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Walker DM, Hefner JL, MacEwan SR, Di Tosto G, Sova LN, Gaughan AA, Huerta TR, McAlearney AS. Differences by Race in Outcomes of an In-Person Training Intervention on Use of an Inpatient Portal: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2024; 7:e245091. [PMID: 38573634 DOI: 10.1001/jamanetworkopen.2024.5091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Importance Differences in patient use of health information technologies by race can adversely impact equitable access to health care services. While this digital divide is well documented, there is limited evidence of how health care systems have used interventions to narrow the gap. Objective To compare differences in the effectiveness of patient training and portal functionality interventions implemented to increase portal use among racial groups. Design, Setting, and Participants This secondary analysis used data from a randomized clinical trial conducted from December 15, 2016, to August 31, 2019. Data were from a single health care system and included 6 noncancer hospitals. Participants were patients who were at least 18 years of age, identified English as their preferred language, were not involuntarily confined or detained, and agreed to be provided a tablet to access the inpatient portal during their stay. Data were analyzed from September 1, 2022, to October 31, 2023. Interventions A 2 × 2 factorial design was used to compare the inpatient portal training intervention (touch, in-person [high] vs built-in video tutorial [low]) and the portal functionality intervention (technology, full functionality [full] vs a limited subset of functions [lite]). Main Outcomes and Measures Primary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and use of specific portal functions. A logistic regression model was used to test the association of the estimators with the comprehensiveness use measure. Outcomes are reported as incidence rate ratios (IRRs) for the frequency outcomes or odds ratios (ORs) for the comprehensiveness outcomes with corresponding 95% CIs. Results Of 2892 participants, 550 (19.0%) were Black individuals, 2221 (76.8%) were White individuals, and 121 (4.2%) were categorized as other race (including African, American Indian or Alaska Native, Asian or Asian American, multiple races or ethnicities, and unknown race or ethnicity). Black participants had a significantly lower frequency (IRR, 0.80 [95% CI, 0.72-0.89]) of inpatient portal use compared with White participants. Interaction effects were not observed between technology, touch, and race. Among participants who received the full technology intervention, Black participants had lower odds of being comprehensive users (OR, 0.76 [95% CI, 0.62-0.91), but interaction effects were not observed between touch and race. Conclusions and Relevance In this study, providing in-person training or robust portal functionality did not narrow the divide between Black participants and White participants with respect to their inpatient portal use. Health systems looking to narrow the digital divide may need to consider intentional interventions that address underlying issues contributing to this inequity. Trial Registration ClinicalTrials.gov Identifier: NCT02943109.
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Affiliation(s)
- Daniel M Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
| | - Jennifer L Hefner
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Sarah R MacEwan
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus
| | - Gennaro Di Tosto
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
| | - Lindsey N Sova
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
| | - Alice A Gaughan
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
| | - Timothy R Huerta
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
| | - Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- CATALYST, The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus
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Seiber EE, Garrity K, Moon KJ, Jankowski E, Nawaz S, Garner JA, Headings A, Jonas DE, Clark A, Bose-Brill S, Shrodes JC, Hoseus J, Baker C, McAlearney AS, Hefner JL, Joseph JJ, Vallangeon D, Walker DM. Sustainability of Social Needs Resolution Interventions: A Call to Consider Cost. Am J Prev Med 2024:S0749-3797(24)00022-9. [PMID: 38272244 DOI: 10.1016/j.amepre.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Eric E Seiber
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA; Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA.
| | - Katharine Garrity
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH, USA
| | - Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Emma Jankowski
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA; Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA
| | - Jennifer A Garner
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH, USA; John Glenn College of Public Affairs, Ohio State University, Columbus, OH, USA
| | - Amy Headings
- The Mid-Ohio Food Collective, Columbus, Ohio, USA
| | - Daniel E Jonas
- Division of General Internal Medicine, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Aaron Clark
- Department of Family and Community Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Seuli Bose-Brill
- Division of General Internal Medicine, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Jennifer C Shrodes
- Division of General Internal Medicine, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Jenelle Hoseus
- Health Impact Ohio, Columbus, Ohio, United States of America
| | - Carrie Baker
- Health Impact Ohio, Columbus, Ohio, United States of America
| | - Ann Scheck McAlearney
- Department of Family and Community Medicine, Ohio State University College of Medicine, Columbus, OH, USA; Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), Ohio State University College of Medicine, Columbus, OH, USA
| | - Jennifer L Hefner
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Dana Vallangeon
- Ohio Association of Community Health Centers, Columbus, OH, USA
| | - Daniel M Walker
- Department of Family and Community Medicine, Ohio State University College of Medicine, Columbus, OH, USA; Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), Ohio State University College of Medicine, Columbus, OH, USA
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Di Tosto G, Hefner JL, Walker DM, Gregory ME, McAlearney AS, Sieck CJ. Development of a conceptual model of the capacity for patients to engage in their health care: a group concept mapping study. BMC Health Serv Res 2023; 23:846. [PMID: 37563581 PMCID: PMC10413602 DOI: 10.1186/s12913-023-09785-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 07/05/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Patient engagement is seen as a necessary component in achieving the triple aim of improved population health, improved experience of care, and lower per capita health care costs. While there has been a substantial increase in the number of tools and patient-centered initiatives designed to help patients participate in health decisions, there remains a limited understanding of engagement from the perspective of patients and a lack of measures designed to capture the multi-faceted nature of the concept. METHODS Development of a concept map of patient engagement followed a five-step modified Group Concept Mapping (GCM) methodology of preparation, generation, structuring, analysis and interpretation. We engaged a Project Advisory Committee at each step, along with three rounds of survey collection from clinicians and patients for element generation (272 clinicians, 61 patients), statement sorting (30 clinicians, 15 patients), and ranking and rating of statements (159 clinicians, 67 patients). The survey of three separate samples, as opposed to focus groups of 'experts,' was an intentional decision to gain a broad perspective about the concept of patient engagement. We conducted the structure and analysis steps within the groupwisdom concept mapping software. RESULTS The final concept map comprised 47 elements organized into 5 clusters: Relationship with Provider, Patient Attitudes and Behaviors, Access, Internal Resources and External Resources. There was considerable agreement in the way elements in each cluster were rated by patients and clinicians. An analysis of the importance of the constitutive elements of patient engagement relative to their addressability highlighted actionable items in the domain of Relationship with Provider, aimed at building trust and enabling patients to ask questions. At the same time, the analysis also identified elements traditionally considered barriers to engagement, like personal access to the internet and the patient's level of digital literacy, as difficult to address by the healthcare system, but also relatively less important for patients. CONCLUSIONS Through our GCM approach, incorporating perspectives of both patients and clinicians, we identified items that can be used to assess patient engagement efforts by healthcare systems. As a result, our study offers specific insight into areas that can be targeted for intervention by healthcare systems to improve patient engagement.
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Affiliation(s)
- Gennaro Di Tosto
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4100, Columbus, OH, USA.
| | - Jennifer L Hefner
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Daniel M Walker
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4100, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Megan E Gregory
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4100, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Cynthia J Sieck
- Center for Health Equity, Dayton Children's Hospital, Dayton, OH, USA
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Walker DM, Garner JA, Hefner JL, Headings A, Jonas DE, Clark A, Bose-Brill S, Nawaz S, Seiber E, McAlearney AS, Brock G, Zhao S, Reopell L, Coovert N, Shrodes JC, Spees C, Sieck CJ, Di Tosto G, DePuccio M, Williams A, Hoseus J, Baker C, Brown MM, Joseph JJ. Rationale and design of the linking education, produce provision, and community referrals to improve diabetes care (LINK) study. Contemp Clin Trials 2023; 130:107212. [PMID: 37121390 DOI: 10.1016/j.cct.2023.107212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Individuals with type 2 diabetes (T2D) experiencing food insecurity may have other non-medical, health-related social needs (e.g., transportation, housing instability) that decrease their ability to attain T2D control and impact other health outcomes. METHODS A pragmatic randomized controlled trial (pRCT) to test the effect of produce provision, diabetes and culinary skills training and education, and social needs screening, navigation, and resolution, on hemoglobin A1c (A1c) levels in individuals with T2D (A1c ≥7.5%) experiencing food insecurity; a cost-effectiveness evaluation of the interventions that comprise the pRCT; and a process evaluation to understand the contextual factors that impact the uptake, effectiveness, and sustainability of the interventions. SETTING Ambulatory care clinics (e.g., family medicine, general internal medicine, endocrinology) affiliated with an academic medical center in an urban environment in the Midwest. DESIGN 2 × 2 factorial design. INTERVENTIONS Cooking Matters for Diabetes is a 6-week diabetes and culinary education intervention. The Health Impact Ohio Central Ohio Pathways Hub intervention is a community health worker model designed to evaluate and address participants' social needs. All participants will receive referral to the Mid-Ohio Farmacy to provide weekly access to fresh produce. OUTCOMES Primary outcome of the pRCT is change in A1c at 3 months; secondary outcomes include A1c at 6 months, and diabetes self-efficacy, food insecurity, and diet quality at 3 and 6 months. DISCUSSION Food insecurity, unmet social needs, diabetes education and self-efficacy are critical issues that must be addressed to improve T2D treatment, care, and health equity. CLINICALTRIALS gov: NCT05472441.
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Affiliation(s)
- Daniel M Walker
- The Ohio State University College of Medicine, Columbus, OH, United States of America.
| | - Jennifer A Garner
- The School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, United States of America; The John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, United States of America
| | - Jennifer L Hefner
- The Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Amy Headings
- The Mid-Ohio Food Collective, Columbus, OH, United States of America
| | - Daniel E Jonas
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Aaron Clark
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Seuli Bose-Brill
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Saira Nawaz
- The Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Eric Seiber
- The Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Ann Scheck McAlearney
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Guy Brock
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Songzhu Zhao
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Luiza Reopell
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Nicolette Coovert
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Jennifer C Shrodes
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Colleen Spees
- The Ohio State University College of Medicine, Columbus, OH, United States of America; The School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Cynthia J Sieck
- Dayton Children's Hospital Center for Health Equity, Dayton, OH, United States of America
| | - Gennaro Di Tosto
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Matthew DePuccio
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Amaris Williams
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Jenelle Hoseus
- Health Impact Ohio, Columbus, OH, United States of America
| | - Carrie Baker
- Health Impact Ohio, Columbus, OH, United States of America
| | | | - Joshua J Joseph
- The Ohio State University College of Medicine, Columbus, OH, United States of America
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Sieck CJ, Nicks SE, Salem J, DeVos T, Thatcher E, Hefner JL. Addressing Equity and Social Needs: The New Frontier of Patient Engagement Research. Adv Health Care Manag 2022; 21:151-165. [PMID: 36437621 DOI: 10.1108/s1474-823120220000021008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Patient engagement has been a focus of patient-centered care in recent years, encouraging health care organizations to increase efforts to facilitate a patient's ability to participate in health care. At the same time, a growing body of research has examined the impact that social determinants of health (SDOH) have on patient health outcomes. Additionally, health care equity is increasingly becoming a focus of many organizations as they work to ensure that all patients receive equitable care. These three domains - patient engagement, SDOH, and health care equity - can intersect in the implementation of social needs screenings among health care organizations. We present a case study on a two-phase social needs screening implementation project and describe how this process focuses on equity. As health care organizations seek to increase patient engagement, address SDOH, and improve health equity, we highlight the need to move away from a siloed approach and view these efforts as interrelated. By approaching efforts to address these challenges and barriers as the duty of all those involved in the patient care process, there may be larger strides made toward equitable health care.
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O'Rourke BP, Hogan TH, Teater J, Fried M, Williams M, Miller A, Clark AD, Huynh P, Kauffman E, Hefner JL. Initiation of medication for opioid use disorder across a health system: A retrospective analysis of patient characteristics and inpatient outcomes. Drug Alcohol Depend Rep 2022; 5:100114. [PMID: 36844164 PMCID: PMC9948916 DOI: 10.1016/j.dadr.2022.100114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/08/2022]
Abstract
Objectives Medication for opioid use disorder (MOUD) has gained significant momentum as an evidence-based intervention for treating opioid use disorder (OUD). The purpose of this study was to characterize MOUD initiations for buprenorphine and extended release (ER) naltrexone across all care sites at a major health system in the Midwest and determine whether MOUD initiation was associated with inpatient outcomes. Methods The study population comprised patients with OUD in the health system between 2018 and 2021. First, we described characteristics of all MOUD initiations for the study population within the health system. Second, we compared inpatient length of stay (LOS) and unplanned readmission rates between patients prescribed MOUD and patients not prescribed MOUD, including a pre-post comparison of patients prescribed MOUD before versus after initiation. Results The 3,831 patients receiving MOUD were mostly white, non-Hispanic and generally received buprenorphine over ER naltrexone. 65.5% of most recent initiations occurred in an inpatient setting. Compared to those not prescribed MOUD, inpatient encounters where patients received MOUD on or before the admission date were significantly less likely to be unplanned readmissions (13% vs. 20%, p < 0.001) and their LOS was 0.14 days shorter (p = 0.278). Among patients prescribed MOUD, there was a significant reduction in the readmission rate after initiation compared to before (13% vs. 22%, p < 0.001). Conclusions This study is the first to examine MOUD initiations for thousands of patients across multiple care sites in a health system, finding that receiving MOUD is associated with clinically meaningful reductions in readmission rates.
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Affiliation(s)
- Brian P. O'Rourke
- The Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 1841 Neil Ave Rm 250, Columbus, OH 43210, USA,Corresponding author.
| | - Tory H. Hogan
- The Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 1841 Neil Ave Rm 250, Columbus, OH 43210, USA
| | - Julie Teater
- The Department of Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH 43210, USA
| | - Martin Fried
- The Division of General Internal Medicine, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH 43210, USA
| | - Margaret Williams
- The Division of Hospital Medicine, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH 43210, USA
| | - Alison Miller
- Neurological Institute, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, Columbus, OH 43210, USA
| | - Aaron D. Clark
- The Department of Family and Community Medicine, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH 43210, USA
| | - Phuong Huynh
- The Department of Family and Community Medicine, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH 43210, USA
| | - Emily Kauffman
- The Division of General Internal Medicine, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH 43210, USA,Department of Emergency Medicine, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH 43210, USA
| | - Jennifer L. Hefner
- The Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 1841 Neil Ave Rm 250, Columbus, OH 43210, USA,The Department of Family and Community Medicine, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH 43210, USA
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DePuccio MJ, Garner JA, Hefner JL, Coovert N, Clark A, Walker DM. Multi-stakeholder perspectives on the implementation of a clinic-based food referral program for patients with chronic conditions: a qualitative examination. Transl Behav Med 2022; 12:927-934. [PMID: 36205467 PMCID: PMC9540973 DOI: 10.1093/tbm/ibac027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Clinic-based food referral programs (FRPs) may help alleviate food insecurity and improve access to nutritious foods by systematically identifying and referring food-insecure primary care patients to community-based food resources. The purpose of this study was to examine the barriers to and facilitators of implementation of an FRP offered to primary care patients who screen positive for food insecurity and have a qualifying chronic condition. we used a multi-stakeholder approach to conduct semi-structured interviews with healthcare providers and administrators from an academic medical center (AMC) (n = 20), representatives of a regional foodbank and its affiliated pantries (n = 11), and patients referred to the FRP (n = 20), during the initial phase of FRP implementation from April to September 2020. Interviews were audio-recorded, transcribed verbatim, and coded using a deductive dominant approach that allowed for the identification of emergent themes. Seven major themes emerged across the two domains of analysis: barriers to and facilitators of FRP implementation. Key barriers were (a) provider time constraints and competing demands; (b) inadequate physician feedback regarding patient use of the program; (c) patient transportation barriers; and (d) stigma associated with food pantry use. Key facilitators of implementation included (a) program champions; (b) screening and referral coordination; and (c) addressing food pantry-related stigma. This study identifies factors that deter and facilitate the implementation of an AMC-based FRP. Our findings highlight opportunities for healthcare and community-based organizations to refine and optimize FRP models toward the ultimate aim of advancing health equity for food-insecure patients.
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Affiliation(s)
| | - Jennifer A Garner
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH 43210, USA,The John Glenn College of Public Affairs, The Ohio State University, Columbus, OH 43210, USA
| | - Jennifer L Hefner
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA,Department of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Nicolette Coovert
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Aaron Clark
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Daniel M Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA,The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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McAlearney AS, Walker DM, Sieck CJ, Fareed N, MacEwan SR, Hefner JL, Di Tosto G, Gaughan A, Sova LN, Rush LJ, Moffatt-Bruce S, Rizer MK, Huerta TR. Effect of In-Person vs Video Training and Access to All Functions vs a Limited Subset of Functions on Portal Use Among Inpatients: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2231321. [PMID: 36098967 PMCID: PMC9471980 DOI: 10.1001/jamanetworkopen.2022.31321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/22/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Inpatient portals provide patients with clinical data and information about their care and have the potential to influence patient engagement and experience. Although significant resources have been devoted to implementing these portals, evaluation of their effects has been limited. Objective To assess the effects of patient training and portal functionality on use of an inpatient portal and on patient satisfaction and involvement with care. Design, Setting, and Participants This randomized clinical trial was conducted from December 15, 2016, to August 31, 2019, at 6 noncancer hospitals that were part of a single health care system. Patients who were at least 18 years of age, identified English as their preferred language, were not involuntarily confined or detained, and agreed to be provided a tablet to access the inpatient portal during their stay were eligible for participation. Data were analyzed from May 1, 2019, to March 15, 2021. Interventions A 2 × 2 factorial intervention design was used to compare 2 levels of a training intervention (touch intervention, consisting of in-person training vs built-in video tutorial) and 2 levels of portal function availability (tech intervention) within an inpatient portal (all functions operational vs a limited subset of functions). Main Outcomes and Measures The primary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and patients' satisfaction and involvement with their care. Results Of 2892 participants, 1641 were women (56.7%) with a median age of 47.0 (95% CI, 46.0-48.0) years. Most patients were White (2221 [76.8%]). The median Charlson Comorbidity Index was 1 (95% CI, 1-1) and the median length of stay was 6 (95% CI, 6-7) days. Notably, the in-person training intervention was found to significantly increase inpatient portal use (incidence rate ratio, 1.34 [95% CI, 1.25-1.44]) compared with the video tutorial. Patients who received in-person training had significantly higher odds of being comprehensive portal users than those who received the video tutorial (odds ratio, 20.75 [95% CI, 16.49-26.10]). Among patients who received the full-tech intervention, those who also received the in-person intervention used the portal more frequently (incidence rate ratio, 1.36 [95% CI, 1.25-1.48]) and more comprehensively (odds ratio, 22.52; [95% CI, 17.13-29.62]) than those who received the video tutorial. Patients who received in-person training had higher odds (OR, 2.01 [95% CI, 1.16-3.50]) of reporting being satisfied in the 6-month postdischarge survey. Similarly, patients who received the full-tech intervention had higher odds (OR, 2.06 [95%CI, 1.42-2.99]) of reporting being satisfied in the 6-month postdischarge survey. Conclusions and Relevance Providing in-person training or robust portal functionality increased inpatient engagement with the portal during the hospital stay. The effects of the training intervention suggest that providing personalized training to support use of this health information technology can be a powerful approach to increase patient engagement via portals. Trial Registration ClinicalTrials.gov Identifier: NCT02943109.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Daniel M. Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Cynthia J. Sieck
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Dayton Children’s Hospital Center for Health Equity, Dayton, Ohio
| | - Naleef Fareed
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
| | - Sarah R. MacEwan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus
| | - Jennifer L. Hefner
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Gennaro Di Tosto
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Alice Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Lindsey N. Sova
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Laura J. Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | | | - Milisa K. Rizer
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
| | - Timothy R. Huerta
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
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Hogan TH, Stevens L, Hefner JL, Lemak CH. Health system chief diversity officers: who are they and what do they do? Health Serv Manage Res 2022:9514848221115091. [PMID: 35848145 DOI: 10.1177/09514848221115091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Chief Diversity Officer, or CDO, is an increasingly common leadership role within U.S. health care delivery systems. Very little is known about the CDO role across hospitals and health systems. To map the responsibilities and characteristics of how CDOs are positioned within health care, we first searched the web pages of health systems to identify which systems have CDOs, or what we call "CDO-equivalents." Second, we expanded the search of public documents to new-hire announcements and the online social/professional media site, LinkedIn, to identify information regarding each identified leader's roles and responsibilities. Finally, text from these documents describing the leader's roles was uploaded to Atlas.ti, a qualitative analytic software, to identify common themes. There were 60 diversity leaders among 359 U.S. health care systems. Seven consistent roles and responsibilities were identified reflecting a very broad scope of work. Future research should focus on exploring the scope of this leadership role.
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Affiliation(s)
- Tory H Hogan
- The Division of Health Services Management and Policy, 2647The Ohio State University, Columbus, OH, USA
| | - Lena Stevens
- The Division of Health Services Management and Policy, 2647The Ohio State University, Columbus, OH, USA
| | - Jennifer L Hefner
- The Division of Health Services Management and Policy, 2647The Ohio State University, Columbus, OH, USA
| | - Christy Harris Lemak
- The Department of Health Services Administration, 48654The University of Alabama, Birmingham, AL, USA
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Walker DM, Hefner JL, DePuccio MJ, Garner JA, Headings A, Joseph JJ, Clark A. Approaches for overcoming barriers to cross-sector data sharing. Am J Manag Care 2022; 28:11-16. [PMID: 35049256 DOI: 10.37765/ajmc.2022.88811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To characterize factors influencing the development and sustainability of data sharing in the Mid-Ohio Farmacy (MOF), a produce referral program implemented in partnership between a community-based organization (the Mid-Ohio Food Collective ["Food Collective"]) and an academic medical center (The Ohio State University Wexner Medical Center [OSUWMC]). STUDY DESIGN We used an in-depth case study approach to identify challenges that arose during implementation of the MOF and related solutions via semistructured interviews with representatives of both organizations (May-September 2020). METHODS Key informants from OSUWMC (n = 20) and the Food Collective (n = 11) were identified using a combination of purposive and convenience sampling; they included administrators, project champions, clinical providers, and food pantry representatives. Interview transcripts were coded using a deductive dominant approach guided by a logic model aimed at determining the resources and activities relevant to the development of the partnership. RESULTS Challenges of cross-sector data sharing fit into 3 themes: data sharing regulations, data exchange capabilities, and cross-sector data integration. Overcoming these challenges required creative workarounds-for example, linking patients across organizations was done via establishment of a unique, partnership-specific patient identifier, which was incorporated into the health system's electronic health record for continuity. CONCLUSIONS Our findings suggest that current regulatory frameworks are misspecified to the growing interest in cross-sector partnerships between health care and community-based organizations. Future efforts to support these relationships should consider clarifying rules around data sharing and increasing Medicaid support for nonmedical, health-related social needs.
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Affiliation(s)
- Daniel M Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, 460 Medical Center Dr, Ste 520, Columbus, OH 43210.
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Attipoe S, Hoffman J, Rust S, Huang Y, Barnard JA, Schweikhart S, Hefner JL, Walker DM, Linwood S. Characterization of Electronic Health Record Use Outside Scheduled Clinic Hours among Primary Care Pediatricians: A Retrospective Descriptive Task Analysis of Electronic Health Record Access Log Data (Preprint). JMIR Med Inform 2021; 10:e34787. [PMID: 35551055 PMCID: PMC9136654 DOI: 10.2196/34787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/01/2022] [Accepted: 03/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many of the benefits of electronic health records (EHRs) have not been achieved at expected levels because of a variety of unintended negative consequences such as documentation burden. Previous studies have characterized EHR use during and outside work hours, with many reporting that physicians spend considerable time on documentation-related tasks. These studies characterized EHR use during and outside work hours using clock time versus actual physician clinic schedules to define the outside work time. Objective This study aimed to characterize EHR work outside scheduled clinic hours among primary care pediatricians using a retrospective descriptive task analysis of EHR access log data and actual physician clinic schedules to define work time. Methods We conducted a retrospective, exploratory, descriptive task analysis of EHR access log data from primary care pediatricians in September 2019 at a large Midwestern pediatric health center to quantify and identify actions completed outside scheduled clinic hours. Mixed-effects statistical modeling was used to investigate the effects of age, sex, clinical full-time equivalent status, and EHR work during scheduled clinic hours on the use of EHRs outside scheduled clinic hours. Results Primary care pediatricians (n=56) in this study generated 1,523,872 access log data points (across 1069 physician workdays) and spent an average of 4.4 (SD 2.0) hours and 0.8 (SD 0.8) hours per physician per workday engaged in EHRs during and outside scheduled clinic hours, respectively. Approximately three-quarters of the time working in EHR during or outside scheduled clinic hours was spent reviewing data and reports. Mixed-effects regression revealed no associations of age, sex, or clinical full-time equivalent status with EHR use during or outside scheduled clinic hours. Conclusions For every hour primary care pediatricians spent engaged with the EHR during scheduled clinic hours, they spent approximately 10 minutes interacting with the EHR outside scheduled clinic hours. Most of their time (during and outside scheduled clinic hours) was spent reviewing data, records, and other information in EHR.
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Affiliation(s)
- Selasi Attipoe
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Jeffrey Hoffman
- Division of Clinical Informatics, Nationwide Children's Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Steve Rust
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Yungui Huang
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - John A Barnard
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Sharon Schweikhart
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Jennifer L Hefner
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Daniel M Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Simon Linwood
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
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Hefner JL, Nembhard IM, Zimpel-Leal K. Emergent Homecare Models Are Shaping Care in England: An Ethnographic Study of Four Distinct Homecare Models. Adv Health Care Manag 2021; 20. [PMID: 34779190 DOI: 10.1108/s1474-823120210000020001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This chapter addresses the grand challenge of an aging society and the subsequent growing demand for in-home care for the elderly - often referred to as homecare. It examines how emergent homecare models in England differ from the "time and task" model and how they are shaping the care market. These models offer new approaches regarding what, how, and when care is delivered at home. Homecare providers face rising demand driven not only by population aging but also by market demand for personalized care, choice, continuity of care, and real-time availability. The landscape presents an opportunity for innovative models to become established, by offering a more inducing service design and value propositions that respond to customers' needs. Using the "business model canvas" to guide data collection, this study presents an ethnographic case analysis of four homecare organizations with distinct emergent homecare models. The study includes 14 months of field observation and 33 in-depth interviews. It finds that providers are becoming increasingly aware of evolving customer needs, establishing models such as the "uberization," "community-based," "live-in," and "preventative" described in the chapter. These models are becoming more pervasive and are mostly market-driven; however, some of their innovations are market shaping. The major innovations are in their value propositions, partnership arrangements, and customer segments. Their value propositions focus on well-being outcomes, including choice and personalization for care users; their workforces are perceived to be a major stakeholder segment, and their networks of partners offer access to complementary services, investments, and specialist knowledge.
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Hefner JL, Nembhard IM, Fleuren BPI, Stephenson AL, Sullivan EE, Raj M, Tietschert MV, Sriharan A, Lai AY, DePuccio MJ, Thomas SC, McAlearney AS. Even Superheroes Need Rest: A Guide to Facilitating Recovery from Work for Health-care Workers during COVID-19 and beyond. Adv Health Care Manag 2021; 20. [PMID: 34779188 DOI: 10.1108/s1474-823120210000020010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The COVID-19 pandemic burdens health-care workers (HCWs) worldwide. Amid high-stress conditions and unprecedented needs for crisis management, organizations face the grand challenge of supporting the mental health and well-being of their HCWs. The current literature on mental health and well-being primarily focuses on improving personal resilience among HCWs. However, this puts the responsibility for coping with COVID-19-related stress almost fully on the individual. This chapter discusses an important alternative framing of this issue - how health-care organizations (HCOs) can facilitate recovery from work processes (i.e., returning to a baseline level by engaging in nonwork activities after work) for their workers. Based on a narrative review of the occupational health psychology literature, we provide practical strategies for supporting the four key recovery experiences of detachment, control, mastery, and relaxation, as well as present general recommendations about how to promote recovery. These strategies can help HCOs facing the grand challenge of sustaining worker well-being and functioning during the COVID-19 pandemic, as well as during future pandemics and for workers facing high work pressure in general.
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Abstract
The COVID-19 pandemic stressed the health care sector's longstanding pain points, including the poor quality of frontline work and the staffing challenges that result from it. This has renewed interest in technology-centered approaches to achieving not only the "Triple Aim" of reducing costs while raising access and quality but also the "Quadruple Aim" of doing so without further squeezing wages and abrading job quality for frontline workers. How can we leverage technology toward the achievement of the Quadruple Aim? I view this as a "grand challenge" for health care managers and policymakers. Those looking for guidance will find that most analyses of the workforce impact of technological change consider broad classes of technology such as computers or robots outside of any particular industry context. Further, they typically predict changes in work or labor market outcomes will come about at some ill-defined point in the medium to long run. This decontextualization and detemporization proves markedly problematic in the health care sector: the nonmarket, institutional factors driving technology adoption and implementation loom especially large in frontline care delivery, and managers and policymakers understandably must consider a well-defined, near-term, i.e., 5-10-year, time horizon. This study is predicated on interviews with hospital and home health agency administrators, union representatives, health care information technology (IT) experts and consultants, and technology developers. I detail the near-term drivers and anticipated workforce impact of technological changes in frontline care delivery. With my emergent prescriptions for managers and policymakers, I hope to guide sectoral actors in using technology to address the "grand challenge" inherent to achieving the Quadruple Aim.
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Hefner JL, Nembhard IM, Gregory ME, Walker DM, Sova LN, Pfeil SA, Rothwell CD, Volney JJ, Gaughan AA, McAlearney AS. Improving Training Motivation and Transfer in Hospitals: Extension of a Conceptual Model. Adv Health Care Manag 2021; 20. [PMID: 34779187 DOI: 10.1108/s1474-823120210000020006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health-care professionals undergo numerous training programs each year in order to fulfill licensure requirements and organizational obligations. However, evidence suggests that a substantial amount of what is taught during training is never learned or transferred back to routine work. A major contributor to this issue is low training motivation. Prior conceptual models on training transfer in the organizational sciences literature consider this deficit, yet do not account for the unique conditions of the hospital setting. This chapter seeks to close this gap by adapting conceptual models of training transfer to this setting that are grounded in organizational science. Based on theory and supplemented by semistructured key informant interviews (i.e., organizational leaders and program directors), we introduce an applied model of training motivation to facilitate training transfer in the hospital setting. In this model, training needs analysis is positioned as a key antecedent to ensure support for training, relevant content, and perceived utility of training. We posit that these factors, along with training design and logistics, enhance training motivation in hospital environments. Further, we suggest that training motivation subsequently impacts learning and transfer, with elements of the work environment also serving as moderators of the learning-transfer relationship. Factors such as external support for training content (e.g., from accrediting bodies) and allocation of time for training are emphasized as facilitators. The proposed model suggests there are factors unique to the hospital work setting that impact training motivation and transfer that should be considered when developing and implementing training initiatives in this setting.
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MacEwan SR, Gaughan A, Hefner JL, McAlearney AS. Identifying the role of inpatient portals to support health literacy: Perspectives from patients and care team members. Patient Educ Couns 2021; 104:836-843. [PMID: 33071027 DOI: 10.1016/j.pec.2020.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/27/2020] [Accepted: 09/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Health literacy is a fundamental contributor to an individual's ability to self-manage their health and appropriately use health care services. Tools that positively impact health literacy therefore have potential to improve health outcomes. Inpatient portals are a tool that provides patients an opportunity to cultivate health literacy skills during hospitalization. Our study investigated how inpatient portal use could impact attributes of health literacy. METHODS We conducted semi-structured interviews with 132 patients and 440 care team members to learn about patients' inpatient portal use. Interview transcripts were analyzed deductively and inductively to categorize data and understand emergent themes around health literacy. RESULTS Patients and care team members identified inpatient portal functions that they perceived to positively impact health literacy. These functions included providing patients access to health information, care plans, and educational materials, as well as enabling patient communication with their care team. CONCLUSION Recognizing the potential of inpatient portals to improve health literacy is critical to ensure they are implemented in ways that leverage this benefit for patients. PRACTICE IMPLICATIONS Health care organizations should implement inpatient portals that include features that support health literacy and encourage patients to use these portals in ways that improve their health literacy skills.
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Affiliation(s)
- Sarah R MacEwan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.
| | - Alice Gaughan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer L Hefner
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA; Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA; Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Hefner JL, Hogan TH, Opoku-Agyeman W, Menachemi N. Defining safety net hospitals in the health services research literature: a systematic review and critical appraisal. BMC Health Serv Res 2021; 21:278. [PMID: 33766014 PMCID: PMC7993482 DOI: 10.1186/s12913-021-06292-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 03/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to identify the range of ways that safety net hospitals (SNHs) have been empirically operationalized in the literature and determine the extent to which patterns could be identified in the use of empirical definitions of SNHs. Methods We conducted a PRISMA guided systematic review of studies published between 2009 and 2018 and analyzed 22 articles that met the inclusion criteria of hospital-level analyses with a clear SNH definition. Results Eleven unique SNH definitions were identified, and there were no obvious patterns in the use of a definition category (Medicaid caseload, DSH payment status, uncompensated care, facility characteristics, patient care mix) by the journal type where the article appeared, dataset used, or the year of publication. Conclusions Overall, there is broad variability in the conceptualization of, and variables used to define, SNHs. Our work advances the field toward the development of standards in measuring, operationalizing, and conceptualizing SNHs across research and policy questions. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06292-9.
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Affiliation(s)
- Jennifer L Hefner
- Division of Health Services Management and Policy, School of Public Health, The Ohio State University, Columbus, OH, USA.
| | - Tory Harper Hogan
- Division of Health Services Management and Policy, School of Public Health, The Ohio State University, Columbus, OH, USA
| | - William Opoku-Agyeman
- School of Health and Applied Human Sciences, University of North Carolina at Wilmington, Wilmington, NC, USA
| | - Nir Menachemi
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
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Sieck CJ, Rastetter M, Hefner JL, Glover AR, Magaña C, Gray DM, Joseph JJ, Panchal B, Olayiwola JN. The Five A's of Access for TechQuity. J Health Care Poor Underserved 2021. [DOI: 10.1353/hpu.2021.0064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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McAlearney AS, Hefner JL, MacEwan SR, Gaughan A, DePuccio M, Walker DM, Hogan CT, Fareed N, Sieck CJ, Huerta TR. Care Team Perspectives About an Inpatient Portal: Benefits and Challenges of Patients' Portal Use During Hospitalization. Med Care Res Rev 2020; 78:537-547. [PMID: 32552351 DOI: 10.1177/1077558720925296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While current research about inpatient portals has focused largely on the patient perspective, it is also critical to consider the care team point of view, as support from these individuals is essential to successful portal implementation and use. We held brief in-person interviews with 433 care team members across a six-hospital health system to explore opinions about patients' use of an inpatient portal as perceived by care team members. Using the Inpatient Portal Evaluation Framework, we characterized benefits and challenges of portal use that care team members reported affected patients, themselves, and the collaborative work of these care teams with their patients. Interviewees noted inpatient portals can improve patient care and experience and also indicated room for improvement in portal use for hospitalized patients. Further understanding of the care team perspective is critical to inform approaches to inpatient portal implementation that best benefit both patients and providers.
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Abstract
High patient satisfaction is not simply a customer service goal; it is an important dimension of quality and part of financial incentives and public reporting requirements. However, patient experience is often siloed within health system organizational charts and considered separately from quality and safety initiatives, instead of being seen predominantly as a "customer service" initiative. Representatives from 52 health care systems across the United States completed an online survey to explore both the processes and infrastructure hospitals employ to improve patient experience, and the metrics hospitals use to assess the quality of patient experience beyond patient satisfaction survey data. When asked about performance metrics beyond satisfaction, most hospitals or systems noted other metrics of the entire patient experience such as the rate of complaints or grievances and direct feedback from patient and family advisors. Additionally, respondents suggested that a broader definition of "quality of the patient experience" may be appropriate to encompass measures of access, clinical processes, and quality of care and patient safety outcomes. Almost all respondents that we surveyed listed metrics from these less traditional categories, indicating that performance improvement within the patient experience domain in these organizations is linked with other areas of hospital performance that rely on the same metrics, such as clinical quality and patient safety.
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Lin EJD, Hefner JL, Zeng X, Moosavinasab S, Huber T, Klima J, Liu C, Lin SM. A deep learning model for pediatric patient risk stratification. Am J Manag Care 2019; 25:e310-e315. [PMID: 31622071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Current models for patient risk prediction rely on practitioner expertise and domain knowledge. This study presents a deep learning model-a type of machine learning that does not require human inputs-to analyze complex clinical and financial data for population risk stratification. STUDY DESIGN A comparative predictive analysis of deep learning versus other popular risk prediction modeling strategies using medical claims data from a cohort of 112,641 pediatric accountable care organization members. METHODS "Skip-Gram," an unsupervised deep learning approach that uses neural networks for prediction modeling, used data from 2014 and 2015 to predict the risk of hospitalization in 2016. The area under the curve (AUC) of the deep learning model was compared with that of both the Clinical Classifications Software and the commercial DxCG Intelligence predictive risk models, each with and without demographic and utilization features. We then calculated costs for patients in the top 1% and 5% of hospitalization risk identified by each model. RESULTS The deep learning model performed the best across 6 predictive models, with an AUC of 75.1%. The top 1% of members selected by the deep learning model had a combined healthcare cost $5 million higher than that of the group identified by the DxCG Intelligence model. CONCLUSIONS The deep learning model outperforms the traditional risk models in prospective hospitalization prediction. Thus, deep learning may improve the ability of managed care organizations to perform predictive modeling of financial risk, in addition to improving the accuracy of risk stratification for population health management activities.
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Affiliation(s)
| | | | | | | | | | | | | | - Simon M Lin
- Nationwide Children's Hospital, 575 Children's Crossroad, Columbus, OH 43215.
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Moffatt-Bruce SD, Hefner JL, Mekhjian H, McAlearney JS, Latimer, RN, MS T, Ellison C, Scheck McAlearney A. Republished: What Is the Return on Investment for Implementation of a Crew Resource Management Program at an Academic Medical Center? Am J Med Qual 2019; 34:502-508. [DOI: 10.1177/1062860619873226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Crew Resource Management (CRM) training has been used successfully within hospital units to improve quality and safety. This article presents a description of a health system-wide implementation of CRM focusing on the return on investment (ROI). The costs included training, programmatic fixed costs, time away from work, and leadership time. Cost savings were calculated based on the reduction in avoidable adverse events and cost estimates from the literature. Between July 2010 and July 2013, roughly 3000 health system employees across 12 areas were trained, costing $3.6 million. The total number of adverse events avoided was 735—a 25.7% reduction in observed relative to expected events. Savings ranged from a conservative estimate of $12.6 million to as much as $28.0 million. Therefore, the overall ROI for CRM training was in the range of $9.1 to $24.4 million. CRM presents a financially viable way to systematically organize for quality improvement.
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Hefner JL, Fareed N, Walker DM, Huerta TR, McAlearney AS. Central line infections in United States hospitals: An exploration of variation in central line device days and infection rates across hospitals that serve highly complex patient populations. Am J Infect Control 2019; 47:1032-1034. [PMID: 30638670 DOI: 10.1016/j.ajic.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
Our descriptive analyses show a wide distribution in rates of central line device days and central line-associated bloodstream infections for a given standardized infection ratio-the measure linked to federal payment penalties-among 215 US hospitals serving highly complex patient populations. We established that the standardized infection ratio masks hospital-level variation in device use and associated patient safety.
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Sieck CJ, Walker DM, Gregory M, Fareed N, Hefner JL. Assessing capacity to engage in healthcare to improve the patient experience through health information technology. Patient Experience Journal 2019. [DOI: 10.35680/2372-0247.1366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Walker DM, Hefner JL, Fareed N, Huerta TR, McAlearney AS. Exploring the Digital Divide: Age and Race Disparities in Use of an Inpatient Portal. Telemed J E Health 2019; 26:603-613. [PMID: 31313977 DOI: 10.1089/tmj.2019.0065] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: Age and race disparities in the use of new technologies-the digital divide-may be limiting the potential of patient-facing health information technology to improve health and health care. Objective: To investigate whether disparities exist in the use of patient portals designed specifically for the inpatient environment. Methods: Patients admitted to the six hospitals affiliated with a large, Midwestern academic medical center from July 2017 to July 2018 were provided with access to a tablet equipped with an inpatient portal and recruited to participate in the study (n = 842). Demographic characteristics of study enrollees were obtained from patients' electronic health records and surveys given to patients during their hospital stay. Log files from the inpatient portal were used to create a global measure of use and calculate use rates for specific portal features. Results: We found both age and race disparities in use of the inpatient portal. Patients aged 60-69 (45.3% difference, p < 0.001) and those over age 70 (36.7% difference, p = 0.04) used the inpatient portal less than patients aged 18-29. In addition, African American patients used the portal less than White patients (40.4% difference, p = 0.004). Discussion: These findings suggest that the availability of the technology alone may be insufficient to overcome barriers to use and that additional intervention may be needed to close the digital divide. Conclusions: We identified lower use of the inpatient portal among African American and older patients, relative to White and younger patients, respectively.
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Affiliation(s)
- Daniel M Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer L Hefner
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Naleef Fareed
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
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Hefner JL, MacEwan SR, Biltz A, Sieck CJ. Patient portal messaging for care coordination: a qualitative study of perspectives of experienced users with chronic conditions. BMC Fam Pract 2019; 20:57. [PMID: 31053063 PMCID: PMC6499960 DOI: 10.1186/s12875-019-0948-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patient portal secure messaging (asynchronous electronic communication between physicians and their established patients) allows patients to manage their care through asynchronous, direct communication with their providers. This type of engagement with health information technology could have important benefits for patients with chronic conditions, and a more thorough understanding of the use and barriers of secure messaging among this population is needed. The objective of this study was to explore how experienced portal users engage with secure messaging to manage their chronic conditions. METHODS Three focus groups were conducted with 17 total patients who self-reported a cardiopulmonary condition. Participants were asked questions about their experience with patient portal secure messaging. Focus group transcripts were coded through inductive and deductive methods to reveal common themes. RESULTS Patients' motivation for using messaging included the speed and ease of such communication and direct access to a physician. Messaging was used by patients as an extension of the office visit and supported coordination of care among providers as well as patient collaboration with family members or caretakers. Patients identified challenges to using messaging, including technological barriers, worry about uncompensated physician time spent responding to messages, and confusion about what constitutes an appropriate 'non-urgent' message. CONCLUSIONS This study highlights the potential of patient portal messaging as a tool for care coordination to enhance chronic disease self-management. However, uncertainty about the appropriate use of portal messaging persists even among experienced users. Additional patient training in the proper use of secure messaging and its benefits for disease self-management may help to resolve these concerns.
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Affiliation(s)
- Jennifer L Hefner
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA. .,CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, USA. .,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Cunz Hall, Room 200B, 1841 Neil Ave, Columbus, OH, 43210, USA.
| | - Sarah R MacEwan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Alison Biltz
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Cynthia J Sieck
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.,CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, USA
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Huerta T, Fareed N, Hefner JL, Sieck CJ, Swoboda C, Taylor R, McAlearney AS. Patient Engagement as Measured by Inpatient Portal Use: Methodology for Log File Analysis. J Med Internet Res 2019; 21:e10957. [PMID: 30907733 PMCID: PMC6452277 DOI: 10.2196/10957] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 12/28/2018] [Accepted: 12/29/2018] [Indexed: 12/21/2022] Open
Abstract
Background Inpatient portals (IPPs) have the potential to increase patient engagement and satisfaction with their health care. An IPP provides a hospitalized patient with similar functions to those found in outpatient portals, including the ability to view vital signs, laboratory results, and medication information; schedule appointments; and communicate with their providers. However, IPPs may offer additional functions such as meal planning, real-time messaging with the inpatient care team, daily schedules, and access to educational materials relevant to their specific condition. In practice, IPPs have been developed as websites and tablet apps, with hospitals providing the required technology as a component of care during the patient’s stay. Objective This study aimed to describe how inpatients are using IPPs at the first academic medical center to implement a system-wide IPP and document the challenges and choices associated with this analytic process. Methods We analyzed the audit log files of IPP users hospitalized between January 2014 and January 2016. Data regarding the date/time and duration of interactions with each of the MyChart Bedside modules (eg, view lab results or medications and patient schedule) and activities (eg, messaging the provider and viewing educational videos) were captured as part of the system audit logs. The development of a construct to describe the length of time associated with a single coherent use of the tool—which we call a session—provides a foundational unit of analysis. We defined frequency as the number of sessions a patient has during a given provision day. We defined comprehensiveness in terms of the percentage of functions that an individual uses during a given provision day. Results The analytic process presented data challenges such as length of stay and tablet-provisioning factors. This study presents data visualizations to illustrate a series of data-cleaning issues. In the presence of these robust approaches to data cleaning, we present the baseline usage patterns associated with our patient panel. In addition to frequency and comprehensiveness, we present considerations of median data to mitigate the effect of outliers. Conclusions Although other studies have published usage data associated with IPPs, most have not explicated the challenges and choices associated with the analytic approach deployed within each study. Our intent in this study was to be somewhat exhaustive in this area, in part, because replicability requires common metrics. Our hope is that future researchers in this area will avail themselves of these perspectives to engage in critical assessment moving forward.
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Affiliation(s)
- Timothy Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States.,CATALYST: Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Naleef Fareed
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,CATALYST: Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Jennifer L Hefner
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States.,CATALYST: Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Cynthia J Sieck
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,CATALYST: Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Christine Swoboda
- CATALYST: Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Robert Taylor
- CATALYST: Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, United States.,CATALYST: Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, United States
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Sieck CJ, Hefner JL, McAlearney AS. Improving the patient experience through patient portals: Insights from experienced portal users. Patient Experience Journal 2018. [DOI: 10.35680/2372-0247.1269] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Sieck CJ, Walker DM, Hefner JL, Volney J, Huerta TR, McAlearney AS. Understanding Secure Messaging in the Inpatient Environment: A New Avenue for Communication and Patient Engagement. Appl Clin Inform 2018; 9:860-868. [PMID: 30517969 PMCID: PMC6281442 DOI: 10.1055/s-0038-1675814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/05/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patient portals, and the secure messaging feature in particular, have been studied in the outpatient setting, but research in the inpatient setting is relatively less mature. OBJECTIVE To understand the topics discussed in secure messaging in the inpatient environment, we analyzed and categorized messages sent within an inpatient portal. MATERIALS AND METHODS This observational study examined the content of all secure messages sent from December 2013 to June 2017 within an inpatient portal at a large Midwestern academic medical center (AMC). We analyzed a total of 2,598 messages, categorizing them by sender (patient, family, or care team member), type, and topic, and conducted a descriptive analysis of categories and an examination of code co-occurrence. RESULTS Patients were the most frequent message senders (63%); family members sent the fewest messages (10%). We identified five types of messages: Alert/Request; Thanks; Response; Question; and Other (typo/test message). Patient messages included Alerts/Requests (38%), Questions (31%), Statements of Thanks (24%), Response (1.2%), and Other (5%). We also identified 14 nonmutually exclusive message topics: Medication; Procedure/Treatment Plan; Schedule; Pain; Results; Diet; Discharge; Non-Medication Questions; Provider Requests; Symptoms; Custodial; Technical Issues; Potential Error; and Contact Information. Patient message topics most commonly discussed Symptoms (18%), Procedure/Treatment Plan (14%), or Pain (12%). CONCLUSION Our analysis of secure message content suggests certain message types and topics such as Alerts/Requests and Questions about symptoms and treatment plans are particularly important to patients. These findings demonstrate that both patients and family members utilize the secure messaging function to engage in the care process by posing questions, making requests, and alerting staff to problems. As this technology is implemented in additional facilities, future work should examine how use of secure messaging may be influenced by factors including patients' demographics, reasons for hospitalization, and length of stay.
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Affiliation(s)
- Cynthia J. Sieck
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Daniel M. Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Jennifer L. Hefner
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Jaclyn Volney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Timothy R. Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, United States
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McAlearney AS, Walker DM, Hefner JL. Moving Organizational Culture from Volume to Value: A Qualitative Analysis of Private Sector Accountable Care Organization Development. Health Serv Res 2018; 53:4767-4788. [PMID: 30047138 DOI: 10.1111/1475-6773.13012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The concept of shifting from volume (i.e., billing for as many patients and services as possible) to value (i.e., reducing costs while improving quality) has been a key underpinning of the development of accountable care organizations (ACOs), yet the cultural change necessary to make this shift has been previously unexplored. DATA SOURCES/STUDY SETTING Primary data collected through site visits to four private sector ACOs. STUDY DESIGN Cross-sectional, semi-structured interview study with analysis done at the ACO level to learn about ACO development. DATA COLLECTION One hundred and forty-eight interviews recorded and transcribed verbatim followed by rigorous qualitative analysis using a grounded theory approach. PRINCIPAL FINDINGS The importance of shifting organizational culture from volume to value was emphasized across sites and interviewees, particularly when defining an ACO; describing the shift in organizational focus to value; and discussing how to create value by emphasizing quality over volume. Value was viewed as more than cost-benefit, but rather encapsulated a paradigmatic cultural change in the way care is provided. CONCLUSIONS We found that moving from volume to value is central to the culture change required of an ACO. Our findings can inform future efforts that aim to create a more effective value-based health care system.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH.,Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST) in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH
| | - Daniel M Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH.,CATALYST, College of Medicine, The Ohio State University, Columbus, OH
| | - Jennifer L Hefner
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH.,CATALYST, College of Medicine, The Ohio State University, Columbus, OH
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Abstract
BACKGROUND Inpatient portals are an emerging technology that can facilitate collaborative interactions between patients and care teams, but little is known about how organizations attempt to implement and facilitate inpatient portal use for their providers. METHODS We held in-person, semistructured interviews with care team members and information technology (IT) staff and conducted rigorous thematic analysis of transcripts. RESULTS Interviews with 220 care team members and 4 IT staff identified 3 new areas of training needed to optimize inpatient portal implementation and use that extend beyond training to use other technologies: (1) teaching staff to train patients about tool use; (2) training about how to promote tool use to patients; and (3) training about optimal use of secure messaging. DISCUSSION Our findings show that inpatient portals are implemented within a collaborative multistakeholder context. Training efforts must consider the importance of this collaborative context to help providers learn to both incorporate the technology into their workflow and assist patients with portal use.
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Affiliation(s)
- Jennifer L Hefner
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Center for the Advancement of Team Science, Analytics and Systems Thinking in Health Services and Implementation Science Research (Catalyst), College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Cynthia J Sieck
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Center for the Advancement of Team Science, Analytics and Systems Thinking in Health Services and Implementation Science Research (Catalyst), College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Center for the Advancement of Team Science, Analytics and Systems Thinking in Health Services and Implementation Science Research (Catalyst), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, United States
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Hefner JL, Huerta TR, McAlearney AS, Barash B, Latimer T, Moffatt-Bruce SD. Navigating a ship with a broken compass: evaluating standard algorithms to measure patient safety. J Am Med Inform Assoc 2017; 24:310-315. [PMID: 27578751 DOI: 10.1093/jamia/ocw126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/24/2016] [Indexed: 11/12/2022] Open
Abstract
Objective Agency for Healthcare Research and Quality (AHRQ) software applies standardized algorithms to hospital administrative data to identify patient safety indicators (PSIs). The objective of this study was to assess the validity of PSI flags and report reasons for invalid flagging. Material and Methods At a 6-hospital academic medical center, a retrospective analysis was conducted of all PSIs flagged in fiscal year 2014. A multidisciplinary PSI Quality Team reviewed each flagged PSI based on quarterly reports. The positive predictive value (PPV, the percent of clinically validated cases) was calculated for 12 PSI categories. The documentation for each reversed case was reviewed to determine the reasons for PSI reversal. Results Of 657 PSI flags, 185 were reversed. Seven PSI categories had a PPV below 75%. Four broad categories of reasons for reversal were AHRQ algorithm limitations (38%), coding misinterpretations (45%), present upon admission (10%), and documentation insufficiency (7%). AHRQ algorithm limitations included 2 subcategories: an "incident" was inherent to the procedure, or highly likely (eg, vascular tumor bleed), or an "incident" was nonsignificant, easily controlled, and/or no intervention was needed. Discussion These findings support previous research highlighting administrative data problems. Additionally, AHRQ algorithm limitations was an emergent category not considered in previous research. Herein we present potential solutions to address these issues. Conclusions If, despite poor validity, US policy continues to rely on PSIs for incentive and penalty programs, improvements are needed in the quality of administrative data and the standardized PSI algorithms. These solutions require national motivation, research attention, and dissemination support.
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Affiliation(s)
- Jennifer L Hefner
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Barbara Barash
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Tina Latimer
- Quality and Operations, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Susan D Moffatt-Bruce
- Quality and Operations, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Hefner JL, Sieck CJ, Walker DM, Huerta TR, McAlearney AS. System-Wide Inpatient Portal
Implementation: Survey of Health Care Team Perceptions. JMIR Med Inform 2017; 5:e31. [PMID: 28912115 PMCID: PMC5620453 DOI: 10.2196/medinform.7707] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/23/2017] [Accepted: 08/21/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Inpatient portals, a new type of patient portal tailored specifically to the hospital setting, can allow patients to access up-to-date health information and exchange secure communications with their care team. As such, inpatient portals present an opportunity for patients to increase engagement in their care during a time of acute crisis that emphasizes focus on a patient's health. While there is a large body of research on patient portals in the outpatient setting, questions are being raised specifically about inpatient portals, such as how they will be incorporated into the flow of patient care in hectic, stressed, team-based hospital settings. OBJECTIVE Our aim is to improve understanding about hospital care team members' perceptions of the value of an interactive patient portal for admitted patients, as well as to ascertain staff orientation toward this new technology. METHODS Throughout the course of 2016, an inpatient portal, MyChart Bedside (MCB) was implemented across a five-hospital health system. The portal is a tablet-based app that includes a daily schedule, lab/test results, secure messaging with the care team, a place to take notes, and access to educational materials. Within a month of initial rollout, hospital care team members completed a 5-minute, anonymous online survey to assess attitudes and perceptions about MCB use and staff training for the new technology. RESULTS Throughout the health system, 686 staff members completed the survey: 193 physicians (23.6%), 439 nurses (53.7%), and 186 support staff (22.7%). Questions about the importance of MCB, self-efficacy in using MCB with patients, and feelings about sufficient training and resources showed that an average of 40-60% of respondents in each group reported a positive orientation toward the MCB technology and training received. This positive orientation was highest among support staff, lower among nurses, and lowest for physicians (all differences by staff role were statistically significant at P<.001). Additionally, 62.0% of respondents reported "not enough" training. CONCLUSIONS Despite the robust training effort, similar to that used in previous health information technology implementations at this health system, hospital care team members reported only a moderately positive orientation toward MCB and its potential, and the majority wanted more training. We propose that due to the unique elements of the inpatient portal-interactive features used by patients and providers requiring explanation and collaboration-traditional training approaches may be insufficient. Introduction of the inpatient portal as a new collaborative tool may thus require new methods of training to support enhanced engagement between patients and their care team.
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Affiliation(s)
- Jennifer L Hefner
- Department of Family Medicine, The College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Cynthia J Sieck
- Department of Family Medicine, The College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Daniel M Walker
- Department of Family Medicine, The College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- Department of Family Medicine, The College of Medicine, The Ohio State University, Columbus, OH, United States
- Department of Biomedical Informatics, The College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Ann Scheck McAlearney
- Department of Family Medicine, The College of Medicine, The Ohio State University, Columbus, OH, United States
- Division of Health Services Management and Policy, The College of Public Health, The Ohio State University, Columbus, OH, United States
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Yen PY, McAlearney AS, Sieck CJ, Hefner JL, Huerta TR. Health Information Technology (HIT) Adaptation: Refocusing on the Journey to Successful HIT Implementation. JMIR Med Inform 2017; 5:e28. [PMID: 28882812 PMCID: PMC5608986 DOI: 10.2196/medinform.7476] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/04/2017] [Accepted: 08/04/2017] [Indexed: 11/26/2022] Open
Abstract
In past years, policies and regulations required hospitals to implement advanced capabilities of certified electronic health records (EHRs) in order to receive financial incentives. This has led to accelerated implementation of health information technologies (HIT) in health care settings. However, measures commonly used to evaluate the success of HIT implementation, such as HIT adoption, technology acceptance, and clinical quality, fail to account for complex sociotechnical variability across contexts and the different trajectories within organizations because of different implementation plans and timelines. We propose a new focus, HIT adaptation, to illuminate factors that facilitate or hinder the connection between use of the EHR and improved quality of care as well as to explore the trajectory of changes in the HIT implementation journey as it is impacted by frequent system upgrades and optimizations. Future research should develop instruments to evaluate the progress of HIT adaptation in both its longitudinal design and its focus on adaptation progress rather than on one cross-sectional outcome, allowing for more generalizability and knowledge transfer.
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Affiliation(s)
- Po-Yin Yen
- Washington University in St Louis, Institute for Informatics, St Louis, MO, United States.,Goldfarb School of Nursing, BJC Healthcare, St Louis, MO, United States
| | - Ann Scheck McAlearney
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
| | - Cynthia J Sieck
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
| | - Jennifer L Hefner
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
| | - Timothy R Huerta
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
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Sieck CJ, Hefner JL, Schnierle J, Florian H, Agarwal A, Rundell K, McAlearney AS. The Rules of Engagement: Perspectives on Secure Messaging From Experienced Ambulatory Patient Portal Users. JMIR Med Inform 2017; 5:e13. [PMID: 28676467 PMCID: PMC5516097 DOI: 10.2196/medinform.7516] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/28/2017] [Accepted: 04/14/2017] [Indexed: 11/23/2022] Open
Abstract
Background Patient portals have shown promise in engaging individuals in self-management of chronic conditions by allowing patients to input and track health information and exchange secure electronic messages with their providers. Past studies have identified patient barriers to portal use including usability issues, low health literacy, and concerns about loss of personal contact as well as provider concerns such as increased time spent responding to messages. However, to date, studies of both patient and provider perspectives on portal use have focused on the pre-implementation or initial implementation phases and do not consider how these issues may change as patients and providers gain greater experience with portals. Objective Our study examined the following research question: Within primary care offices with high rates of patient-portal use, what do experienced physician and patient users of the ambulatory portal perceive as the benefits and challenges of portal use in general and secure messaging in particular? Methods This qualitative study involved 42 interviews with experienced physician and patient users of an ambulatory patient portal, Epic’s MyChart. Participants were recruited from the Department of Family Medicine at a large Academic Medical Center (AMC) and included providers and their patients, who had been diagnosed with at least one chronic condition. A total of 29 patients and 13 primary care physicians participated in the interviews. All interviews were conducted by telephone and followed a semistructured interview guide. Interviews were transcribed verbatim to permit rigorous qualitative analysis. Both inductive and deductive methods were used to code and analyze the data iteratively, paying particular attention to themes involving secure messaging. Results Experienced portal users discussed several emergent themes related to a need for greater clarity on when and how to use the secure messaging feature. Patient concerns included worry about imposing on their physician’s time, the lack of provider compensation for responding to secure messages, and uncertainty about when to use secure messaging to communicate with their providers. Similarly, providers articulated a lack of clarity as to the appropriate way to communicate via MyChart and suggested that additional training for both patients and providers might be important. Patient training could include orienting patients to the “rules of engagement” at portal sign-up, either in the office or through an online tutorial. Conclusions As secure messaging through patient portals is increasingly being used as a method of physician-patient communication, both patients and providers are looking for guidance on how to appropriately engage with each other using this tool. Patients worry about whether their use is appropriate, and providers are concerned about the content of messages, which allow them to effectively manage patient questions. Our findings suggest that additional training may help address the concerns of both patients and providers, by providing “rules of engagement” for communication via patient portals.
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Affiliation(s)
- Cynthia J Sieck
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jennifer L Hefner
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jeanette Schnierle
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Hannah Florian
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Aradhna Agarwal
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Kristen Rundell
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Ann Scheck McAlearney
- The Ohio State University College of Medicine, Columbus, OH, United States.,The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, United States
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McAlearney AS, Hefner JL, Sieck CJ, Walker DM, Aldrich AM, Sova LN, Gaughan AA, Slevin CM, Hebert C, Hade E, Buck J, Grove M, Huerta TR. Searching for management approaches to reduce HAI transmission (SMART): a study protocol. Implement Sci 2017; 12:82. [PMID: 28659159 PMCID: PMC5490089 DOI: 10.1186/s13012-017-0610-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/14/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) impact patients' lives through prolonged hospitalization, morbidity, and death, resulting in significant costs to both health systems and society. Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are two of the most preventable HAIs. As a result, these HAIs have been the focus of significant efforts to identify evidence-based clinical strategies to reduce infection rates. The Comprehensive Unit-based Safety Program (CUSP) provides a formal model for translating CLABSI-reduction evidence into practice. Yet, a national demonstration project found organizations experienced variable levels of success using CUSP to reduce CLABSIs. In addition, in Fiscal year 2019, Medicare will expand use of CLABSI and CAUTI metrics beyond ICUs to the entire hospital for reimbursement purposes. As a result, hospitals need guidance about how to successfully translate HAI-reduction efforts such as CUSP to non-ICU settings (clinical practice), and how to shape context (management practice)-including culture and management strategies-to proactively support clinical teams. METHODS Using a mixed-methods approach to evaluate the contribution of management factors to successful HAI-reduction efforts, our study aims to: (1) Develop valid and reliable measures of structural management practices associated with the recommended CLABSI Management Strategies for use as a survey (HAI Management Practice Guideline Survey) to support HAI-reduction efforts in both medical/surgical units and ICUs; (2) Develop, validate, and then deploy the HAI Management Practice Guideline Survey, first across Ohio hospitals, then nationwide, to determine the positive predictive value of the measurement instrument as it relates to CLABSI- and CAUTI-prevention; and (3) Integrate findings into a Management Practices Toolkit for HAI reduction that includes an organization-specific data dashboard for monitoring progress and an implementation program for toolkit use, and disseminate that Toolkit nationwide. DISCUSSION Providing hospitals with the tools they need to successfully measure management structures that support clinical care provides a powerful approach that can be leveraged to reduce the incidence of HAIs experienced by patients. This study is critical to providing the information necessary to successfully "make health care safer" by providing guidance on how contextual factors within a healthcare setting can improve patient safety across hospitals.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH 43201 USA
| | - Jennifer L. Hefner
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Cynthia J. Sieck
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Daniel M. Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Alison M. Aldrich
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Lindsey N. Sova
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Alice A. Gaughan
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Caitlin M. Slevin
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
| | - Courtney Hebert
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH 43201 USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 310-E Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43201 USA
- Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH USA
| | - Erinn Hade
- Center for Biostatistics, College of Medicine, The Ohio State University, 320G Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43201 USA
| | - Jacalyn Buck
- The Ohio State University Wexner Medical Center, 134 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
- Administrator of Health System Nursing Quality, Research, Education and Evidence- Based Practice, The Ohio State University Wexner Medical Center, Office 2021, 600 Ackerman Road, Columbus, OH 43202 USA
| | - Michele Grove
- The Ohio State University Wexner Medical Center, 134 Doan Hall, 410 W. 10th Ave, Columbus, OH 43210 USA
| | - Timothy R. Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, 2231 North High Street, Suite 273, Columbus, OH 43201 USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 310-E Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43201 USA
- Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH USA
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Rizer MK, Sieck C, Lehman JS, Hefner JL, Huerta TR, McAlearney AS. Working with an Electronic Medical Record in Ambulatory Care: A Study of Patient Perceptions of Intrusiveness. Perspect Health Inf Manag 2017; 14:1g. [PMID: 28566996 PMCID: PMC5430115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess patient perceptions of electronic medical record (EMR) intrusiveness during ambulatory visits to clinics associated with a large academic medical center. METHOD We conducted a survey of patients seen at any of 98 academic medical center clinics. The survey assessed demographics, visit satisfaction, computer use, and perceived intrusiveness of the computer. RESULTS Of 7,058 patients, slightly more than 80 percent reported that the physician had used the computer while in the room, but only 24 percent were shown results in the EMR. Most patients were very satisfied or satisfied with their visit and did not find the computer intrusive (83 percent). Younger respondents, those shown results, and those who reported that the physician used the computer were more likely to perceive the computer as intrusive. Qualitative comments suggest different perceptions related to computer intrusiveness than to EMR use more generally. DISCUSSION Patients were generally accepting of EMRs and therefore use of computers in the exam room. However, subgroups of patients may require greater study to better understand patient perceptions related to EMR use and intrusiveness. CONCLUSION Results suggest the need for greater focus on how physicians use computers in the exam room in a manner that facilitates maintaining good rapport with patients.
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Affiliation(s)
- Milisa K Rizer
- Departments of Family Medicine and Biomedical Informatics in the College of Medicine of The Ohio State University and chief medical information officer of the Ohio State University Wexner Medical Center in Columbus, OH
| | - Cynthia Sieck
- Department of Family Medicine in the College of Medicine of The Ohio State University in Columbus, OH
| | - Jennifer S Lehman
- Department of Family Medicine in the College of Medicine of The Ohio State University in Columbus, OH
| | - Jennifer L Hefner
- Department of Family Medicine in the College of Medicine of The Ohio State University in Columbus, OH
| | - Timothy R Huerta
- Departments of Family Medicine and Biomedical Informatics in the College of Medicine of The Ohio State University in Columbus, OH
| | - Ann Scheck McAlearney
- Department of Family Medicine in the College of Medicine of The Ohio State University and research director for the Central Ohio Practice-Based Research Network in Columbus, OH
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Gray DM, Hefner JL, Nguyen MC, Eiferman D, Moffatt-Bruce SD. The Link Between Clinically Validated Patient Safety Indicators and Clinical Outcomes. Am J Med Qual 2016; 32:583-590. [PMID: 27940883 DOI: 10.1177/1062860616683014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a paucity of evidence on the association between clinically validated Patient Safety Indicators (PSIs) and inpatient length of stay, mortality, and 30-day unplanned readmission. The authors perform a retrospective analysis of patient discharges from an academic medical center comprising 6 hospitals from July 2012 to June 2014. Multivariable regression models are used to assess the relationship between length of stay, mortality, and 30-day unplanned readmission and the presence of a clinically validated PSI. Cases flagged with a clinically validated PSI are associated with a statistically greater length of stay, 30-day unplanned readmission, and mortality as compared to cases without a PSI. This study demonstrates a strong association between clinically validated PSIs and patient outcomes. The findings have important implications in policy and practice as health care reform dictates improvement in the experience of care, health of populations, and per capita costs.
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Affiliation(s)
| | | | | | - Daniel Eiferman
- 2 The Ohio State University Wexner Medical Center, Columbus, OH
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McAlearney AS, Sieck CJ, Hefner JL, Aldrich AM, Walker DM, Rizer MK, Moffatt-Bruce SD, Huerta TR. High Touch and High Tech (HT2) Proposal: Transforming Patient Engagement Throughout the Continuum of Care by Engaging Patients with Portal Technology at the Bedside. JMIR Res Protoc 2016; 5:e221. [PMID: 27899338 PMCID: PMC5172441 DOI: 10.2196/resprot.6355] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 01/04/2023] Open
Abstract
Background For patients with complex care needs, engagement in disease management activities is critical. Chronic illnesses touch almost every person in the United States. The costs are real, personal, and pervasive. In response, patients often seek tools to help them manage their health. Patient portals, personal health records tethered to an electronic health record, show promise as tools that patients value and that can improve health. Although patient portals currently focus on the outpatient experience, the Ohio State University Wexner Medical Center (OSUWMC) has deployed a portal designed specifically for the inpatient experience that is connected to the ambulatory patient portal available after discharge. While this inpatient technology is in active use at only one other hospital in the United States, health care facilities are currently investing in infrastructure necessary to support large-scale deployment. Times of acute crisis such as hospitalization may increase a patient’s focus on his/her health. During this time, patients may be more engaged with their care and especially interested in using tools to manage their health after discharge. Evidence shows that enhanced patient self-management can lead to better control of chronic illness. Patient portals may serve as a mechanism to facilitate increased engagement. Objective The specific aims of our study are (1) to investigate the independent effects of providing both High Tech and High Touch interventions on patient-reported outcomes at discharge, including patients’ self-efficacy for managing chronic conditions and satisfaction with care; and (2) to conduct a mixed-methods analysis to determine how providing patients with access to MyChart Bedside (MCB, High Tech) and training/education on patient portals, and MyChart Ambulatory (MCA, High Touch) will influence engagement with the patient portal and relate to longer-term outcomes. Methods Our proposed 4-year study uses a mixed-methods research (MMR) approach to evaluate a randomized controlled trial studying the effectiveness of a High Tech intervention (MCB, the inpatient portal), and an accompanying High Touch intervention (training patients to use the portal to manage their care and conditions) in a sample of hospitalized patients with two or more chronic conditions. This study measures how access to a patient portal tailored to the inpatient stay can improve patient experience and increase patient engagement by (1) improving patients’ perceptions of the process of care while in the hospital; (2) increasing patients’ self-efficacy for managing chronic conditions; and (3) facilitating continued use of a patient portal for care management after discharge. In addition, we aim to enhance patients’ use of the portal available to outpatients (MCA) once they are discharged. Results This study has been funded by the Agency for Healthcare Research and Quality (AHRQ). Research is ongoing and expected to conclude in August 2019. Conclusions Providing patients real-time access to health information can be a positive force for change in the way care is provided. Meaningful use policies require minimum demonstrated use of patient portal technology, most often in the ambulatory setting. However, as the technology matures to bridge the care transition, there is a greater need to understand how patient portals transform care delivery. By working in concert with patients to address and extend current technologies, our study aims to advance efforts to increase patients’ engagement in their care and develop a template for how other hospitals might integrate similar technologies.
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Affiliation(s)
- Ann Scheck McAlearney
- Research Division, Department of Family Medicine, The Ohio State University, Columbus, OH, United States
| | - Cynthia J Sieck
- Research Division, Department of Family Medicine, The Ohio State University, Columbus, OH, United States
| | - Jennifer L Hefner
- Research Division, Department of Family Medicine, The Ohio State University, Columbus, OH, United States
| | - Alison M Aldrich
- Research Division, Department of Family Medicine, The Ohio State University, Columbus, OH, United States
| | - Daniel M Walker
- Research Division, Department of Family Medicine, The Ohio State University, Columbus, OH, United States
| | - Milisa K Rizer
- Information Technology, Wexner Medical Center, Ohio State University, Columbus, OH, United States.,Clinical Division, Department of Family Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Susan D Moffatt-Bruce
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Quality & Patient Safety, Wexner Medical Center, The Ohio State University, Columbus, OH, United States.,Department of Surgery, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- Research Division, Department of Family Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
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Sieck CJ, Hefner JL, Wexler R, Taylor CA, McAlearney AS. Why do they do that?: Looking beyond typical reasons for non-urgent ED use among Medicaid patients. Patient Experience Journal 2016. [DOI: 10.35680/2372-0247.1140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Hefner JL, Tripathi RS, Abel EE, Farneman M, Galloway J, Moffatt-Bruce SD. Quality Improvement Intervention to Decrease Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery. Am J Crit Care 2016; 25:423-30. [PMID: 27587423 DOI: 10.4037/ajcc2016165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND In 2010, the incidence of prolonged mechanical ventilation (> 24 hours) after isolated coronary artery bypass graft (CABG) surgery was 26.9% at the study site, The Ohio State University Wexner Medical Center, compared with the national like-hospital rate of 10.9%. OBJECTIVES To use the principles of lean management to reduce the incidence of prolonged mechanical ventilation and to assess the sustainability of that reduction over time. METHODS A multidisciplinary prolonged ventilation task force conducted a gap analysis leading to 3 interventions: (1) a standardized extubation protocol, (2) dry erase boards in patients' rooms to facilitate team communication, and (3) edits of the postoperative order set within the electronic health record. Outcomes of mechanical ventilation in CABG patients before and after the interventions are compared. RESULTS All target outcomes changed significantly after the interventions, including a reduction in the median hours of initial mechanical ventilation (from 11.4 hours to 6.9 hours, P < .001). The percentage of patients reintubated did not increase (a decrease from 11.8% to 3.5% was not significant, P = .08). The rate of prolonged ventilation decreased from 29.4% to 8.6% (P = .004), and this reduction was sustained for 4 years after the interventions. CONCLUSIONS Success factors included the multidisciplinary task force and continual protocol reeducation among front-line staff.
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Affiliation(s)
- Jennifer L Hefner
- Jennifer L. Hefner is an assistant professor, Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Ravi S. Tripathi is director of cardiovascular critical care and Erik E. Abel is a clinical transformation officer, Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio. Michelle Farneman is a senior quality manager, cardiovascular services, Department of Quality and Operations, The Ohio State University Wexner Medical Center. Jason Galloway is assistant director, Department of Respiratory Therapy, The Ohio State University Wexner Medical Center. Susan D. Moffatt-Bruce is a thoracic surgeon, Division of Cardiothoracic Surgery, The Ohio State University Wexner Medical Center.
| | - Ravi S Tripathi
- Jennifer L. Hefner is an assistant professor, Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Ravi S. Tripathi is director of cardiovascular critical care and Erik E. Abel is a clinical transformation officer, Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio. Michelle Farneman is a senior quality manager, cardiovascular services, Department of Quality and Operations, The Ohio State University Wexner Medical Center. Jason Galloway is assistant director, Department of Respiratory Therapy, The Ohio State University Wexner Medical Center. Susan D. Moffatt-Bruce is a thoracic surgeon, Division of Cardiothoracic Surgery, The Ohio State University Wexner Medical Center
| | - Erik E Abel
- Jennifer L. Hefner is an assistant professor, Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Ravi S. Tripathi is director of cardiovascular critical care and Erik E. Abel is a clinical transformation officer, Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio. Michelle Farneman is a senior quality manager, cardiovascular services, Department of Quality and Operations, The Ohio State University Wexner Medical Center. Jason Galloway is assistant director, Department of Respiratory Therapy, The Ohio State University Wexner Medical Center. Susan D. Moffatt-Bruce is a thoracic surgeon, Division of Cardiothoracic Surgery, The Ohio State University Wexner Medical Center
| | - Michelle Farneman
- Jennifer L. Hefner is an assistant professor, Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Ravi S. Tripathi is director of cardiovascular critical care and Erik E. Abel is a clinical transformation officer, Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio. Michelle Farneman is a senior quality manager, cardiovascular services, Department of Quality and Operations, The Ohio State University Wexner Medical Center. Jason Galloway is assistant director, Department of Respiratory Therapy, The Ohio State University Wexner Medical Center. Susan D. Moffatt-Bruce is a thoracic surgeon, Division of Cardiothoracic Surgery, The Ohio State University Wexner Medical Center
| | - Jason Galloway
- Jennifer L. Hefner is an assistant professor, Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Ravi S. Tripathi is director of cardiovascular critical care and Erik E. Abel is a clinical transformation officer, Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio. Michelle Farneman is a senior quality manager, cardiovascular services, Department of Quality and Operations, The Ohio State University Wexner Medical Center. Jason Galloway is assistant director, Department of Respiratory Therapy, The Ohio State University Wexner Medical Center. Susan D. Moffatt-Bruce is a thoracic surgeon, Division of Cardiothoracic Surgery, The Ohio State University Wexner Medical Center
| | - Susan D Moffatt-Bruce
- Jennifer L. Hefner is an assistant professor, Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Ravi S. Tripathi is director of cardiovascular critical care and Erik E. Abel is a clinical transformation officer, Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio. Michelle Farneman is a senior quality manager, cardiovascular services, Department of Quality and Operations, The Ohio State University Wexner Medical Center. Jason Galloway is assistant director, Department of Respiratory Therapy, The Ohio State University Wexner Medical Center. Susan D. Moffatt-Bruce is a thoracic surgeon, Division of Cardiothoracic Surgery, The Ohio State University Wexner Medical Center
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Hefner JL, Hilligoss B, Knupp A, Bournique J, Sullivan J, Adkins E, Moffatt-Bruce SD. Cultural Transformation After Implementation of Crew Resource Management: Is It Really Possible? Am J Med Qual 2016; 32:384-390. [PMID: 27422314 DOI: 10.1177/1062860616655424] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Crew resource management (CRM) has the potential to improve safety culture and reduce patient safety errors across different hospitals and inherent cultures, but hospital-wide implementations have not been studied. The authors examined the impact of a systematic CRM implementation across 8 departments spanning 3 hospitals and 2 campuses. The Hospital Survey on Patient Safety Culture (HSOPS) was administered electronically to all employees before CRM implementation and about 2 years after; changes in percent positive composite scores were compared in pre-post analyses. Across all respondents, there was a statistically significant increase in composite score for 10 of the 12 HSOPS dimensions ( P < .05). These significant results persisted across the 8 departments studied and among both practitioners and staff. Consideration of score changes across dimensions reveals that the teamwork and communication dimensions of patient safety culture may be more highly influenced by CRM training than supervisor and management dimensions.
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Affiliation(s)
| | | | - Amy Knupp
- 1 The Ohio State University, Columbus, OH, USA
| | | | | | - Eric Adkins
- 1 The Ohio State University, Columbus, OH, USA
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Moffatt-Bruce SD, Hefner JL, Mekhjian H, McAlearney JS, Latimer T, Ellison C, McAlearney AS. What Is the Return on Investment for Implementation of a Crew Resource Management Program at an Academic Medical Center? Am J Med Qual 2016; 32:5-11. [DOI: 10.1177/1062860615608938] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Crew Resource Management (CRM) training has been used successfully within hospital units to improve quality and safety. This article presents a description of a health system-wide implementation of CRM focusing on the return on investment (ROI). The costs included training, programmatic fixed costs, time away from work, and leadership time. Cost savings were calculated based on the reduction in avoidable adverse events and cost estimates from the literature. Between July 2010 and July 2013, roughly 3000 health system employees across 12 areas were trained, costing $3.6 million. The total number of adverse events avoided was 735—a 25.7% reduction in observed relative to expected events. Savings ranged from a conservative estimate of $12.6 million to as much as $28.0 million. Therefore, the overall ROI for CRM training was in the range of $9.1 to $24.4 million. CRM presents a financially viable way to systematically organize for quality improvement.
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Abstract
BACKGROUND Website development for health care has only been prevalent in the last two and a half decades. The first websites were electronic versions of brochures providing hardly any interaction with the consumer or potential consumer. The percentage of consumers that use the internet during the decision-making process for health care providers continues to rise. As a result, the websites of health care providers are becoming more of a representation of the facility and creating an organizational image rather than a brochure-like informational page. OBJECTIVES The purpose of this study was to analyze substance abuse treatment center's websites in the State of California with the goal of informing the management of substance abuse centers regarding an effective and inexpensive means to closing the marketing gaps in the industry. METHODS This brief research report presents the results of employing an automated web-crawler to assess website quality along five dimensions: accessibility, content, marketing, technology, and usability score. RESULTS The sample mean scores for all dimensions were between 4 and 6 on a 10-point scale. On average larger facilities had higher quality websites. CONCLUSIONS The low mean scores on these dimensions indicate that that substance abuse centers have significant room for improvement of their website's. Efficiently spending marketing funds to increase the effectiveness of a treatment center's website can be a low cost way for even small facilities to increase market competitiveness.
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Affiliation(s)
- Thomas W Link
- a Department of Management , University of North Carolina at Greensboro , Greensboro , North Carolina , USA.,b Department of Health Policy and Management , The George Washington University , Washington, DC , USA
| | - Jennifer L Hefner
- c Family Medicine, The Ohio State University , Columbus , Ohio , USA
| | - Eric W Ford
- d Bloomberg School of Public Health, Johns Hopkins University , Baltimore , Maryland , USA
| | - Timothy R Huerta
- e Departments of Family Medicine and Biomedical Informatics , Ohio State University Medical Center , Columbus , Ohio , USA
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McAlearney AS, Hefner JL. Getting to Zero: Goal Commitment to Reduce Blood Stream Infections. Med Care Res Rev 2015; 73:458-77. [PMID: 26589674 DOI: 10.1177/1077558715616028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Abstract
While preventing health care-associated infections (HAIs) can save lives and reduce health care costs, efforts designed to eliminate HAIs have had mixed results. Variability in contextual factors such as work culture and management practices has been suggested as a potential explanation for inconsistent results across organizations and interventions. We examine goal-setting as a factor contributing to program outcomes in eight hospitals focused on preventing central line-associated bloodstream infections (CLABSIs). We conducted qualitative case studies to compare higher- and lower-performing hospitals, and explored differences in contextual factors that might contribute to performance variation. We present a goal commitment framework that characterizes factors associated with successful CLABSI program outcomes. Across 194 key informant interviews, internal and external moderators and characteristics of the goal itself differentiated actors' goal commitment at higher- versus lower-performing hospitals. Our findings have implications for organizations struggling to prevent HAIs, as well as informing the broader goal commitment literature.
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Moffatt-Bruce S, Hefner JL, Nguyen MC. What is new in critical illness and injury science? Patient safety amidst chaos: Are we on the same team during emergency and critical care interventions? Int J Crit Illn Inj Sci 2015; 5:135-7. [PMID: 26557481 PMCID: PMC4613410 DOI: 10.4103/2229-5151.164909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Susan Moffatt-Bruce
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio, USA
| | - Jennifer L Hefner
- The Ohio State University Wexner Medical Center, Department of Family Medicine, Columbus, Ohio, USA
| | - Michelle C Nguyen
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio, USA
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Rizer MK, Kaufman B, Sieck CJ, Hefner JL, McAlearney AS. Top 10 Lessons Learned from Electronic Medical Record Implementation in a Large Academic Medical Center. Perspect Health Inf Manag 2015; 12:1g. [PMID: 26396558 PMCID: PMC4558484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Electronic medical record (EMR) implementation efforts face many challenges, including individual and organizational barriers and concerns about loss of productivity during the process. These issues may be particularly complex in large and diverse settings with multiple specialties providing inpatient and outpatient care. This case report provides an example of a successful EMR implementation that emphasizes the importance of flexibility and adaptability on the part of the implementation team. It also presents the top 10 lessons learned from this EMR implementation in a large midwestern academic medical center. Included are five overarching lessons related to leadership, initial approach, training, support, and optimization as well as five lessons related to the EMR system itself that are particularly important elements of a successful implementation.
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Affiliation(s)
- Milisa K Rizer
- Milisa K. Rizer, MD, MPH, is chief medical information officer, associate professor of clinical family medicine, and associate professor of biomedical informatics at The Ohio State University in Columbus, OH
| | - Beth Kaufman
- Beth Kaufman, RN, is the assistant director of health systems informatics at The Ohio State University Wexner Medical Center in Columbus, OH
| | - Cynthia J Sieck
- Cynthia J. Sieck, PhD, MPH, is an assistant professor in the Department of Family Medicine at The Ohio State University in Columbus, OH
| | - Jennifer L Hefner
- Jennifer L. Hefner, PhD, MPH, is a postdoctoral researcher in the Department of Family Medicine at The Ohio State University in Columbus, OH
| | - Ann Scheck McAlearney
- Ann Scheck McAlearney, ScD, MS, is a professor of family medicine and vice chair for research in the Department of Family Medicine at The Ohio State University in Columbus, OH
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Johansen ME, Hefner JL, Foraker RE. Antiplatelet and Statin Use in US Patients With Coronary Artery Disease Categorized by Race/Ethnicity and Gender, 2003 to 2012. Am J Cardiol 2015; 115:1507-12. [PMID: 25840577 DOI: 10.1016/j.amjcard.2015.02.052] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/26/2015] [Accepted: 02/26/2015] [Indexed: 11/30/2022]
Abstract
Antiplatelets and statins are efficacious for preventing future cardiovascular events in patients with coronary heart disease. Disparity in cardiovascular outcomes exists by race/ethnicity and gender; however, few studies have explored potential disparities in long-term antiplatelet and statin use by race/ethnicity and gender. We conducted a repeated cross-sectional analysis using the nationally representative Medical Expenditure Panel Survey from 2003 to 2012. The sample consisted of 14,334 men and women >29 years with coronary heart disease. We identified antiplatelet and statin use, medical conditions, and sociodemographic characteristics. Rates of use did not change for statins or the combination of statins and antiplatelets from 2003 to 2012 but decreased for antiplatelets (p = 0.015). Of the total sample, 70.9% (95% confidence interval [CI] 69.7 to 72.1) reported use of antiplatelets, 52.5% (95% CI 51.1 to 53.8) reported statin use, and 43.1% (95% CI 41.8 to 44.4) reported the combination. Use of antiplatelets and statins were associated with one another (odds ratio 3.22; 95% CI 2.87 to 3.62). From 2009 to 2012, black and Hispanic men along with all race/ethnicities of women were less likely to report use of statins, antiplatelets, and the combination of the 2 compared with white men, even after controlling for sociodemographics. Changing the definition of a medication use, inclusion of cardiovascular risk factors, or the inclusion of warfarin in the antiplatelet category did not substantially change the results. Future practice and policy goals should focus on increasing the number of high-risk patients on appropriate preventative medications while focusing particular attention on decreasing the identified disparity.
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Affiliation(s)
- Michael E Johansen
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.
| | - Jennifer L Hefner
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Randi E Foraker
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
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Affiliation(s)
| | - Jennifer L. Hefner
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH
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