Clinician and patient perspectives of a new model of triage in a community rehabilitation program that reduced waiting time: a qualitative analysis

2013 ◽  
Vol 37 (3) ◽  
pp. 324 ◽  
Author(s):  
Katherine E. Harding ◽  
Nicholas F. Taylor ◽  
Birgitte Bowers ◽  
Maree Stafford ◽  
Sandra G. Leggat
Keyword(s):  
Waiting Times ◽  
Rehabilitation Program ◽  
Rehabilitation Service ◽  
Wait List ◽  
Negative Consequences ◽  
Structured Interviews ◽  
New Model ◽  
Community Rehabilitation ◽  
Before And After ◽  
The Impact

Background A trial of a new model of triage (Specific and Timely Appointments for Triage: STAT) at a community rehabilitation program (CRP) reduced the mean time to first appointment from 17.5 to 10.0 days. However, quantitative findings reveal little about the impact of the system on those who used it. We aimed to explore the experiences of patients and clinicians following the introduction of STAT. Method Qualitative study within a convergent mixed-methods design applied to a controlled before and after trial at a CRP. Semi-structured interviews (n = 32) were conducted with clinicians who experienced the change to STAT, patients admitted to the CRP using STAT and patients who attended rehabilitation via a triaged wait list at another site. Results Clinicians reported shorter waiting times, more flexibility and increased efficiency with STAT, and noted the importance of effective change management. Patients reported a more efficient and consistent pathway to rehabilitation with STAT. Waiting had negative consequences for some patients at the triaged wait list site. Conclusions The qualitative data provide context to the quantitative results by showing that the changes that reduced waiting times were also well accepted and perceived to be beneficial by both patients and clinicians. What is known about the topic? Triage systems are widely used but can contribute to inefficiencies in health care. An alternative method of triage (STAT) using early allocation to face-to-face appointments has been shown to reduce waiting times in a community rehabilitation service. What does this paper add? This paper explains and adds important context to the quantitative findings by exploring the perceptions of the staff and patients who experienced both the existing and alternative models of triage. What are the implications for practitioners? The STAT model was well received by staff and patients, suggesting that this simple intervention was a feasible and effective method of reducing waiting times for community rehabilitation, and may be applicable to other services that share similar features.

scholarly journals Impact of COVID-19 Pandemic on Retail Structure in Barcelona: From Tourism-Phobia to the Desertification of City Center

2021 ◽  
Vol 13 (15) ◽  
pp. 8215
Author(s):  
Lluís Frago Clols
Keyword(s):  
Multiple Scales ◽  
Real Estate Market ◽  
Structured Interviews ◽  
City Center ◽  
Urban Theory ◽  
The Real Estate ◽  
Tourist Flows ◽  
Before And After ◽  
The Impact ◽  
The City

COVID-19 has meant major transformations for commercial fabric. These transformations have been motivated by the collapse of consumer mobility at multiple scales. We analyzed the impact of the collapse of global tourist flows on the commercial fabric of Barcelona city center, a city that has been a global reference in over-tourism and tourism-phobia. Fieldwork in the main commercial areas before and after the pandemic and complementary semi-structured interviews with the main agents involved highlight the relationship between global tourist flows and commercial fabric. The paper shows how the end of global tourism has meant an important commercial desertification. The end of the integration of the city center into global consumer flows has implications for urban theory. It means a downscaling of the city center and the questioning of traditional center-periphery dynamics. It has been shown that the tourist specialization of commerce has important effects on the real estate market and makes it particularly vulnerable. However, the touristic specialization of commercial activities as a strategy of resilience has also been presented. This adaptation faces the generalized commercial desertification that drives the growing concentration of consumption around the online channel.

scholarly journals Impact of the Paralympic Games on the Beliefs of Children with Physical Disabilities Engaging in Sports and Physical Activities: A Chinese Perspective

2021 ◽  
Vol 18 (14) ◽  
pp. 7296
Author(s):  
Jing Qi ◽  
Jin-He Cai ◽  
Xun Meng
Keyword(s):  
Attitude Change ◽  
Physical Disabilities ◽  
Chinese Children ◽  
Physical Education Teachers ◽  
Structured Interviews ◽  
Negative Attitudes ◽  
Before And After ◽  
Sports And Physical Activity ◽  
The Impact ◽  
Paralympic Games

The purpose of this qualitative study was to explore the beliefs of Chinese children with physical disabilities engaging in sports and physical activity (PA), and the impact of the Paralympic Games on these beliefs. Five Chinese children with physical disabilities (female = 2, male = 3) were recruited for participating in the workshops of the Paralympic Games and PA, and received individual semi-structured interviews before and after the workshop implementations. Interview transcripts were analysed and presented as descriptive summaries. Three themes emerged based on the analysis of the participants’ interview data: (1) shocked, knowledgeable, and useful; (2) willingness to try, and (3) hope to obtain support. Results indicated that children with physical disabilities in this study acknowledged the positive outcomes of participating in the workshops of the Paralympic Games on the sports and PA engagement attitude change. However, children with disabilities also expressed that they need more related knowledge and information. The results of the study revealed that impairment and contextual factors (i.e., lack of support from family and physical education teachers, unsafe environments, and negative attitudes of peers without disabilities) were barriers to sports and PA engagement among children with physical disabilities in this study.

The Opportunity Cost of Changing Clinical Practice in Anticipation of a Surge of Covid-19 patients – A Convergent Mixed Methods Study Protocol

2020 ◽  
Vol 8 (3) ◽  
pp. 301
Author(s):  
Veena Manja ◽  
James Wiedeman ◽  
Jeffrey S Hoch ◽  
Diana Lee Farmer
Keyword(s):  
Mixed Methods ◽  
Teaching And Learning ◽  
Mixed Methods Study ◽  
Case Mix ◽  
Negative Consequences ◽  
Structured Interviews ◽  
Case Volume ◽  
Quantitative Phase ◽  
Trade Offs ◽  
The Impact

Background: The rapid rise of COVID-19 infections has strained the capacity of healthcare systems worldwide. Many organizations are changing practice to make room for a surge in patients with COVID-19 infections. Cancelling and rescheduling elective procedures is one strategy advocated and used by many. This process may result in negative consequences for the patients who need procedures and have negative teaching and economic implications.Rationale and Study Design: This convergent mixed-methods study includes analysis of surgical databases to evaluate differences in case-volume and case-mix before and after the emergence of COVID-19 pandemic (quantitative phase), prospective observational study of patients impacted by the delayed scheduling of surgical procedures (quantitative phase) and 1:1 semi-structured interviews with patients, physicians and administrators to understand the impact of operational changes as a result on COVID-19 infection on patient care, teaching and learning and fiscal outcomes.Methods: The quantitative phase will consist of a review of the surgical database to quantify the differences in case-volume and case-mix during 2019 and 2020. In addition a prospective cohort of patients impacted by the delay in these procedures will be followed for 6 months to assess changes in patient important outcomes due to changes in scheduling procedures. The qualitative phase will consist of 1:1 semi-structured interviews to gain a depth of understanding of the trade-offs due to a change in practice related to COVID-19. The interviews will be analyzed using qualitative description.Discussion: The COVID-19 pandemic has caused worldwide disruption in the practice of healthcare, current focus on increasing capacity in preparation for a COVID-19 surge may have unforeseen consequences for patients who need non-COVID-19 related care. Studying the impact prospectively will provide information on the trade-offs associated with change in healthcare priorities. These results may be helpful in informing optimal healthcare practices and resource allocation in the future. 

scholarly journals The social impact of the ‘Social solidarity income’ in Greece: A qualitative interpretation

2021 ◽  
Vol 14 (1) ◽  
pp. 5
Author(s):  
Theodoros Sakellaropoulos ◽  
Varvara Lalioti ◽  
Nikos Kourachanis
Keyword(s):  
Social Impact ◽  
Social Situation ◽  
Survival Strategies ◽  
Social Solidarity ◽  
Structured Interviews ◽  
Minimum Income ◽  
Positive Elements ◽  
The Social ◽  
Before And After ◽  
The Impact

The present article sheds light on the implementation of the ‘Social Solidarity Income’ (SSI) in Greece, an example of a guaranteed minimum income (GMI). Drawing on the findings of 40 semi-structured interviews carried out in five selected municipalities, the article focuses on the ‘social impact’ of the SSI. More specifically, it investigates two inter-related themes: a) the social situation of beneficiaries and the survival strategies they used before and after receiving the SSI; and b) aspects of the SSI that should be improved at the implementation stage. It is argued that, despite certain positive elements of the SSI, such as the monetary allowance, which is a key component of the SSI and assists beneficiaries in covering their basic needs, the impact of the SSI on the lives of individuals is relatively small and a large proportion of the beneficiaries continue to rely on the survival strategies they used before implementation of the SSI

scholarly journals Telehealth to support referral management in a universal health system: a before-and-after study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sabrina Dalbosco Gadenz ◽  
Josué Basso ◽  
Patrícia Roberta Berithe Pedrosa de Oliviera ◽  
Stephan Sperling ◽  
Marcus Vinicius Dutra Zuanazzi ◽  
...  
Keyword(s):  
Linear Models ◽  
Patient Flow ◽  
Waiting Times ◽  
Median Number ◽  
Waiting Lists ◽  
Referral Management ◽  
Before And After ◽  
The Impact ◽  
Universal Health ◽  
Before And After Study

Abstract Background Management of patient flow within a healthcare network, allowing equitable and qualified access to healthcare, is a major challenge for universal health systems. Implementation of telehealth strategies to support referral management has been shown to increase primary care resolution and to promote coordination of care. The objective of this study was to assess the impact of telehealth strategies on waiting lists and waiting times for specialized care in Brazil. Methods Before-and-after study with measures obtained between January 2019 and February 2020. Baseline measurements of waiting lists were obtained immediately before the implementation of a remotely operated referral management system. Post-interventional measurements were obtained monthly, up to six months after the beginning of operation. Data was extracted from the database of the project. General linear models were applied to assess interaction of locality and time over number of cases on waiting lists and waiting times. Results At baseline, the median number of cases on waiting lists ranged from 2961 to 12,305 cases. Reductions of the number of cases on waiting lists after six months of operation were observed in all localities. The magnitude of the reduction ranged from 54.67 to 88.97 %. Interaction of time measurements was statistically significant from the second month onward. Median waiting times ranged from 159 to 241 days at baseline. After six months, there was a decrease of 100 and 114 waiting days in two localities, respectively, with reduction of waiting times only for high-risk cases in the third locality. Conclusions Adoption of telehealth strategies resulted in the reduction of number of cases on waiting lists. Results were consistent across localities, suggesting that telehealth interventions are viable in diverse settings.

scholarly journals Eight Weeks Unsupervised Pulmonary Rehabilitation in Previously Hospitalized of SARS-CoV-2 Infection

2021 ◽  
Vol 11 (8) ◽  
pp. 806
Author(s):  
Vasileios T. Stavrou ◽  
Konstantinos N. Tourlakopoulos ◽  
George D. Vavougios ◽  
Eirini Papayianni ◽  
Katerina Kiribesi ◽  
...  
Keyword(s):  
Pulmonary Rehabilitation ◽  
Stress Measurement ◽  
Rehabilitation Program ◽  
Rehabilitation Programs ◽  
Sit To Stand ◽  
Plasma Antioxidant Capacity ◽  
Before And After ◽  
Plasma Antioxidant ◽  
The Impact ◽  
Pulmonary Rehabilitation Program

The aim of our study was to determine the impact of unsupervised Pulmonary Rehabilitation (uns-PR) on patients recovering from COVID-19, and determine its anthropometric, biological, demographic and fitness correlates. All patients (n = 20, age: 64.1 ± 9.9 years, 75% male) participated in unsupervised Pulmonary Rehabilitation program for eight weeks. We recorded anthropometric characteristics, pulmonary function parameters, while we performed 6 min walk test (6 MWT) and blood sampling for oxidative stress measurement before and after uns-PR. We observed differences before and after uns-PR during 6 MWT in hemodynamic parameters [systolic blood pressure in resting (138.7 ± 16.3 vs. 128.8 ± 8.6 mmHg, p = 0.005) and end of test (159.8 ± 13.5 vs. 152.0 ± 12.2 mmHg, p = 0.025), heart rate (5th min: 111.6 ± 16.9 vs. 105.4 ± 15.9 bpm, p = 0.049 and 6th min: 112.5 ± 18.3 vs. 106.9 ± 17.9 bpm, p = 0.039)], in oxygen saturation (4th min: 94.6 ± 2.9 vs. 95.8 ± 3.2%, p = 0.013 and 1st min of recovery: 97.8 ± 0.9 vs. 97.3 ± 0.9%), in dyspnea at the end of 6 MWT (1.3 ± 1.5 vs. 0.6 ± 0.9 score, p = 0.005), in distance (433.8 ± 102.2 vs. 519.2 ± 95.4 m, p < 0.001), in estimated O2 uptake (14.9 ± 2.4 vs. 16.9 ± 2.2 mL/min/kg, p < 0.001) in 30 s sit to stand (11.4 ± 3.2 vs. 14.1 ± 2.7 repetitions, p < 0.001)] Moreover, in plasma antioxidant capacity (2528.3 ± 303.2 vs. 2864.7 ± 574.8 U.cor., p = 0.027), in body composition parameters [body fat (32.2 ± 9.4 vs. 29.5 ± 8.2%, p = 0.003), visceral fat (14.0 ± 4.4 vs. 13.3 ± 4.2 score, p = 0.021), neck circumference (39.9 ± 3.4 vs. 37.8 ± 4.2 cm, p = 0.006) and muscle mass (30.1 ± 4.6 vs. 34.6 ± 7.4 kg, p = 0.030)] and sleep quality (6.7 ± 3.9 vs. 5.6 ± 3.3 score, p = 0.036) we observed differences before and after uns-PR. Our findings support the implementation of unsupervised pulmonary rehabilitation programs in patients following COVID-19 recovery, targeting the improvement of many aspects of long COVID-19 syndrome.

The Impact of Removing Snacks of Low Nutritional Value From Middle Schools

2009 ◽  
Vol 36 (6) ◽  
pp. 999-1011 ◽  
Author(s):  
Marlene B. Schwartz ◽  
Sarah A. Novak ◽  
Susan S. Fiore
Keyword(s):  
Middle Schools ◽  
School Nutrition ◽  
Negative Consequences ◽  
Weight Concerns ◽  
Nutrition Guidelines ◽  
School Based ◽  
Before And After ◽  
Obesity Prevention Programs ◽  
The Impact ◽  
At Home

Removing low nutrition snacks from schools is controversial. Although the objective is to decrease the consumption of these foods at school, some critics argue that children will compensate by eating more of these foods at home. Others worry that school-based obesity prevention programs will increase student preoccupation with weight. The present study examines these concerns. Three middle schools replaced snacks and beverages that did not meet nutrition guidelines, whereas three comparison schools made no systematic changes. Students were surveyed about dietary intake and weight concerns before and after implementation of the intervention. Findings indicate that removing low nutrition items from schools decreased students’ consumption with no compensatory increase at home. Furthermore, there were no differences in students’ reported weight concerns. These results support the value of strengthening school nutrition standards to improve student nutrition and provide evidence dispelling concerns that such efforts will have unintended negative consequences.

scholarly journals Inpatient rehabilitation service utilization and outcomes under US ACA Medicaid expansion

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying ( Jessica) Cao ◽  
Jing Nie ◽  
Katia Noyes
Keyword(s):  
Length Of Stay ◽  
Inpatient Rehabilitation ◽  
Assessment Instrument ◽  
Functional Improvement ◽  
Rehabilitation Service ◽  
Care Utilization ◽  
Medicaid Expansion ◽  
Acute Conditions ◽  
Before And After ◽  
The Impact

Abstract Background To investigate the impact of the US Medicaid expansion on care utilization and health outcomes of patients treated in the inpatient rehabilitation facilities (IRF). Methods A retrospective observational study with a difference-in-difference design. The data was obtained from Inpatient Rehabilitation Facility – Patient Assessment Instrument (IRF-PAI). Sample included all Medicaid beneficiaries (aged 18–64 years) who received initial inpatient rehabilitation for stroke, hip fracture (acute conditions), or joint replacement (elective condition) (N = 14,917) before (2013) and after (2016) the expansion. The study estimated the differences in length of stay, functional improvement, and possibility of returning to community before and after ACA Medicaid expansion in the expansion regions relative to the non-expansion regions. The analysis was fully adjusted for patient demographics, health conditions, facility characteristics and time trends. Results Compared with non-expansion states, service volume in the expansion regions increased more for the two acute conditions (49 and 27% vs. 1% and − 4%) and decreased less for the selective condition (− 12% vs. -34%) after ACA Medicaid expansion. Medicaid expansion was associated with significant decreases in patient functional improvements (− 1.63 points for stroke, − 3.61 points for fracture and − 2.73 points for joint; P < 0.05). Length of stay and the possibility of returning to community after discharge were not significantly different. Conclusions Medicaid expansion was associated with increases in the utilization of inpatient rehabilitation services and decreases in the patient functional improvements. Cautions should be taken with the decreases in functional improvements among some subpopulation in the short-term; longer follow up periods are needed to account for gradual changes in patient needs.

scholarly journals The impact of the two-week wait rule on the diagnosis and management of bladder cancer in a single UK institution

2010 ◽  
Vol 92 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Christopher Blick ◽  
David Bailey ◽  
Neil Haldar ◽  
Amarjit Bdesha ◽  
John Kelleher ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Waiting Times ◽  
Newly Diagnosed ◽  
Multidisciplinary Team Meeting ◽  
Significant Delay ◽  
Patient Pathway ◽  
Before And After ◽  
Routine Basis ◽  
Treatment Data ◽  
The Impact

INTRODUCTION The objective of this study was to investigate the impact of the 2-week wait rule on patient waiting times for the diagnosis and treatment of bladder cancer. PATIENTS AND METHODS Data reporting the waiting times from diagnosis to treatment for 100 consecutive patients newly diagnosed with bladder cancer immediately before and after the implementation of the 2-week wait rule were compared. The data were collected both prospectively and retrospectively from cancer multidisciplinary team meeting files and patient records. Various steps of the patient pathway were analysed including waiting times from referral to consultation as well as time to investigation and first treatment. Data were also analysed based upon tumour stage/grade and whether referrals were made on an urgent or routine basis. RESULTS One hundred newly diagnosed patients with bladder cancer in each group covered a period of 4–5 years (1997–2001 and 2001–2006). Following the introduction of the 2-week wait rule, there was a 47.6% reduction in the time from referral to first consultation with a specialist (42 days vs 22 days; P < 0.001). The time between first investigation and treatment has not reduced significantly. We also found that, despite the introduction of the 2-week wait rule, only 42% of the patients were diagnosed with bladder cancer using this pathway. Patients referred as ‘routine’ waited longer to be seen in hospital although there was no significant delay in receiving treatment. CONCLUSIONS The introduction of the 2-week wait rule has significantly reduced the time patients with bladder cancer wait for their first consultation with a specialist. However, there is no significant change in the time between first consultation and treatment.

scholarly journals The Value of Thoracic Computed Tomography Scans in Clinical Diagnosis: A Prospective Study

2006 ◽  
Vol 13 (6) ◽  
pp. 311-316 ◽  
Author(s):  
Mark O Turner ◽  
John R Mayo ◽  
Nestor L Müller ◽  
Michael Schulzer ◽  
J Mark FitzGerald
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Clinical Diagnosis ◽  
Waiting Times ◽  
Tertiary Care ◽  
Ct Scans ◽  
Thoracic Ct ◽  
Chest Disease ◽  
Before And After ◽  
The Impact

BACKGROUND: Computed tomography (CT) scans are used extensively to investigate chest disease because of their cross-sectional perspective and superior contrast resolution compared with chest radiographs. These advantages lead to a more accurate imaging assessment of thoracic disease. The actual use and evaluation of the clinical impact of thoracic CT has not been assessed since scanners became widely available.OBJECTIVE: To identify patterns of utilization, waiting times and the impact of CT scan results on clinical diagnoses.DESIGN: A before and after survey of physicians who had ordered thoracic CT scans.SETTING: Vancouver General Hospital – a tertiary care teaching centre in Vancouver, British Columbia.SUBJECTS: Physicians who had ordered CT scans.INTERVENTION: Physicians completed a standard questionnaire before and after the CT scan result was available.MEASUREMENTS: Changes in the clinical diagnosis, estimates of the probabilities for the diagnosis both before and after the CT scan, and waiting times.RESULTS: Four hundred fifty-four thoracic CT cases had completed questionnaires, of whom 80% were outpatients. A change in diagnosis was made in 48% of cases (25% with a normal CT scan and 23% with CT scan findings that indicated a different diagnosis). The largest change in probability scores for the clinical diagnosis before and after the CT scan was 43.9% for normal scans, while it was 36.3% for a different diagnosis and 26.3% for the same diagnosis. High-priority scans were associated with decreased waiting time (−7.89 days for each unit increase in priority).CONCLUSIONS: The CT scan results were associated with a change in diagnosis in 48% of cases. Normal scans constituted 25% of the total and had the greatest impact scores. Waiting times were highly correlated with increased urgency of the presenting problem.

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