Browsing by Subject "Documentation"

Now showing 1 - 6 of 6
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    Assessing Key Stakeholders' Knowledge, Needs, and Preferences for Head and Neck Cancer Survivorship Care Plans.
    (Journal of cancer education : the official journal of the American Association for Cancer Education, 2019-06) Zullig, Leah L; Ramos, Katherine; Berkowitz, Callie; Miller, Julie J; Dolor, Rowena J; Koontz, Bridget F; Yousuf Zafar, S; Hutch Allen, D; Tenhover, Jennifer A; Bosworth, Hayden B
    Cancer survivorship care plans (SCPs) are endorsed to support quality care for cancer survivors, but uptake is slow. We assessed knowledge, needs, and preferences for SCP content and delivery from a wide variety of stakeholders. We focused SCP content for head and neck cancer as it is a disease prone to long-term side effects requiring management from multiple providers. We conducted telephone-based, qualitative interviews. We purposively sampled head and neck cancer survivors (n = 4), primary care physicians in the community (n = 5), and providers affiliated with a large academic medical center (n = 5) who treat head and neck cancer, cancer specialists (n = 6), and nurse practitioners/supportive care staff (n = 5). Interviews were recorded, transcribed, and analyzed using direct content analysis. Few participants reported personal experience with SCPs, but most supported the concept. Several key themes emerged: (1) perceived ambiguity regarding roles and responsibilities for SCPs, (2) a need to tailor the content and language based on the intended recipient, (3) documentation process should be as automated and streamlined as possible, (4) concerns about using the SCP to coordinate with outside providers, and (5) that SCPs would have added value as a "living document." We also report SCP-related issues that are unique to serving patients diagnosed with head and neck cancer. Effort is needed to tailor SCPs for different recipients and optimize their potential for successful implementation, impact on care outcomes, and sustainability. Many cancer survivors may not receive a SCP as part of routine care. Survivors could engage their health care team by requesting a SCP.
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    Forensic document examination and algorithmic handwriting analysis of Judahite biblical period inscriptions reveal significant literacy level.
    (PloS one, 2020-01) Shaus, Arie; Gerber, Yana; Faigenbaum-Golovin, Shira; Sober, Barak; Piasetzky, Eli; Finkelstein, Israel
    Arad is a well preserved desert fort on the southern frontier of the biblical kingdom of Judah. Excavation of the site yielded over 100 Hebrew ostraca (ink inscriptions on potsherds) dated to ca. 600 BCE, the eve of Nebuchadnezzar's destruction of Jerusalem. Due to the site's isolation, small size and texts that were written in a short time span, the Arad corpus holds important keys to understanding dissemination of literacy in Judah. Here we present the handwriting analysis of 18 Arad inscriptions, including more than 150 pair-wise assessments of writer's identity. The examination was performed by two new algorithmic handwriting analysis methods and independently by a professional forensic document examiner. To the best of our knowledge, no such large-scale pair-wise assessments of ancient documents by a forensic expert has previously been published. Comparison of forensic examination with algorithmic analysis is also unique. Our study demonstrates substantial agreement between the results of these independent methods of investigation. Remarkably, the forensic examination reveals a high probability of at least 12 writers within the analyzed corpus. This is a major increment over the previously published algorithmic estimations, which revealed 4-7 writers for the same assemblage. The high literacy rate detected within the small Arad stronghold, estimated (using broadly-accepted paleo-demographic coefficients) to have accommodated 20-30 soldiers, demonstrates widespread literacy in the late 7th century BCE Judahite military and administration apparatuses, with the ability to compose biblical texts during this period a possible by-product.
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    Implementation of Changes to Medical Student Documentation at Duke University Health System: Balancing Education With Service.
    (Academic medicine : journal of the Association of American Medical Colleges, 2021-06) Gagliardi, Jane P; Bonanno, Brian; McPeek Hinz, Eugenia R; Musser, R Clayton; Knudsen, Nancy W; Palko, Michael; McNair, Felice; Lee, Hui-Jie; Clay, Alison S

    Purpose

    When the Centers for Medicare and Medicaid Services (CMS) changed policies about medical student documentation, students with proper supervision may now document their history, physical exam, and medical decision making in the electronic health record (EHR) for billable encounters. Since documentation is a core entrustable professional activity for medical students, the authors sought to evaluate student opportunities for documentation and feedback across and between clerkships.

    Method

    In February 2018, a multidisciplinary workgroup was formed to implement student documentation at Duke University Health System, including educating trainees and supervisors, tracking EHR usage, and enforcing CMS compliance. From August 2018 to August 2019, locations and types of student-involved services (student-faculty or student-resident-faculty) were tracked using billing data from attestation statements. Student end-of-clerkship evaluations included opportunity for documentation and receipt of feedback. Since documentation was not allowed before August 2018, it was not possible to compare with prior student experiences.

    Results

    In the first half of the academic year, 6,972 patient encounters were billed as student-involved services, 52% (n = 3,612) in the inpatient setting and 47% (n = 3,257) in the outpatient setting. Most (74%) of the inpatient encounters also involved residents, and most (92%) of outpatient encounters were student-teaching physician only.Approximately 90% of students indicated having had opportunity to document in the EHR across clerkships, except for procedure-based clerkships such as surgery and obstetrics. Receipt of feedback was present along with opportunity for documentation more than 85% of the time on services using evaluation and management coding. Most students (> 90%) viewed their documentation as having a moderate or high impact on patient care.

    Conclusions

    Changes to student documentation were successfully implemented and adopted; changes met both compliance and education needs within the health system without resulting in potential abuses of student work for service.
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    Multispectral imaging reveals biblical-period inscription unnoticed for half a century.
    (PloS one, 2017-01) Faigenbaum-Golovin, Shira; Mendel-Geberovich, Anat; Shaus, Arie; Sober, Barak; Cordonsky, Michael; Levin, David; Moinester, Murray; Sass, Benjamin; Turkel, Eli; Piasetzky, Eli; Finkelstein, Israel
    Most surviving biblical period Hebrew inscriptions are ostraca-ink-on-clay texts. They are poorly preserved and once unearthed, fade rapidly. Therefore, proper and timely documentation of ostraca is essential. Here we show a striking example of a hitherto invisible text on the back side of an ostracon revealed via multispectral imaging. This ostracon, found at the desert fortress of Arad and dated to ca. 600 BCE (the eve of Judah's destruction by Nebuchadnezzar), has been on display for half a century. Its front side has been thoroughly studied, while its back side was considered blank. Our research revealed three lines of text on the supposedly blank side and four "new" lines on the front side. Our results demonstrate the need for multispectral image acquisition for both sides of all ancient ink ostraca. Moreover, in certain cases we recommend employing multispectral techniques for screening newly unearthed ceramic potsherds prior to disposal.
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    Provider Interaction With an Electronic Health Record Notification to Identify Eligible Patients for a Cluster Randomized Trial of Advance Care Planning in Primary Care: Secondary Analysis.
    (Journal of medical Internet research, 2023-05) Ma, Jessica E; Lowe, Jared; Berkowitz, Callie; Kim, Azalea; Togo, Ira; Musser, R Clayton; Fischer, Jonathan; Shah, Kevin; Ibrahim, Salam; Bosworth, Hayden B; Totten, Annette M; Dolor, Rowena

    Background

    Advance care planning (ACP) improves patient-provider communication and aligns care to patient values, preferences, and goals. Within a multisite Meta-network Learning and Research Center ACP study, one health system deployed an electronic health record (EHR) notification and algorithm to alert providers about patients potentially appropriate for ACP and the clinical study.

    Objective

    The aim of the study is to describe the implementation and usage of an EHR notification for referring patients to an ACP study, evaluate the association of notifications with study referrals and engagement in ACP, and assess provider interactions with and perspectives on the notifications.

    Methods

    A secondary analysis assessed provider usage and their response to the notification (eg, acknowledge, dismiss, or engage patient in ACP conversation and refer patient to the clinical study). We evaluated all patients identified by the EHR algorithm during the Meta-network Learning and Research Center ACP study. Descriptive statistics compared patients referred to the study to those who were not referred to the study. Health care utilization, hospice referrals, and mortality as well as documentation and billing for ACP and related legal documents are reported. We evaluated associations between notifications with provider actions (ie, referral to study, ACP not documentation, and ACP billing). Provider free-text comments in the notifications were summarized qualitatively. Providers were surveyed on their satisfaction with the notification.

    Results

    Among the 2877 patients identified by the EHR algorithm over 20 months, 17,047 unique notifications were presented to 45 providers in 6 clinics, who then referred 290 (10%) patients. Providers had a median of 269 (IQR 65-552) total notifications, and patients had a median of 4 (IQR 2-8). Patients with more (over 5) notifications were less likely to be referred to the study than those with fewer notifications (57/1092, 5.2% vs 233/1785, 13.1%; P<.001). The most common free-text comment on the notification was lack of time. Providers who referred patients to the study were more likely to document ACP and submit ACP billing codes (P<.001). In the survey, 11 providers would recommend the notification (n=7, 64%); however, the notification impacted clinical workflow (n=9, 82%) and was difficult to navigate (n=6, 55%).

    Conclusions

    An EHR notification can be implemented to remind providers to both perform ACP conversations and refer patients to a clinical study. There were diminishing returns after the fifth EHR notification where additional notifications did not lead to more trial referrals, ACP documentation, or ACP billing. Creation and optimization of EHR notifications for study referrals and ACP should consider the provider user, their workflow, and alert fatigue to improve implementation and adoption.

    Trial registration

    ClinicalTrials.gov NCT03577002; https://clinicaltrials.gov/ct2/show/NCT03577002.
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    Using PDSA cycles to improve oral care compliance.
    (American journal of infection control, 2023-01) Williams, Bridget; Doran Shelley, Paula; Patel, Vishal; Prothro, Celeste; Reynolds, Staci S
    Oral care has been shown to reduce healthcare-associated pneumonia (HAP) rates, however, compliance with this practice is suboptimal. Using quality improvement PDSA cycles over an 8-week period, we saw improvements in oral care documentation compliance through statistical process control charts; HAP rates did not significantly decrease. Infection prevention leadership should consider regularly incorporating PDSA cycles to improve compliance with evidence-based infection prevention practices.