scholarly journals System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation (Preprint)

2020 ◽  
Author(s):  
Diego Garcia-Huidobro ◽  
Solange Rivera ◽  
Sebastián Valderrama Chang ◽  
Paula Bravo ◽  
Daniel Capurro
Keyword(s):  
Patient Satisfaction ◽  
Online Survey ◽  
Clinical Skills ◽  
Diagnostic Process ◽  
Control Group ◽  
Health Network ◽  
Provider Perceptions ◽  
Concurrent Control ◽  
The Impact ◽  
Concurrent Control Group

BACKGROUND As the COVID-19 pandemic disrupted medical practice, telemedicine emerged as an alternative to outpatient visits. However, it is not known how patients and physicians responded to an accelerated implementation of this model of medical care. OBJECTIVE The aim of this study is to report the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions. METHODS This study was conducted at the UC Christus Health Network, a large private academic health network in Santiago, Chile. The satisfaction of patients receiving telemedicine care in March and April 2020 was compared to those receiving in-person care during the same period (concurrent control group) as well as in March and April 2019 (retrospective control group). Patient satisfaction with in-person care was measured using the Net Promoter Score (NPS) survey. Patient satisfaction with telemedicine was assessed with an online survey assessing similar domains. Providers rated their satisfaction and responded to open-ended questions assessing challenges, strategies used to address challenges, the diagnostic process, treatment, and the patient-provider relationship. RESULTS A total of 3962 patients receiving telemedicine, 1187 patients from the concurrent control group, and 1848 patients from the retrospective control group completed the surveys. Satisfaction was very high with both telemedicine and in-person services. Overall, 263 physicians from over 41 specialties responded to the survey. During telemedicine visits, most providers felt their clinical skills were challenged (61.8%). Female providers felt more challenged than male providers (70.7% versus 50.9%, <i>P</i>=.002). Surgeons, obstetricians, and gynecologists felt their clinical skills were challenged the least, compared to providers from nonsurgical specialties (<i>P</i>&lt;.001). Challenges related to the delivery modality, diagnostic process, and patient-provider relationship differed by provider specialty (<i>P</i>=.046, <i>P</i>&lt;.001, and <i>P</i>=.02, respectively). CONCLUSIONS Telemedicine implemented in response to the COVID-19 pandemic produced high patient and provider satisfaction. Specialty groups perceived the impact of this new mode of clinical practice differently.

scholarly journals System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation

10.2196/22146 ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. e22146
Author(s):  
Diego Garcia-Huidobro ◽  
Solange Rivera ◽  
Sebastián Valderrama Chang ◽  
Paula Bravo ◽  
Daniel Capurro
Keyword(s):  
Patient Satisfaction ◽  
Online Survey ◽  
Clinical Skills ◽  
Diagnostic Process ◽  
Control Group ◽  
Health Network ◽  
Provider Perceptions ◽  
Concurrent Control ◽  
The Impact ◽  
Concurrent Control Group

Background As the COVID-19 pandemic disrupted medical practice, telemedicine emerged as an alternative to outpatient visits. However, it is not known how patients and physicians responded to an accelerated implementation of this model of medical care. Objective The aim of this study is to report the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions. Methods This study was conducted at the UC Christus Health Network, a large private academic health network in Santiago, Chile. The satisfaction of patients receiving telemedicine care in March and April 2020 was compared to those receiving in-person care during the same period (concurrent control group) as well as in March and April 2019 (retrospective control group). Patient satisfaction with in-person care was measured using the Net Promoter Score (NPS) survey. Patient satisfaction with telemedicine was assessed with an online survey assessing similar domains. Providers rated their satisfaction and responded to open-ended questions assessing challenges, strategies used to address challenges, the diagnostic process, treatment, and the patient-provider relationship. Results A total of 3962 patients receiving telemedicine, 1187 patients from the concurrent control group, and 1848 patients from the retrospective control group completed the surveys. Satisfaction was very high with both telemedicine and in-person services. Overall, 263 physicians from over 41 specialties responded to the survey. During telemedicine visits, most providers felt their clinical skills were challenged (61.8%). Female providers felt more challenged than male providers (70.7% versus 50.9%, P=.002). Surgeons, obstetricians, and gynecologists felt their clinical skills were challenged the least, compared to providers from nonsurgical specialties (P<.001). Challenges related to the delivery modality, diagnostic process, and patient-provider relationship differed by provider specialty (P=.046, P<.001, and P=.02, respectively). Conclusions Telemedicine implemented in response to the COVID-19 pandemic produced high patient and provider satisfaction. Specialty groups perceived the impact of this new mode of clinical practice differently.

A comparison of randomized concurrent control groups with matched historical control groups: are historical controls valid?

1986 ◽  
Vol 4 (7) ◽  
pp. 1114-1120 ◽  
Author(s):  
L F Diehl ◽  
D J Perry
Keyword(s):  
Historical Control Group ◽  
Historical Control ◽  
Disease Stage ◽  
Control Group ◽  
Control Groups ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Concurrent Control ◽  
Percentage Points ◽  
Concurrent Control Group

The use of a historical control group is predicated on the assumption that survival and relapse-free survival in the historical control group closely approximate the survival and relapse-free survival in a randomized concurrent control group. This assumption has never been tested. This study compares survival and relapse-free survival in randomized control groups with historical control groups matched for disease, stage, and follow-up. Of the 43 matched control groups, 42% varied by more than 10 percentage points, 21% varied by more than 20 percentage points, and 5% varied by more than 30 percentage points. Of the 18 that varied by greater than 10 percentage points, 17 had superior survival or relapse-free survival in the randomized concurrent control group. This study indicates that the assumption that historical control groups may replace randomized concurrent control groups is not valid.

scholarly journals Impact of COVID-19 on Malaysian Dental Students’ Physical, Mental, Financial and Academic Concerns

2021 ◽  
Author(s):  
Widya Lestari ◽  
Nur Hazirah Yazid ◽  
Zawin Najah Azhar ◽  
Azlini Ismail ◽  
Cortino Sukotjo
Keyword(s):  
Online Survey ◽  
Clinical Skills ◽  
Clinical Skill ◽  
Cross Sectional Study ◽  
Dental Students ◽  
Health Concern ◽  
Financial Health ◽  
Cross Sectional ◽  
Novel Coronavirus ◽  
The Impact

Abstract Background The coronavirus disease 2019 (COVID-19) caused by a novel coronavirus (SARS-CoV-2) has spread across the world at unprecedented speed and gained worldwide attention. The pandemic proved to hold an impact to humankind including dental students in all aspects of life. Dental students’ performances may indirectly be affected following the preventive measures in containing the disease. This study aims to evaluate the impact of COVID-19 pandemic on physical, mental, financial health and academic concern among dental students in Malaysia. Methods The current research implemented a cross sectional study among dental students in Malaysia. Assessment of the impact of COVID-19 on dental education was done by the distribution of a set of online survey consisting of 28 questions to dental students (n = 353) from public and private universities in Malaysia. The questionnaires include sociodemographic backgrounds and assessment on the 4 main domains. Results A total number of 353 respondents was recorded and 76.2% comprised of female. 59.7% were clinical students and 40.3% were preclinical students. 55.8% of the respondents attended hybrid mode of study. 78.0%, 76.5% and 91.8% students were concerned about their own emotional, physical health and the amount of clinical skill they acquire respectively. Year 3 students were found to be more concerned about their mental and financial health concern (p < 0.05). Conclusions COVID-19 pandemic had indeed significantly affected Malaysian dental students mainly due to fear of the quality of online learning and the amount of clinical skills acquired.

scholarly journals The patient satisfaction in primary care consultation—Questionnaire (PiC): An instrument to assess the impact of patient-centred communication on patient satisfaction

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254644
Author(s):  
Stefanie Stark ◽  
Lukas Worm ◽  
Marie Kluge ◽  
Marco Roos ◽  
Larissa Burggraf
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Control Group ◽  
Present Sample ◽  
Survey Tool ◽  
Randomised Study ◽  
Primary Care Consultation ◽  
Care Consultation ◽  
And Control ◽  
The Impact

Background Primary care consultation is significantly influenced by communication between the General Practitioner (GP) and their patients. Hypothesising that patient satisfaction can be tested based on an expectation-experience comparison, the aim of this article is to discuss the influence of communication on patient satisfaction. Methods A standardised questionnaire was developed striving for a universal primary care survey tool that focuses on patient satisfaction in the context of patient-centred-communication. The sample consisted of 14 German GPs with 80 patients each (n = 1120). Due to the inclusion in an overarching cluster-randomised-study (CRT), the medical practices to be examined were divided into intervention and control groups. The intervention was developed as a reflective training on patient-centred communication. Results The results in the present sample show no correlation between patient-centred-communication and patient satisfaction. There are also no significant differences between the intervention and control group. Discussion The results raise the question to what extent patient satisfaction can be shaped significantly through patient-centred-communication. The presented project represents part of the basic research in general medical care research and contributes to the transparent processing of theoretical assumptions. With the results described here, communication models with a focus on patient centredness can be evaluated with regard to their practical relevance and transferability.

Changing pattern of pulmonary metastases with adjuvant chemotherapy in patients with osteosarcoma: results from the multiinstitutional osteosarcoma study.

1991 ◽  
Vol 9 (4) ◽  
pp. 600-605 ◽  
Author(s):  
A M Goorin ◽  
J J Shuster ◽  
A Baker ◽  
M E Horowitz ◽  
W H Meyer ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Pulmonary Nodules ◽  
Pulmonary Involvement ◽  
Control Group ◽  
Event Free Survival ◽  
Free Survival ◽  
Concurrent Control ◽  
Survival After Relapse ◽  
Disease Free ◽  
Concurrent Control Group

The multiinstitutional osteosarcoma study (MIOS), a randomized trial of adjuvant therapy for osteosarcoma with a concurrent control group, registered 113 patients from June 1982 to August 1984. Preliminary analysis of the study indicated a significant event-free survival advantage favoring immediate adjuvant chemotherapy, (P less than .001). For patients treated with surgery alone or with surgery and adjuvant chemotherapy, the lungs were involved in more than 80% of the relapses. Patients relapsing after surgery alone tended to relapse earlier (P less than .01), had more pulmonary nodules (P less than .01), and had more frequent bilateral pulmonary involvement (P less than .01) than those treated with immediate postsurgical adjuvant chemotherapy. However, patients relapsing after treatment with surgery alone experienced a significantly longer interval to further disease progression (P less than .01) and improved survival after relapse (P = .01) when compared with patients who relapsed after treatment with immediate adjuvant chemotherapy. The only factor predictive of survival after relapse was if the patient could be made surgically disease-free after initial relapse (P = .03).

scholarly journals P115: Bounceback reports-improving patient care

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S97-S98
Author(s):  
F. Pinto ◽  
M. B-Lajoie
Keyword(s):  
Online Survey ◽  
Response Rate ◽  
Clinical Skills ◽  
High Yield ◽  
Academic Hospital ◽  
Outcome Feedback ◽  
Improving Patient Care ◽  
The Impact ◽  
Final Disposition

Introduction: Seeking patient outcome feedback (POF), defined as obtaining information on a patients clinical course beyond ones care, is crucial to the learning process. However, the lack of POF is a major pitfall of emergency medicine. Emergency department (ED) bouncebacks, which are characterized as patients with unplanned returns to the ED after being discharged, are an important type of POF to study because they represent a potential misdiagnosis or mismanagement and can highlight areas for physician self-improvement. Currently, most hospitals do not relay details about ED bouncebacks back to the treating physician, unless a grave error occurred. This studys purpose is to provide weekly reports to all physicians in the ED on patients who have unplanned returns within 7 days of discharge from the ED, and evaluate the impact this has on the physicians practice on seeking POF. Methods: A new weekly report was distributed to physicians working at an academic hospital outlining the patients who have returned within 7 days of discharge from the ED, their new presenting complaint and final disposition. An online survey was also administered to all ED staff evaluating the amount of POF they sought pre and post report, and their attitude towards the new reports. Results: 22 responses were received, for a response rate of 85%. The majority of respondents follow the reports (73%) and actively seek POF by looking up patients charts and results(70%). Additionally, 58% state that they seek POF more often since receiving these reports, for both the bouncebacks and their other patients. Furthermore, 37% claimed that the reports helped improve the appropriateness of their referrals and 32% stated it helped increase their confidence in their clinical practice. The majority of physicians (87%) found the reports to be helpful and would like to continue receiving it. Conclusion: Weekly bounceback reports are a high-yield tool for increasing POF sought in the ED and have benefits for both the physician and the department as a whole. They can be used to not only identify patients who may have had an error in their management, but also help to improve physicians’ clinical skills by encouraging and enabling follow-up of patients they managed. Thus, bounceback reports are a valuable tool to provide to physicians and should be considered by ED Departments.

Impacting Readmission Rates and Patient Satisfaction: Results of a Discharge Pharmacist Pilot Program

2011 ◽  
Vol 46 (11) ◽  
pp. 876-883 ◽  
Author(s):  
Samaneh Tavalali Wilkinson ◽  
Pal Aroop ◽  
J. Couldry Richard
Keyword(s):  
Patient Satisfaction ◽  
High Risk ◽  
Readmission Rate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Control Group ◽  
Unplanned Readmission ◽  
Discharge Process ◽  
Readmission Rates ◽  
The Impact

Background Readmission to a hospital within 30 days of discharge has become a key quality outcome measure. With an observed 30-day readmission rate as high as 20% and attributed costs of almost $17.4 billion a year for Medicare patients, the potential implications for patients and the entire health care system are significant. Medication-related complications have been shown to increase the risk for unplanned readmission. Pharmacists have an opportunity to impact quality and cost by risk stratifying and identify patients at high risk for hospital readmission. Objective To study the impact of a pharmacist-driven discharge counseling program for high-risk patients identified by BOOST (Better Outcomes for Older adults through Safe Transitions) criteria on 30-day readmission rates. Method This was a prospective, cohort, nonrandomized trial at a single medical-surgical unit with telemetry capability at a single academic medical center including 669 patients who were older than 18 years. Primary outcome was 30-day readmission rate. Secondary outcomes were the number and type of pharmacist interventions, cost avoidance, and patient satisfaction results. Results The readmission rate for patients counseled by a pharmacist during the discharge process was 15.7% compared to 21.6% for patients not counseled by a pharmacist on discharge (relative risk [RR] 0.728; 95% confidence interval [CI], 0.514–1.032; P = .04). The readmission rate for adult medicine patients not counseled at discharge by a pharmacist in the study was comparable to the readmission rates of a similar patient control group at 3 months and 1 year prior to the initiation of the study (18.7% and 19.1% vs 19.6%). Conclusions Pharmacists' support in the discharge process facilitated increased communication on the multidisciplinary team and resulted in a lower unplanned readmission rate for patients.

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