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Grobman B, Mansur A, Babalola D, Srinivasan AP, Antonio JM, Lu CY. Suicide among Cancer Patients: Current Knowledge and Directions for Observational Research. J Clin Med 2023; 12:6563. [PMID: 37892700 PMCID: PMC10607431 DOI: 10.3390/jcm12206563] [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: 09/06/2023] [Revised: 10/03/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Cancer is a major public health concern associated with an increased risk of psychosocial distress and suicide. The reasons for this increased risk are still being characterized. The purpose of this study is to highlight existing observational studies on cancer-related suicides in the United States and identify gaps for future research. This work helps inform clinical and policy decision-making on suicide prevention interventions and ongoing research on the detection and quantification of suicide risk among cancer patients. We identified 73 peer-reviewed studies (2010-2022) that examined the intersection of cancer and suicide using searches of PubMed and Embase. Overall, the reviewed studies showed that cancer patients have an elevated risk of suicide when compared to the general population. In general, the risk was higher among White, male, and older cancer patients, as well as among patients living in rural areas and with lower socioeconomic status. Future studies should further investigate the psychosocial aspects of receiving a diagnosis of cancer on patients' mental health as well as the impact of new treatments and their availability on suicide risk and disparities among cancer patients to better inform policies.
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Affiliation(s)
- Ben Grobman
- Harvard Medical School, Boston, MA 02115, USA; (B.G.); (A.M.)
| | - Arian Mansur
- Harvard Medical School, Boston, MA 02115, USA; (B.G.); (A.M.)
| | - Dolapo Babalola
- College of Medicine, University of Ibadan, Ibadan 200285, Nigeria;
| | | | | | - Christine Y. Lu
- Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA 02215, USA
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW 2050, Australia
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney, The Northern Sydney Local Health District, Sydney, NSW 2064, Australia
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Perla LY, Beck LB, Grunberg NE. Assessment of Veterans Affairs Case Management Leadership. Prof Case Manag 2023; 28:110-120. [PMID: 36999761 DOI: 10.1097/ncm.0000000000000615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
PURPOSE/OBJECTIVES The critical work of Veterans Affairs (VA) case managers is to assist and advocate for veterans navigating the VA and civilian health care systems, aligning services, developing integrated care plans, and supporting team-based care (Hunt & Burgo-Black, 2011). The article reviews publications regarding VA case management leadership because case managers who function as leaders are likely to better coordinate health care services for veterans. PRIMARY PRACTICE SETTING VA case managers adhere to the Commission for Case Managers (CCM) scope of practice through patient advocacy, education, and resource management, while ensuring the care is safe, effective, and equitable. VA case managers are competent in veteran health care benefits, health care resources, military service, and the prevailing military culture. They work in a variety of clinical settings including more than 1,400 facilities throughout the United States. FINDINGS/CONCLUSIONS The present literature review indicates that few published articles address leadership among VA case managers. Several publications suggest that VA case managers lead, as well as manage, without indicating the extent to which they function as leaders. The literature reviewed indicates an association between unsuccessful program implementation and a lack of staff adaptability, a lack of necessary resources, a lack of ongoing involvement of senior leaders, and a fear of reprisal. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Because of the 2018 MISSION Act, the number of veterans seeking services in the community has increased and further complicated the coordination of services for VA case managers. Understanding the leadership elements influencing successful care coordination processes is important for veterans to receive high-quality health care services.
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Affiliation(s)
- Lisa Y Perla
- Lisa Y. Perla, PhD, MSN, CFNP, is a licensed and certified family nurse practitioner and a certified case manager and rehabilitation registered nurse. Dr. Perla earned her PhD in nursing research and the prestigious VA Jonas Scholars award from the Uniformed Services University of the Health Sciences in Bethesda, MD. Dr. Perla's work encompasses numerous clinical and administrative roles in the areas of emergency medicine, medical and surgical transplantation, intensive care, and rehabilitation medicine. She is a national speaker on the topics of neurological emergencies and leadership. Dr. Perla's current work is in Veterans' Affairs, Central Office in Washington, DC. She is the National Polytrauma Coordinator for Veterans with multiple trauma and brain injury and collaborates across the enterprise with a team of rehabilitation specialists to synchronize their health care. Her research is in the leadership of registered nurse and social work case managers
- Lucille B. Beck, PhD, is an audiologist and former Chief Officer for Rehabilitation Services. She is currently a senior advisor to the Under Secretary for Health responsible and servicing in several Veterans Affairs Central Office leadership roles. She has extensive experience as a leader representing Rehabilitation and Prosthetic Services with oversight of eight national programs and two comprehensive systems of care requiring case management and care coordination. Dr. Beck received the rank of Meritorious Executive in the Senior Executive Service by President William Clinton. His written remarks recognized Dr. Beck "for sustained extraordinary accomplishment in management of programs of the U.S. government and for leadership exemplifying the highest standards of service to the public, reflecting credit on her career in civil service." Dr. Beck has jointly held faculty appointments at Gallaudet University, George Washington University, and the University of Maryland. She has authored numerous publications, scientific papers, and is a well-known presenter on topics ranging from amplification, outcomes, patient satisfaction, and other issues in Audiology and Rehabilitation for Veterans
- Neil E. Grunberg, PhD, is Professor of Military & Emergency Medicine (MEM), Medical & Clinical Psychology (MPS), and Neuroscience (NES) in the Uniformed Services University (USU) School of Medicine (SOM); Professor in the Graduate School of Nursing (GSN); Director of Research and Development in the Leadership Education and Development (LEAD) program; Director of Faculty Development for MEM. He is a medical and social psychologist who has been on faculty at USU since 1979. His role in LEAD is to ensure that the LEAD program and sessions are based upon sound evidence and scholarship and to oversee research relevant to leadership education and training
| | - Lucille B Beck
- Lisa Y. Perla, PhD, MSN, CFNP, is a licensed and certified family nurse practitioner and a certified case manager and rehabilitation registered nurse. Dr. Perla earned her PhD in nursing research and the prestigious VA Jonas Scholars award from the Uniformed Services University of the Health Sciences in Bethesda, MD. Dr. Perla's work encompasses numerous clinical and administrative roles in the areas of emergency medicine, medical and surgical transplantation, intensive care, and rehabilitation medicine. She is a national speaker on the topics of neurological emergencies and leadership. Dr. Perla's current work is in Veterans' Affairs, Central Office in Washington, DC. She is the National Polytrauma Coordinator for Veterans with multiple trauma and brain injury and collaborates across the enterprise with a team of rehabilitation specialists to synchronize their health care. Her research is in the leadership of registered nurse and social work case managers
- Lucille B. Beck, PhD, is an audiologist and former Chief Officer for Rehabilitation Services. She is currently a senior advisor to the Under Secretary for Health responsible and servicing in several Veterans Affairs Central Office leadership roles. She has extensive experience as a leader representing Rehabilitation and Prosthetic Services with oversight of eight national programs and two comprehensive systems of care requiring case management and care coordination. Dr. Beck received the rank of Meritorious Executive in the Senior Executive Service by President William Clinton. His written remarks recognized Dr. Beck "for sustained extraordinary accomplishment in management of programs of the U.S. government and for leadership exemplifying the highest standards of service to the public, reflecting credit on her career in civil service." Dr. Beck has jointly held faculty appointments at Gallaudet University, George Washington University, and the University of Maryland. She has authored numerous publications, scientific papers, and is a well-known presenter on topics ranging from amplification, outcomes, patient satisfaction, and other issues in Audiology and Rehabilitation for Veterans
- Neil E. Grunberg, PhD, is Professor of Military & Emergency Medicine (MEM), Medical & Clinical Psychology (MPS), and Neuroscience (NES) in the Uniformed Services University (USU) School of Medicine (SOM); Professor in the Graduate School of Nursing (GSN); Director of Research and Development in the Leadership Education and Development (LEAD) program; Director of Faculty Development for MEM. He is a medical and social psychologist who has been on faculty at USU since 1979. His role in LEAD is to ensure that the LEAD program and sessions are based upon sound evidence and scholarship and to oversee research relevant to leadership education and training
| | - Neil E Grunberg
- Lisa Y. Perla, PhD, MSN, CFNP, is a licensed and certified family nurse practitioner and a certified case manager and rehabilitation registered nurse. Dr. Perla earned her PhD in nursing research and the prestigious VA Jonas Scholars award from the Uniformed Services University of the Health Sciences in Bethesda, MD. Dr. Perla's work encompasses numerous clinical and administrative roles in the areas of emergency medicine, medical and surgical transplantation, intensive care, and rehabilitation medicine. She is a national speaker on the topics of neurological emergencies and leadership. Dr. Perla's current work is in Veterans' Affairs, Central Office in Washington, DC. She is the National Polytrauma Coordinator for Veterans with multiple trauma and brain injury and collaborates across the enterprise with a team of rehabilitation specialists to synchronize their health care. Her research is in the leadership of registered nurse and social work case managers
- Lucille B. Beck, PhD, is an audiologist and former Chief Officer for Rehabilitation Services. She is currently a senior advisor to the Under Secretary for Health responsible and servicing in several Veterans Affairs Central Office leadership roles. She has extensive experience as a leader representing Rehabilitation and Prosthetic Services with oversight of eight national programs and two comprehensive systems of care requiring case management and care coordination. Dr. Beck received the rank of Meritorious Executive in the Senior Executive Service by President William Clinton. His written remarks recognized Dr. Beck "for sustained extraordinary accomplishment in management of programs of the U.S. government and for leadership exemplifying the highest standards of service to the public, reflecting credit on her career in civil service." Dr. Beck has jointly held faculty appointments at Gallaudet University, George Washington University, and the University of Maryland. She has authored numerous publications, scientific papers, and is a well-known presenter on topics ranging from amplification, outcomes, patient satisfaction, and other issues in Audiology and Rehabilitation for Veterans
- Neil E. Grunberg, PhD, is Professor of Military & Emergency Medicine (MEM), Medical & Clinical Psychology (MPS), and Neuroscience (NES) in the Uniformed Services University (USU) School of Medicine (SOM); Professor in the Graduate School of Nursing (GSN); Director of Research and Development in the Leadership Education and Development (LEAD) program; Director of Faculty Development for MEM. He is a medical and social psychologist who has been on faculty at USU since 1979. His role in LEAD is to ensure that the LEAD program and sessions are based upon sound evidence and scholarship and to oversee research relevant to leadership education and training
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Valença-Feitosa F, Carvalho GAC, Alcantara TS, Quintans-Júnior LJ, Alves-Conceição V, Lyra-Jr DP. Identifying health outcomes of pharmaceutical clinical services in patients with cancer: A systematic review. Res Social Adm Pharm 2023; 19:591-598. [PMID: 36604226 DOI: 10.1016/j.sapharm.2022.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/13/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cancer is a major public health problem that imposes limitations on patients being treated. One of the strategies to improve health outcomes in cancer patients and promote the safety of their treatment is the provision of pharmaceutical clinical services (PCS). However, there is no evidence of health outcomes that are influenced by such services. OBJECTIVE Identify the health outcomes influenced by PCS in cancer patients. METHODS A systematic review was performed in the following databases: Cochrane Library, LILACS, PubMed, EMBASE, and Web of Science, and using the PRISMA Statement In addition to the search, we analyzed the references of systematic reviews and meta-analyses. The descriptors used were defined by the MeSH keywords "neoplasms," "pharmacists," and "pharmaceutical services". We analyzed the studies with an observational design published until March 2018 that used PCS and related them with the health outcomes. Two reviewers independently assessed titles, abstracts, and full texts according to the eligibility criteria, and then extracted data and assessed the methodological quality of the studies. RESULTS A total of 658 articles were found in the initial search, of which eight met the inclusion criteria. Six studies evaluated clinical outcomes: four assessed adverse reactions, one identified six barriers that prevented patients' adherence to medication and solved three of these barriers, and two evaluated PCS related to drug-related problems (DRP) in identification and resolution. Four studies identified a humanistic outcome: two evaluated the quality of life of patients on cancer treatment associated with improvement of symptoms, two investigated pain, and two performed a patient satisfaction survey on PCS. This systematic review identified only one study with an economic outcome, addressing the reduction of medical expenses related to the treatment of neutropenia that affects cancer patients. Most of the studies showed good methodological quality. CONCLUSIONS This systematic review identified health outcomes associated with PCS in cancer patients: clinical (adverse drug reaction, DRP resolution, adherence, and pain), humanistic (quality of life and satisfaction), and economic outcomes (reduction of treatment costs for cancer).
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Affiliation(s)
- F Valença-Feitosa
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, CEP: 49100-000, São Cristóvão, SE, Brazil.
| | - G A C Carvalho
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, CEP: 49100-000, São Cristóvão, SE, Brazil.
| | - T S Alcantara
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, CEP: 49100-000, São Cristóvão, SE, Brazil.
| | - L J Quintans-Júnior
- Laboratory of Neurosciences and Pharmacological Tests (LANEF), Federal University of Sergipe, University City "Prof. José Aloísio Campos", Jardim Rosa Elze, São Cristóvão, CEP: 49100-000, Brazil.
| | - V Alves-Conceição
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, CEP: 49100-000, São Cristóvão, SE, Brazil.
| | - D P Lyra-Jr
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Cidade Universitária "Prof. José Aloísio Campos", Jardim Rosa Elze, CEP: 49100-000, São Cristóvão, SE, Brazil.
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Dent KR, Szymanski BR, Kelley MJ, Katz IR, McCarthy JF. Suicide risk following a new cancer diagnosis among Veterans in Veterans Health Administration care. Cancer Med 2022; 12:3520-3531. [PMID: 36029038 PMCID: PMC9939100 DOI: 10.1002/cam4.5146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/29/2022] [Accepted: 07/28/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Cancer diagnoses are associated with an increased risk for suicide. The aim of this study was to evaluate this association among Veterans receiving Veterans Health Administration (VHA) care, a population that has an especially high suicide risk. METHODS Among 4,926,373 Veterans with VHA use in 2011 and in 2012 or 2013, and without VHA cancer diagnoses in 2011, we assessed suicide risk following incident cancer diagnoses. Risk time was from initial VHA use in 2012-2013 to 12/31/2018 or death, whichever came first. Cox proportional hazards regression models evaluated associations between new cancer diagnoses and suicide risk, adjusting for age, sex, VHA regional network, and mental health comorbidities. Suicide rates were calculated among Veterans with new cancer diagnoses through 84 months following diagnosis. RESULTS A new cancer diagnosis corresponded to a 47% higher suicide risk (Adjusted Hazard Ratio [aHR] = 1.47, 95% CI: 1.33-1.63). The cancer subtype associated with the highest suicide risk was esophageal cancer (aHR = 6.01, 95% CI: 3.73-9.68), and other significant subtypes included head and neck (aHR = 3.55, 95% CI: 2.74-4.62) and lung cancer (aHR = 2.35, 95% CI: 1.85-3.00). Cancer stages 3 (aHR = 2.36, 95% CI: 1.80-3.11) and 4 (aHR = 3.53, 95% CI: 2.81-4.43) at diagnosis were positively associated with suicide risk. Suicide rates were highest within 3 months following diagnosis and remained elevated in the 3-6- and 6-12-month periods following diagnosis. CONCLUSION Among Veteran VHA users, suicide risk was elevated following new cancer diagnoses. Risk was particularly high in the first 3 months. Additional screening and suicide prevention efforts may be warranted for VHA Veterans newly diagnosed with cancer.
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Affiliation(s)
- Kallisse R. Dent
- Veterans Affairs (VA) Serious Mental Illness Treatment Resource and Evaluation CenterOffice of Mental Health and Suicide PreventionAnn ArborMichiganUSA
| | - Benjamin R. Szymanski
- Veterans Affairs (VA) Serious Mental Illness Treatment Resource and Evaluation CenterOffice of Mental Health and Suicide PreventionAnn ArborMichiganUSA
| | - Michael J. Kelley
- Veterans Affairs (VA) National Oncology ProgramSpecialty Care Services, VAWashingtonDistrict of ColumbiaUSA,Duke Cancer InstituteDurhamNorth CarolinaUSA,Hematology‐OncologyDurham VA Health Care SystemDurhamNorth CarolinaUSA
| | - Ira R. Katz
- VA Office of Mental Health and Suicide PreventionWashingtonDistrict of ColumbiaUSA
| | - John F. McCarthy
- Veterans Affairs (VA) Serious Mental Illness Treatment Resource and Evaluation CenterOffice of Mental Health and Suicide PreventionAnn ArborMichiganUSA
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Yan L, Tan J, Chen H, Yao L, Li Y, Zhao Q, Xiao M. Experience and support of Chinese healthcare professionals as second victims of patient safety incidents: A cross-sectional study. Perspect Psychiatr Care 2022; 58:733-743. [PMID: 33993485 DOI: 10.1111/ppc.12843] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To describe the experience and support of Chinese healthcare professionals as second victims of PSIs. DESIGN AND METHODS A cross-sectional study with anonymous online self-report questionnaires was adopted. A total of 1357 Chinese healthcare professionals participated in this study. The Chinese version of the Second Victim Experience and Support Tool (C-SVEST) was used to evaluate the experience of second victims and the quality of support resources. Descriptive and inferential statistics were employed to analyze the data. FINDINGS This study showed that 350 participants (25.8%) had been involved in PSIs during their careers. The majority of respondents who had experienced PSIs agreed they suffered more from psychological distress, followed by professional self-efficacy distress, and physical distress. Besides, they regarded colleague support and management support as the most desirable support. Statistically significant differences were reported in some items. First, compared with medical staff without professional titles, staff with professional titles suffered more from psychological distress but gained more support from colleagues. PRACTICE IMPLICATIONS The second victim phenomenon deserves further attention. The programs focusing on training qualified colleagues to provide emotional support should be developed, implemented, and evaluated. Moreover, it is necessary to build a better patient safety culture with nonpunitive responses and encourage the disclosure and reporting of PSIs.
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Affiliation(s)
- Lupei Yan
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jingxing Tan
- School of Nursing, University of South China, Hunan, China
| | - Hao Chen
- Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Lili Yao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuerong Li
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Giannitrapani KF, Silveira MJ, Azarfar A, Glassman PA, Singer SJ, Asch SM, Midboe AM, Zenoni MA, Gamboa RC, Becker WC, Lorenz KA. Cross Disciplinary Role Agreement is Needed When Coordinating Long-Term Opioid Prescribing for Cancer: a Qualitative Study. J Gen Intern Med 2021; 36:1867-1874. [PMID: 33948790 PMCID: PMC8298631 DOI: 10.1007/s11606-021-06747-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cancer pain is highly prevalent and often managed in primary care or by oncology providers in combination with primary care providers. OBJECTIVES To understand interdisciplinary provider experiences coordinating opioid pain management for patients with chronic cancer-related pain in a large integrated healthcare system. DESIGN Qualitative research. PARTICIPANTS We conducted 20 semi-structured interviews with interdisciplinary providers in two large academically affiliated VA Medical Centers and their associated community-based outpatient clinics. Participants included primary care providers (PCPs) and oncology-based personnel (OBPs). APPROACH We deductively identified 94 examples of care coordination for cancer pain in the 20 interviews. We secondarily used an inductive open coding approach and identified themes through constant comparison coming to research team consensus. RESULTS Theme 1: PCPs and OBPs generally believed one provider should handle all opioid prescribing for a specific patient, but did not always agree on who that prescriber should be in the context of cancer pain. Theme 2: There are special circumstances where having multiple prescribers is appropriate (e.g., a pain crisis). Theme 3: A collaborative process to opioid cancer pain management would include real-time communication and negotiation between PCPs and oncology around who will handle opioid prescribing. Theme 4: Providers identified multiple barriers in coordinating cancer pain management across disciplines. CONCLUSIONS Our findings highlight how real-time negotiation about roles in opioid pain management is needed between interdisciplinary clinicians. Lack of cross-disciplinary role agreement may result in delays in clinically appropriate cancer pain management.
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Affiliation(s)
- K F Giannitrapani
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA. .,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
| | - M J Silveira
- Geriatric Research Education Clinical Center (GRECC), Ann Arbor VA Health Care System, University of Michigan, Ann Arbor, MI, USA.,Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - A Azarfar
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,University of Central Florida, Orlando, FL, USA
| | - P A Glassman
- Pharmacy Benefits Management Services, Department of Veterans Affairs, Washington, DC, USA.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - S J Singer
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - S M Asch
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - A M Midboe
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - M A Zenoni
- Pain Research Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Health Care System, West Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - R C Gamboa
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - W C Becker
- Pain Research Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Health Care System, West Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - K A Lorenz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Aboumrad M, Neily J, Watts BV. Teaching Root Cause Analysis Using Simulation: Curriculum and Outcomes. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519894270. [PMID: 31897434 PMCID: PMC6920588 DOI: 10.1177/2382120519894270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 05/07/2023]
Abstract
BACKGROUND Clinicians are key drivers for improving health care quality and safety. However, some may lack experience in quality improvement and patient safety (QI/PS) methodologies, including root cause analysis (RCA). OBJECTIVE The Department of Veterans Affairs (VA) sought to develop a simulation approach to teach clinicians from the VA's Chief Resident in Quality and Safety program about RCA. We report the use of experiential learning to teach RCA, and clinicians' preparedness to conduct and teach RCA post-training. We provide curriculum details and materials to be adapted for widespread use. METHODS The course was designed to meet the learning objectives through simulation. We developed course materials, including presentations, a role-playing case, and an elaborate RCA case. Learning objectives included (1) basic structure of RCA, (2) process flow diagramming, (3) collecting information for RCA, (4) cause and effect diagramming, and (5) identifying actions and outcomes. We administered a voluntary, web-based survey in November 2016 to participants (N = 114) post-training to assess their competency with RCA. RESULTS A total of 93 individuals completed the survey of the 114 invited to participate, culminating an 82% response rate. Nearly all respondents (99%, N = 92) reported feeling at least moderately to extremely prepared to conduct and teach RCA post-training. Most respondents reported feeling very to extremely prepared to conduct and teach RCA (77%, N = 72). CONCLUSIONS Experiential learning involving simulations may be effective to improve clinicians' competency in QI/PS practices, including RCA. Further research is warranted to understand how the training affects clinicians' capacity to participate in real RCA teams post-training, as well as applicability to other disciplines and interdisciplinary teams.
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Affiliation(s)
- Maya Aboumrad
- National Center for Patient Safety,
White River Junction, VT, USA
- White River Junction Veterans Affairs
Medical Center, White River Junction, VT, USA
- Maya Aboumrad, Veterans Affairs Medical
Center, 215 North Main Street, White River Junction, VT 05009, USA.
| | - Julia Neily
- National Center for Patient Safety,
White River Junction, VT, USA
- White River Junction Veterans Affairs
Medical Center, White River Junction, VT, USA
| | - Bradley V Watts
- National Center for Patient Safety,
White River Junction, VT, USA
- White River Junction Veterans Affairs
Medical Center, White River Junction, VT, USA
- Department of Psychiatry, Geisel School
of Medicine at Dartmouth, Hanover, NH, USA
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