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Christensen A, Havyer R, Lorenz A, Alli A, Kilpatrick M, Feely M, Carey E. COVID-19 communication resources in a major health system: development and dissemination. BMJ Support Palliat Care 2022:spcare-2022-004024. [PMID: 36581452 DOI: 10.1136/spcare-2022-004024] [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] [Received: 11/04/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Early in the pandemic, institutional leadership recognised the importance of providing staff with practical, clinically based communication resources. This paper describes the process of cultivating and disseminating rapid communication resources across a multisite institution to assist others who may need to rapidly respond to communication challenges in the future. METHODS In April 2020, the Mayo Healthcare Incident Command System charged the Center for Palliative Medicine with developing and disseminating clinical communication resources within several weeks. The Education Chair for the Center for Palliative Medicine created a COVID-19 communication task force composed of clinician-educators with expertise in serious illness communication from all three academic Mayo Clinic sites. The task force elected to focus on providing accessible, just-in-time online content curated from existing resources and adapted to situational needs. RESULTS The task force developed one-page resources with example language on 16 topic areas. Topics included exploring patient values, discussing time-limited trials and making recommendations. The COVID-19 communication website was launched on 28 May, 6 weeks after the institutional request. CONCLUSIONS Key takeaway lessons were the need for: (1) alignment with institutional need and priority, (2) rapid team formation with communication education experts across a variety of institutional geographic settings, (3) quick consensus on topic and content delivery to be practically helpful to clinicians, (4) collaboration with outside groups to use and adapt already available resources when possible and (5) early and iterative involvement with information specialists to help facilitate institutional dissemination.
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Affiliation(s)
- April Christensen
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel Havyer
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanda Lorenz
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Adebisi Alli
- WellNEST Medicine, Phoenix, Arizona, USA
- Department of Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
| | - Molly Kilpatrick
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Molly Feely
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elise Carey
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Griffin JM, Havyer R, Schaepe K, Riffin C, Bangerter LR. HEALTH CARE PROVIDER ATTITUDES ABOUT INTEGRATING FAMILY CAREGIVERS INTO CLINICAL ENCOUNTERS. Innov Aging 2019. [PMCID: PMC6841286 DOI: 10.1093/geroni/igz038.2278] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The presence of family caregivers in clinical encounters is becoming more common with the aging of the US population and the continued shift of care responsibilities from health professionals in clinical settings to family caregivers at home. Patients accompanied to clinical encounters by caregivers are more likely to be older, sicker, and have lower health literacy. Research shows, however, that providers often do not initiate any caregiver participation and when they do, conversations center on relaying technical medical information rather than preferences and capacity to provide caregiving assistance. Little is known about provider perceptions of engaging caregivers in clinical encounters. Using data from 20 semi-structured interviews with physicians from primary and specialty care, we identified 3 inter-related themes about engaging caregivers in clinical encounters: 1) ambivalence about caregivers’ role in clinical encounters; 2) trepidation about posing questions directly to caregivers; and, 3) beliefs that systemic barriers exist that inhibit integration of caregivers. Providers, especially in primary care encounters, chiefly view caregivers as sources of supplemental information or for absorbing or reinforcing clinical instructions for care at home. Providers also voiced concerns about the ethics of assessing caregiver capacity to provide assistance to the patient without having clinical authority to treat or adequate resources to provide to caregivers. Finally, providers identified structural barriers, including time constraints, for integrating caregivers into the clinical care team. Findings provide insight into provider attitudes on the caregivers’ role, a perspective that is essential for understanding opportunities and challenges for implementing caregiver interventions in clinical settings.
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Thorsteinsdottir B, Peterson SM, Naessens JM, McCoy RG, Hanson GJ, Hickson LJ, Chen CYY, Rahman PA, Shah ND, Borkenhagen L, Chandra A, Havyer R, Leppin A, Takahashi PY. Care Transitions Program for High-Risk Frail Older Adults is Most Beneficial for Patients with Cognitive Impairment. J Hosp Med 2019; 14:329-335. [PMID: 30794142 PMCID: PMC6546541 DOI: 10.12788/jhm.3112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 07/19/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although posthospitalization care transitions programs (CTP) are highly diverse, their overall program thoroughness is most predictive of their success. OBJECTIVE To identify components of a successful homebased CTP and patient characteristics that are most predictive of reduced 30-day readmissions. DESIGN Retrospective cohort. PATIENTS A total of 315 community-dwelling, hospitalized, older adults (≥60 years) at high risk for readmission (Elder Risk Assessment score ≥16), discharged home over the period of January 1, 2011 to June 30, 2013. SETTING Midwest primary care practice in an integrated health system. INTERVENTION Enrollment in a CTP during acute hospitalization. MEASUREMENTS The primary outcome was all-cause readmission within 30 days of the first CTP evaluation. Logistic regression was used to examine independent variables, including patient demographics, comorbidities, number of medications, completion, and timing of program fidelity measures, and prior utilization of healthcare. RESULTS The overall 30-day readmission rate was 17.1%. The intensity of follow-up varied among patients, with 17.1% and 50.8% of the patients requiring one and ≥3 home visits, respectively, within 30 days. More than half (54.6%) required visits beyond 30 days. Compared with patients who were not readmitted, readmitted patients were less likely to exhibit cognitive impairment (29.6% vs 46.0%; P = .03) and were more likely to have high medication use (59.3% vs 44.4%; P = .047), more emergency department (ED; 0.8 vs 0.4; P = .03) and primary care visits (4.0 vs 3.0; P = .018), and longer cumulative time in the hospital (4.6 vs 2.5 days; P = .03) within 180 days of the index hospitalization. Multivariable analysis indicated that only cognitive impairment and previous ED visits were important predictors of readmission. CONCLUSIONS No single CTP component reliably predicted reduced readmission risk. Patients with cognitive impairment and polypharmacy derived the most benefit from the program.
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Affiliation(s)
- Bjorg Thorsteinsdottir
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota
- Corresponding Author: Bjorg Thorsteinsdottir, MD: E-mail: thorsteinsdottir. ; Telephone: 507-774-5944
| | - Stephanie M Peterson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - James M Naessens
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
| | - Rozalina G McCoy
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Gregory J Hanson
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - LaTonya J Hickson
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Christina YY Chen
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Parvez A Rahman
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Nilay D Shah
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Lynn Borkenhagen
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anupam Chandra
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rachel Havyer
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Aaron Leppin
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Griffin J, Bangerter L, Havyer R, Comer M, Biggar V, Frangiosa T. ENGAGING FAMILY CAREGIVERS TO IMPROVE HEALTH CARE DELIVERY: ESTABLISHING CLINICAL BEST PRACTICES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - L Bangerter
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery
| | | | - M Comer
- Geoffrey Beene Foundation Alzheimer’s Initiative
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Bangerter LR, Griffin JM, Zarit SH, Havyer R. Measuring the Needs of Family Caregivers of People With Dementia: An Assessment of Current Methodological Strategies and Key Recommendations. J Appl Gerontol 2017; 38:1304-1318. [DOI: 10.1177/0733464817705959] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While dementia caregivers are regarded as a population with high unmet needs, there is little consensus as to how caregivers’ needs should be conceptualized and measured. This article describes how dementia caregivers’ needs are currently assessed in the scientific literature with the goal of suggesting guidelines for the enhancement of future measurement of caregiver needs. A review of 26 articles identified overarching themes within measurement approaches including variation in methodological rigor, proxy indicators of need, dual needs assessment of caregiver and person with dementia (PWD), and third-party needs assessment. We recommend future research dedicate theoretical attention to the conceptualization and classification of caregivers’ needs to build a stronger foundation for measurement. The measurement development process should capitalize on mixed-methodology and follow instrument development and validation guidelines set forth by measurement theory. Reliable and valid instruments are essential to developing services and policies that address dementia caregivers’ needs.
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Affiliation(s)
- Lauren R. Bangerter
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Joan M. Griffin
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Steven H. Zarit
- Department of Human Development and Family Studies,The Pennsylvania State University, University Park, USA
| | - Rachel Havyer
- Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
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Griffin JM, Havyer R. Carers providing end-of-life care at home have limited formal support in managing medications. Evid Based Nurs 2015; 18:115. [PMID: 25743939 DOI: 10.1136/eb-2014-102028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Joan M Griffin
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel Havyer
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Affiliation(s)
| | | | - Rachel Havyer
- Primary Care Internal Medicine Mayo ClinicRochesterMNUnited States
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Abstract
Urticaria is a common disorder characterised by well-demarcated and intensely pruritic erythematous skin swellings. Common triggers include infection, allergic reactions or medications. While often idiopathic, the presence of urticaria can be associated with underlying systemic disease. We report a case of a patient who presented with diffuse and refractory urticaria. A thorough workup was conducted to determine the aetiology including routine age-appropriate cancer screening. Mammography revealed four lesions in the patient's left breast with biopsy consistent with invasive ductal carcinoma. Disappearance of the urticarial lesions with mastectomy suggests an association between breast malignancy and urticaria. Thus, refractory urticaria with unknown cause should prompt a thorough history, physical examination and review of age-appropriate cancer screening.
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Abstract
Of those individuals diagnosed with Hodgkin lymphoma, 85% will survive and may be affected by residual effects of their cancer and its therapy (chemotherapy, radiation therapy, stem cell transplantation). Hodgkin lymphoma survivors are at risk of developing secondary malignancies, cardiovascular disease, pulmonary disease, thyroid disease, infertility, premature menopause, chronic fatigue, and psychosocial issues. These conditions usually have a long latency and therefore present years or decades after Hodgkin lymphoma treatment, when the patient's care is being managed by a primary care provider. This review summarizes these unique potential medical and psychologic sequelae of Hodgkin lymphoma, and provides screening and management recommendations.
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Affiliation(s)
- Carrie A Thompson
- Division of Hematology, Mayo Clinic College of Medicine, Department of Internal Medicine, Rochester, MN 55905, USA.
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