scholarly journals A patient-centered system in a provider-centered world: challenges of incorporating post-discharge wound data into practice

2016 ◽  
Vol 23 (3) ◽  
pp. 514-525 ◽  
Author(s):  
Patrick C Sanger ◽  
Andrea Hartzler ◽  
Ross J Lordon ◽  
Cheryl AL Armstrong ◽  
William B Lober ◽  
...  
Keyword(s):  
Design Process ◽  
Data Transfer ◽  
Clinical Care ◽  
Healthcare Providers ◽  
Surgical Patients ◽  
Discharge Process ◽  
Post Discharge ◽  
Patient Centered ◽  
Semistructured Interviews ◽  
Present Design

Objective The proposed Meaningful Use Stage 3 recommendations require healthcare providers to accept patient-generated health data (PGHD) by 2017. Yet, we know little about the tensions that arise in supporting the needs of both patients and providers in this context. We sought to examine these tensions when designing a novel, patient-centered technology – mobile Post-Operative Wound Evaluator (mPOWEr) – that uses PGHD for post-discharge surgical wound monitoring. Materials and Methods As part of the iterative design process of mPOWEr, we conducted semistructured interviews and think-aloud sessions using mockups with surgical patients and providers. We asked participants how mPOWEr could enhance the current post-discharge process for surgical patients, then used grounded theory to develop themes related to conflicts and agreements between patients and providers. Results We identified four areas of agreement: providing contextual metadata, accessible and actionable data presentation, building on existing sociotechnical systems, and process transparency. We identified six areas of conflict, with patients preferring: more flexibility in data input, frequent data transfer, text-based communication, patient input in provider response prioritization, timely and reliable provider responses, and definitive diagnoses. Discussion We present design implications and potential solutions to the identified conflicts for each theme, illustrated using our work on mPOWEr. Our experience highlights the importance of bringing a variety of stakeholders, including patients, into the design process for PGHD applications. Conclusion We have identified critical barriers to integrating PGHD into clinical care and describe design implications to help address these barriers. Our work informs future efforts to ensure the smooth integration of essential PGHD into clinical practice.

Patient and pediatric caregiver experiences and expectations about opioid risk education and counselling

2020 ◽  
Vol 16 (3) ◽  
pp. 227-232
Author(s):  
Tanvee Thakur, BPharm, MS ◽  
Betty Chewning, PhD
Keyword(s):  
Content Analysis ◽  
Pilot Study ◽  
Research Training ◽  
Healthcare Providers ◽  
Patient Centered ◽  
Semistructured Interviews ◽  
Risk Education ◽  
Caregiver Experiences ◽  
Perceptions And Expectations ◽  
Unique Study

Objective: This pilot study seeks to explore patient and caregiver experiences, perceptions, and expectations about opioid risk counselling.Design: Semistructured interviews were conducted in Madison, WI. Inductive content analysis was used for analysis.Participants: Adult patients and pediatric caregivers for patients prescribed opioids in the last 30 days.Outcome measure: Patient’s experiences, perceptions, and expectations about opioid risk and safety counselling.Results: Two out of 16 patients were reported being counseled about risks, and only one patient was told about medication being an opioid. Respondents expressed their desire to learn about dependency and overdose risks and the fact that the medication is an opioid. While patients wanted to be educated by all healthcare providers, pharmacists were deemed most important for opioid risk counseling.Conclusion: This unique study points out the need for more research, training, and resources for aligning opioid risk counselling and education with patient expectations as a patient centered effort.

scholarly journals GERIATRICS MICU CO-MANAGEMENT: INTEGRATING GERIATRIC ASSESSMENTS FOR CRITICALLY ILL PATIENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S448-S448
Author(s):  
Gowrishankar Gnanasekaran ◽  
Eduardo Mireles-Cabodevila
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Task Force ◽  
Clinical Care ◽  
Elderly Care ◽  
Management Program ◽  
Quality Improvement Initiative ◽  
Discharge Process ◽  
Patient Centered

Abstract Programs like orthogeriatrics, geriatric cardiology have shown to improve outcomes in hospitalized geriatric patients. Our Geriatrics MICU Co-management program is a quality improvement initiative that instigates a partnership approach with critical care medicine in integrating geriatric assessments and build foundation for interdisciplinary care of critically ill patients. MICU (Medical Intensive Care Unit) protocols do not have standard geriatrics assessments integrated in clinical care. An electronic dash-board identifies high risk elderly (HRE) patients admitted at a MICU in a large teaching hospital in Northeast Ohio based on nursing specific screening triggers. A geriatrics co-management team engages in a comprehensive geriatric assessments and care transition. 386 patient were identified using HRE screening triggers in a period of 100 days. 33 % (n=131) were generated as consults for co-management. A pilot review on 131 HRE patients was conducted. 70% (n=93) patients had incident frailty. 93% (n=87) of patients with frailty were diagnosed with incident delirium. 56% (n=74) of patients were newly diagnosed with cognitive impairment. 56 % (N=74) of patients had a medication reduction. An average of 1.23 medication was changed. 85% (n =112) of patients had a warm hand off to the next level of provider on discharge. 90% (n=119) of patients notified improved self-management skills and better understanding of discharge process. The Geri-MICU program demonstrates a patient -centered approach in integrating geriatric assessments for critically ill patients and build foundation of a geriatrics-critical care task force. The program would be a mile stone in optimizing elderly care in critical care units.

scholarly journals Care transition from rehabilitation to home: A QI project using the RED Toolkit to decrease readmission rates

2021 ◽  
Vol 10 (1) ◽  
pp. 46
Author(s):  
Jennifer R. Bernard ◽  
Eileen L. Creel ◽  
Rhonda K Pecoraro
Keyword(s):  
Quality Improvement ◽  
Hip Fracture ◽  
Healthcare Providers ◽  
Inpatient Rehabilitation ◽  
Care Plan ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Discharge Process ◽  
Post Discharge ◽  
Post Intervention

Objective: This quality improvement (QI) project’s aim was to lower 30-day healthcare reutilization for patients aged 50 or older with hip fracture using an evidence-based discharge process method, the Re-Engineered Discharge (RED) Toolkit.Methods: The QI project of a revised patient discharge process to lower healthcare reutilization of Baton Rouge Rehabilitation Hospital (BRRH) hip fracture patients was implemented as an evidence-based quality improvement initiative. Inpatient and outpatient discharge process revisions were implemented at an inpatient rehabilitation facility (IRF) based on Re-Engineered Discharge (RED) Toolkit recommendations. Inpatient revisions included patient barrier identification with associated documentation changes to the IRF interdisciplinary team form. Outpatient modifications consisted of an After-Hospital Care Plan (AHCP), and two post-discharge Telephone Follow-Up (TFU) calls.Results: Healthcare reutilization and thirty-day hospital readmission for this project were measured at 8.5% and 5.7%, respectively. A decrease in healthcare reutilization of at least 1.6% was observed for the IRF. Most participants scored at a high level (88.6%) of “patient knowledge of self-management” post intervention. Out of participants who did not attend their first Primary Care Provider (PCP) appointment, 33.3% experienced healthcare reutilization. This result emphasized the importance of seeing one’s PCP post-discharge. Patient satisfaction increased by 5% and 6.73%, measured by Hospital Consumer Assessment of HealthCare Providers and Systems (HCAHP) scores for nursing care and physician care, respectively.Conclusions: Implementation of a RED Toolkit-based discharge process at an IRF positively impacted all three study outcomes and associated healthcare costs in lowering preventable readmissions.

scholarly journals Adding exercise to a care pathway for patients undergoing surgery for head and neck cancer

2020 ◽  
Author(s):  
Julia Daun ◽  
Rosemary Twomey ◽  
Joseph C. Dort ◽  
Lauren C. Capozzi ◽  
Trafford Crump ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Care Pathway ◽  
Clinical Care ◽  
Healthcare Providers ◽  
Symptom Burden ◽  
Surgical Patients ◽  
Structured Interviews ◽  
Clinical Workflow

Head and neck cancer (HNC) surgical patients experience high symptom burden. Exercise prehabilitation has the potential to improve patient outcomes, but the perspectives of patients and healthcare providers (HCPs) must be considered to facilitate implementation. The purpose of this study was to obtain qualitative feedback from HNC surgical patients and HCPs regarding: (1) adding patient assessments across the HNC surgical timeline, and (2) the logistics and potential benefits of a future exercise prehabilitation intervention. Semi-structured interviews took place with patients and HCPs. Interview questions included satisfaction with study recruitment, measurement completion, impact on clinical workflow (HCPs), and perceptions of a future prehabilitation program. Transcripts were analyzed using a constructivist philosophy and interpretive description methodology. Ten patients and ten HCPs participated in this study. Four themes were identified: (1) the value of exercise and its importance in clinical care, (2) acceptability and necessity of assessments, (3) factors to support implementation, and (4) the components of an ideal prehabilitation program. Overall, these findings highlight the importance and value of exercise across the HNC surgical timeline from both the patient and HCPs’ perspective. These findings will inform the future implementation of a multiphasic exercise prehabilitation trial in HNC surgical patients.

Abstract 105: A 360 Degree Perspective on the Timing of Patient Discharge: A Multidisciplinary Survey of Patients, Physicians, and Nurses on Discharge Practices Within a Cardiovascular Service Line at a Tertiary Academic Institution

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Harshith Avula ◽  
Srinath Adusumalli ◽  
Kartik Telukuntla ◽  
Daniel M Kolansky ◽  
Leah Moran ◽  
...  
Keyword(s):  
Transitional Care ◽  
Healthcare Providers ◽  
Patient Discharge ◽  
Early Discharge ◽  
Optimal Time ◽  
Discharge Process ◽  
Discharge Time ◽  
Post Discharge ◽  
Survey Period ◽  
Provider Perspectives

Background: Early hospital discharge for patients has been linked to improved post-discharge outcomes. Health systems continue to struggle with early discharges and past interventions have centered around provider perspectives of the discharge process, with no identifiable studies focusing on patient perspectives. We sought to examine the discharge process from a comprehensive perspective, obtaining simultaneous patient and healthcare provider beliefs to improve our institution’s discharge process. Methods: Our study was approved by the Institutional Review Board at the University of Pennsylvania and all participants provided informed consent. Physicians and nurses who took part in discharges from our inpatient cardiology services participated in an electronic survey regarding discharge processes over a six-month period. Patients being discharged from these services also completed anonymous surveys at the time of discharge from the hospital. Results: The survey was completed by 476 patients, 47 nurses, and 44 physicians. Approximately 54% of physicians and 43% of nurses reported that the ideal time of discharge is between 8:00 AM and 12:00 PM. A vast majority (85%) of patients reported that discharges before 2:00 PM are best, with 60% of patients reporting that discharges should ideally occur before 12:00 PM. Nearly half (46%) of patients, 64% of physicians, and 75% of nurses reported that the discharges they participated in occurred after 2:00 PM, which was consistent with the mean discharge times reported by institutional data taken during the survey period. Less than half (40%) of patients also reported that they were informed of their discharge before 12:00 PM on their day of discharge. The majority of healthcare providers reported that they do not believe early discharges would reduce the rate of 30-day readmissions (physicians 87%, nurses 88%) or lead to safer discharges (physicians 78%, nurses 69%). More than one-third (36%) of patients reported that a delay in coordination of transitional care (e.g. medication delivery, transportation issues, and inadequate communication with primary team) contributed to a later discharge time. Conclusion: Our data reveal that both patients and providers believe that the optimal time for discharge is prior to 12:00 PM, despite the fact that most discharges occur after 2:00 PM. Patients cite delays in coordination of transitional care as the most common reason for delayed discharge times, and were typically informed of their formal discharge after noon on the day of discharge. Although most healthcare providers do not believe that early discharge improves outcomes, additional studies are needed to investigate outcomes associated with early discharge time.

Patient-Centered Care and Autonomy: Shared Decision-Making in Practice and a Suggestion for Practical Application in the Critically Ill

2019 ◽  
Vol 35 (11) ◽  
pp. 1352-1355
Author(s):  
Marianna V. Mapes ◽  
Peter A. DePergola ◽  
William T. McGee
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Critically Ill ◽  
Care Service ◽  
Clinical Care ◽  
Patient Centered Care ◽  
Practical Application ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care

Decision-making for the hospitalized dying and critically ill is often characterized by an understanding of autonomy that leads to clinical care and outcomes that are antithetical to patients’ preferences around suffering and quality of life. A better understanding of autonomy will facilitate the ultimate goal of a patient-centered approach and ensure compassionate, high-quality care that respects our patients’ values. We reviewed the medical literature and our experiences through the ethics service, palliative care service, and critical care service of a large community teaching hospital. The cumulative experience of a senior intensivist was filtered through the lens of a medical ethicist and the palliative care team. The practical application of patient-centered care was discerned from these interactions. We determined that a clearer understanding of patient-centeredness would improve the experience and outcomes of care for our patients as well as our adherence to ethical practice. The practical applications of autonomy and patient-centered care were evaluated by the authors through clinical interactions on the wards to ascertain problems in understanding their meaning. Clarification of autonomy and patient-centeredness is provided using specific examples to enhance understanding and application of these principles in patient-centered care.

scholarly journals Innovative Strategies to Facilitate Patient-Centered Research in Multiple Chronic Conditions

2021 ◽  
Vol 10 (10) ◽  
pp. 2112
Author(s):  
Tullika Garg ◽  
Courtney A. Polenick ◽  
Nancy Schoenborn ◽  
Jane Jih ◽  
Alexandra Hajduk ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Clinical Care ◽  
Intervention Development ◽  
Healthcare Services ◽  
Multiple Chronic Conditions ◽  
Patient Centered ◽  
Older Americans ◽  
Innovative Strategies ◽  
Department Of Health ◽  
Innovative Methods

Multiple chronic conditions (MCC) are one of today’s most pressing healthcare concerns, affecting 25% of all Americans and 75% of older Americans. Clinical care for individuals with MCC is often complex, condition-centric, and poorly coordinated across multiple specialties and healthcare services. There is an urgent need for innovative patient-centered research and intervention development to address the unique needs of the growing population of individuals with MCC. In this commentary, we describe innovative methods and strategies to conduct patient-centered MCC research guided by the goals and objectives in the Department of Health and Human Services MCC Strategic Framework. We describe methods to (1) increase the external validity of trials for individuals with MCC; (2) study MCC epidemiology; (3) engage clinicians, communities, and patients into MCC research; and (4) address health equity to eliminate disparities.

scholarly journals Young adults’ perceptions of living with atopic dermatitis in relation to the concept of self-management: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044777
Author(s):  
Susanne Lundin ◽  
Marina Jonsson ◽  
Carl-Fredrik Wahlgren ◽  
Emma Johansson ◽  
Anna Bergstrom ◽  
...  
Keyword(s):  
Young Adults ◽  
Atopic Dermatitis ◽  
Qualitative Study ◽  
Healthcare Providers ◽  
Transition Process ◽  
Population Based ◽  
Self Management ◽  
School Age ◽  
Perceived Availability ◽  
Semistructured Interviews

ObjectivesLearning to take control of one’s health is an important part of the transition from adolescence to adulthood. This study aimed to explore young adults’ perceptions of living with atopic dermatitis (AD) in relation to the concept of self-management.DesignA qualitative study with an inductive approach was performed through semistructured interviews (n=15). The interviews were recorded, transcribed verbatim and analysed with systematic text condensation.ParticipantsYoung adults (mean age 23,4 years) with persistent AD in a longitudinal population-based birth cohort. To capture experience of living with persistent AD (preschool/school-age onset) of different severity (mild to severe/very severe), a purposive selection was performed. In total, 15 young adults were included. Persistent AD (preschool/school-age onset) was defined as dry skin in combination with itchy rash of typical localisation in the 12 months preceding the 16-year and the 24-year follow-ups. Severity was self-assessed using the Patient Oriented Eczema Measure.ResultsDespite having experience of AD since childhood, the respondents expressed uncertainty about treatment and how it affected their bodies. Their uncertainties and feelings affected how they used topical corticosteroids. The respondents emphasised that they perceived availability of healthcare and knowledge about treatment of AD among healthcare providers to be limited. The participants did not state any experiences of support to self-management from healthcare, which affect young adults’ possibilities to take full control of their AD care.ConclusionsYoung adults with preschool/school-age onset of AD are unsure how to treat and manage the disease. One explanation may be insufficient transition process.

scholarly journals Structure and processes of emergency observation units with a geriatric focus: a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pieter Heeren ◽  
Annabelle Hendrikx ◽  
Janne Ceyssens ◽  
Els Devriendt ◽  
Mieke Deschodt ◽  
...  
Keyword(s):  
Scoping Review ◽  
Emergency Care ◽  
Older Patients ◽  
Clinical Care ◽  
Care Needs ◽  
Post Discharge ◽  
Care Services ◽  
Observation Units ◽  
Primary Care Services ◽  
Healthcare Professions

Abstract Background Combining observation principles and geriatric care concepts is considered a promising strategy for risk-stratification of older patients with emergency care needs. We aimed to map the structure and processes of emergency observation units (EOUs) with a geriatric focus and explore to what extent the comprehensive geriatric assessment (CGA) approach was implemented in EOUs. Methods The revised scoping methodology framework of Arksey and O’Malley was applied. Manuscripts reporting on dedicated areas within hospitals for observation of older patients with emergency care needs were eligible for inclusion. Electronic database searches were performed in MEDLINE, EMBASE and CINAHL in combination with backward snowballing. Two researchers conducted data charting independently. Data-charting forms were developed and iteratively refined. Data inconsistencies were judged by a third researcher or discussed in the research team. Quality assessment was conducted with the Methodological Index for Non-Randomized Studies. Results Sixteen quantitative studies were included reporting on fifteen EOUs in seven countries across three continents. These units were located in the ED, immediately next to the ED or remote from the ED (i.e. hospital-based). All studies reported that staffing consisted of at least three healthcare professions. Observation duration varied between 4 and 72 h. Most studies focused on medical and functional assessment. Four studies reported to assess a patients’ medical, functional, cognitive and social capabilities. If deemed necessary, post-discharge follow-up (e.g. community/primary care services and/or outpatient clinics) was provided in eleven studies. Conclusion This scoping review documented that the structure and processes of EOUs with a geriatric focus are very heterogeneous and rarely cover all elements of CGA. Further research is necessary to determine how complex care principles of ‘observation medicine’ and ‘CGA’ can ideally be merged and successfully implemented in clinical care.

scholarly journals User-centered design of discharge warnings tool for colorectal surgery patients

2017 ◽  
Vol 24 (5) ◽  
pp. 975-980 ◽  
Author(s):  
Aanand D Naik ◽  
Molly J Horstman ◽  
Linda T Li ◽  
Michael K Paasche-Orlow ◽  
Bryan Campbell ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Reading Level ◽  
Heuristic Evaluation ◽  
User Centered Design ◽  
Post Discharge ◽  
Patient Centered ◽  
Discharge Care ◽  
8Th Grade ◽  
Grade Reading Level ◽  
User Centered

Abstract Objectives: Readmission following colorectal surgery, typically due to surgery-related complications, is common. Patient-centered discharge warnings may guide recognition of early complication signs after colorectal surgery. Materials and Methods: User-centered design of a discharge warnings tool consisted of iterative health literacy review and a heuristic evaluation with human factors and clinical experts as well as patient end users to establish content validity and usability. Results: Literacy evaluation of the prototype suggested >12th-grade reading level. Subsequent revisions reduced reading level to 8th grade or below. Contents were formatted during heuristic evaluation into 3 action-oriented zones (green, yellow, and red) with relevant warning lexicons. Usability testing demonstrated comprehension of this 3-level lexicon and recognition of appropriate patient actions to take for each level. Discussion: We developed a discharge warnings tool for colorectal surgery using staged user-centered design. The lexicon of surgical discharge warnings could structure communication among patients, caregivers, and clinicians to improve post-discharge care.

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