scholarly journals Individualization process of the standardized care plan in acute care hospitalization units: Study protocol

2018 ◽  
Vol 75 (1) ◽  
pp. 197-204 ◽  
Author(s):  
Mònica Castellà-Creus ◽  
Pilar Delgado-Hito ◽  
Isabel Andrés-Martínez ◽  
Maria-Eulàlia Juvé-Udina
Keyword(s):  
Acute Care ◽  
Study Protocol ◽  
Care Plan ◽  
Standardized Care

scholarly journals Videogame intervention to increase advance care planning conversations by hospitalists with older adults: study protocol for a stepped-wedge clinical trial

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045084
Author(s):  
D Mohan ◽  
A James O'Malley ◽  
Julia Chelen ◽  
Meredith MacMartin ◽  
Megan Murphy ◽  
...  
Keyword(s):  
Acute Care ◽  
Study Protocol ◽  
Video Game ◽  
Phase Iii ◽  
Care Plan ◽  
Behavioural Intervention ◽  
Quality Improvement Initiative ◽  
Stepped Wedge ◽  
Absolute Increase ◽  
Advance Care

IntroductionFewer than half of all people in the USA have a documented advance care plan (ACP). Hospitalisation offers an opportunity for physicians to initiate ACP conversations. Despite expert recommendations, hospital-based physicians (hospitalists) do not routinely engage in these conversations, reserving them for the critically ill.The objective of this study is to test the effect of a novel behavioural intervention on the incidence of ACP conversations by hospitalists practicing at a stratified random sample of hospitals drawn from 220 US acute care hospitals staffed by a large, nationwide acute care physician practice with an ongoing ACP quality improvement initiative.Methods and analysisWe developed Hopewell Hospitalist, a theory-based adventure video game, to modify physicians' attitudes towards ACP conversations and to increase their motivation for engaging in them. The planned study is a pragmatic stepped-wedge crossover phase III trial, testing the efficacy of Hopewell Hospitalist for increasing ACP conversations. We will randomise 40 hospitals to the month (step) in which they receive the intervention. We aim to recruit 30 hospitalists from up to eight hospitals each step to complete the intervention, playing Hopewell Hospitalist for at least 2 hours. The primary outcome is ACP billing for patients aged 65 and older managed by participating hospitalists. We hypothesise that the intervention will increase ACP billing in the quarter after dissemination, and have 80% power to detect a 1% absolute increase and 99% power to detect a 3.5% absolute increase.Ethics and disseminationDartmouth’s Committee for the Protection of Human Subjects has approved the study protocol, which is registered on clinicaltrials.gov. We will disseminate the results through manuscripts and the trials website. Hopewell Hospitalist will be made available on the iOS Application Store for download, free of cost, at the conclusion of the trial.Trial registration numberNCT04557930.

scholarly journals Economic evaluation of Australian acute care accreditation (ACCREDIT-CBA (Acute)): study protocol for a mixed-method research project

BMJ Open ◽  
2013 ◽  
Vol 3 (2) ◽  
pp. e002381 ◽  
Author(s):  
Virginia Mumford ◽  
David Greenfield ◽  
Reece Hinchcliff ◽  
Max Moldovan ◽  
Kevin Forde ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Acute Care ◽  
Study Protocol ◽  
Mixed Method ◽  
Mixed Method Research ◽  
Research Project ◽  
Acute Study

Standardized care plan for the child with bacterial meningitis

1987 ◽  
Vol 7 (5) ◽  
pp. 66-76 ◽  
Author(s):  
MB LeBoeuf ◽  
M Greco-Gallagher
Keyword(s):  
Bacterial Meningitis ◽  
Care Plan ◽  
Standardized Care

scholarly journals Developing a framework to guide the de-adoption of low-value clinical practices in acute care medicine: a study protocol

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Jeanna Parsons Leigh ◽  
Daniel J. Niven ◽  
Jamie M. Boyd ◽  
Henry T. Stelfox
Keyword(s):  
Acute Care ◽  
Study Protocol ◽  
Clinical Practices

scholarly journals User-centered design of a longitudinal care plan for children with medical complexity

2020 ◽  
Vol 27 (12) ◽  
pp. 1860-1870
Author(s):  
Arti D Desai ◽  
Grace Wang ◽  
Julia Wignall ◽  
Dylan Kinard ◽  
Vidhi Singh ◽  
...  
Keyword(s):  
Acute Care ◽  
Information Needs ◽  
Healthcare Providers ◽  
Care Plan ◽  
User Centered Design ◽  
Children With Medical Complexity ◽  
Medical Complexity ◽  
Care Coordinators ◽  
Acute Care Settings ◽  
Design Preferences

Abstract Objective To determine the content priorities and design preferences for a longitudinal care plan (LCP) among caregivers and healthcare providers who care for children with medical complexity (CMC) in acute care settings. Materials and Methods We conducted iterative one-on-one design sessions with CMC caregivers (ie, parents/legal guardians) and providers from 5 groups: complex care, primary care, subspecialists, emergency care, and care coordinators. Audio-recorded sessions included content categorization activities, drawing exercises, and scenario-based testing of an electronic LCP prototype. We applied inductive content analysis of session materials to elicit content priorities and design preferences between sessions. Analysis informed iterative prototype revisions. Results We conducted 30 design sessions (10 with caregivers, 20 with providers). Caregivers expressed high within-group variability in their content priorities compared to provider groups. Emergency providers had the most unique content priorities among clinicians. We identified 6 key design preferences: a familiar yet customizable layout, a problem-based organization schema, linked content between sections, a table layout for most sections, a balance between unstructured and structured data fields, and use of family-centered terminology. Discussion Findings from this study will inform enhancements of electronic health record-embedded LCPs and the development of new LCP tools and applications. The design preferences we identified provide a framework for optimizing integration of family and provider content priorities while maintaining a user-tailored experience. Conclusion Health information platforms that incorporate these design preferences into electronic LCPs will help meet the information needs of caregivers and providers caring for CMC in acute care settings.

scholarly journals Potential of an Electronic Health Record-Integrated Patient Portal for Improving Care Plan Concordance during Acute Care

2019 ◽  
Vol 10 (03) ◽  
pp. 358-366 ◽  
Author(s):  
Anuj K. Dalal ◽  
Patricia Dykes ◽  
Lipika Samal ◽  
Kelly McNally ◽  
Eli Mlaver ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Acute Care ◽  
Transitions Of Care ◽  
Care Plan ◽  
Health Record ◽  
Patient Portal ◽  
Intention To Treat ◽  
Electronic Health ◽  
The Impact ◽  
Treat Analysis

Background Care plan concordance among patients and clinicians during hospitalization is suboptimal. Objective This article determines whether an electronic health record (EHR)-integrated patient portal was associated with increased understanding of the care plan, including the key recovery goal, among patients and clinicians in acute care setting. Methods The intervention included (1) a patient portal configured to solicit a single patient-designated recovery goal and display the care plan from the EHR for participating patients; and (2) an electronic care plan for all unit-based nurses that displays patient-inputted information, accessible to all clinicians via the EHR. Patients admitted to an oncology unit, including their nurses and physicians, were enrolled before and after implementation. Main outcomes included mean concordance scores for the overall care plan and individual care plan elements. Results Of 457 and 283 eligible patients approached during pre- and postintervention periods, 55 and 46 participated in interviews, respectively, including their clinicians. Of 46 postintervention patients, 27 (58.7%) enrolled in the patient portal. The intention-to-treat analysis demonstrated a nonsignificant increase in the mean concordance score for the overall care plan (62.0–67.1, adjusted p = 0.13), and significant increases in mean concordance scores for the recovery goal (30.3–57.7, adjusted p < 0.01) and main reason for hospitalization (58.6–79.2, adjusted p < 0.01). The on-treatment analysis of patient portal enrollees demonstrated significant increases in mean concordance scores for the overall care plan (61.9–70.0, adjusted p < 0.01), the recovery goal (30.4–66.8, adjusted p < 0.01), and main reason for hospitalization (58.3–81.7, adjusted p < 0.01), comparable to the intention-to-treat analysis. Conclusion Implementation of an EHR-integrated patient portal was associated with increased concordance for key care plan components. Future efforts should be directed at improving concordance for other care plan components and conducting larger, randomized studies to evaluate the impact on key outcomes during transitions of care. Clinical Trials Identifier NCT02258594.

Improving the final year of life at the institutional level: Quality dying initiative (QDI).

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 124-124
Author(s):  
Jeff Myers ◽  
Tracey DasGupta
Keyword(s):  
Acute Care ◽  
Large Scale ◽  
Care Setting ◽  
Family Members ◽  
Care Plan ◽  
Acute Care Setting ◽  
Improvement Project ◽  
Implementation Phase ◽  
Dying Patients ◽  
Care Of The Dying

124 Background: For a tertiary academic health sciences and comprehensive cancer centre, care of the dying is a significant element of the institution’s overall patient and family care experience. The aim for this large-scale quality improvement project was to improve the quality of the experience for a patient in the final year of life and their family members. Methods: This is descriptive study involves one institution and the characterization of three distinct patient populations: A - Imminently dying patients for whom care goals have been clarified to be comfort, B - Patients for whom death “this admission” would not be a surprise and C - Among patients being discharged, death “within the next year” would not be a surprise, linking in the outpatient cancer care setting. Results: On average 19 deaths per week are in some way expected for the institution’s acute care setting. Phase 1 of the QDI included a review of evidence and best practices in care of the dying as well as comprehensive plans for both organizational engagement and communications. Phase 2 of the QDI (i.e. “Implementation Phase”) involved interventions for each patient population. A corporate-wide “Comfort Strategy” was developed to address Population A. Components include standardized order sets, standardized interprofessional “Comfort Assessment and Documentation”, the palliative care team’s “Coaching Consult”, a “Family Member Education” process and an evaluation plan that includes an experience survey routinely sent to family members following a patient’s death. The intervention was piloted on and subsequently rolled out to all inpatient oncology units. Interventions for Population B and C are the triggering of Goals of Care and Advance Care Plan discussions respectively. Key metrics have been identified for all three patient populations and are based on care elements considered important by dying patients and their family members. These now comprise a dashboard, which has been endorsed for roll out to all patient care units in the acute care setting. Conclusions: A quality framework can be effectively applied for the institutional context of developing an approach to improving the final year of life for a cancer patient.

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