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Correia RH, Dash D, Jones A, Vanstone M, Aryal K, Siu HYH, Gopaul A, Costa AP. Primary care quality for older adults: Practice-based quality measures derived from a RAND/UCLA appropriateness method study. PLoS One 2024; 19:e0297505. [PMID: 38241388 PMCID: PMC10798529 DOI: 10.1371/journal.pone.0297505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024] Open
Abstract
We established consensus on practice-based metrics that characterize quality of care for older primary care patients and can be examined using secondary health administrative data. We conducted a two-round RAND/UCLA Appropriateness Method (RAM) study and recruited 10 Canadian clinicians and researchers with expertise relevant to the primary care of elderly patients. Informed by a literature review, the first RAM round evaluated the appropriateness and importance of candidate quality measures in an online questionnaire. Technical definitions were developed for each endorsed indicator to specify how the indicator could be operationalized using health administrative data. In a virtual synchronous meeting, the expert panel offered feedback on the technical specifications for the endorsed indicators. Panelists then completed a second (final) questionnaire to rate each indicator and corresponding technical definition on the same criteria (appropriateness and importance). We used statistical integration to combine technical expert panelists' judgements and content analysis of open-ended survey responses. Our literature search and internal screening resulted in 61 practice-based quality indicators for rating. We developed technical definitions for indicators endorsed in the first questionnaire (n = 55). Following the virtual synchronous meeting and second questionnaire, we achieved consensus on 12 practice-based quality measures across four Priority Topics in Care of the Elderly. The endorsed indicators provide a framework to characterize practice- and population-level encounters of family physicians delivering care to older patients and will offer insights into the outcomes of their care provision. This study presented a case of soliciting expert feedback to develop measurable practice-based quality indicators that can be examined using administrative data to understand quality of care within population-based data holdings. Future work will refine and operationalize the technical definitions established through this process to examine primary care provision for older adults in a particular context (Ontario, Canada).
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Affiliation(s)
- Rebecca H. Correia
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Darly Dash
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Komal Aryal
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Henry Yu-Hin Siu
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Aquila Gopaul
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Andrew P. Costa
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Ali AZ, Wright B, Curran JA, Newton AS. Review: Patient engagement in child, adolescent, and youth mental health care research - a scoping review. Child Adolesc Ment Health 2023; 28:524-535. [PMID: 36494910 DOI: 10.1111/camh.12615] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Youth and children's lived experiences are rarely considered in studies seeking to improve or evaluate their mental health care. We conducted a scoping review to identify approaches to child, adolescent, and youth engagement in mental health studies as well as study-reported barriers, constraints, and facilitators to engagement. METHOD We systematically searched six electronic databases for literature. We included studies of mental health care service design, development, or evaluation that involved engagement of children, adolescents, and/or youth with mental disorders or who intentionally self-harm. Studies could be of any design as long as patient engagement was used at any point during its design and/or conduct. Engagement could include co-designing health services/interventions and/or participating as a co-researcher. We assessed the reporting of patient engagement using the Guidance for Reporting Involvement of Patients and the Public 2 Long-Form (GRIPP2-LF) checklist and used the Experience Based Co-design (EBCD) framework to guide data extraction and analysis. RESULTS Sixteen articles were included in the review. Most studies used engagement to develop or adapt a mental health service (75%) and utilized a participatory or co-design approach (69%). Participants were namely adolescents and youth (aged 10-24 years) with some studies including young adults (up to 29 years old). Most studies followed less than 50% of the EBCD framework, and the commonly reported study barriers were related to aspects addressed in EBCD: time restrictions, recruitment, and generalizability. Frequently reported study facilitators included study methodology, youth engagement, and having a diverse participant sample. CONCLUSIONS Findings from this review suggest that the EBCD framework is not commonly used to guide patient engagement in studies of mental health care services. Future initiatives should consider following the framework to ensure meaningful evaluation and improvements to youth and children's mental health care services.
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Affiliation(s)
- Amber Z Ali
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Bruce Wright
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Janet A Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Olmos-Ochoa TT, Luger TM, Oishi A, Dyer KE, Sumberg A, Canelo I, Gideonse TK, Cheney A, Yano EM, Hamilton AB. Challenges to Engaging Women Veterans in Quality Improvement From Patient Care to Policy: Women's Health Managers' Perspectives. Womens Health Issues 2023; 33:199-207. [PMID: 36153165 DOI: 10.1016/j.whi.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Patients are uniquely positioned to identify issues and to provide innovative solutions to problems impacting their care. Yet, patient engagement in quality improvement (QI) and health care governance remains limited and underexplored. In the Veterans Health Administration, the work of women's health managers (WHMs) includes engaging women veterans, a numerical minority with unique health care needs, in QI. We aimed to understand the extent to which WHMs engage women veterans along a continuum, highlight challenges to engagement, and identify potential strategies to facilitate multilevel patient engagement. METHODS Data were generated from a multisite evaluation to improve delivery of comprehensive women's health care in Veterans Health Administration primary care sites. We conducted 39 semistructured interviews with WHMs across 21 sites. Guided by Carman et al.'s patient engagement framework, we analyzed the interviews using rapid-qualitative and content analysis methods. RESULTS When effectively engaged, women veterans were important champions and partners in QI activities to improve the structure and delivery of care. However, most WHMs engaged women veterans in mainly informal or passive ways-that is, solicited feedback through comment cards, surveys, focus groups, and townhall meetings-and did not report pursuing more in-depth or long-term forms of engagement. WHMs also identified a variety of facilitators and challenges to engaging women veterans in QI. CONCLUSIONS There may be unanticipated benefits to health care policy from engaging patients in QI, especially for patients with unique health care needs who represent a minority within the health care system. However, managers require training and workflow integration of patient engagement tasks to increase their efficiency and allow for meaningful patient engagement.
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Affiliation(s)
- Tanya T Olmos-Ochoa
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California.
| | - Tana M Luger
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California; Covenant Health Network, Phoenix, Arizona
| | - Anneka Oishi
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Karen E Dyer
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Annie Sumberg
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Ismelda Canelo
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Theodore K Gideonse
- Department of Health, Science, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California
| | - Ann Cheney
- Department of Social Medicine, Population, and Public Health, University of California Riverside School of Medicine, Riverside, California
| | - Elizabeth M Yano
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; Department of Medicine, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Alison B Hamilton
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Psychiatry & Biobehavioral Sciences, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Abstract
BACKGROUND Super-utilizers of the health care system compose a small percentage of the population, yet use the most health care resources. Hotspotting addresses this issue by providing high-quality, personalized care to this population. PURPOSE This review examined how hotspotting has been defined, implemented, and measured. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guided this review. Twelve databases were searched for hotspotting interventions in practice settings. RESULTS Sixteen studies were included. Hotspotting was primarily defined by the Camden Coalition of Healthcare Providers and relied on multiple professions, including nursing. Hotspotting interventions addressed access to care, social determinants of health, patient engagement, and health literacy. Some studies indicated that hotspotting reduced readmissions and emergency department visits and increased use in social services. CONCLUSIONS Patients benefit from an interprofessional, personalized approach to their care planning. Hotspotting can lead to high-quality care through building trusted relationships.
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