselice
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Amy P. Rushing
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Adrian Diaz
- Department of Surgery, Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH USA
- Center for Surgical Health Assessment, Research, and Policy, The Ohio State University, 395 W 12th Avenue, Columbus, OH USA
| | - Vijaya T. Daniel
- Department of Surgery, University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA USA
| | - M. Didem Ayturk
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA USA
| | - Catarina I. Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Avenue, Worcester, MA USA
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Jia P, Furuya-Kanamori L, Qin ZS, Jia PY, Xu C. Association between response rates and monetary incentives in sample study: a systematic review and meta-analysis. Postgrad Med J 2020; 97:501-510. [PMID: 32848082 DOI: 10.1136/postgradmedj-2020-137868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/12/2020] [Accepted: 06/18/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the effect of monetary incentive and the dose-response relationship of participants' response rates in surveys. METHODS Three databases were searched for randomised controlled trials (RCTs) that investigated the effect of monetary incentives on participants' first and final response rates. First response is defined as the responses after the participant was initially contacted and final response is defined as the responses after several reminders were sent. The potential dose-response relationship of the amount of monetary incentive on the relative response rate (RRR) was established by fitting a restricted cubic spline function based on the robust-error meta-regression model. RESULTS 105 RCTs were identified. The first RRR increased by 49% (RRR=1.49; 95% CI 1.29 to 1.72) when monetary incentives were provided. Dose-response analysis revealed that an amount between US$6.25 and US$8 had the maximum effect on increasing the first response rate. On average, the final RRR increased almost by 20% (RRR=1.18; 95% CI 1.11 to 1.25) with monetary incentive compared to no-monetary incentive. An amount between US$10 and US$15 had the maximum effect on the final response rate, with an increase in the final RRR of 34% (RRR=1.34; 95% CI 1.19 to 1.51). There was a significant increase in the response rate when two or more reminders were sent. CONCLUSION Monetary incentives and reminders improve the response rates. Future studies need to consider providing monetary incentives and sending at least two reminders to increase the response rate and reduce the chances of non-response bias.
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Affiliation(s)
- Pengli Jia
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Luis Furuya-Kanamori
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Zong-Shi Qin
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Peng-Yan Jia
- State Key Laboratory of Grassland Agro-ecosystems, College of Pastoral Agricultural Science and Technology, Lanzhou University, Lanzhou, China
| | - Chang Xu
- Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar
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Tung YC, Chou YY, Chang YH, Chung KP. Association of intrinsic and extrinsic motivating factors with physician burnout and job satisfaction: a nationwide cross-sectional survey in Taiwan. BMJ Open 2020; 10:e035948. [PMID: 32161163 PMCID: PMC7066621 DOI: 10.1136/bmjopen-2019-035948] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE The aim of this study was to systematically and simultaneously examine the association of intrinsic and extrinsic motivating factors with physician burnout and job dissatisfaction. DESIGN A nationally representative survey was fielded from September to November 2017. SETTING Hospitals and clinics throughout Taiwan. PARTICIPANTS A total of 6674 physicians. MAIN EXPOSURE MEASURE The main exposure measures were intrinsic motivators (sense of calling, personally rewarding hours per day and meaningful, long-term relationships with patients) and extrinsic motivators (income, work hours, autonomy, and pay-for-performance (P4P) and bundled payment initiatives). MAIN OUTCOME MEASURES The main outcome measures were physician burnout and job dissatisfaction. RESULTS A total of 1152 physicians returned the surveys. More sense of calling and personally rewarding hours per day were associated with less physician burnout (OR 0.16, 95% CI 0.10 to 0.26 and OR 0.25, 95% CI 0.13 to 0.47, respectively) and job dissatisfaction (OR 0.35, 95% CI 0.21 to 0.57 and OR 0.46, 95% CI 0.26 to 0.83, respectively). Longer work hours were associated with more physician burnout (OR 2.67, 95% CI 1.54 to 4.63) and job dissatisfaction (OR 1.71, 95% CI 1.05 to 2.79). Not receiving P4P bonuses from their organisations was associated with more physician burnout (OR 1.56, 95% CI 1.02 to 2.38). Not sharing the losses from caring for patients included in the bundled payment system was associated with less physician burnout (OR 0.59, 95% CI 0.36 to 0.97). CONCLUSIONS Fostering a healthcare work environment that supports intrinsic motivation and improves work hours may reduce physician burnout and job dissatisfaction. Rewarding physicians fairly and equitably may prevent them from feeling burned out. Value-based care delivery and payment model innovations, such as bundled payments, may encourage healthcare professionals to coordinate care through the standardisation of care to decrease burnout.
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Affiliation(s)
- Yu-Chi Tung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ying-Yi Chou
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsuan Chang
- Planning Division, National Health Insurance Administration, Taipei, Taiwan
- Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
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Hannon CP, Keating TC, Lange JK, Ricciardi BF, Waddell BS, Della Valle CJ. Anesthesia and Analgesia Practices in Total Joint Arthroplasty: A Survey of the American Association of Hip and Knee Surgeons Membership. J Arthroplasty 2019; 34:2872-2877.e2. [PMID: 31371038 DOI: 10.1016/j.arth.2019.06.055] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/08/2019] [Accepted: 06/25/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to survey the current analgesia and anesthesia practices used by total joint arthroplasty surgeon members of the American Association of Hip and Knee Surgeons (AAHKS). METHODS A survey of 28 questions was created and approved by the AAHKS Research Committee. The survey was distributed to all 2208 board-certified adult reconstruction surgeon members of AAHKS in November 2018. RESULTS There were 622 responses (28.2%) to the survey. A majority of respondents (93.2%, n = 576) use preemptive analgesia prior to total joint arthroplasty. Most respondents use a spinal for total knee arthroplasty (TKA) (74.4%) and total hip arthroplasty (THA) (72.6%). A peripheral nerve block is routinely used by 68.7% of respondents in primary TKA. Periarticular injection or local infiltration anesthesia is routinely used by 80.3% of respondents for both TKA and THA patients. The average number of opioid pills prescribed postoperatively after TKA is 49 pills (range 0-200) and after THA is 44 pills (range 0-200). Most surgeons (58%) expect that this prescription should last for 2 weeks. A majority of respondents (74.0%) use multimodal analgesics in addition to opioids. CONCLUSION There is no consensus regarding the optimal multimodal anesthetic and analgesic regimen for total joint arthroplasty among surveyed board-certified arthroplasty surgeon members of AAHKS. Understanding current practice patterns in anesthesia, analgesia, and opioid prescribing may serve as a platform for future work aimed at establishing best clinical practices of maximizing effective postoperative pain control and minimizing the risks associated with prescribing opioids.
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Affiliation(s)
- Charles P Hannon
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Timothy C Keating
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Jeffrey K Lange
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Benjamin F Ricciardi
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, University of Rochester School of Medicine, Rochester, NY
| | - Bradford S Waddell
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Craig J Della Valle
- Adult Reconstruction Division, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Advancing regulatory science and assessment of FDA REMS programs: A mixed-methods evaluation examining physician survey response. J Clin Transl Sci 2019; 3:199-209. [PMID: 31660244 PMCID: PMC6799639 DOI: 10.1017/cts.2019.400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/16/2019] [Accepted: 07/20/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose: Food and Drug Administration’s (FDA) Draft Guidance for Industry on pharmaceutical REMS (Risk Evaluation and Mitigation Strategies) assessment and survey methodology highlights physician knowledge–attitudes–behaviors (KAB) surveys as regulatory science tools. This mixed-methods evaluation advances regulatory science and the assessment of FDA REMS programs when using physician surveys. We: (1) reviewed published physician survey response rates; and (2) assessed response bias in a simulation study of secondary survey data using different accrual cut-off strategies. Methods: A systematic literature review was conducted of US physician surveys (2000–2014) on pharmaceutical use (n = 75). Kruskal–Wallis tests were used to examine the relationships between response rates and survey design characteristics. The simulation was conducted using secondary data from a population-based physician KAB survey on diabetes risk management with antipsychotic use in Missouri Medicaid (n = 973 accrued over 30 weeks). Survey item responses were compared using Pearson’s chi-square tests for two faster completion simulations: Fixed Sample (n = 300) and Fixed Time (8 weeks). Results: Survey response rates ranged from 7% to 100% (median = 48%, IQR = 34%–68%). Surveys of targeted populations and surveys using member lists were associated with higher response rates (p = 0.02). In the simulation, 9 of 20 (45%) KAB items, including diabetes screening advocacy, differed significantly using the smaller Fixed Sample strategy (achieved in 12 days) versus full accrual. Fewer response differences were found using the Fixed Time strategy (2 of 20 [10%] items). Conclusions: Published data on physician surveys report low response rates with most associated with the sample source selected. FDA REMS assessments should include formal evaluation of survey accrual and response bias.
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18
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Do Physicians Prefer to Complete Online or Mail Surveys? Findings From a National Longitudinal Survey. Eval Health Prof 2018; 42:41-70. [DOI: 10.1177/0163278718807744] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Survey response rates for physicians are falling generally, and surveys of physicians tend to have lower response rates than those of the general population. To maximize response, respondents are often given a choice of modes in which to respond. The aim of this article is to describe mode response patterns and identify factors related to physicians’ decisions to complete surveys online rather than by mail. The data are from the fifth annual wave of the Medicine in Australia: Balancing Employment and Life longitudinal survey of physicians, in which there was a 43.5% response rate (10,746/24,711) and 33.7% of respondents completed the survey online. Online completion was more likely when the physician had completed the survey online in the previous wave, was a general practitioner rather than other medical specialist or doctor-in-training, worked in a remote location, and was young and male. Free-text spontaneous comments from respondents indicated that mode choice was based on a combination of preference, previous experience, and feasibility. These results provide support for the use of mixed mode survey designs, which can accommodate doctors with different mode preferences and cast doubt over the possibility of tailoring mode based on respondent characteristics.
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Abstract
A major challenge with surveying physicians is low response. In this article, we present results of an experiment conducted to determine the optimal monetary incentive amount for gaining response from physicians to a short screener survey. Sampled physicians were randomly assigned to three prepaid cash incentive conditions (US$2, US$5, US$10) compared to a control (US$0). This study found using any incentive increased response versus no incentive. The US$10 incentive produced the highest response and was significantly greater than the US$2 incentive group. However, we did not find a statistical difference between the $5 and US$10 incentives or between the US$2 and US$5 incentives. In addition, any incentive amount increased the likelihood of early response compared to no incentive. This study builds on previously mixed results about the effects of various incentive amounts and effect on early survey response. These findings provide practical advice for researchers surveying physicians.
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Wan S, Teichman PG, Latif D, Boyd J, Gupta R. Healthcare provider perceptions of the role of interprofessional care in access to and outcomes of primary care in an underserved area. J Interprof Care 2017; 32:220-223. [PMID: 29083272 DOI: 10.1080/13561820.2017.1387772] [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] [Indexed: 10/18/2022]
Abstract
To meet the needs of an aging population who often have multiple chronic conditions, interprofessional care is increasingly adopted by patient-centred medical homes and Accountable Care Organisations to improve patient care coordination and decrease costs in the United States, especially in underserved areas with primary care workforce shortages. In this cross-sectional survey across multiple clinical settings in an underserved area, healthcare providers perceived overall outcomes associated with interprofessional care teams as positive. This included healthcare providers' beliefs that interprofessional care teams improved patient outcomes, increased clinic efficiency, and enhanced care coordination and patient follow-up. Teams with primary care physician available each day were perceived as better able to coordinate care and follow up with patients (p = .031), while teams that included clinical pharmacists were perceived as preventing medication-associated problems (p < .0001). Healthcare providers perceived the interprofessional care model as a useful strategy to improve various outcomes across different clinical settings in the context of a shortage of primary care physicians.
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Affiliation(s)
- Shaowei Wan
- a Department of Pharmaceutical and Administrative Sciences , University of Charleston School of Pharmacy , Charleston , West Virginia , USA
| | - Peter G Teichman
- b Family Medicine, Charleston Internal Medicine , Charleston , West Virginia , USA
| | - David Latif
- a Department of Pharmaceutical and Administrative Sciences , University of Charleston School of Pharmacy , Charleston , West Virginia , USA
| | - Jennifer Boyd
- c Clinical Quality, West Virginia Primary Care Association , Charleston , West Virginia , USA
| | - Rahul Gupta
- d Bureau for Public Health , West Virginia Department of Health and Human Resources , Charleston , West Virginia , USA
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Chyou PH, Schroeder D, Schwei K, Acharya A. Statistical Application and Cost Saving in a Dental Survey. Clin Med Res 2017; 15:1-5. [PMID: 28373286 PMCID: PMC5573523 DOI: 10.3121/cmr.2017.1323] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 10/27/2016] [Accepted: 01/26/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To effectively achieve a robust survey response rate in a timely manner, an alternative approach to survey distribution, informed by statistical modeling, was applied to efficiently and cost-effectively achieve the targeted rate of return. DESIGN A prospective environmental scan surveying adoption of health information technology utilization within their practices was undertaken in a national pool of dental professionals (N=8000) using an alternative method of sampling. The piloted approach to rate of cohort sampling targeted a response rate of 400 completed surveys from among randomly targeted eligible providers who were contacted using replicated subsampling leveraging mailed surveys. METHODS Two replicated subsample mailings (n=1000 surveys/mailings) were undertaken to project the true response rate and estimate the total number of surveys required to achieve the final target. Cost effectiveness and non-response bias analyses were performed. RESULTS The final mailing required approximately 24% fewer mailings compared to targeting of the entire cohort, with a final survey capture exceeding the expected target. An estimated $5000 in cost savings was projected by applying the alternative approach. Non-response analyses found no evidence of bias relative to demographics, practice demographics, or topically-related survey questions. CONCLUSION The outcome of this pilot study suggests that this approach to survey studies will accomplish targeted enrollment in a cost effective manner. Future studies are needed to validate this approach in the context of other survey studies.
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Affiliation(s)
- Po-Huang Chyou
- Biomedical Informatics Research Center at Marshfield Clinic Research Foundation, Marshfield, Wisconsin, USA
| | - Dixie Schroeder
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Kelsey Schwei
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Amit Acharya
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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Marcks BA, Wetterneck CT, Woods DW. Investigating Healthcare Providers' Knowledge of Trichotillomania and its Treatment. Cogn Behav Ther 2017. [DOI: 10.1080/16506070510010657a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pezzino NC, Marciniak MW, Smith MG, Ferreri SP. Physician-reported factors that encourage collaboration with community pharmacists. J Am Pharm Assoc (2003) 2017; 57:S279-S283.e2. [PMID: 28411013 DOI: 10.1016/j.japh.2017.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/31/2017] [Accepted: 02/13/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine factors that encourage physicians to establish collaborative practice agreements with community pharmacists. METHODS A 20-item cross-sectional survey was mailed to a random sample of 1000 family medicine physicians practicing in North Carolina. Two weeks after the initial mailing, a reminder was sent to physicians. Physicians were entered into a drawing to receive a gift card as an incentive for survey completion. The questionnaire collected demographic information, factors important to physicians for collaboration with a community pharmacist, and physician perceptions of pharmacist qualifications. Descriptive statistics were used to analyze patterns in the Likert scale survey responses. RESULTS Of the 1000 mailed surveys, 67 were returned as undeliverable, resulting in a final sample size of 933 surveys. One hundred forty-six family medicine physicians responded to the survey, yielding a 15.6% response rate. Respondents were 58% male, 73% had been practicing longer than 10 years, and 60% had an academic affiliation. Our results indicate that an established relationship with a community pharmacist is the most important factor when considering a collaborative practice agreement. At least 90% of physicians reported that the most important pharmacist contributions were drug therapy adverse effect management, drug interaction management, medication access assistance, prescription counseling, and medication adherence. A majority of physicians reported that community pharmacists improve quality outcomes and metrics (74% and 72%, respectively). CONCLUSION Physicians in North Carolina recognize the value of the services a pharmacist can provide to their patients. Developing relationships between community pharmacists and physicians and describing the value of additional credentialing in the provision of patient care will be integral in establishing collaborative practice agreements in the community setting.
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Watkins V, Nagle C, Kent B, Hutchinson AM. Labouring Together: collaborative alliances in maternity care in Victoria, Australia-protocol of a mixed-methods study. BMJ Open 2017; 7:e014262. [PMID: 28270390 PMCID: PMC5353350 DOI: 10.1136/bmjopen-2016-014262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION For over a decade, enquiries into adverse perinatal outcomes have led to reports that poor collaboration has been detrimental to the safety and experience of maternity care. Despite efforts to improve collaboration, investigations into maternity care at Morecambe Bay (UK) and Djerriwarrh Health Services (Australia) have revealed that poor collaboration and decision-making remain a threat to perinatal safety. The Labouring Together study will investigate how elements hypothesised to influence the effectiveness of collaboration are reflected in perceptions and experiences of clinicians and childbearing women in Victoria, Australia. The study will explore conditions that assist clinicians and women to work collaboratively to support positive maternity outcomes. Results of the study will provide a platform for consumers, clinician groups, organisations and policymakers to work together to improve the quality, safety and experience of maternity care. METHODS AND ANALYSIS 4 case study sites have been selected to represent a range of models of maternity care in metropolitan and regional Victoria, Australia. A mixed-methods approach including cross-sectional surveys and interviews will be used in each case study site, involving both clinicians and consumers. Quantitative data analysis will include descriptive statistics, 2-way multivariate analysis of variance for the dependent and independent variables, and χ2 analysis to identify the degree of congruence between consumer preferences and experiences. Interview data will be analysed for emerging themes and concepts. Data will then be analysed for convergent lines of enquiry supported by triangulation of data to draw conclusions. ETHICS AND DISSEMINATION Organisational ethics approval has been received from the case study sites and Deakin University Human Research Ethics Committee (2014-238). Dissemination of the results of the Labouring Together study will be via peer-reviewed publications and conference presentations, and in written reports for each case study site to support organisational change.
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Affiliation(s)
- Vanessa Watkins
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Eastern Health, Women and Children Program, Victoria, Australia
| | - Cate Nagle
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Women's and Children's Division, Western Health, Sunshine Hospital, Victoria, Australia
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia
| | | | - Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia
- Centre for Nursing Research, Deakin University and Monash Health Partnership, Monash Health, Victoria, Australia
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Ernst SA, Brand T, Lhachimi SK, Zeeb H. Combining Internet-Based and Postal Survey Methods in a Survey among Gynecologists: Results of a Randomized Trial. Health Serv Res 2017; 53:879-895. [PMID: 28217941 DOI: 10.1111/1475-6773.12664] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess whether a combination of Internet-based and postal survey methods (mixed-mode) compared to postal-only survey methods (postal-only) leads to improved response rates in a physician survey, and to compare the cost implications of the different recruitment strategies. DATA SOURCES/STUDY SETTING All primary care gynecologists in Bremen and Lower Saxony, Germany, were invited to participate in a cross-sectional survey from January to July 2014. STUDY DESIGN The sample was divided into two strata (A; B) depending on availability of an email address. Within each stratum, potential participants were randomly assigned to mixed-mode or postal-only group. PRINCIPAL FINDINGS In Stratum A, the mixed-mode group had a lower response rate compared to the postal-only group (12.5 vs. 20.2 percent; RR = 0.61, 95 percent CI: 0.44-0.87). In stratum B, no significant differences were found (15.6 vs. 16.2 percent; RR = 0.95, 95 percent CI: 0.62-1.44). Total costs (in €) per valid questionnaire returned (Stratum A: 399.72 vs. 248.85; Stratum B: 496.37 vs. 455.15) and per percentage point of response (Stratum A: 1,379.02 vs. 861.02; Stratum B 1,116.82 vs. 1,024.09) were higher, whereas variable costs were lower in mixed-mode compared to the respective postal-only groups (Stratum A cost ratio: 0.47, Stratum B cost ratio: 0.71). CONCLUSIONS In this study, primary care gynecologists were more likely to participate by traditional postal-only than by mixed-mode survey methods that first offered an Internet option. However, the lower response rate for the mixed-mode method may be partly due to the older age structure of the responding gynecologists. Variable costs per returned questionnaire were substantially lower in mixed-mode groups and indicate the potential for cost savings if the sample population is sufficiently large.
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Affiliation(s)
| | - Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Stefan K Lhachimi
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany.,Collaborative Research Group for Evidence-Based Public Health, Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
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Cook DA, Wittich CM, Daniels WL, West CP, Harris AM, Beebe TJ. Incentive and Reminder Strategies to Improve Response Rate for Internet-Based Physician Surveys: A Randomized Experiment. J Med Internet Res 2016; 18:e244. [PMID: 27637296 PMCID: PMC5045523 DOI: 10.2196/jmir.6318] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/01/2016] [Accepted: 08/03/2016] [Indexed: 11/13/2022] Open
Abstract
Background Most research on how to enhance response rates in physician surveys has been done using paper surveys. Uncertainties remain regarding how to enhance response rates in Internet-based surveys. Objective To evaluate the impact of a low-cost nonmonetary incentive and paper mail reminders (formal letter and postcard) on response rates in Internet-based physician surveys. Methods We executed a factorial-design randomized experiment while conducting a nationally representative Internet-based physician survey. We invited 3966 physicians (randomly selected from a commercial database of all licensed US physicians) via email to complete an Internet-based survey. We used 2 randomly assigned email messages: one message offered a book upon survey completion, whereas the other did not mention the book but was otherwise identical. All nonrespondents received several email reminders. Some physicians were further assigned at random to receive 1 reminder via paper mail (either a postcard or a letter) or no paper reminder. The primary outcome of this study was the survey response rate. Results Of the 3966 physicians who were invited, 451 (11.4%) responded to at least one survey question and 336 (8.5%) completed the entire survey. Of those who were offered a book, 345/2973 (11.6%) responded compared with 106/993 (10.7%) who were not offered a book (odds ratio 1.10, 95% CI 0.87-1.38, P=.42). Regarding the paper mail reminder, 168/1572 (10.7%) letter recipients, 148/1561 (9.5%) postcard recipients, and 69/767 (9.0%) email-only recipients responded (P=.35). The response rate for those receiving letters or postcards was similar (odds ratio 1.14, 95% CI 0.91-1.44, P=.26). Conclusions Offering a modest nonmonetary incentive and sending a paper reminder did not improve survey response rate. Further research on how to enhance response rates in Internet-based physician surveys is needed.
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Affiliation(s)
- David A Cook
- Mayo Clinic Online Learning, Mayo Clinic College of Medicine, Rochester, MN, United States.
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Werner P. Family Physicians’ Recommendations for the Treatment of Alzheimer’s Disease. Am J Alzheimers Dis Other Demen 2016; 21:403-10. [PMID: 17267372 DOI: 10.1177/1533317506294844] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to examine family physicians’ recommendations for various pharmacological and nonpharmacological treatments for Alzheimer’s disease (AD) and its correlates. A phone survey was conducted with 395 family physicians using an experimental vignette methodology, varying in the severity of the disease. Information regarding participants’ recommendations about 10 interventions for the person described in the vignette was elicited. Sociodemographic and professional correlates were examined. Engagement in social activities and participation in support groups were the interventions most recommended by the physicians. Isolation and physical restraints were the least recommended. Recommendations about AD treatments were associated with the severity of the disease and the extent to which the person described in the vignette was perceived as dangerous. Physicians’ recommendations were very similar to those of the lay public, a fact that might contribute to the efficiency of the treatment plan.
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Affiliation(s)
- Perla Werner
- Department of Gerontology, University of Haifa, Israel.
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Agarwal A, Raad D, Kairouz V, Fudyma J, Curtis AB, Schünemann HJ, Akl EA. The effect of a monetary incentive for administrative assistants on the survey response rate: a randomized controlled trial. BMC Med Res Methodol 2016; 16:94. [PMID: 27495186 PMCID: PMC4975879 DOI: 10.1186/s12874-016-0201-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is sufficient evidence that monetary incentives are effective in increasing survey response rates in the general population as well as with physicians. The objective of this study was to assess the impact of a monetary incentive intended for administrative assistants on the survey response rate of physicians in leadership positions. METHODS This was an ancillary study to a national survey of chairs of academic Departments of Medicine in the United States about measuring faculty productivity. We randomized survey participants to receive or not receive a $5 gift card enclosed in the survey package. The cover letter explained that the gift card was intended for the administrative assistants as a "thank you for their time." We compared the response rates between the 2 study arms using the Chi-square test. RESULTS Out of 152 participants to whom survey packages were mailed to, a total of 78 responses were received (51 % response rate). The response rates were 59 % in the incentive arm and 46 % in the no incentive arm. The relative effect of the incentive compared to no monetary incentive was borderline statistically significant (relative risk (RR) = 1.36, 95 % confidence interval (CI) 0.99 to 1.87; p = 0.055). CONCLUSION Monetary incentives intended for administrative assistants likely increase the response rate of physicians in leadership positions.
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Affiliation(s)
- Arnav Agarwal
- Department of Clinical Epidemiology and Biostatistics, McMaster University, CRL-209, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.,Faculty of Medicine, University of Toronto, 1 King's College Circle #3172, Toronto, ON, M5S 1A8, Canada
| | - Dany Raad
- Department of Medicine, State University of New York at Buffalo, 3435 Main Street, 14214, Buffalo, NY, USA
| | - Victor Kairouz
- Department of Medicine, State University of New York at Buffalo, 3435 Main Street, 14214, Buffalo, NY, USA
| | - John Fudyma
- Department of Medicine, State University of New York at Buffalo, 3435 Main Street, 14214, Buffalo, NY, USA
| | - Anne B Curtis
- Department of Medicine, State University of New York at Buffalo, 3435 Main Street, 14214, Buffalo, NY, USA
| | - Holger J Schünemann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, CRL-209, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.,Department of Medicine, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada
| | - Elie A Akl
- Department of Clinical Epidemiology and Biostatistics, McMaster University, CRL-209, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada. .,Department of Internal Medicine, American University of Beirut, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon.
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Guthrie KD, Stoner SC, Hartwig DM, May JR, Nicolaus SE, Schramm AM, DiDonato KL. Physicians' Preferences for Communication of Pharmacist-Provided Medication Therapy Management in Community Pharmacy. J Pharm Pract 2016; 30:17-24. [PMID: 26033794 DOI: 10.1177/0897190015585764] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVES (1) To identify physicians' preferences in regard to pharmacist-provided medication therapy management (MTM) communication in the community pharmacy setting; (2) to identify physicians' perceived barriers to communicating with a pharmacist regarding MTM; and (3) to determine whether Missouri physicians feel MTM is beneficial for their patients. METHODS A cross-sectional prospective survey study of 2021 family and general practice physicians registered with MO HealthNet, Missouri's Medicaid program. RESULTS The majority (52.8%) of physicians preferred MTM data to be communicated via fax. Most physicians who provided care to patients in long-term care (LTC) facilities (81.0%) preferred to be contacted at their practice location as opposed to the LTC facility. The greatest barriers to communication were lack of time and inefficient communication practices. Improved/enhanced communication was the most common suggestion for improvement in the MTM process. Approximately 67% of respondents reported MTM as beneficial or somewhat beneficial for their patients. CONCLUSIONS Survey respondents saw value in the MTM services offered by pharmacists. However, pharmacists should use the identified preferences and barriers to improve their currently utilized communication practices in hopes of increasing acceptance of recommendations. Ultimately, this may assist MTM providers in working collaboratively with patients' physicians.
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Affiliation(s)
- Kendall D Guthrie
- 1 Red Cross Pharmacy, Inc, Warrensburg, MO, USA.,2 Was PGY1 Community Practice Resident, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA at the time this study was conducted
| | - Steven C Stoner
- 3 School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | | | | | | | - Kristen L DiDonato
- 3 School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA.,4 Red Cross Pharmacy, Inc, Excelsior Springs, MO, USA
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Hoyer DP, Kaiser GM, Cicinnati V, Radunz S, Braun F, Greif-Higer G, Schulze M, Schmidt HJ, Paul A, Beckebaum S. Training, work, and lifestyle of transplant physicians and surgeons in Germany. Clin Transplant 2016; 30:1046-52. [PMID: 27291870 DOI: 10.1111/ctr.12786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND International data on training, work, and lifestyle of transplant physicians and surgeons are scarce. Such data might help in development of uniform education paths and provide insights for young clinicians interested in this field. This study aimed at the evaluation of these data in all transplant-associated medical disciplines. METHODS A survey on professional and academic training, workload, and lifestyle was generated. The questionnaire was distributed to all members of the German Transplant Association (DTG), utilizing the tool SurveyMonkey(®) . RESULTS A total of 127 members of the DTG responded (male/female 66.1%/33.9%, 45.8±10.3 years). The majority had been working in transplant medicine for more than 10 years (61.9%). Fifteen respondents (11.8%) obtained an official European certification (European Union of Medical Specialists). A total of 57 (48.3%) respondents worked full time on research during training. The research focus was clinical for most respondents (n=72, 61.5%). An average working time of 62±1.5 h/wk was reported. Fifty-eight percent of all respondents complained of inadequate remuneration and 50% reported inadequate acknowledgment of their professional performance. CONCLUSION This is the first study reporting characteristics of training, work, and lifestyle in an interdisciplinary cohort of German transplant physicians and surgeons. Enormous efforts in clinical and research work were reported, associated with high rates of professional and financial dissatisfaction.
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Affiliation(s)
- Dieter P Hoyer
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
| | - Gernot M Kaiser
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Vito Cicinnati
- Department of Transplantation Medicine, University Hospital Münster, Münster, Germany.,Department of Internal Medicine, Gastroenterology and Hepatology, St. Josef-Krankenhaus, Essen, Germany
| | - Sonia Radunz
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Felix Braun
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Gertrud Greif-Higer
- Department of Psychosomatics and Psychotherapy, University Hospital Mainz, Mainz, Germany
| | - Maren Schulze
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Hartmut J Schmidt
- Department of Transplantation Medicine, University Hospital Münster, Münster, Germany
| | - Andreas Paul
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Susanne Beckebaum
- Department of Transplantation Medicine, University Hospital Münster, Münster, Germany.,Department of Internal Medicine, Gastroenterology and Hepatology, St. Josef-Krankenhaus, Essen, Germany
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Zillich AJ, Sutherland JM, Wilson SJ, Diekema DJ, Ernst EJ, Vaughn TE, Doebbeling BN. Antimicrobial Use Control Measures to Prevent and Control Antimicrobial Resistance in US Hospitals. Infect Control Hosp Epidemiol 2016; 27:1088-95. [PMID: 17006817 DOI: 10.1086/507963] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 02/21/2006] [Indexed: 11/03/2022]
Abstract
Objective.Clinical practice guidelines and recommended practices to control use of antibiotics have been published, but the effect of these practices on antimicrobial resistance (AMR) rates in hospitals is unknown. The objective of this study was to examine relationships between antimicrobial use control strategies and AMR rates in a national sample of US hospitals.Design.Cross-sectional, stratified study of a nationally representative sample of US hospitals.Methods.A survey instrument was sent to the person responsible for infection control at a sample of 670 US hospitals. The outcome was current prevalences of 4 epidemiologically important, drug-resistant pathogens, considered concurrently: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, ceftazidime-resistant Klebsiella species, and quinolone (ciprofloxacin)-resistant Escherichia coli Five independent variables regarding hospital practices were selected from the survey: the extent to which hospitals (1) implement practices recommended in clinical practice guidelines and ensure best practices for antimicrobial use, (2) disseminate information on clinical practice guidelines for antimicrobial use, (3) use antimicrobial-related information technology, (4) use decision support tools, and (5) communicate to prescribers about antimicrobial use. Control variables included the hospitals' number of beds, teaching status, Veterans Affairs status, geographic region, and number of long-term care beds; and the presence of an intensive care unit, a burn unit, or transplant services. A generalized estimating equation modeled all resistance rates simultaneously to identify overall predictors of AMR levels at the facility.Results.Completed survey instruments were returned by 448 hospitals (67%). Four antimicrobial control measures were associated with higher prevalence of AMR. Implementation of recommended practices for antimicrobial use (P< .01) and optimization of the duration of empirical antibiotic prophylaxis (P<.01) were associated with a lower prevalence of AMR. Use of restrictive formularies (P = .05) and dissemination of clinical practice guideline information (P<.01) were associated with higher prevalence of AMR. Number of beds and Veterans Affairs status were also associated with higher AMR rates overall.Conclusions.Implementation of guideline-recommended practices to control antimicrobial use and optimize the duration of empirical therapy appears to help control AMR rates in US hospitals. A longitudinal study would confirm the results of this cross-sectional study. These results highlight the need for systems interventions and reengineering to ensure more-consistent application of guideline-recommended measures for antimicrobial use.
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Affiliation(s)
- Alan J Zillich
- Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, Indiana 46202, USA.
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Guo Y, Kopec JA, Cibere J, Li LC, Goldsmith CH. Population Survey Features and Response Rates: A Randomized Experiment. Am J Public Health 2016; 106:1422-6. [PMID: 27196650 DOI: 10.2105/ajph.2016.303198] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To study the effects of several survey features on response rates in a general population health survey. METHODS In 2012 and 2013, 8000 households in British Columbia, Canada, were randomly allocated to 1 of 7 survey variants, each containing a different combination of survey features. Features compared included administration modes (paper vs online), prepaid incentive ($2 coin vs none), lottery incentive (instant vs end-of-study), questionnaire length (10 minutes vs 30 minutes), and sampling frame (InfoCanada vs Canada Post). RESULTS The overall response rate across the 7 groups was 27.9% (range = 17.1-43.4). All survey features except the sampling frame were associated with statistically significant differences in response rates. The survey mode elicited the largest effect on the odds of response (odds ratio [OR] = 2.04; 95% confidence interval [CI] = 1.61, 2.59), whereas the sampling frame showed the least effect (OR = 1.14; 95% CI = 0.98, 1.34). The highest response was achieved by mailing a short paper survey with a prepaid incentive. CONCLUSIONS In a mailed general population health survey in Canada, a 40% to 50% response rate can be expected. Questionnaire administration mode, survey length, and type of incentive affect response rates.
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Affiliation(s)
- Yimeng Guo
- At the time of the study, Yimeng (Jimmy) Guo was with the University of British Columbia and Arthritis Research Canada, Vancouver, BC. Jacek A. Kopec is with the Arthritis Research Canada and the Division of Epidemiology, Biostatistics, and Public Health Practice, School of Population and Public Health at the University of British Columbia, Vancouver. Jolanda Cibere is with Arthritis Research Canada and the Department of Medicine at the University of British Columbia. Linda C. Li is with Arthritis Research Canada and the Department of Physical Therapy at the University of British Columbia. Charles H. Goldsmith is with the Faculty of Health Science at Simon Fraser University, Vancouver
| | - Jacek A Kopec
- At the time of the study, Yimeng (Jimmy) Guo was with the University of British Columbia and Arthritis Research Canada, Vancouver, BC. Jacek A. Kopec is with the Arthritis Research Canada and the Division of Epidemiology, Biostatistics, and Public Health Practice, School of Population and Public Health at the University of British Columbia, Vancouver. Jolanda Cibere is with Arthritis Research Canada and the Department of Medicine at the University of British Columbia. Linda C. Li is with Arthritis Research Canada and the Department of Physical Therapy at the University of British Columbia. Charles H. Goldsmith is with the Faculty of Health Science at Simon Fraser University, Vancouver
| | - Jolanda Cibere
- At the time of the study, Yimeng (Jimmy) Guo was with the University of British Columbia and Arthritis Research Canada, Vancouver, BC. Jacek A. Kopec is with the Arthritis Research Canada and the Division of Epidemiology, Biostatistics, and Public Health Practice, School of Population and Public Health at the University of British Columbia, Vancouver. Jolanda Cibere is with Arthritis Research Canada and the Department of Medicine at the University of British Columbia. Linda C. Li is with Arthritis Research Canada and the Department of Physical Therapy at the University of British Columbia. Charles H. Goldsmith is with the Faculty of Health Science at Simon Fraser University, Vancouver
| | - Linda C Li
- At the time of the study, Yimeng (Jimmy) Guo was with the University of British Columbia and Arthritis Research Canada, Vancouver, BC. Jacek A. Kopec is with the Arthritis Research Canada and the Division of Epidemiology, Biostatistics, and Public Health Practice, School of Population and Public Health at the University of British Columbia, Vancouver. Jolanda Cibere is with Arthritis Research Canada and the Department of Medicine at the University of British Columbia. Linda C. Li is with Arthritis Research Canada and the Department of Physical Therapy at the University of British Columbia. Charles H. Goldsmith is with the Faculty of Health Science at Simon Fraser University, Vancouver
| | - Charles H Goldsmith
- At the time of the study, Yimeng (Jimmy) Guo was with the University of British Columbia and Arthritis Research Canada, Vancouver, BC. Jacek A. Kopec is with the Arthritis Research Canada and the Division of Epidemiology, Biostatistics, and Public Health Practice, School of Population and Public Health at the University of British Columbia, Vancouver. Jolanda Cibere is with Arthritis Research Canada and the Department of Medicine at the University of British Columbia. Linda C. Li is with Arthritis Research Canada and the Department of Physical Therapy at the University of British Columbia. Charles H. Goldsmith is with the Faculty of Health Science at Simon Fraser University, Vancouver
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Leyenaar JK, O'Brien ER, Malkani N, Lagu T, Lindenauer PK. Direct Admission to Hospital: A Mixed Methods Survey of Pediatric Practices, Benefits, and Challenges. Acad Pediatr 2016; 16:175-82. [PMID: 26293551 PMCID: PMC4757507 DOI: 10.1016/j.acap.2015.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 06/23/2015] [Accepted: 07/03/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Direct admissions account for 25% of pediatric unscheduled hospitalizations. Despite this, our knowledge of direct admission practices and safety is limited. This study aimed to characterize direct admission practices, benefits, and challenges at a diverse sample of hospitals and to identify diagnoses most appropriate for this admission approach. METHODS We conducted a national survey at a stratified random sample of 177 US hospitals using both closed and open-ended questions. Descriptive statistics were calculated to summarize numeric responses, while qualitative content analysis was performed to identify emergent themes. RESULTS Responses were received from 108 hospitals (61%). Hospitals represented all geographic regions and employed varied emergency medicine and inpatient care models. One hundred three respondents (95%) reported that their hospitals accepted direct admissions, and 45 (50%) expressed the view that more children should be admitted directly. Perceived benefits included the following: improved efficiency; patient and physician satisfaction; earlier access to pediatric-specific care; continuity of care; and reduced risk of nosocomial infection. Risks and challenges included the following: difficulties determining admission appropriateness; inconsistent processes; provision of timely care; and patient safety. Populations and diagnoses reported as most appropriate and inappropriate for direct admission varied considerably across respondents. CONCLUSIONS While respondents described benefits of direct admission for both patients and health care systems, many also reported challenges and safety concerns. Our results may inform subsequent epidemiologic and patient-centered outcomes research to evaluate the safety and effectiveness of direct admissions.
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Affiliation(s)
- JoAnna K Leyenaar
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts Medical Center, Boston, Mass; Tufts University School of Medicine, Boston, Mass.
| | - Emily R O'Brien
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts Medical Center, Boston, Mass
| | | | - Tara Lagu
- Tufts University School of Medicine, Boston, Mass; Center for Quality of Care Research, Baystate Medical Center, Springfield, Mass
| | - Peter K Lindenauer
- Tufts University School of Medicine, Boston, Mass; Center for Quality of Care Research, Baystate Medical Center, Springfield, Mass
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Chen JS, Sprague BL, Klabunde CN, Tosteson ANA, Bitton A, Onega T, MacLean CD, Harris K, Schapira MM, Haas JS. Take the money and run? Redemption of a gift card incentive in a clinician survey. BMC Med Res Methodol 2016; 16:25. [PMID: 26911445 PMCID: PMC4766634 DOI: 10.1186/s12874-016-0126-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinician surveys provide critical information about many facets of health care, but are often challenging to implement. Our objective was to assess use by participants and non-participants of a prepaid gift card incentive that could be later reclaimed by the researchers if unused. METHODS Clinicians were recruited to participate in a mailed or online survey as part of a study to characterize women's primary health care provider attitudes towards breast and cervical cancer screening guidelines and practices (n = 177). An up-front incentive of a $50 gift card to a popular online retailer was included with the study invitation. Clinicians were informed that the gift card would expire if it went unused after 4 months. Outcome measures included use of gift cards by participants and non-participants and comparison of hypothetical costs of different incentive strategies. RESULTS 63.5% of clinicians who responded to the survey used the gift card, and only one provider who didn't participate used the gift card (1.6%). Many of those who participated did not redeem their gift cards (36.5% of respondents). The price of the incentives actually claimed totaled $3700, which was less than half of the initial outlay. Since some of the respondents did not redeem their gift cards, the cost of incentives was less than it might have been if we had provided a conditional incentive of $50 to responders after they had completed the survey. CONCLUSIONS Redeemable online gift card codes may provide an effective way to motivate clinicians to participate in surveys.
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Affiliation(s)
- Jane S Chen
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA.,Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | - Carrie N Klabunde
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Anna N A Tosteson
- Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Asaf Bitton
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA.,Harvard Medical School, Boston, MA, USA
| | - Tracy Onega
- Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA
| | | | - Kimberly Harris
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA
| | - Marilyn M Schapira
- University of Pennsylvania and the Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Jennifer S Haas
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA. .,Harvard Medical School, Boston, MA, USA. .,Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Legleye S, Pennec S, Monnier A, Stephan A, Brouard N, Bilsen J, Cohen J. Surveying End-of-Life Medical Decisions in France: Evaluation of an Innovative Mixed-Mode Data Collection Strategy. Interact J Med Res 2016; 5:e8. [PMID: 26892632 PMCID: PMC4777884 DOI: 10.2196/ijmr.3712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 03/06/2015] [Accepted: 07/12/2015] [Indexed: 11/24/2022] Open
Abstract
Background Monitoring medical decisions at the end of life has become an important issue in many societies. Built on previous European experiences, the survey and project Fin de Vie en France (“End of Life in France,” or EOLF) was conducted in 2010 to provide an overview of medical end-of-life decisions in France. Objective To describe the methodology of EOLF and evaluate the effects of design innovations on data quality. Methods EOLF used a mixed-mode data collection strategy (paper and Internet) along with follow-up campaigns that employed various contact modes (paper and telephone), all of which were gathered from various institutions (research team, hospital, and medical authorities at the regional level). A telephone nonresponse survey was also used. Through descriptive statistics and multivariate logistic regressions, these innovations were assessed in terms of their effects on the response rate, quality of the sample, and differences between Web-based and paper questionnaires. Results The participation rate was 40.0% (n=5217). The respondent sample was very close to the sampling frame. The Web-based questionnaires represented only 26.8% of the questionnaires, and the Web-based secured procedure led to limitations in data management. The follow-up campaigns had a strong effect on participation, especially for paper questionnaires. With higher participation rates (63.21% and 63.74%), the telephone follow-up and nonresponse surveys showed that only a very low proportion of physicians refused to participate because of the topic or the absence of financial incentive. A multivariate analysis showed that physicians who answered on the Internet reported less medication to hasten death, and that they more often took no medical decisions in the end-of-life process. Conclusions Varying contact modes is a useful strategy. Using a mixed-mode design is interesting, but selection and measurement effects must be studied further in this sensitive field.
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Affiliation(s)
- Stephane Legleye
- Institut National d'études Démographiques, Department of Survey and Sampling, Paris, France.
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Funkhouser E, Vellala K, Baltuck C, Cacciato R, Durand E, McEdward D, Sowell E, Theisen SE, Gilbert GH. Survey Methods to Optimize Response Rate in the National Dental Practice-Based Research Network. Eval Health Prof 2016; 40:332-358. [PMID: 26755526 DOI: 10.1177/0163278715625738] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surveys of health professionals typically have low response rates, and these rates have been decreasing in the recent years. We report on the methods used in a successful survey of dentist members of the National Dental Practice-Based Research Network. The objectives were to quantify the (1) increase in response rate associated with successive survey methods, (2) time to completion with each successive step, (3) contribution from the final method and personal contact, and (4) differences in response rate and mode of response by practice/practitioner characteristics. Dentist members of the network were mailed an invitation describing the study. Subsequently, up to six recruitment steps were followed: initial e-mail, two e-mail reminders at 2-week intervals, a third e-mail reminder with postal mailing a paper questionnaire, a second postal mailing of paper questionnaire, and staff follow-up. Of the 1,876 invited, 160 were deemed ineligible and 1,488 (87% of 1,716 eligible) completed the survey. Completion by step: initial e-mail, 35%; second e-mail, 15%; third e-mail, 7%; fourth e-mail/first paper, 11%; second paper, 15%; and staff follow-up, 16%. Overall, 76% completed the survey online and 24% on paper. Completion rates increased in absolute numbers and proportionally with later methods of recruitment. Participation rates varied little by practice/practitioner characteristics. Completion on paper was more likely by older dentists. Multiple methods of recruitment resulted in a high participation rate: Each step and method produced incremental increases with the final step producing the largest increase.
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Affiliation(s)
| | | | | | | | - Emily Durand
- 5 HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | - Deborah McEdward
- 6 College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Ellen Sowell
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah E Theisen
- 7 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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- 1 University of Alabama at Birmingham, Birmingham, AL, USA
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Kamath AF, Courtney PM, Bozic KJ, Mehta S, Parsley BS, Froimson MI. Bundled Payment in Total Joint Care: Survey of AAHKS Membership Attitudes and Experience with Alternative Payment Models. J Arthroplasty 2015; 30:2045-56. [PMID: 26077149 DOI: 10.1016/j.arth.2015.05.036] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/13/2015] [Accepted: 05/22/2015] [Indexed: 02/01/2023] Open
Abstract
The goal of alternative payment models (APMs), particularly bundling of payments in total joint arthroplasty (TJA), is to incentivize physicians, hospitals, and payers to deliver quality care at lower cost. To study the effect of APMs on the field of adult reconstruction, we conducted a survey of AAHKS members using an electronic questionnaire format. Of the respondents, 61% are planning to or participate in an APM. 45% of respondents feel that a bundled payment system will be the most effective model to improve quality and to reduce costs. Common concerns were disincentives to operate on high-risk patients (94%) and uncertainty about revenue sharing (79%). While many members feel that APMs may improve value in TJA, surgeons continue to have reservations about implementation.
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Affiliation(s)
- Atul F Kamath
- Department of Orthopedic Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Paul M Courtney
- Department of Orthopedic Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Kevin J Bozic
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Samir Mehta
- Department of Orthopedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian S Parsley
- Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, Texas
| | - Mark I Froimson
- Trinity Health Unified Clinical Organization, Chief Clinical Officer, Trinity Health, Livonia, Michigan
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Abstract
BACKGROUND In academia, women remain underrepresented. The authors' sought to examine differences in faculty position and professional satisfaction among academic physicians by gender. METHODS From 2008 to 2012, academic faculty members at a single institution were surveyed (2008, n = 737; 2010, n = 1151; and 2012, n = 971) regarding current position, choice of position, professional satisfaction, and desire for leaving. Logistic regression was performed to compare aspects of professional satisfaction by gender. RESULTS Men more often held tenure track positions compared with women (2008, 45 percent versus 20 percent; 2010, 47 percent versus 20 percent; and 2012, 49 percent versus 20 percent; p < 0.001). Women were more likely to engage in only clinical activities compared with men (2008, 31 percent versus 18 percent; 2010, 28 percent versus 14 percent; and 2012, 33 percent versus 13 percent; p < 0.001) and less likely to participate in research. Women chose tracks to accommodate work-life balance [2008, OR, 1.9 (95 percent CI, 1.29 to 2.76); 2010, OR, 2.0 (95 percent CI, 1.38 to 2.76); and 2012, OR, 2.1 (95 percent CI, 1.40 to 3.00)], rather than the opportunity of tenure [2008, OR, 0.4 (95 percent CI, 0.23 to 0.75); 2010, OR, 0.5 (95 percent CI, 0.35 to 0.85); and 2012, OR, 0.5 (95 percent CI, 0.29 to 0.76) compared with men. Men reported higher professional satisfaction compared with women (2008, 5.7 versus 5.4, p < 0.009; 2012, 5.3 versus 5.0, p < 0.03). Men were more likely to leave because of leadership opportunities (14.4 percent versus 9.2 percent, p < 0.03) and compensation (14.2 percent versus 9.2 percent, p < 0.03) compared with women. CONCLUSIONS Women report lower levels of professional satisfaction in academic practice compared with men. Given the increasing pressures of academic practice, efforts to align work-life balance and professional goals could potentially improve faculty satisfaction and retention.
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Parkinson A, Jorm L, Douglas KA, Gee A, Sargent GM, Lujic S, McRae IS. Recruiting general practitioners for surveys: reflections on the difficulties and some lessons learned. Aust J Prim Health 2015; 21:254-8. [PMID: 24581281 DOI: 10.1071/py13129] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 01/21/2014] [Indexed: 11/23/2022]
Abstract
Surveys of GPs are essential to facilitate future planning and delivery of health services. However, recruitment of GPs into research has been disappointing with response rates declining over recent years. This study identified factors that facilitated or hampered GP recruitment in a recent survey of Australian GPs where a range of strategies were used to improve recruitment following poor initial responses. GP response rates for different stages of the survey were examined and compared with reasons GPs and leaders of university research networks cited for non-participation. Poor initial response rates were improved by including a questionnaire in the mail-out, changing the mail-out source from an unknown research team to locally known network leaders, approaching a group of GPs known to have research and training interests, and offering financial compensation. Response rates increased from below 1% for the first wave to 14.5% in the final wave. Using a known and trusted network of professionals to endorse the survey combined with an explicit compensation payment significantly enhanced GP response rates. To obtain response rates for surveys of GPs that are high enough to sustain external validity requires an approach that persuades GPs and their gatekeepers that it is worth their time to participate.
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Economic Impact of Orthopedic Adult Reconstruction Office Practice: The Implications of Hospital Employment Models on Local Economies. J Arthroplasty 2015; 30:923-30. [PMID: 25707995 DOI: 10.1016/j.arth.2015.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/06/2015] [Accepted: 01/11/2015] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to evaluate the economic attributes of private practice adult reconstruction (AR) offices. 458 AAHKS surgeons responded; 65% were in private practice (fee-for-service, non-salaried, non-employed AR surgeons). 54% had considered hospital employment in the past two years. The average group employs 13.4 orthopedic surgeons (3.4 AR), and 105 other employees. The average total budget is $12.5 million per year with $4 million in salaries, and $238,000 in tax revenue generated. Co-management joint ventures are a better model than hospital employment for aligning AR surgeons and hospitals and realizing the cost effectiveness and quality improvement goals of PPACA and AARA while preserving the economic impact of AR private practice.
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Variation in CT pediatric head examination radiation dose: results from a national survey. AJR Am J Roentgenol 2015; 204:W293-301. [PMID: 25714315 DOI: 10.2214/ajr.14.12997] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this article is to examine the variation in radiation dose, CT dose index volume (CTDIvol), and dose-length product (DLP) for pediatric head CT examinations as a function of hospital characteristics across the United States. MATERIALS AND METHODS. A survey inquiring about hospital information, CT scanners, pediatric head examination protocol, CTDIvol, and DLP was mailed to a representative sample of U.S. hospitals. Follow-up mailings were sent to nonrespondents. Descriptive characteristics of respondents and nonrespondents were compared using design-based Pearson chi-square tests. Dose estimates were compared across hospital characteristics using Bonferroni-adjusted Wald test. Hospital-level factors associated with dose estimates were evaluated using multiple linear regressions and modified Poisson regression models. RESULTS. Surveys were sent out to 751 hospitals; 292 responded to the survey, of which 253 were eligible (35.5% response rate, calculated as number of hospitals who completed surveys [n = 253] divided by sum of number who were eligible and initially consented [n = 712] plus estimated number who were eligible among those who refused [n = 1]). Most respondents reported using MDCT scanners (99.2%) and having a dedicated pediatric head CT protocol (93%). Estimated mean reported CTDIvol values were 27.3 mGy (95% CI, 24.4-30.1 mGy), and DLP values were 390.9 mGy × cm (95% CI, 346.6-435.1 mGy × cm). These values did not vary significantly by region, trauma level, teaching status, CT accreditation, number of CT scanners, or report of a dedicated pediatric CT protocol. However, estimated CTDIvol reported by children's hospitals was 19% lower than that reported by general hospitals (p < 0.01). CONCLUSION. Most hospitals (82%) report doses that meet American College of Radiology accreditation levels. However, [corrected] the mean CTDI(vol) at children's hospitals was approximately 7 mGy (21%, adjusted for covariates), lower than that at nonchildren's hospitals.
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Cunningham CT, Quan H, Hemmelgarn B, Noseworthy T, Beck CA, Dixon E, Samuel S, Ghali WA, Sykes LL, Jetté N. Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol 2015; 15:32. [PMID: 25888346 PMCID: PMC4404667 DOI: 10.1186/s12874-015-0016-z] [Citation(s) in RCA: 630] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 03/10/2015] [Indexed: 11/29/2022] Open
Abstract
Background Survey research in healthcare is an important tool to collect information about healthcare delivery, service use and overall issues relating to quality of care. Unfortunately, physicians are often a group with low survey response rates and little research has looked at response rates among physician specialists. For these reasons, the purpose of this project was to explore survey response rates among physician specialists in a large metropolitan Canadian city. Methods As part of a larger project to look at physician payment plans, an online survey about medical billing practices was distributed to 904 physicians from various medical specialties. The primary method for physicians to complete the survey was via the Internet using a well-known and established survey company (www.surveymonkey.com). Multiple methods were used to encourage survey response such as individual personalized email invitations, multiple reminders, and a draw for three gift certificate prizes were used to increase response rate. Descriptive statistics were used to assess response rates and reasons for non-response. Results Overall survey response rate was 35.0%. Response rates varied by specialty: Neurology/neurosurgery (46.6%); internal medicine (42.9%); general surgery (29.6%); pediatrics (29.2%); and psychiatry (27.1%). Non-respondents listed lack of time/survey burden as the main reason for not responding to our survey. Conclusions Our survey results provide a look into the challenges of collecting healthcare research where response rates to surveys are often low. The findings presented here should help researchers in planning future survey based studies. Findings from this study and others suggest smaller monetary incentives for each individual may be a more appropriate way to increase response rates.
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Affiliation(s)
- Ceara Tess Cunningham
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Brenda Hemmelgarn
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. .,Department of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Tom Noseworthy
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Cynthia A Beck
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. .,Department of Psychiatry, University of Calgary, Calgary, AB, Canada.
| | - Elijah Dixon
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. .,Department of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Susan Samuel
- Department of Pediatric Nephrology, University of Calgary, Calgary, AB, Canada.
| | - William A Ghali
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. .,Department of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Lindsay L Sykes
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Nathalie Jetté
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. .,Department of Clinical Neurosciences, Hotchkiss Brain Institute and Institute for Public Health, University of Calgary, Calgary, AB, Canada.
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St-Amant H, Ware MA, Julien N, Lacasse A. Prevalence and determinants of cannabinoid prescription for the management of chronic noncancer pain: a postal survey of physicians in the Abitibi-Témiscamingue region of Quebec. CMAJ Open 2015; 3:E251-7. [PMID: 26389104 PMCID: PMC4565172 DOI: 10.9778/cmajo.20140095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Few studies have been conducted to explore physicians' prescription practices and attitudes toward the use of cannabinoids in Canada.We measured the prevalence and identified determinants of cannabinoid prescription for the management of chronic noncancer pain among physicians in southwestern Quebec. METHODS In February 2013, we conducted a postal survey using a modified Dillman method that involved physicians practising in the Abitibi-Témiscamingue region of Quebec. We used multivariate logistic regression models to identify determinants of cannabinoid prescription. RESULTS A total of 166 physicians of 318 practising in the region participated in the survey (response rate 52.2%). The prevalence of cannabinoid prescription was 27.3% (45/165) for any indication and 23.0% (38/165) for the management of chronic noncancer pain; 91.1% (41/45) of the physicians prescribed cannabinoids to 5 or fewer patients. Of the 38 physicians who prescribed cannabinoids for chronic noncancer pain, 35 (92.1%) prescribed nabilone, 7 (18.4%) medical marijuana and 2 (5.3%) nabiximols. The principal determinant of cannabinoid prescription was the physician's level of comfort with prescribing cannabinoids (adjusted odds ratio 1.25, 95% confidence interval 1.01-1.55, per 1-point increase in comfort level measured on 10-point scale). Respondents reported that continuing medical education (CME) activities could increase their comfort level. They also indicated a need for guidelines or algorithms that included cannabinoid use as well as more studies about the efficacy and safety of cannabinoids for the management of chronic noncancer pain. INTERPRETATION We found that cannabinoids were not often prescribed for the management of chronic noncancer pain and that survey respondents were not comfortable with prescribing this drug class. This degree of discomfort could be addressed by CME activities, more effective dissemination of guidelines and more evidence regarding cannabinoid use for the management of chronic noncancer pain.
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Affiliation(s)
- Huguette St-Amant
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que
| | - Mark A. Ware
- Alan Edwards Pain Management Unit, McGill University Health Centre, Montréal, Que
| | - Nancy Julien
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Que
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Juve AM, Lasater K, Swide C. Teaching: aligning faculty member and resident perceptions. CLINICAL TEACHER 2015; 12:88-93. [PMID: 25789892 DOI: 10.1111/tct.12282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This study sought to examine and address concerns received from residents regarding their perception of the length of time faculty members devoted to intraoperative teaching. METHOD Faculty members and residents were surveyed on their perceptions of intraoperative teaching. The survey was evaluated using descriptive methods. A disparity was noted between faculty member and resident perceptions of time devoted to intraoperative teaching. To better understand the disparity, a series of focus groups to discuss the survey results were held with both faculty members and residents. To address the disparity, a teaching tool was developed using the keywords of the American Board of Anesthesiology's in-training examination. Faculty members and residents used this tool in the intraoperative environment for 2 months. After 2 months, faculty members and residents were surveyed to see whether a change in perception took place. The use of the teaching tool was continued. Faculty members and residents were surveyed after 1 year of continued use to assess usage and satisfaction with the tool. RESULTS The pre-intervention survey yielded responses from 29.6 per cent (n = 64) of the teaching faculty members and 29.2 per cent (n = 24) of the residents. The post-intervention survey yielded responses from 64 per cent of the faculty members and 62.5 per cent of the residents. After implementation of the tool, an improved alignment of resident and faculty member perceptions of the time faculty members spent teaching intraoperatively was observed. The majority of faculty members and residents reported continued use and satisfaction with the keyword tool after 1 year of use. DISCUSSION This experience revealed the importance of making simple, pragmatic changes to improve resident perceptions of intraoperative teaching time.
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Affiliation(s)
- Amy Miller Juve
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Suhonen R, Stolt M, Katajisto J, Leino-Kilpi H. Review of sampling, sample and data collection procedures in nursing research - An example of research on ethical climate as perceived by nurses. Scand J Caring Sci 2015; 29:843-58. [DOI: 10.1111/scs.12194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/17/2014] [Indexed: 01/24/2023]
Affiliation(s)
- Riitta Suhonen
- Department of Nursing Science; University of Turku; Turku Finland
| | - Minna Stolt
- Department of Nursing Science; University of Turku; Turku Finland
| | - Jouko Katajisto
- Department of Mathematics and Statistics; University of Turku; Turku Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science/Turku University Hospital; University of Turku; Turku Finland
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Starzyk EJ, Kelley MA, Caskey RN, Schwartz A, Kennelly JF, Bailey RC. Infant male circumcision: healthcare provider knowledge and associated factors. PLoS One 2015; 10:e0115891. [PMID: 25635664 PMCID: PMC4312077 DOI: 10.1371/journal.pone.0115891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/26/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The emerging science demonstrates various health benefits associated with infant male circumcision and adult male circumcision; yet rates are declining in the United States. The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend that healthcare providers present evidence-based risk and benefit information for infant male circumcision to parent(s) and guardian(s). The purpose of this study was to assess providers' level of infant male circumcision knowledge and to identify the associated characteristics. METHODS An online survey was administered to healthcare providers in the family medicine, obstetrics, and pediatrics medical specialties at an urban academic health center. To assess infant male circumcision knowledge, a 17 point summary score was constructed to identify level of provider knowledge within the survey. RESULTS Ninety-two providers completed the survey. Providers scored high for the following knowledge items: adverse event rates, protects against phimosis and urinary tract infections, and does not prevent hypospadias. Providers scored lower for items related to more recent research: protection against cervical cancer, genital ulcer disease, bacterial vaginosis, and reduction in HIV acquisition. Two models were constructed looking at (1) overall knowledge about male circumcision, and (2) knowledge about male circumcision reduction in HIV acquisition. Pediatricians demonstrated greater overall infant male circumcision knowledge, while obstetricians exhibited significantly greater knowledge for the HIV acquisition item. CONCLUSION Providers' knowledge levels regarding the risks and benefits of infant male circumcision are highly variable, indicating the need for system-based educational interventions.
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Affiliation(s)
- Erin J. Starzyk
- University of Illinois at Chicago, School of Public Health, Division of Community Health Sciences, Chicago, Illinois, United States of America
| | - Michele A. Kelley
- University of Illinois at Chicago, School of Public Health, Division of Community Health Sciences, Chicago, Illinois, United States of America
| | - Rachel N. Caskey
- University of Illinois at Chicago, College of Medicine, Department of Internal Medicine and Pediatrics, Chicago, Illinois, United States of America
| | - Alan Schwartz
- University of Illinois at Chicago, College of Medicine, Department of Medical Education, Chicago, Illinois, United States of America
| | - Joan F. Kennelly
- University of Illinois at Chicago, School of Public Health, Division of Community Health Sciences, Chicago, Illinois, United States of America
| | - Robert C. Bailey
- University of Illinois at Chicago, School of Public Health, Division of Epidemiology and Biostatistics, Chicago, Illinois, United States of America
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Leyenaar JK, Bergert L, Mallory LA, Engel R, Rassbach C, Shen M, Woehrlen T, Cooperberg D, Coghlin D. Pediatric primary care providers' perspectives regarding hospital discharge communication: a mixed methods analysis. Acad Pediatr 2015; 15:61-8. [PMID: 25444655 PMCID: PMC4371737 DOI: 10.1016/j.acap.2014.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 07/18/2014] [Accepted: 07/19/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Effective communication between inpatient and outpatient providers may mitigate risks of adverse events associated with hospital discharge. However, there is an absence of pediatric literature defining effective discharge communication strategies at both freestanding children's hospitals and general hospitals. The objectives of this study were to assess associations between pediatric primary care providers' (PCPs) reported receipt of discharge communication and referral hospital type, and to describe PCPs' perspectives regarding effective discharge communication and areas for improvement. METHODS We administered a questionnaire to PCPs referring to 16 pediatric hospital medicine programs nationally. Multivariable models were developed to assess associations between referral hospital type and receipt and completeness of discharge communication. Open-ended questions asked respondents to describe effective strategies and areas requiring improvement regarding discharge communication. Conventional qualitative content analysis was performed to identify emergent themes. RESULTS Responses were received from 201 PCPs, for a response rate of 63%. Although there were no differences between referral hospital type and PCP-reported receipt of discharge communication (relative risk 1.61, 95% confidence interval 0.97-2.67), PCPs referring to general hospitals more frequently reported completeness of discharge communication relative to those referring to freestanding children's hospitals (relative risk 1.78, 95% confidence interval 1.26-2.51). Analysis of free text responses yielded 4 major themes: 1) structured discharge communication, 2) direct personal communication, 3) reliability and timeliness of communication, and 4) communication for effective postdischarge care. CONCLUSIONS This study highlights potential differences in the experiences of PCPs referring to general hospitals and freestanding children's hospitals, and presents valuable contextual data for future quality improvement initiatives.
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Affiliation(s)
- JoAnna K. Leyenaar
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts University School of Medicine, Boston, MA
| | - Lora Bergert
- Division of Pediatric Hospital Medicine, Department of Pediatrics, The John A Burns School of Medicine, Honolulu, HI
| | - Leah A. Mallory
- Division of Pediatric Hospital Medicine, Department of Pediatrics, The Barbara Bush Children’s Hospital at Maine Medical Center, Portland, ME
| | - Richard Engel
- University of Arizona College of Medicine-Phoenix, Phoenix Children’s Hospital, Phoenix, AZ
| | - Caroline Rassbach
- Stanford University School of Medicine, Lucile Packard Children’s Hospital, Palo Alto, CA 94304
| | - Mark Shen
- Dell Children’s Medical Center of Central Texas
| | - Tess Woehrlen
- Michigan State University College of Osteopathic Medicine, East Lansing MI
| | - David Cooperberg
- Drexel University College of Medicine, St. Christopher’s Hospital for Children, Philadelphia, PA
| | - Daniel Coghlin
- The Warren Alpert Medical School of Brown University, Hasbro Children’s Hospital, Providence, RI
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Weeks DL, Keeney BJ, Evans PC, Moore QD, Conrad DA. Provider perceptions of the electronic health record incentive programs: a survey of eligible professionals who have and have not attested to meaningful use. J Gen Intern Med 2015; 30:123-30. [PMID: 25164087 PMCID: PMC4284265 DOI: 10.1007/s11606-014-3008-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The HITECH Act of 2009 enabled the Centers for Medicare & Medicaid Services (CMS) to provide financial incentives to health care providers who demonstrate "meaningful use" (MU) of their electronic health records (EHRs). Despite stakeholder involvement in the rule-making phase, formal input about the MU program from a cross section of providers has not been reported since incentive payments began. OBJECTIVE To examine the perspectives and experiences of a random sample of health care professionals eligible for financial incentives (eligible professionals or EPs) for demonstrating meaningful use of their EHRs. It was hypothesized that EPs actively participating in the MU program would generally view the purported benefits of MU more positively than EPs not yet participating in the incentive program. DESIGN Survey data were collected by mail from a random sample of EPs in Washington State and Idaho. Two follow-up mailings were made to non-respondents. PARTICIPANTS The sample included EPs who had registered for incentive payments or attested to MU (MU-Active) and EPs not yet participating in the incentive program (MU-Inactive). MAIN MEASURES The survey assessed perceptions of general realities and influences of MU on health care; views on the influence of MU on clinics; and personal views about MU. EP opinions were assessed with close- and open-ended items. KEY RESULTS Close-ended responses indicated that MU-Active providers were generally more positive about the program than MU-Inactive providers. However, the majority of respondents in both groups felt that MU would not reduce care disparities or improve the accuracy of patient information. The additional workload on EPs and their staff was viewed as too great a burden on productivity relative to the level of reimbursement for achieving MU goals. The majority of open-ended responses in each group reinforced the general perception that the MU program diverted attention from treating patients by imposing greater reporting requirements. CONCLUSIONS Survey results indicate the need by CMS to step up engagement with EPs in future planning for the MU program, while also providing support for achieving MU standards.
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Affiliation(s)
- Douglas L Weeks
- Inland Northwest Health Services, 711 S. Cowley St., Spokane, WA, 99202, USA,
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Clark MA, Roman A, Rogers ML, Tyler DA, Mor V. Surveying multiple health professional team members within institutional settings: an example from the nursing home industry. Eval Health Prof 2014; 37:287-313. [PMID: 24500999 PMCID: PMC4380513 DOI: 10.1177/0163278714521633] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Quality improvement and cost containment initiatives in health care increasingly involve interdisciplinary teams of providers. To understand organizational functioning, information is often needed from multiple members of a leadership team since no one person may have sufficient knowledge of all aspects of the organization. To minimize survey burden, it is ideal to ask unique questions of each member of the leadership team in areas of their expertise. However, this risks substantial missing data if all eligible members of the organization do not respond to the survey. Nursing home administrators (NHA) and directors of nursing (DoN) play important roles in the leadership of long-term care facilities. Surveys were administered to NHAs and DoNs from a random, nationally representative sample of U.S. nursing homes about the impact of state policies, market forces, and organizational factors that impact provider performance and residents' outcomes. Responses were obtained from a total of 2,686 facilities (response rate [RR] = 66.6%) in which at least one individual completed the questionnaire and 1,693 facilities (RR = 42.0%) in which both providers participated. No evidence of nonresponse bias was detected. A high-quality representative sample of two providers in a long-term care facility can be obtained. It is possible to optimize data collection by obtaining unique information about the organization from each provider while minimizing the number of items asked of each individual. However, sufficient resources must be available for follow-up to nonresponders with particular attention paid to lower resourced, lower quality facilities caring for higher acuity residents in highly competitive nursing home markets.
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Affiliation(s)
- Melissa A Clark
- School of Public Health, Brown University, Providence, RI, USA
| | - Anthony Roman
- Center for Survey Research, University of Massachusetts-Boston, Boston, MA, USA
| | | | - Denise A Tyler
- School of Public Health, Brown University, Providence, RI, USA
| | - Vincent Mor
- School of Public Health, Brown University, Providence, RI, USA
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Abstract
The authors offer tips for investigators and potential respondents with regard to surveys and response rates.
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Affiliation(s)
- Sasha Mazzarello
- Ottawa Hospital Research Institute; and University of Ottawa, Ottawa, Ontario, Canada
| | - Mark Clemons
- Ottawa Hospital Research Institute; and University of Ottawa, Ottawa, Ontario, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute; and University of Ottawa, Ottawa, Ontario, Canada
| | - Carmel Jacobs
- Ottawa Hospital Research Institute; and University of Ottawa, Ottawa, Ontario, Canada
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