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Jalilvand MA, Raeisi AR, Shaarbafchizadeh N. Hospital governance accountability structure: a scoping review. BMC Health Serv Res 2024; 24:47. [PMID: 38200541 PMCID: PMC10777527 DOI: 10.1186/s12913-023-10135-0] [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: 05/23/2023] [Accepted: 10/11/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Hospitals, as complex organizations with clinical, financial, and social functions, face different barriers to providing high-quality and safe services at reasonable costs. Various initiatives have been carried out in hospital governance to improve quality, safety, and accountability. This research aims to identify the structures and dimensions that make hospital governance accountable. METHODS The research used Arksey and O'Malley's scoping review framework to examine the research literature on hospital governance structure and accountability. The literature review included PubMed, Web of Science, Embase, Scopus ProQuest, Google search engine, and Google Scholar databases from 2010 to 2023. Data were analyzed using the content analysis method. RESULTS Excluding unrelated and duplicate sources, 40 articles and reports were included in the study. The studies were reviewed and analyzed based on organizational type, type of source, year of publication, objectives, and key findings. Accountable governance features were extracted from the selected articles and reports. The four main themes include inclusive governance, commitment to accountability, planning for accountability, and autonomous governance. Thirteen subthemes were extracted from the study literature. CONCLUSION Various initiatives have been implemented regarding the reform of the governance structure of public hospitals in different countries. Many of these reforms aim to improve financial and clinical accountability. The study results could be used to identify the structures and dimensions that make hospital governance accountable.
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Affiliation(s)
- Mohammad Ali Jalilvand
- Student Research Committee, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Reza Raeisi
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Nasrin Shaarbafchizadeh
- Health Services Management, Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Stein JN, Klein JW, Payne TH, Jackson SL, Peacock S, Oster NV, Carpenter TP, Elmore JG. Communicating with Vulnerable Patient Populations: A Randomized Intervention to Teach Inpatients to Use the Electronic Patient Portal. Appl Clin Inform 2018; 9:875-883. [PMID: 30541152 PMCID: PMC6291377 DOI: 10.1055/s-0038-1676333] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/14/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Patient portals are expanding as a means to engage patients and have evidence for benefit in the outpatient setting. However, few studies have evaluated their use in the inpatient setting, or with vulnerable patient populations. OBJECTIVE This article assesses an intervention to teach hospitalized vulnerable patients to access their discharge summaries using electronic patient portals. METHODS Patients at a safety net hospital were randomly assigned to portal use education or usual care. Surveys assessed perceptions of discharge paperwork and the electronic portal. RESULTS Of the 202 prescreened eligible patients (e.g., deemed mentally competent, spoke English, and had a telephone), only 43% had working emails. Forty-four percent of participants did not remember receiving or reading discharge paperwork. Patients trained in portal use (n = 47) or receiving usual care (n = 23) preferred hospitals with online record access (85 and 83%, respectively), and felt that online access would increase their trust in doctors (85 and 87%) and satisfaction with care (91% each). Those who received training in portal use were more likely to register for the portal (48% vs. 11%; p < 0.01). CONCLUSION Patients had positive perceptions of portals, and education increased portal use. Lack of email access is a notable barrier to electronic communication with vulnerable patients.
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Affiliation(s)
- Jacob N. Stein
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Jared W. Klein
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Thomas H. Payne
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
- Information Technology Services, University of Washington School of Medicine, Seattle, Washington, United States
| | - Sara L. Jackson
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Sue Peacock
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Natalia V. Oster
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Trinell P. Carpenter
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
| | - Joann G. Elmore
- University of California, Los Angeles, California, United States
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Belyeu BM, Klein JW, Reisch LM, Peacock S, Oster NV, Elmore JG, Jackson SL. Patients' perceptions of their doctors' notes and after-visit summaries: A mixed methods study of patients at safety-net clinics. Health Expect 2017; 21:485-493. [PMID: 29095554 PMCID: PMC5867322 DOI: 10.1111/hex.12641] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 12/22/2022] Open
Abstract
Background Patients are increasingly offered electronic access to their doctors' notes, and many consistently receive paper After‐Visit Summaries. Specific feedback from patients about notes and summaries are lacking, particularly within safety‐net settings. Design A mixed methods study Setting and Participants Patients with poorly controlled diabetes attending two urban safety‐net primary care clinics in Washington State. Methods Patients read their own most recent clinic note and After‐Visit Summary, then completed a brief survey followed by a focus group discussion (3 groups in a large general medicine teaching clinic and 1 in an HIV/AIDS clinic) about their perceptions of the clinic note and After‐Visit Summary. Results Twenty‐seven patients participated; 70% were male, 41% were Black, 48% were unemployed or disabled, 56% reported fair/poor health, and 37% had accessed the electronic patient portal. A majority of patients felt their note content was useful (89%); a minority reported that their notes were not accurate (19%), had too much medical jargon (29%), or were too long (26%). Themes identified from the discussions included reliance on the provider to explain confusing content; a desire for more rather than less detail; and perceived inaccuracies, particularly in heavily templated notes. In each focus group, one or more portal users were enthusiastically willing to teach other patients. Conclusions The majority of focus group participants at this safety‐net site had not accessed the electronic patient portal, but those who had were willing to promote the portal benefits and assist others. Patients identified specific opportunities to improve clinic notes and After‐Visit Summaries.
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Affiliation(s)
- Brittaney M Belyeu
- Department of Medicine, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, CA, USA
| | - Jared W Klein
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Lisa M Reisch
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Sue Peacock
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Natalia V Oster
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Joann G Elmore
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Sara L Jackson
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Xie Y, Maziarz M, Tuot DS, Chertow GM, Himmelfarb J, Hall YN. Risk prediction to inform surveillance of chronic kidney disease in the US Healthcare Safety Net: a cohort study. BMC Nephrol 2016; 17:57. [PMID: 27276913 PMCID: PMC4898308 DOI: 10.1186/s12882-016-0272-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 06/01/2016] [Indexed: 01/13/2023] Open
Abstract
Background The capacity of electronic health record (EHR) data to guide targeted surveillance in chronic kidney disease (CKD) is unclear. We sought to leverage EHR data for predicting risk of progressing from CKD to end-stage renal disease (ESRD) to help inform surveillance of CKD among vulnerable patients from the healthcare safety-net. Methods We conducted a retrospective cohort study of adults (n = 28,779) with CKD who received care within 2 regional safety-net health systems during 1996–2009 in the Western United States. The primary outcomes were progression to ESRD and death as ascertained by linkage with United States Renal Data System and Social Security Administration Death Master files, respectively, through September 29, 2011. We evaluated the performance of 3 models which included demographic, comorbidity and laboratory data to predict progression of CKD to ESRD in conditions commonly targeted for disease management (hypertension, diabetes, chronic viral diseases and severe CKD) using traditional discriminatory criteria (AUC) and recent criteria intended to guide population health management strategies. Results Overall, 1730 persons progressed to end-stage renal disease and 7628 died during median follow-up of 6.6 years. Performance of risk models incorporating common EHR variables was highest in hypertension, intermediate in diabetes and chronic viral diseases, and lowest in severe CKD. Surveillance of persons who were in the highest quintile of ESRD risk yielded 83–94 %, 74–95 %, and 75–82 % of cases who progressed to ESRD among patients with hypertension, diabetes and chronic viral diseases, respectively. Similar surveillance yielded 42–71 % of ESRD cases among those with severe CKD. Discrimination in all conditions was universally high (AUC ≥0.80) when evaluated using traditional criteria. Conclusions Recently proposed discriminatory criteria account for varying risk distribution and when applied to common clinical conditions may help to inform surveillance of CKD in diverse populations. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0272-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuxiang Xie
- Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Marlena Maziarz
- Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Delphine S Tuot
- Division of Nephrology, University of California San Francisco and San Francisco General Hospital, San Francisco, CA, USA
| | - Glenn M Chertow
- Division of Nephrology, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Jonathan Himmelfarb
- Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Yoshio N Hall
- Kidney Research Institute, Department of Medicine, University of Washington, Seattle, WA, USA. .,Kidney Research Institute, University of Washington, 325 9th Ave, Box 359606, Seattle, WA, 98104, USA.
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Oster NV, Jackson SL, Dhanireddy S, Mejilla R, Ralston JD, Leveille S, Delbanco T, Walker JD, Bell SK, Elmore JG. Patient Access to Online Visit Notes: Perceptions of Doctors and Patients at an Urban HIV/AIDS Clinic. J Int Assoc Provid AIDS Care 2014; 14:306-12. [PMID: 24729072 DOI: 10.1177/2325957414526783] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patients living with HIV/AIDS face large societal and medical challenges. Inviting patients to read their doctors' visit notes via secure electronic portals may empower patients and improve health. We investigated whether utilization and perceptions about access to doctors' notes differed among doctors and patients in an HIV/AIDS clinic versus primary care setting. We analyzed pre- and 1-year postintervention data from 99 doctors and 3819 patients. HIV clinic patients did not report differences in perceived risks and benefits compared to primary care clinic patients, however, they were more likely to share notes with friends (33% versus 9%, P=.002), other health professionals (24% versus 8%, P=.03), or another doctor (38% versus 9%, P<.0001). HIV clinic doctors were less likely than primary care doctors to change the level of candor in visit notes (P<.04). Our findings suggest that HIV clinic patients and doctors are ready to share visit notes online.
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Affiliation(s)
- Natalia V Oster
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Sara L Jackson
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Shireesha Dhanireddy
- Division of Infectious Disease, University of Washington Medical Center, Seattle, WA, USA
| | - Roanne Mejilla
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James D Ralston
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
| | - Suzanne Leveille
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Tom Delbanco
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Janice D Walker
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sigall K Bell
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joann G Elmore
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
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Krupski A, Sears JM, Joesch JM, Estee S, He L, Huber A, Dunn C, Roy-Byrne P, Ries R. Self-reported alcohol and drug use six months after brief intervention: do changes in reported use vary by mental-health status? Addict Sci Clin Pract 2012. [PMID: 23186062 PMCID: PMC3685518 DOI: 10.1186/1940-0640-7-24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Although brief intervention (BI) for alcohol and other drug problems has been associated with subsequent decreased levels of self-reported substance use, there is little information in the extant literature as to whether individuals with co-occurring hazardous substance use and mental illness would benefit from BI to the same extent as those without mental illness. This is an important question, as mental illness is estimated to co-occur in 37% of individuals with an alcohol use disorder and in more than 50% of individuals with a drug use disorder. The goal of this study was to explore differences in self-reported alcohol and/or drug use in patients with and without mental illness diagnoses six months after receiving BI in a hospital emergency department (ED). Methods This study took advantage of a naturalistic situation where a screening, brief intervention, and referral to treatment (SBIRT) program had been implemented in nine large EDs in the US state of Washington as part of a national SBIRT initiative. A subset of patients who received BI was interviewed six months later about current alcohol and drug use. Linear regression was used to assess whether change in substance use measures differed among patients with a mental illness diagnosis compared with those without. Data were analyzed for both a statewide (n = 828) and single-hospital (n = 536) sample. Results No significant differences were found between mentally ill and non-mentally ill subgroups in either sample with regard to self-reported hazardous substance use at six-month follow-up. Conclusion These results suggest that BI may not have a differing impact based on the presence of a mental illness diagnosis. Given the high prevalence of mental illness among individuals with alcohol and other drug problems, this finding may have important public health implications.
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Affiliation(s)
- Antoinette Krupski
- Department of Psychiatry and Behavioral Sciences, Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), University of Washington at Harborview Medical Center, Seattle, WA, USA.
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Dillon JK, Christensen B, McDonald T, Huang S, Gauger P, Gomez P. The Financial Burden of Mandibular Trauma. J Oral Maxillofac Surg 2012; 70:2124-34. [DOI: 10.1016/j.joms.2012.04.048] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 04/23/2012] [Accepted: 04/27/2012] [Indexed: 11/25/2022]
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Dhanireddy S, Walker J, Reisch L, Oster N, Delbanco T, Elmore JG. The urban underserved: attitudes towards gaining full access to electronic medical records. Health Expect 2012; 17:724-32. [PMID: 22738155 DOI: 10.1111/j.1369-7625.2012.00799.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND As the use of electronic medical records (EMRs) spreads, health-care organizations are increasingly offering patients online access to their medical records. Studies evaluating patient attitudes towards viewing elements of their records through secure, electronic patient portals have generally not included medically underserved patients or those with HIV/AIDS. The goal of this study was to gain insight into such patients' attitudes towards online access to their medical records, including their doctors' visit notes. METHODS Qualitative study of four focus groups with adult patients in general adult medicine and HIV clinics at a large county hospital. Transcripts were analysed for themes using an immersion/crystallization approach. RESULTS Patients' baseline understanding of the health record was limited. Perceived benefits of online access were improved patient understanding of health and disease, convenience, empowerment and a stronger relationship with their provider. Concerns included threats to privacy, worries about being unable to understand their record, fear that the computer would replace direct provider contact and hesitancy about potential demands on a provider's time. Patients also recommended providing online visit reminders, links to credible health information and assistance for paying bills. CONCLUSION Despite their initial lack of knowledge of the health record, focus group participants were overwhelmingly positive about the prospect of online access to medical records. However, they worried about potential loss of privacy and interference with the patient-provider relationship. As EMRs increasingly offer patients open access to their medical records, vulnerable patient groups will likely join others in desiring and adopting such change, but may need targeted support during times of transition.
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Affiliation(s)
- Shireesha Dhanireddy
- Associate Professor Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
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