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Sönmez N, Srinivasan K, Venkatesh R, Buell RW, Ramdas K. Evidence from the first Shared Medical Appointments (SMAs) randomised controlled trial in India: SMAs increase the satisfaction, knowledge, and medication compliance of patients with glaucoma. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001648. [PMID: 37471312 PMCID: PMC10358908 DOI: 10.1371/journal.pgph.0001648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/16/2023] [Indexed: 07/22/2023]
Abstract
In Shared Medical Appointments (SMAs), patients with similar conditions meet the physician together and each receives one-on-one attention. SMAs can improve outcomes and physician productivity. Yet privacy concerns have stymied adoption. In physician-deprived nations, patients' utility from improved access may outweigh their disutility from loss of privacy. Ours is to our knowledge the first SMA trial for any disease, in India, where doctors are scarce. In a 1,000-patient, single-site, randomized controlled trial at Aravind Eye Hospital, Pondicherry, we compared SMAs and one-on-one appointments, over four successive visits, for patients with glaucoma. We examined patients' satisfaction, knowledge, intention-to-follow-up, follow-up rates, and medication compliance rates (primary outcomes) using intention-to-treat analysis. Of 1,034 patients invited between July 12, 2016 -July 19, 2018, 1,000 (96.7%) consented to participate, and were randomly assigned to either SMAs (NSMA = 500) or one-on-one appointments (N1-1 = 500). Patients who received SMAs showed higher satisfaction (MeanSMA = 4.955 (SD 0.241), Mean1-1 = 4.920 (SD 0.326); difference in means 0.035; 95% CI, 0.017-0.054, p = 0.0002) and knowledge (MeanSMA = 3.416 (SD 1.340), Mean1-1 = 3.267 (SD 1.492); difference in means 0.149; 95% CI, 0.057-0.241, p = 0.002) than patients who received one-on-one appointments. Across conditions, there was no difference in patients' intention-to-follow-up (MeanSMA = 4.989 (SD 0.118), Mean1-1 = 4.986 (SD 0.149); difference in means 0.003; 95% CI, -0.006-0.012, p = 0.481) and actual follow-up rates (MeanSMA = 87.5% (SD 0.372), Mean1-1 = 88.7% (SD 0.338); difference in means -0.012; 95% CI, -0.039-0.015, p = 0.377). Patients who received SMAs exhibited higher medication compliance rates (MeanSMA = 97.0% (SD 0.180), Mean1-1 = 94.9% (SD 0.238); difference in means 0.020; 95% CI, 0.004-0.036, p = 0.013). SMAs improved satisfaction, learning, and medication compliance, without compromising follow-up rates or measured clinical outcomes. Peer interruptions were negatively correlated with patient satisfaction in early-trial SMAs and positively correlated with patient satisfaction in later-trial SMAs. Trial registration: The trial was registered with Clinical Trials Registry of India (https://ctri.nic.in/) with reference no. REF/2016/11/012659 and registration no. CTRI/2018/02/011998.
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Affiliation(s)
| | | | | | - Ryan W. Buell
- Harvard Business School, Harvard University, Boston, Massachusetts, United States of America
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Musser JA, Cho J, Cohn A, Niziol LM, Ballouz D, Burke DT, Newman-Casey PA. Measuring impact of a quality improvement initiative on glaucoma clinic flow using an automated real-time locating system. BMC Ophthalmol 2022; 22:283. [PMID: 35764976 PMCID: PMC9238160 DOI: 10.1186/s12886-022-02495-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background Lean methodology helps maximize value by reducing waste, first by defining what value and waste are in a system. In ophthalmology clinics, value is determined by the number of patients flowing through the clinic for a given time. We aimed to increase value using a lean-methodology guided policy change, then assessed its impact on clinic flow using an automated radiofrequency identification (RFID) based real-time locating system (RTLS). Methods A total of 6813 clinical visits occurred at a single academic institution’s outpatient glaucoma clinic between January 5, 2018 to July 3, 2018. Over that period, 1589 patients comprising 1972 (29%) of visits were enrolled, with 1031 clinical visits occurring before and 941 visits after a policy change. The original policy was to refract all patients that improved with pinhole testing. The policy change was not to refract patients with a visual acuity ≥20/30 unless a specific request was made by the patient. Pre-post analysis of an automated time-motion study was conducted for the data collected 3 months before and 3 months after the policy change occurred on March 30, 2018. Changes to process and wait times were summarized using descriptive statistics and fitted to linear mixed regression models adjusting for appointment type, clinic volume, and daily clinic trends. Results One thousand nine hundred twenty-three visits with 1588 patients were included in the analysis. Mean [SD] age was 65.9 [14.7] years and 892 [56.2%] were women. After the policy change, technician process time decreased by 2.9 min (p < 0.0001) while daily clinical patient volume increased from 51.9 ± 16.8 patients to 58.4 ± 17.4 patients (p < 0.038). No significant difference was found in total wait time (p = 0.18) or total visit time (p = 0.83). Conclusions Real-time locating systems are effective at capturing clinical flow data and assessing clinical practice change initiatives. The refraction policy change was associated with reduced technician process time and overall the clinic was able to care for 7 more patients per day without significantly increasing patient wait time.
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Oydanich M, Shah Y, Shah K, Khouri AS. An Analysis of the Quality, Reliability, and Popularity of YouTube Videos on Glaucoma. Ophthalmol Glaucoma 2022; 5:306-312. [PMID: 34637976 DOI: 10.1016/j.ogla.2021.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To evaluate the quality, reliability, and popularity of videos relating to glaucoma on YouTube. DESIGN Retrospective, cross-sectional study of YouTube videos about glaucoma. PARTICIPANTS One hundred YouTube videos were analyzed for this study. METHODS An online YouTube search for glaucoma videos was conducted simulating a user search using the keywords glaucoma, high eye pressure, and high intraocular pressure. The first 100 videos were analyzed, and each video was evaluated by 2 independent reviewers using the modified DISCERN (scale, 1-5), Journal of the American Medical Association (JAMA; scale, 0-4), and Global Quality (GQ; scale, 1-5) criteria to assess quality and reliability. Videos were categorized further into 3 groups depending on the source of their upload. Group 1 comprised videos uploaded by academic or government institutions, group 2 comprised videos uploaded by private medical practices, and group 3 comprised videos uploaded by independent users. MAIN OUTCOME MEASURES Modified DISCERN, JAMA, and GQ scores for quality and reliability of information and video power index (VPI) for video popularity. RESULTS No substantial difference in scoring was observed between the 2 independent reviewers. The overall mean ± standard error (SE) scores were modified DISCERN score, 3.81 ± 0.06; JAMA score, 2.93 ± 0.07; and GQ score, 3.98 ± 0.06. The overall mean ± SE VPI score was 9.9 ± 2.9. Significant positive correlations were found between video popularity and quality of information for all 3 criteria (P < 0.05). The videos in groups 1 and 2 showed higher modified DISCERN scores than those in group 3, but did not score higher with either the JAMA or GQ criteria. Videos in group 3 were the most popular when compared with videos in groups 1 or 2 (P < 0.01). CONCLUSIONS Overall, many of the videos had adequate quality and reliability scores. No difference was found among groups 1 through 3 for 2 of the 3 criteria used, suggesting a similar quality of information provided among academic, private, and independent sources.
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Affiliation(s)
- Marko Oydanich
- Department of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Yash Shah
- Department of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Khelly Shah
- Department of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Albert S Khouri
- Department of Ophthalmology & Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey.
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Hou CH, Lee JS, Lin KK, Liu L, Lee YS, Pu C. Accuracy of perceived glaucoma risk by patients in a clinical setting. PLoS One 2021; 16:e0257453. [PMID: 34529708 PMCID: PMC8445404 DOI: 10.1371/journal.pone.0257453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/01/2021] [Indexed: 01/25/2023] Open
Abstract
Objective To determine whether patients attending the ophthalmology department underestimate their glaucoma risks. Method We conducted a cross-sectional survey with a final study population of 1203 individuals from two medical centers in Taiwan during January 1–June 30, 2019. The “High concern” group was defined as the set of patients who rated themselves as having low risk but who had been rated by physicians as having medium or high risk of developing glaucoma over the next year. Results Approximately 12% of the respondents belonged to the “High concern” group. For those with education at the college level or higher, the interaction term was estimated to be 0.294 (95% CI = 0.136–0.634). Marginal effect calculations revealed significant sex-based differences in the effect of knowledge at specific age intervals. Conclusions A considerable proportion of patients attending the ophthalmology department underestimate their glaucoma risks. Misjudgment of glaucoma risks can lead to delays in seeking of medical attention. Glaucoma education should be designed according to each patient’s education level and sex, as its effect is not consistent across different education and sex clusters.
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Affiliation(s)
- Chiun-Ho Hou
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Tainan, Taiwan
- Department of Ophthalmology, Xiaman Chang Gung, Xiaman, People’s Republic of China
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jiahn-Shing Lee
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ken-Kuo Lin
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Laura Liu
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Sung Lee
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Christy Pu
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Tainan, Taiwan
- * E-mail:
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Kim S, Tong B, Lee J, Borodge D, Kooner K. Lifestyle Counseling for Medication Adherence in Glaucoma. Clin Ophthalmol 2021; 15:3521-3529. [PMID: 34429583 PMCID: PMC8380305 DOI: 10.2147/opth.s321351] [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: 06/16/2021] [Accepted: 07/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background Medication adherence in glaucoma patients remains sub-par despite proven benefits of regular administration. The objective was to analyze medication adherence before and after lifestyle counseling in patients with ocular hypertension (OHT) or primary open-angle glaucoma (POAG) (mild, moderate, severe). Methods Prospective cohort study from May to July 2018 at a single academic center. From 391 consecutive records, 247 were excluded based on exclusion criteria with 28 patients not meeting inclusion criteria resulting in the final sample of 116 patients (33 had OHT, 83 had POAG – 28 mild, 39 moderate, 16 severe). Scripted lifestyle counseling focusing on diet, exercise, vitamin intake, stress management, and medication adherence was administered by a team of trained medical students. Primary outcome measure was self-reported medication adherence, defined as not missing an eye drop administration in the past month. A 2–3 week follow-up with scripted telephone survey assessing medication adherence, diet, and exercise was collected. Results At baseline, in 116 patients, 59.5% were adherent to their medication with a breakdown of 42.4% OHT, 64.3% mild, 66.7% moderate, and 68.7% severe and an increasing trend in medication adherence was found across increasing disease severity (p=0.055). Of the 76 (65.5%) patients reached for follow-up, 17 (22.4%) became adherent following lifestyle counseling (p=0.02) increasing overall adherence to 78.9% from 62.5%. Conclusion In our study, comprehensive lifestyle counseling succeeded in increasing medication adherence in patients with OHT and POAG.
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Affiliation(s)
- Sandy Kim
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Betty Tong
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jessica Lee
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Darara Borodge
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karanjit Kooner
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Ophthalmology, Veterans Affairs North Texas Health Care System, Dallas, TX, USA
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Marin-Garcia JA, Vidal-Carreras PI, Garcia-Sabater JJ. The Role of Value Stream Mapping in Healthcare Services: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030951. [PMID: 33499116 PMCID: PMC7908358 DOI: 10.3390/ijerph18030951] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 12/16/2022]
Abstract
Lean healthcare aims to manage and improve the processes in the healthcare sector by eliminating everything that adds no value by improving quality of services, ensuring patient safety and facilitating health professionals’ work to achieve a flexible and reliable organization. Value Stream Mapping (VSM) is considered the starting point of any lean implementation. Some papers report applications of VSM in healthcare services, but there has been less attention paid to their contribution on sustainability indicators. The purpose of this work is to analyze the role of VSM in this context. To do so, a scoping review of works from recent years (2015 to 2019) was done. The results show that most applications of VSM reported are in the tertiary level of care, and the United States of America (USA) is the country which leads most of the applications published. In relation with the development of VSM, a heterogeneity in the maps and the sustainability indicators is remarkable. Moreover, only operational and social sustainability indicators are commonly included. We can conclude that more standardization is required in the development of the VSM in the healthcare sector, also including the environmental indicators.
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Newman-Casey PA, Musser J, Niziol LM, Shedden K, Burke D, Cohn A. Designing and validating a low-cost real time locating system to continuously assess patient wait times. J Biomed Inform 2020; 106:103428. [PMID: 32339749 PMCID: PMC7324007 DOI: 10.1016/j.jbi.2020.103428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/01/2020] [Accepted: 04/19/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Outpatient clinics lack infrastructure to easily measure and understand patient wait times. Our objective was to design a low-cost, portable passive real time locating system within an outpatient clinic setting to measure patient wait times and patient-provider interactions. MATERIALS AND METHODS Direct observation was used to determine workflow in an outpatient glaucoma clinic at the University of Michigan. We used off-the shelf, antenna-integrated ultra-high frequency (UHF) RFID readers (ThingMagic, Astra-Ex, Woburn, MA) and UHF re-useable passive RFID tags (Zebra Impinj Monza 4QT, Seattle, WA). We designed a custom RFID management application in the Java programming language that was equipped with 'live' device administration to collect time and location data from patients and providers. These hardware choices enabled low cost system installation. Hidden Markov Modeling (HMM) was used to smooth patient and provider location data. Location data were validated against direct observations and EHR evaluation. RESULTS The HMM smoothed RFID system data accurately predicted patient location 80.6% of the time and provider location 79.1% of the time, compared to direct observation locations, an improvement over the raw RFID location data (65.0% and 77.9% accurate, respectively). Patient process time was on average 42.8 min (SD = 27.5) and wait time was 47.9 min (SD = 33.1). The installation and recurring capital costs of the system are approximately 10% of available commercially-supplied patient/provider tracking systems. DISCUSSION Passive RFID time study systems can enable real-time localization of people in clinic, facilitating continuous capture of patient wait times and patient-provider interactions. The system must be tailored to the clinic to accurately reflect patient and provider movement. CONCLUSIONS Capturing wait time data continuously and passively can empower continuous clinical quality improvement initiatives to enhance the patient experience.
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Affiliation(s)
- Paula Anne Newman-Casey
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, MI, United States.
| | - John Musser
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, MI, United States
| | - Leslie M Niziol
- Department of Ophthalmology & Visual Sciences, University of Michigan Medical School, MI, United States
| | - Kerby Shedden
- Department of Statistics, University of Michigan, Ann Arbor, MI, United States
| | - David Burke
- Department of Human Genetics, University of Michigan Medical School, MI, United States
| | - Amy Cohn
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, United States
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