Browsing by Subject "Patient-Centered Care"
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Item Open Access A conceptual framework for patient-centered fertility treatment.(Reproductive health, 2017-09-07) Duthie, Elizabeth A; Cooper, Alexandra; Davis, Joseph B; Schoyer, Katherine D; Sandlow, Jay; Strawn, Estil Y; Flynn, Kathryn EBACKGROUND:Patient-centered care is a pillar of quality health care and is important to patients experiencing infertility. In this study we used empirical, in-depth data on couples' experiences of infertility treatment decision making to inform and revise a conceptual framework for patient-centered fertility treatment that was developed based on health care professionals' conceptualizations of fertility treatment, covering effectiveness, burden, safety, and costs. METHODS:In this prospective, longitudinal mixed methods study, we collected data from both members (separately) of 37 couples who scheduled an initial consult with a reproductive specialist. Data collection occurred 1 week before the initial consultation, 1 week after the initial consultation, and then roughly 2, 4, 8, and 12 months later. Data collection included semi-structured qualitative interviews, self-reported questionnaires, and medical record review. Interviews were recorded, transcribed, and content analyzed in NVivo. A single coder analyzed all transcripts, with > 25% of transcripts coded by a second coder to ensure quality control and consistency. RESULTS:Content analysis of the interview transcripts revealed 6 treatment dimensions: effectiveness, physical and emotional burden, time, cost, potential risks, and genetic parentage. Thus, the revised framework for patient-centered fertility treatment retains much from the original framework, with modification to one dimension (from safety to potential risks) and the addition of two dimensions (time and genetic parentage). For patients and their partners making fertility treatment decisions, tradeoffs are explicitly considered across dimensions as opposed to each dimension being considered on its own. CONCLUSIONS:Patient-centered fertility treatment should account for the dimensions of treatment that patients and their partners weigh when making decisions about how to add a child to their family. Based on the lived experiences of couples seeking specialist medical care for infertility, this revised conceptual framework can be used to inform patient-centered treatment and research on infertility and to develop decision support tools for patients and providers.Item Open Access A re-conceptualization of access for 21st century healthcare.(Journal of general internal medicine, 2011-11) Fortney, John C; Burgess, James F; Bosworth, Hayden B; Booth, Brenda M; Kaboli, Peter JMany e-health technologies are available to promote virtual patient-provider communication outside the context of face-to-face clinical encounters. Current digital communication modalities include cell phones, smartphones, interactive voice response, text messages, e-mails, clinic-based interactive video, home-based web-cams, mobile smartphone two-way cameras, personal monitoring devices, kiosks, dashboards, personal health records, web-based portals, social networking sites, secure chat rooms, and on-line forums. Improvements in digital access could drastically diminish the geographical, temporal, and cultural access problems faced by many patients. Conversely, a growing digital divide could create greater access disparities for some populations. As the paradigm of healthcare delivery evolves towards greater reliance on non-encounter-based digital communications between patients and their care teams, it is critical that our theoretical conceptualization of access undergoes a concurrent paradigm shift to make it more relevant for the digital age. The traditional conceptualizations and indicators of access are not well adapted to measure access to health services that are delivered digitally outside the context of face-to-face encounters with providers. This paper provides an overview of digital "encounterless" utilization, discusses the weaknesses of traditional conceptual frameworks of access, presents a new access framework, provides recommendations for how to measure access in the new framework, and discusses future directions for research on access.Item Open Access Anesthesia-Guided Palliative Care in the Perioperative Surgical Home Model.(Anesthesia and analgesia, 2018-07) Cobert, Julien; Hauck, Jennifer; Flanagan, Ellen; Knudsen, Nancy; Galanos, AnthonyItem Open Access Benefits of Population Segmentation Analysis for Developing Health Policy to Promote Patient-Centred Care.(Annals of the Academy of Medicine, Singapore, 2017-07) Chong, Jia Loon; Matchar, David BItem Open Access Can Right-Sizing the Use of Virtual Care Improve Access to Equitable, Patient-Centered Care for Women Veterans?(Journal of general internal medicine, 2023-07) Goldstein, Karen M; Bosworth, Hayden B; Gierisch, Jennifer MItem Open Access Can we understand population healthcare needs using electronic medical records?(Singapore medical journal, 2019-09) Chong, Jia Loon; Low, Lian Leng; Chan, Darren Yak Leong; Shen, Yuzeng; Thin, Thiri Naing; Ong, Marcus Eng Hock; Matchar, David BruceIntroduction
The identification of population-level healthcare needs using hospital electronic medical records (EMRs) is a promising approach for the evaluation and development of tailored healthcare services. Population segmentation based on healthcare needs may be possible using information on health and social service needs from EMRs. However, it is currently unknown if EMRs from restructured hospitals in Singapore provide information of sufficient quality for this purpose. We compared the inter-rater reliability between a population segment that was assigned prospectively and one that was assigned retrospectively based on EMR review.Methods
200 non-critical patients aged ≥ 55 years were prospectively evaluated by clinicians for their healthcare needs in the emergency department at Singapore General Hospital, Singapore. Trained clinician raters with no prior knowledge of these patients subsequently accessed the EMR up to the prospective rating date. A similar healthcare needs evaluation was conducted using the EMR. The inter-rater reliability between the two rating sets was evaluated using Cohen's Kappa and the incidence of missing information was tabulated.Results
The inter-rater reliability for the medical 'global impression' rating was 0.37 for doctors and 0.35 for nurses. The inter-rater reliability for the same variable, retrospectively rated by two doctors, was 0.75. Variables with a higher incidence of missing EMR information such as 'social support in case of need' and 'patient activation' had poorer inter-rater reliability.Conclusion
Pre-existing EMR systems may not capture sufficient information for reliable determination of healthcare needs. Thus, we should consider integrating policy-relevant healthcare need variables into EMRs.Item Open Access Consideration of Out-of-Office Blood Pressure Monitoring in Hypertension Management.(Journal of clinical hypertension (Greenwich, Conn.), 2016-05) Goldstein, Karen M; Zullig, Leah L; Bosworth, Hayden B; Oddone, Eugene ZItem Open Access Improving Care Coordination for Veterans Within VA and Across Healthcare Systems.(Journal of general internal medicine, 2019-05) Cordasco, Kristina M; Hynes, Denise M; Mattocks, Kristin M; Bastian, Lori A; Bosworth, Hayden B; Atkins, DavidItem Open Access Improving Patient and Family Communication in the Care of Patients Undergoing Mechanical VentilationNeiman, Joseph; Chaudhry, Hina; Edmunds, Lavinia; Maheshwari, Ayonija; Young, Samantha; Winters, Bradford; Berenholtz, SeanIntroduction: Approximately 800,000 hospitalized patients are mechanically ventilated each year in the United States, and as the population ages, the incidence of mechanical ventilation (MV) is increasing at a high rate. Patients often describe their experience with mechanical ventilation and the inability to communicate their needs and sensations to their families and providers as the most frightening and frustrating aspect of their care. The mechanically ventilated patient represents a crucial and growing subset of critically ill patients where improvements in patient and family communication are desperately needed. Objectives: Interview former MV patients and family members while engaging a patient and family council to develop a “patient and family-centered ventilator toolkit” to improve communication and to empower families to take an active role in the care of mechanically ventilated patients. Identify: 1) current knowledge and key experiences of mechanical ventilation, and 2) individual-centered approaches to communication. Materials and Methods: Focus groups were conducted with 26 former mechanical ventilation patients and family members using a facilitation guide developed by our multidisciplinary team including former patients and family caregivers. The focus groups were recorded, transcribed, and analyzed using a combination of a priori and inductive thematic codes in NVivo 12, a qualitative data analysis software package. A council of patient and family partners was engaged to develop a communication toolkit. Conclusions: Participants universally stated that mechanical ventilation is frightening, isolating, and in many cases, exceedingly traumatic. They described their challenges and frustrations communicating, as well as communication strategies they improvised. Their strategies were assembled into the toolkit. All participants felt there was an unmet need for communication resources for mechanically ventilated patients and family members. Next Steps: The toolkit is being provided to mechanically ventilated patients and families in an ICU at the Johns Hopkins Hospital. Preliminary survey results suggest patients using the toolkit have greater ease and satisfaction communicating with their care team and loved ones. Surveying and toolkit review are ongoing. Acknowledgements: This work was funded through an Agency for Healthcare Research and Quality award, K18 HS024200.Item Open Access Managing Prostate Cancer Surgical Patients during the COVID-19 Pandemic: A Brief Report of the Duke Cancer Institute's Initial Experience.(Oncology (Williston Park, N.Y.), 2020-05) Moul, Judd W; Chang, Andrew; Inman, Brant AThe coronavirus disease 2019 pandemic has rapidly placed tremendous stress on health systems around the world. In response, multiple health systems have postponed elective surgeries in order to conserve hospital beds and personal protective equipment, minimize patient traffic, and prevent unnecessary utilization and exposure of healthcare workers. The American College of Surgeons released the following statement on March 13, 2020: "Each hospital, health system and surgeon should thoughtfully review all scheduled elective procedures with a plan to minimize, postpone, or cancel electively scheduled operations, endoscopes, or other invasive procedures until we have passed the predicted inflection point in the exposure graph and can be confident that our health care infrastructure can support a potentially rapid and overwhelming uptick in critical patient care needs." In our state, North Carolina, Governor Roy Cooper requested that all hospitals postpone elective and non-urgent procedures and surgeries effective March 23, 2020.Item Open Access Patient and Family Partnerships in the ICU: History, Benefits, and Strategies for the Future(ICU Management & Practice, 2024-04-19) Neiman, Joseph; Arizmendez, Natalia; Abraham, Marie; Dokken, Deborah; Johnson, Beverley; Hirshberg, EliotteThe seamless integration of patient- and family-centred care in the critical care setting remains elusive. This review discusses the history and benefits of patient- and family-centred care, plus strategies for partnering with patients and families in the critical care setting.Item Open Access Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care: A Cluster Randomized Trial.(Annals of internal medicine, 2017-03) Allen, Kelli D; Oddone, Eugene Z; Coffman, Cynthia J; Jeffreys, Amy S; Bosworth, Hayden B; Chatterjee, Ranee; McDuffie, Jennifer; Strauss, Jennifer L; Yancy, William S; Datta, Santanu K; Corsino, Leonor; Dolor, Rowena JBackground
A single-site study showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions.Objective
To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes.Design
Cluster randomized trial with assignment to patient, provider, and patient-provider interventions or usual care. (ClinicalTrials.gov: NCT01435109).Setting
10 Duke University Health System community-based primary care clinics.Participants
537 outpatients with symptomatic hip or knee osteoarthritis.Intervention
The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved electronic delivery of patient-specific osteoarthritis treatment recommendations to providers.Measurements
The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months. Secondary outcomes were objective physical function (Short Physical Performance Battery) and depressive symptoms (Patient Health Questionnaire). Linear mixed models assessed the difference in improvement among groups.Results
No difference was observed in WOMAC score changes from baseline to 12 months in the patient (-1.5 [95% CI, -5.1 to 2.0]; P = 0.40), provider (2.5 [CI, -0.9 to 5.9]; P = 0.152), or patient-provider (-0.7 [CI, -4.2 to 2.8]; P = 0.69) intervention groups compared with usual care. All groups had improvements in WOMAC scores at 12 months (range, -3.7 to -7.7). In addition, no differences were seen in objective physical function or depressive symptoms at 12 months in any of the intervention groups compared with usual care.Limitations
The study involved 1 health care network. Data on provider referrals were not collected.Conclusion
Contrary to a previous study of a combined patient and provider intervention for osteoarthritis in a Department of Veterans Affairs medical center, this study found no statistically significant improvements in the osteoarthritis intervention groups compared with usual care.Primary funding source
National Institute of Arthritis and Musculoskeletal and Skin Diseases.Item Open Access Patient-centered adherence intervention after acute coronary syndrome hospitalization.(Circulation. Cardiovascular quality and outcomes, 2012-07) Lambert-Kerzner, Anne; Del Giacco, Eric J; Fahdi, Ibrahim E; Bryson, Chris L; Melnyk, S Dee; Bosworth, Hayden B; Davis, Ryan; Mun, Howard; Weaver, Jennifer; Barnett, Casey; Radcliff, Tiffany; Hubbard, Amanda; Bosket, Kevin D; Carey, Evan; Virchow, Allison; Mihalko-Corbitt, Renee; Kaufman, Amy; Marchant-Miros, Kathy; Ho, P Michael; Multifaceted Intervention to Improve Cardiac Medication Adherence and Secondary Prevention Measures (Medication) Study InvestigatorsBackground
Adherence to cardioprotective medications in the year after acute coronary syndrome hospitalization is generally poor and is associated with increased risk of rehospitalization and mortality. Few interventions have specifically targeted this high-risk patient population to improve medication adherence. We hypothesize that a multifaceted patient-centered intervention could improve adherence to cardioprotective medications.Methods and results
To evaluate this intervention, we propose enrolling 280 patients with a recent acute coronary syndrome event into a multicenter randomized, controlled trial. The intervention comprises 4 main components: (1) pharmacist-led medication reconciliation and tailoring; (2) patient education; (3) collaborative care between pharmacist and primary care provider/cardiologist; and (4) 2 types of voice messaging (educational and medication refill reminder calls). Patients in the intervention arm will visit with the study pharmacist ≈1 week post-hospital discharge. The pharmacist will work with the patient and collaborate with providers to reconcile medication issues. Voice messages will augment the educational process and remind patients to refill their cardioprotective medications. The study will compare the intervention versus usual care for 12 months. The primary outcome of interest is adherence using the ReComp method. Secondary and tertiary outcomes include achievement of targets for blood pressure and low-density lipoprotein, and reduction in the combined cardiovascular end points of myocardial infarction hospitalization, coronary revascularization, and all-cause mortality. Finally, we will also evaluate the cost-effectiveness of the intervention compared with usual care.Conclusions
If the intervention is effective in improving medication adherence and demonstrating a lower cost, the intervention has the potential to improve cardiovascular outcomes in this high-risk patient population.Item Open Access Patient-centered priorities for improving medication management and adherence.(Patient education and counseling, 2015-01) McMullen, Carmit K; Safford, Monika M; Bosworth, Hayden B; Phansalkar, Shobha; Leong, Amye; Fagan, Maureen B; Trontell, Anne; Rumptz, Maureen; Vandermeer, Meredith L; Centers for Education and Research on Therapeutics Patient-Centered Medication Management Workshop Working Group; Brinkman, William B; Burkholder, Rebecca; Frank, Lori; Hommel, Kevin; Mathews, Robin; Hornbrook, Mark C; Seid, Michael; Fordis, Michael; Lambert, Bruce; McElwee, Newell; Singh, Jasvinder AObjective
The Centers for Education and Research on Therapeutics convened a workshop to examine the scientific evidence on medication adherence interventions from the patient-centered perspective and to explore the potential of patient-centered medication management to improve chronic disease treatment.Methods
Patients, providers, researchers, and other stakeholders (N = 28) identified and prioritized ideas for future research and practice. We analyzed stakeholder voting on priorities and reviewed themes in workshop discussions.Results
Ten priority areas emerged. Three areas were highly rated by all stakeholder groups: creating tools and systems to facilitate and evaluate patient-centered medication management plans; developing training on patient-centered prescribing for providers; and increasing patients' knowledge about medication management. However, priorities differed across stakeholder groups. Notably, patients prioritized using peer support to improve medication management while researchers did not.Conclusion
Engaging multiple stakeholders in setting a patient-centered research agenda and broadening the scope of adherence interventions to include other aspects of medication management resulted in priorities outside the traditional scope of adherence research.Practice implications
Workshop participants recognized the potential benefits of patient-centered medication management but also identified many challenges to implementation that require additional research and innovation.Item Open Access Population segmentation based on healthcare needs: a systematic review.(Systematic reviews, 2019-08-13) Chong, Jia Loon; Lim, Ka Keat; Matchar, David BruceBackground
Healthcare needs-based population segmentation is a promising approach for enabling the development and evaluation of integrated healthcare service models that meet healthcare needs. However, healthcare policymakers interested in understanding adult population healthcare needs may not be aware of suitable population segmentation tools available for use in the literature and barring better-known alternatives, may reinvent the wheel by creating and validating their own tools rather than adapting available tools in the literature. Therefore, we undertook a systematic review to identify all available tools which operationalize healthcare need-based population segmentation, to help inform policymakers developing population-level health service programmes.Methods
Using search terms reflecting concepts of population, healthcare need and segmentation, we systematically reviewed and included articles containing healthcare need-based adult population segmentation tools in PubMed, CINAHL and Web of Science databases. We included tools comprising mutually exclusive segments with prognostic value for clinically relevant outcomes. An updated secondary search on the PubMed database was also conducted as the last search was conducted 2 years ago. All identified tools were characterized in terms of segment formulation, segmentation base, whether they received peer-reviewed validation, requirement for comprehensive electronic medical records, proprietary status and number of segments.Results
A total of 16 unique tools were identified from systematically reviewing 9970 articles. Peer-reviewed validation studies were found for 9 of these tools.Discussion and conclusions
The underlying segmentation basis of most identified tools was found to be conceptually comparable to each other which suggests a broad recognition of archetypical patient overall healthcare need profiles. While many tools operate based on administrative record data, it is noted that healthcare systems without comprehensive electronic medical records would benefit from tools which segment populations through primary data collection. Future work could therefore include development and validation of such primary data collection-based tools. While this study is limited by exclusion of non-English literature, the identified and characterized tools will nonetheless facilitate efforts by policymakers to improve patient-centred care through development and evaluation of services tailored for specific populations segmented by these tools.Item Open Access Primary Care Transformation.(Primary care, 2019-12) Sawin, Gregory; O'Connor, NicolePrimary care transformation will usher in a new era of advanced team-based care with extensive roles beyond the physician to build authentic healing relationships with patients. Smart technology will support these relationships, empower and engage patients, and build confidence that their health care team will take excellent care of them. Investments need to shift from catastrophic hospital-based care to proactive prevention and wellness, pushing us to think of health beyond health care. Systems need to build a culture of continuous improvement, supported by data-driven improvement science, and keep a sharp focus on the patient experience of care.Item Open Access Rationale and Design of the Lung Cancer Screening Implementation. Evaluation of Patient-Centered Care Study.(Annals of the American Thoracic Society, 2017-10) Miranda, Leah S; Datta, Santanu; Melzer, Anne C; Wiener, Renda Soylemez; Davis, James M; Tong, Betty C; Golden, Sara E; Slatore, Christopher GScreening for lung cancer using low-dose computed tomography has been demonstrated to reduce lung cancer-related mortality and is being widely implemented. Further research in this area is needed to assess the impact of screening on patient-centered outcomes. Here, we describe the design and rationale for a new study entitled Lung Cancer Screening Implementation: Evaluation of Patient-Centered Care. The protocol is composed of an interconnected series of studies evaluating patients and clinicians who are engaged in lung cancer screening in real-world settings. The primary goal of this study is to evaluate communication processes that are being used in routine care and to identify best practices that can be readily scaled up for implementation in multiple settings. We hypothesize that higher overall quality of patient-clinician communication processes will be associated with lower levels of distress and decisional conflict as patients decide whether or not to participate in lung cancer screening. This work is a critical step toward identifying modifiable mechanisms that are associated with high quality of care for the millions of patients who will consider lung cancer screening. Given the enormous potential benefits and burdens of lung cancer screening on patients, clinicians, and the healthcare system, it is important to identify and then scale up quality communication practices that positively influence patient-centered care.Item Open Access Recommendations for Providers on Person-Centered Approaches to Assess and Improve Medication Adherence.(Journal of general internal medicine, 2017-01) Bosworth, Hayden B; Fortmann, Stephen P; Kuntz, Jennifer; Zullig, Leah L; Mendys, Phil; Safford, Monika; Phansalkar, Shobha; Wang, Tracy; Rumptz, Maureen HMedication non-adherence is a significant clinical challenge that adversely affects psychosocial factors, costs, and outcomes that are shared by patients, family members, providers, healthcare systems, payers, and society. Patient-centered care (i.e., involving patients and their families in planning their health care) is increasingly emphasized as a promising approach for improving medication adherence, but clinician education around what this might look like in a busy primary care environment is lacking. We use a case study to demonstrate key skills such as motivational interviewing, counseling, and shared decision-making for clinicians interested in providing patient-centered care in efforts to improve medication adherence. Such patient-centered approaches hold considerable promise for addressing the high rates of non-adherence to medications for chronic conditions.Item Open Access Reply to Ngoh et al. Comment on "Surendran et al. The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context. Int. J. Environ. Res. Public Health 2021, 18, 1817".(International journal of environmental research and public health, 2022-04-13) Surendran, Shilpa; Foo, Chuan De; Tam, Chen Hee; Ho, Elaine Qiao Ying; Matchar, David Bruce; Car, Josip; Koh, Gerald Choon HuatWe carefully read the comment [...].Item Open Access STepped exercise program for patients with knee OsteoArthritis (STEP-KOA): protocol for a randomized controlled trial.(BMC musculoskeletal disorders, 2019-05) Allen, Kelli D; Bongiorni, Dennis; Caves, Kevin; Coffman, Cynthia J; Floegel, Theresa A; Greysen, Heather M; Hall, Katherine S; Heiderscheit, Bryan; Hoenig, Helen M; Huffman, Kim M; Morey, Miriam C; Ramasunder, Shalini; Severson, Herbert; Smith, Battista; Van Houtven, Courtney; Woolson, SandraBackground
Physical therapy (PT) and other exercise-based interventions are core components of care for knee osteoarthritis (OA), but both are underutilized, and some patients have limited access to PT services. This clinical trial is examining a STepped Exercise Program for patients with Knee OsteoArthritis (STEP-KOA). This model of care can help to tailor exercise-based interventions to patient needs and also conserve higher resource services (such as PT) for patients who do not make clinically relevant improvements after receiving less costly interventions.Methods / design
Step-KOA is a randomized trial of 345 patients with symptomatic knee OA from two Department of Veterans Affairs sites. Participants are randomized to STEP-KOA and Arthritis Education (AE) Control groups with a 2:1 ratio, respectively. STEP-KOA begins with 3 months of access to an internet-based exercise program (Step 1). Participants not meeting response criteria for clinically meaningful improvement in pain and function after Step 1 progress to Step 2, which involves bi-weekly physical activity coaching calls for 3 months. Participants not meeting response criteria after Step 2 progress to in-person PT visits (Step 3). Outcomes will be assessed at baseline, 3, 6 and 9 months (primary outcome time point). The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), and secondary outcomes are objective measures of physical function. Linear mixed models will compare outcomes between the STEP-KOA and AE control groups at follow-up. We will also evaluate patient characteristics associated with treatment response and conduct a cost-effectiveness analysis of STEP-KOA.Discussion
STEP-KOA is a novel, efficient and patient-centered approach to delivering exercise-based interventions to patients with knee OA, one of the most prevalent and disabling health conditions. This trial will provide information on the effectiveness of STEP-KOA as a novel potential model of care for treatment of OA.Trial registration
Clinicaltrials.gov, NCT02653768 (STepped Exercise Program for Knee OsteoArthritis (STEP-KOA)), Registered January 12, 2016.