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Austad K, Lee JH, Lanney H, Rapoport VO, Wornhoff R, McDaniel K, Li-Garrison L, Jack BW. Evaluating the quality and equity of patient hospital discharge instructions. BMC Health Serv Res 2025; 25:291. [PMID: 39980004 PMCID: PMC11844009 DOI: 10.1186/s12913-025-12410-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Accepted: 02/10/2025] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND Written discharge instructions improve patient understanding and self-management after hospitalization. While a small number of studies have evaluated the quality of hospital discharge instructions, none have focused on patients with a non-English language preference (NELP) or looked for potential disparities. Our goal was to compare the quality of patient discharge instructions between those with English language preference and NELP, including whether instructions were in the patient's preferred language, included all content domains recommended by professional groups, and followed best practices for health literacy. METHODS We analyzed 200 discharge records from inpatient adult medicine discharges at one hospital across a range of diagnoses using case matching by diagnosis and age to construct an English and NELP cohort (each n = 100). We assessed the percentage of discharge instructions written in the patient's preferred language, measured word count, and calculated readability scores. Lastly, two individual raters used a scale-the Quality of Discharge Instructions-Inpatient (QDI-I) scale-to rate them across six domains of content quality. RESULTS Only 8% of patients with NELP received discharge instructions in their preferred language compared to 100% in the English cohort (p < 0.001). The mean overall QDI-I score was similar for the NELP and English cohorts (71.1% of perfect versus 71.3% of perfect, p = 0.92), but the domain of return precautions was inferior among those with NELP (80.5% of perfect vs. 88.8% of perfect, p = 0.013). Instructions in both groups were written at an eighth- to ninth-grade reading level (age 13-15). DISCUSSION We found disparities in quality of written discharge instructions for patients with NELP. Recommended next steps include replication of our methods across health systems and larger sample sizes to examine differences between non-English language groups.
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Affiliation(s)
- Kirsten Austad
- Department of Family Medicine, Boston Medical Center &, Boston University Chobanian and Avedisian School of Medicine, 850 Harrison Avenue, Boston, MA, 02118, USA.
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
| | - Joo Hyun Lee
- Department of Family Medicine, Boston Medical Center &, Boston University Chobanian and Avedisian School of Medicine, 850 Harrison Avenue, Boston, MA, 02118, USA
| | - Howard Lanney
- Department of Family Medicine, Boston Medical Center &, Boston University Chobanian and Avedisian School of Medicine, 850 Harrison Avenue, Boston, MA, 02118, USA
| | - Victoria Oliva Rapoport
- Department of Family Medicine, Boston Medical Center &, Boston University Chobanian and Avedisian School of Medicine, 850 Harrison Avenue, Boston, MA, 02118, USA
| | - Rebecca Wornhoff
- Department of Family Medicine, Boston Medical Center &, Boston University Chobanian and Avedisian School of Medicine, 850 Harrison Avenue, Boston, MA, 02118, USA
| | - Katherine McDaniel
- Department of Family Medicine, Boston Medical Center &, Boston University Chobanian and Avedisian School of Medicine, 850 Harrison Avenue, Boston, MA, 02118, USA
| | | | - Brian W Jack
- Department of Family Medicine, Boston Medical Center &, Boston University Chobanian and Avedisian School of Medicine, 850 Harrison Avenue, Boston, MA, 02118, USA
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Austad K, Thai C, Zavatti A, Nguyen N, Bautista-Hurtado D, Kenney P, Lugo N, Lee JH, Lanney H, Xuan Z, Cordova-Ramos EG, Drainoni ML, Jack B. Tools to improve discharge equity: Protocol for the pilot TIDE trial. Contemp Clin Trials Commun 2025; 43:101419. [PMID: 39810841 PMCID: PMC11731754 DOI: 10.1016/j.conctc.2024.101419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 12/13/2024] [Accepted: 12/21/2024] [Indexed: 01/16/2025] Open
Abstract
Background Written discharge instructions after hospitalization promote patient understanding and positive clinical outcomes. Despite the rising prevalence of patients with non-English language preference (NELP) in the U.S., most hospitals do not routinely provide discharge instructions in their preferred language, thereby placing them at higher risk for medical errors and hospital readmission. Innovative solutions to close this implementation gap at hospital discharge for patients with NELP are needed. The Tools to Improve Discharge Equity (TIDE) intervention leverages communication practices proven effective in addressing communication barriers to create language concordant discharge tools from hospital discharge paperwork. Methods We present the protocol for a type I hybrid implementation-effectiveness pilot randomized trial. The TIDE intervention includes a translated medication calendar, pictographs, and an audio recording of the discharge instructions in the patient's preferred language. We will recruit an estimated 50 patient participants from the hospital's top four non-English language groups-Spanish, Haitian Creole, Cape Verdean Creole, and Vietnamese-as well as the nurse and in-person interpreter caring for them. Outcomes include patient recall of primary diagnosis and overall understanding of discharge instructions using a newly developed 24-point score, patient experience, implementation measures (acceptability, feasibility, and appropriateness), and clinical effectiveness (including hospital reutilization). A mixed methods evaluation will identify determinants of intervention uptake to guide selection of multi-level implementation strategies to test in a future hybrid type III trial. Discussion The TIDE intervention is the first hospital discharge intervention designed for patients with NELP. Result will inform future efforts to improve the safety and equity of the hospital discharge process. Trial registration clinicaltrials.gov NCT05988229 (August 14, 2023) https://classic.clinicaltrials.gov/ct2/show/NCT05988229.
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Affiliation(s)
- Kirsten Austad
- Department of Family Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Cecilia Thai
- Department of Nursing, Boston Medical Center, Boston, MA, USA
| | - Alegna Zavatti
- Department of Interpreter Services, Boston Medical Center, Boston, MA, USA
| | - Nhi Nguyen
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Diana Bautista-Hurtado
- Department of Family Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Patrick Kenney
- Department of Family Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Noelia Lugo
- Department of Family Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Joo H. Lee
- Department of Family Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Howard Lanney
- Department of Family Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Erika G. Cordova-Ramos
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Pediatrics, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Mari-Lynn Drainoni
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Brian Jack
- Department of Family Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
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Buowari DY, Ikpae BE. Awareness of diagnosis and treatment plan among patients in the Accident and Emergency Department of a Nigerian tertiary hospital. Niger Med J 2024; 65:524-532. [PMID: 39398399 PMCID: PMC11470270 DOI: 10.60787/nmj-v65i3-416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2024] Open
Abstract
Background Patient centred care has a correlation to effectiveness of patient engagement, patient care, and perceived quality of care. Even in the emergency room, awareness of diagnosis and treatment plan is a critical component in every doctor-patient interface as it enhances patient-centred care. This study aims to assess awareness of diagnosis and treatment plan among patients in the accident and emergency department. Methodology This is a cross-sectional study conducted at the accident and emergency department of the University of Port Harcourt Teaching Hospital. Result One hundred and ninety-seven respondents were recruited into this study comprising of 51.3% males and 48.8% females. Most 86.8% of the respondents were aware of their diagnosis, of which 91.8% knew the accurate diagnosis. Majority 84.8% of the respondents were aware of the treatment, while 68.8% of the respondents were aware of the names of the medications, most of the respondents 59.4% had no knowledge of the side effects of the medications. The majority, 61.4% were involved in the management decision. No significant relationship existed between the socio-demographic characteristics and knowledge of diagnosis and treatment plan. Conclusion The chaotic and overcrowded nature of the accident and emergency department should not hamper the delivery of patient centred care. Although, findings obtained from this study reveal that majority of the respondents are aware of their diagnosis and treatment plan, a portion of respondents do not understand their plan of care; this indicates the need for further studies to identify interventions that would ensure that gaps in the physician -patient communication are filled as this optimizes patients' satisfaction of care received, gives better sense of control of their total situation and better quality of life.
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Affiliation(s)
- Dabota Yvonne Buowari
- Department of Accident and Emergency, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
| | - Barile Edward Ikpae
- Department of Accident and Emergency, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
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Lindblom S, Flink M, von Koch L, Tistad M, Stenberg U, Elf M, Carlsson AC, Laska AC, Ytterberg C. A person-centred care transition support for people with stroke/TIA: A study protocol for effect and process evaluation using a non-randomised controlled design. PLoS One 2024; 19:e0299800. [PMID: 38483869 PMCID: PMC10939281 DOI: 10.1371/journal.pone.0299800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/31/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Care transitions following a stroke call for integrated care approaches to reduce death and disability. The proposed research described in this study protocol aims to evaluate the effectiveness of a person-centred multicomponent care transition support and the process in terms of contextual moderators, implementation aspects and mechanisms of impact. METHODS A non-randomized controlled trial design will be used. The intervention includes person-centred dialogue intended to permeate all patient-provider communication, various pedagogical modes of information, a person-centred care and rehabilitation plan, and a bridging e-meeting to prepare patients for homecoming. Patients with stroke or TIA who are to be discharged from the participating hospitals to home and referred to a neurorehabilitation team for continued rehabilitation will be included. Follow-ups will be conducted at one week, 3 months and 12 months. Data will be collected on the primary outcome of perceived quality of the care transition, and on the secondary outcomes of health literacy, medication adherence, and perceived person-centeredness. Data for process evaluation will be collected through semi-structured interviews, focus groups, participatory observations, and the Normalisation Measure Development Questionnaire. DISCUSSION The study will provide insights on implementation, mechanisms of impact, contextual moderators, and effectiveness of a care transition support, targeting a poorly functioning part of the care trajectory for people with stroke and TIA. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05646589.
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Affiliation(s)
- Sebastian Lindblom
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme of Women’s Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme of Women’s Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme of Heart & Vascular and Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Tistad
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Una Stenberg
- The Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
- Frambu Centre for Rare Disorders, Siggerud, Norway
| | - Marie Elf
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Axel C. Carlsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Ann Charlotte Laska
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme of Women’s Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
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Morschek L, Schultz JH, Wigbels R, Gebhardt N, Derreza-Greeven C, Friederich HC, Noll A, Unger I, Nikendei C, Bugaj TJ. Thrown in at the deep end: a qualitative study with physicians on the purpose and challenges of discharge interviews. Postgrad Med 2024; 136:180-188. [PMID: 38357911 DOI: 10.1080/00325481.2024.2319566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/09/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Against the backdrop of poor discharge communication in hospitals, this study explores the purpose of discharge interviews from the physicians' perspective and the challenges they are confronted with. Discharge interviews are legally required in Germany as part of the discharge management. Led by the ward physician, the discharge interview should summarize relevant information about the hospital stay, medication, lifestyle interventions and follow-up treatment. METHODS Semi-structured interviews with n = 12 physicians were conducted at Heidelberg University Hospital between February and April 2020. Qualitative content analysis was carried out using MAXQDA. RESULTS Physicians reported gaining information, providing information, and answering open-ended questions as the purpose of the discharge interview. Challenges in conducting discharge interviews were related to finding a common language, patient-related challenges, conditions of everyday ward life, and lack of training. Physicians reported receiving no explicit training on discharge interviews. While professional experience seems to mitigate the lack of training, some physicians expressed a prevailing sense of insecurity. CONCLUSION The lack of preparation for discharge interviews in medical school makes it particularly challenging for physicians to translate their theoretical knowledge into patient-centered discharge communication. Medical training on discharge interviews should be expanded in terms of theoretical input on the ideal content, its purpose and potential (e.g. in reducing readmissions), as well as practical exercises.
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Affiliation(s)
- Lorena Morschek
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Ricarda Wigbels
- Department of Internal Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Nadja Gebhardt
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Cassandra Derreza-Greeven
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
- DZPG (German Centre for Mental Health - Partner Site Heidelberg/Mannheim/Ulm)
| | - Alexandra Noll
- Department of Internal Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Inga Unger
- Department of Internal Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Johannes Bugaj
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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Glick AF, Farkas JS, Gadhavi J, Mendelsohn AL, Schulick N, Yin HS. Pediatric Resident Communication of Hospital Discharge Instructions. Health Lit Res Pract 2023; 7:e178-e186. [PMID: 37812910 PMCID: PMC10561625 DOI: 10.3928/24748307-20230918-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/18/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE Suboptimal provider-parent communication contributes to poor parent comprehension of pediatric discharge instructions, which can lead to adverse outcomes. Residency is a critical window to acquire and learn to utilize key communication skills, potentially supported by formal training programs or visual reminders. Few studies have examined resident counseling practices or predictors of counseling quality. Our objectives were to (1) examine pediatric resident counseling practices and (2) determine how formal training and presence of discharge templates with domain-specific prompts are associated with counseling. METHODS We conducted a cross-sectional survey of a convenience sample of residents in the American Academy of Pediatrics Section on Pediatric Trainees. Outcomes included resident self-report of frequency of (1) counseling in domains of care and (2) use of health literacy-informed counseling strategies (pictures, demonstration, Teach Back, Show Back) (6-point scales; frequent = often/usually/always). Predictor variables were (1) formal discharge-related training (e.g., lectures) and (2) hospital discharge instruction template with space for individual domains. Logistic regression analyses, utilizing generalized estimating equations when appropriate to account for multiple domains (adjusting for resident gender, postgraduate year), were performed. KEY RESULTS Few residents (N = 317) (13.9%) reported formal training. Over 25% of residents infrequently counsel on side effects, diagnosis, and restrictions. Resident reported use of communication strategies was infrequent: drawing pictures (24.1%), demonstration (15.8%), Teach Back (36.8%), Show Back (11.4%). Designated spaces in instruction templates for individual domains were associated with frequent domain-specific counseling (adjusted odds ratio [aOR] 4.1 [95% confidence interval: 3.5-4.8]). Formal training was associated with frequent Teach Back (aOR 2.6 [1.4-5.1]) and Show Back (aOR 2.7 [1.2-6.2]). CONCLUSIONS Lack of formal training and designated space for domain-specific instructions are associated with suboptimal counseling at discharge by pediatric residents. Future research should focus on determining the best mechanisms for teaching trainees communication skills and optimizing written instruction templates to support verbal counseling. [HLRP: Health Literacy Research and Practice. 2023;7(4):e178-e186.].
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Affiliation(s)
- Alexander F. Glick
- Address correspondence to Alexander F. Glick, MD, MS, Department of Pediatrics, NYU Grossman School of Medicine/Bellevue Hospital Center, 462 First Avenue, New York, NY 10016;
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Foster AA, Stoll J, Daly CJ, Clark CM, Sethi S, Jacobs DM. Patient and social factors related to nebulizer use in COPD patients at the transition of care: a qualitative study. BMC Pulm Med 2023; 23:358. [PMID: 37740178 PMCID: PMC10517547 DOI: 10.1186/s12890-023-02651-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Transition from hospital to home is a vulnerable period for patients with COPD exacerbations, with a high risk for readmission and mortality. Twenty percent of patients with an initial hospitalization for a COPD exacerbation are readmitted to a hospital within 30 days, costing the health care system over $15 billion annually. While nebulizer therapy directed at some high-risk COPD patients may improve the transition from hospital to home, patient and social factors are likely to contribute to difficulties with their use. Current literature describing the COPD patient's experience with utilizing nebulizer therapy, particularly during care transitions, is limited. Therefore, the objective of this study was to explore underlying COPD patient and social factors contributing to practical difficulties with nebulizer use at the care transition from hospital to home. METHODS This was a qualitative study conducted between September 2020 and June 2022. Patients were included if they were ≥ 40 years old, had a current diagnosis of COPD, had an inpatient admission at a hospital, and were discharged directly to home with nebulizer therapy. Semi-structured, one-on-one interviews with patients were conducted covering a broad range of patient and social factors and their relationships with nebulizer use and readmission. Interviews were recorded and transcribed verbatim. A thematic analysis was performed using a mixed inductive and deductive approach. RESULTS Twenty-one interviews were conducted, and subjects had a mean age of 64 ± 8.4 years, 62% were female, and 76% were White. The predominant interview themes were health care system interactions and medication management. The interviews highlighted that discharge counseling methods and depth of counseling from hospitals were inconsistent and were not always patient-friendly. They also suggested that patients could appropriately identify, set up, and utilize their nebulizer treatment without difficulties, but additional patient education is required for nebulizer clean up and maintenance. CONCLUSIONS Our interviews suggest that there is room for improvement within the health care system for providing consistent, effective discharge counseling. Also, COPD patients discharged from a hospital on nebulizer therapy can access and understand their treatment but require additional education for nebulizer clean up and maintenance.
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Affiliation(s)
- Amanda A Foster
- Department of Pharmacy Practice, Wegmans School of Pharmacy, St. John Fisher University, Rochester, NY, USA
| | - Jennifer Stoll
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Christopher J Daly
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, 316 Pharmacy Building, Buffalo, NY, 14214, USA
| | - Collin M Clark
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, 316 Pharmacy Building, Buffalo, NY, 14214, USA
| | - Sanjay Sethi
- Department of Pulmonary, Critical Care, and Sleep Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - David M Jacobs
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, 316 Pharmacy Building, Buffalo, NY, 14214, USA.
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Trivedi SP, Corderman S, Berlinberg E, Schoenthaler A, Horwitz LI. Assessment of Patient Education Delivered at Time of Hospital Discharge. JAMA Intern Med 2023; 183:417-423. [PMID: 36939674 PMCID: PMC10028544 DOI: 10.1001/jamainternmed.2023.0070] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/05/2023] [Indexed: 03/21/2023]
Abstract
Importance Patient education at time of hospital discharge is critical for smooth transitions of care; however, empirical data regarding discharge communication are limited. Objective To describe whether key communication domains (medication changes, follow-up appointments, disease self-management, red flags, question solicitation, and teach-back) were addressed at the bedside on the day of hospital discharge, by whom, and for how long. Design, Setting, and Participants This quality improvement study was conducted from September 2018 through October 2019 at inpatient medicine floors in 2 urban, tertiary-care teaching hospitals and purposefully sampled patients designated as "discharge before noon." Data analysis was performed from September 2018 to May 2020. Exposures A trained bedside observer documented all content and duration of staff communication with a single enrolled patient from 7 am until discharge. Main Outcomes and Measures Presence of the key communication domains, role of team members, and amount of time spent at the bedside. Results Discharge days for 33 patients were observed. Patients had a mean (SD) age of 63 (18) years; 14 (42%) identified as White, 15 (45%) were female, and 6 (18%) had a preferred language of Spanish. Thirty patients were discharged with at least 1 medication change. Of these patients, 8 (27%) received no verbal instruction on the change, while 16 of 30 (53%) were informed but not told the purpose of the changes. About half of the patients (15 of 31, 48%) were not told the reason for follow-up appointments, and 18 of 33 (55%) were not given instructions on posthospital disease self-management. Most patients (27 of 33, 81%) did not receive guidance on red-flag signs. While over half of the patients (19 of 33, 58%) were asked if they had any questions, only 1 patient was asked to teach back his understanding of the discharge plan. Median (IQR) total time spent with patients on the day of discharge by interns, senior residents, attending physicians, and nurses was 4.0 (0.75-6.0), 1.0 (0-2.0), 3.0 (0.5-7.0), and 22.5 (15.5-30.0) minutes, respectively. Most of the time was spent discussing logistics rather than discharge education. Conclusions and Relevance In this quality improvement study, patients infrequently received discharge education in key communication domains, potentially leaving gaps in patient knowledge. Interventions to improve the hospital discharge process should address the content, method of delivery, and transparency among team members regarding patient education.
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Affiliation(s)
- Shreya P. Trivedi
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Carl J. Shapiro Institute for Education and Research, Boston, Massachusetts
| | - Sara Corderman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elyse Berlinberg
- NYU Grossman School of Medicine, New York University, New York, New York
| | - Antoinette Schoenthaler
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, Department of Population Health, NYU Langone Health, New York, New York
| | - Leora I. Horwitz
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
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Backman C, Papp S, Harley A, Tonjock Kolle A, Visintini S, Shah S, Berdusco R, Poitras S, Beaulé PE, French-Merkley V. Platform-Based Patient-Clinician Digital Health Interventions for Care Transitions: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e42056. [PMID: 37018041 PMCID: PMC10131754 DOI: 10.2196/42056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND With the increased adoption of technology, the use of digital health interventions in health care settings has increased. Patient-clinician digital health interventions have the potential to improve patient care, especially during important transitions between hospital and home. Digital health interventions can provide support to patients during these transitions, thereby leading to better patient outcomes. OBJECTIVE This scoping review aims to explore the available literature, specifically (1) to examine the impact of platform-based digital health interventions focused on care transitions on patient outcomes, and (2) to identify the barriers to and enablers for the uptake and implementation of these digital health interventions. METHODS This protocol was developed based on Arksey and O'Malley's, Levac and colleagues', and JBI scoping review methodologies, and it has been reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for the Scoping Reviews) format. The search strategies were developed for 4 databases: MEDLINE, CINAHL, EMBASE, and the Cochrane Central Register of Controlled Trials by using key words such as "hospital to home transition" and "platform-based digital health." Studies involving patients 16 years or older that used a platform-based digital health intervention during their hospital to home transition will be included in this review. Two reviewers will independently screen articles for eligibility by using a 2-stage process (ie, title and abstract screening and full-text screening). We expect to refine the eligibility criteria during the title and abstract screening process as we anticipate retrieving a significant number of articles. In addition, we will also perform a targeted search of the grey literature, as well as data extraction. Data analysis will consist of a narrative and descriptive synthesis. RESULTS The review is expected to identify research gaps that will inform the development of future patient-clinician digital health interventions. We have identified a total of 8333 articles. Screening began in September 2022, and data extraction is expected to commence in February 2023 and end by April 2023. Data analyses and final results will be submitted to a peer-reviewed journal in August 2023. CONCLUSIONS We expect to find a wide variety of postcare interventions, some gaps in the quality of research evidence, as well as a lack of detailed information on digital health interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/42056.
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Affiliation(s)
| | | | | | | | | | - Soha Shah
- Bruyère Continuing Care, Ottawa, ON, Canada
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Proposing a Scientific and Technological Approach to the Summaries of Clinical Issues of Inpatient Elderly with Delirium: A Viewpoint. Healthcare (Basel) 2022; 10:healthcare10081534. [PMID: 36011191 PMCID: PMC9408148 DOI: 10.3390/healthcare10081534] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/13/2022] [Accepted: 08/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background/rationale: Despite mounting evidence about delirium, this complex geriatric syndrome is still not well managed in clinical contexts. The aging population creates a very demanding area for innovation and technology in healthcare. For instance, an outline of an aging-friendly healthcare environment and clear guidance for technology-supported improvements for people at delirium risk are lacking. Objective: We aimed to foster debate about the importance of technical support in optimizing healthcare professional practice and improving the outcomes for inpatients’ at delirium risk. We focused on critical clinical points in the field of delirium worthy of being addressed by a multidisciplinary approach. Methods: Starting from a consensus workshop sponsored by the Management Perfectioning Course based at the Marco Biagi Foundation (Modena, Italy) about clinical issues related to delirium management still not addressed in our healthcare organizations, we developed a requirements’ analysis among the representatives of different disciplines and tried to formulate how technology could support the summaries of the clinical issues. We analyzed the national and international panorama by a PubMed consultation of articles with the following keywords in advanced research: “delirium”, “delirium management”, “technology in healthcare”, and “elderly population”. Results: Despite international recommendations, delirium remains underdiagnosed, underdetected, underreported, and mismanaged in the acute hospital, increasing healthcare costs, healthcare professionals’ job distress, and poor clinical outcomes. Discussion: Although all healthcare professionals recognize delirium as a severe and potentially preventable source of morbidity and mortality for hospitalized older people, it receives insufficient attention in resource allocation and multidisciplinary research. We synthesized how tech-based tools could offer potential solutions to the critical clinical points in delirium management.
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11
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Jones B, James P, Vijayasiri G, Li Y, Bozaan D, Okammor N, Hendee K, Jenq G. Patient Perspectives on Care Transitions From Hospital to Home. JAMA Netw Open 2022; 5:e2210774. [PMID: 35522278 PMCID: PMC9077479 DOI: 10.1001/jamanetworkopen.2022.10774] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Understanding the patient's perspective of their care transition process from hospital or skilled nursing facility (SNF) to home may highlight gaps in care and inform system improvements. OBJECTIVE To gather data about patients' care transition experiences and factors associated with follow-up appointment completion. DESIGN, SETTING, AND PARTICIPANTS A survey tool was developed with input from patient advisors and organizations participating in a collaborative quality initiative. Seventeen hospitals, 12 practitioner organizations, and 6 SNFs in Michigan collaborated to identify shared patients who were aged 18 years and older, had a working telephone number, recently returned home or to an assisted living facility with a diagnosis of congestive heart failure or chronic obstructive pulmonary disease, or after an SNF stay. Using consecutive sampling, interviewers collected 5 telephone surveys per month. From October 2018 to December 2019, patients or caregivers were surveyed via telephone 8 to 12 days after discharge from a hospital or SNF. Data were analyzed from March 2020 to January 2022. EXPOSURE Care transition experiences. MAIN OUTCOMES AND MEASURES The primary outcome was to identify patient-perceived gaps during care transition experiences, including postdischarge follow-up. RESULTS On the basis of pilot data, the response rate was estimated at 34%, yielding 1257 surveys. Of 1257 survey respondents (mean [SD] age, 70 [12.94] years for 968 patients for whom age data was available), 654 (52%) were female; 829 (74%) were White, 250 (22%) were Black or African American, and 40 (4%) were another race. Eleven percent of patients reported not receiving a telephone number to call for postdischarge questions. Nearly 80% of patients (977 patients) received a follow-up telephone call, and most found it valuable. Twenty percent of patients (255 patients) reported at least 1 social determinant of health issue. Lack of transportation was associated with reduced likelihood of completing a follow-up visit, decreasing the odds of completing a follow-up by nearly 70% (odds ratio [OR], 0.31; 95% CI, 0.18-0.53; P < .001). Compared with other patient groups, Black patients were less likely to report completing a postdischarge follow-up visit (OR, 0.49; 95% CI, 0.36-0.67; P < .001) or to receive prescribed medical equipment (OR, 4.23; 95% CI, 1.30-13.83; P = .02). CONCLUSIONS AND RELEVANCE An examination of patient discharge experiences from a hospital or SNF identified inconsistencies in care transition processes, social determinants of health issues needing to be addressed after discharge, and racial disparities between patients who attend follow-up appointments. Physicians should be aware of these findings and their consequences for patient experiences.
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Affiliation(s)
- Beth Jones
- Department of Internal Medicine, Michigan Medicine, Ann Arbor
- Integrated Michigan Patient-Centered Alliance in Care Transitions, Michigan Medicine, Ann Arbor
| | - Pam James
- Department of Internal Medicine, Michigan Medicine, Ann Arbor
- Integrated Michigan Patient-Centered Alliance in Care Transitions, Michigan Medicine, Ann Arbor
| | - Ganga Vijayasiri
- Department of Internal Medicine, Michigan Medicine, Ann Arbor
- Integrated Michigan Patient-Centered Alliance in Care Transitions, Michigan Medicine, Ann Arbor
| | - Yiting Li
- Department of Internal Medicine, Michigan Medicine, Ann Arbor
- Integrated Michigan Patient-Centered Alliance in Care Transitions, Michigan Medicine, Ann Arbor
| | - Dave Bozaan
- Department of Internal Medicine, Michigan Medicine, Ann Arbor
- Integrated Michigan Patient-Centered Alliance in Care Transitions, Michigan Medicine, Ann Arbor
- Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan
- St. Joseph Mercy Chelsea Hospital, Michigan Medicine, Chelsea
| | - Nkiru Okammor
- Department of Internal Medicine, Michigan Medicine, Ann Arbor
- Integrated Michigan Patient-Centered Alliance in Care Transitions, Michigan Medicine, Ann Arbor
| | - Karly Hendee
- Department of Internal Medicine, Michigan Medicine, Ann Arbor
- Integrated Michigan Patient-Centered Alliance in Care Transitions, Michigan Medicine, Ann Arbor
| | - Grace Jenq
- Department of Internal Medicine, Michigan Medicine, Ann Arbor
- Integrated Michigan Patient-Centered Alliance in Care Transitions, Michigan Medicine, Ann Arbor
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12
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Figueroa R, Taramasco C, Flores C, Ortiz L, Vásquez-Venegas C, Salas P, Zeng-Treilter Q. A physician's perspective on the incorporation of pictograms as a supplement to medical instructions in Chile: A pilot study. Ing Rech Biomed 2022. [DOI: 10.1016/j.irbm.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Lie HC, Juvet LK, Street RL, Gulbrandsen P, Mellblom AV, Brembo EA, Eide H, Heyn L, Saltveit KH, Strømme H, Sundling V, Turk E, Menichetti J. Effects of Physicians' Information Giving on Patient Outcomes: a Systematic Review. J Gen Intern Med 2022; 37:651-663. [PMID: 34355348 PMCID: PMC8858343 DOI: 10.1007/s11606-021-07044-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Providing diagnostic and treatment information to patients is a core clinical skill, but evidence for the effectiveness of different information-giving strategies is inconsistent. This systematic review aimed to investigate the reported effects of empirically tested communication strategies for providing information on patient-related outcomes: information recall and (health-related) behaviors. METHODS The databases MEDLINE, Embase, PsycINFO (Ovid), Cochrane Central Register of Controlled Trials, and relevant bibliographies were systematically searched from the inception to April 24, 2020, without restrictions, for articles testing information-giving strategies for physicians (PROSPERO ID: CRD42019115791). Pairs of independent reviewers identified randomized controlled studies with a low risk of selection bias as from the Cochrane risk of bias 2 tool. Main outcomes were grouped into patient information recall and behavioral outcomes (e.g., alcohol consumption, weight loss, participation in screening). Due to high heterogeneity in the data on effects of interventions, these outcomes were descriptively reported, together with studies', interventions', and information-giving strategies' characteristics. PRISMA guidelines were followed. RESULTS Seventeen of 9423 articles were included. Eight studies, reporting 10 interventions, assessed patient information recall: mostly conducted in experimental settings and testing a single information-giving strategy. Four of the ten interventions reported significant increase in recall. Nine studies assessed behavioral outcomes, mostly in real-life clinical settings and testing multiple information-giving strategies simultaneously. The heterogeneity in this group of studies was high. Eight of the nine interventions reported a significant positive effect on objectively and subjectively measured patients' behavioral outcomes. DISCUSSION Using specific framing strategies for achieving specific communication goals when providing information to patients appears to have positive effects on information recall and patient health-related behaviors. The heterogeneity observed in this group of studies testifies the need for a more consistent methodological and conceptual agenda when testing medical information-giving strategies. TRIAL REGISTRATION PROSPERO registration number: CRD42019115791.
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Affiliation(s)
- Hanne C Lie
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lene K Juvet
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.,Norvegian Institute of Public Health, Oslo, Norway
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, TX, USA
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research (HØKH) Centre, Akershus University Hospital, Lørenskog, Norway
| | - Anneli V Mellblom
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.,Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
| | - Espen Andreas Brembo
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hilde Eide
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Lena Heyn
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Kristina H Saltveit
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hilde Strømme
- Library of Medicine and Science, University of Oslo, Oslo, Norway
| | - Vibeke Sundling
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.,Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway
| | - Eva Turk
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.,Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Julia Menichetti
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway. .,Health Services Research (HØKH) Centre, Akershus University Hospital, Lørenskog, Norway.
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14
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Staples JA, Liu G, Brubacher JR, Karimuddin A, Sutherland JM. Physician Financial Incentives to Reduce Unplanned Hospital Readmissions: an Interrupted Time Series Analysis. J Gen Intern Med 2021; 36:3431-3440. [PMID: 33948803 PMCID: PMC8606373 DOI: 10.1007/s11606-021-06803-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 04/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2012, the Ministry of Health in British Columbia, Canada, introduced a $75 incentive payment that could be claimed by hospital physicians each time they produced a written post-discharge care plan for a complex patient at the time of hospital discharge. OBJECTIVE To examine whether physician financial payments incentivizing enhanced discharge planning reduce subsequent unplanned hospital readmissions. DESIGN Interrupted time series analysis of population-based hospitalization data. PARTICIPANTS Individuals with one or more eligible hospitalizations occurring in British Columbia between 2007 and 2017. MAIN MEASURES The proportion of index hospital discharges with subsequent unplanned hospital readmission within 30 days, as measured each month of the 11-year study interval. We used interrupted time series analysis to determine if readmission risk changed after introduction of the incentive payment policy. KEY RESULTS A total of 40,588 unplanned hospital readmissions occurred among 409,289 eligible index hospitalizations (crude 30-day readmission risk, 9.92%). Policy introduction was not associated with a significant step change (0.393%; 95CI, - 0.190 to 0.975%; p = 0.182) or change-in-trend (p = 0.317) in monthly readmission risk. Policy introduction was associated with significantly fewer prescription fills for potentially inappropriate medications among older patients, but no improvement in prescription fills for beta-blockers after cardiovascular hospitalization and no change in 30-day mortality. Incentive payment uptake was incomplete, rising from 6.4 to 23.5% of eligible hospitalizations between the first and last year of the post-policy interval. CONCLUSION The introduction of a physician incentive payment was not associated with meaningful changes in hospital readmission rate, perhaps in part because of incomplete uptake by physicians. Policymakers should consider these results when designing similar interventions elsewhere. TRIAL REGISTRATION ClinicalTrials.gov ID, NCT03256734.
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Affiliation(s)
- John A. Staples
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, Canada
- Centre for Health Evaluation & Outcome Sciences (CHÉOS), Vancouver, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research (CHSPR), School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jeffrey R. Brubacher
- Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Ahmer Karimuddin
- Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Jason M. Sutherland
- Centre for Health Evaluation & Outcome Sciences (CHÉOS), Vancouver, Canada
- Centre for Health Services and Policy Research (CHSPR), School of Population and Public Health, University of British Columbia, Vancouver, Canada
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15
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Naseri C, McPhail SM, Morris ME, Haines TP, Etherton-Beer C, Shorr R, Flicker L, Bulsara M, Lee DCA, Francis-Coad J, Waldron N, Hill AM. Tailored Education Increased Capability and Motivation for Fall Prevention in Older People After Hospitalization. Front Public Health 2021; 9:683723. [PMID: 34414157 PMCID: PMC8369365 DOI: 10.3389/fpubh.2021.683723] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/28/2021] [Indexed: 12/25/2022] Open
Abstract
Recently hospitalized older people are at risk of falls and face barriers to undertaking fall prevention strategies after they return home from hospital. The authors examined the effects of tailored education delivered by physiotherapists on the knowledge (capability) and the motivation of older people to engage in fall prevention after hospital discharge. Utilizing data gathered from a recent trial, data was analyzed from 390 people who were 60 years and over without impaired cognition (>7/10 abbreviated mental test score) and discharged from three Australian hospitals. Motivation and capability were measured at baseline in the hospital and at 6-months after hospital discharge by blinded assistants using structured surveys. Bivariate analysis using generalized linear modeling explored the impact of education on the capability and motivation. Engagement in fall prevention strategies was entered as an independent variable during analysis to determine associations with capability and motivation. The education significantly improved capability [-0.4, 95% CI (-0.7, -0.2), p < 0.01] and motivation [-0.8, 95% CI (-1.1, -0.5), p < 0.01] compared with social-control at the time of hospital discharge. In contrast, social-control participants gained capability and motivation over the 6-months, and no significant differences were found between groups in capability [0.001, 95% CI (-0.2, 0.2), p = 0.9] and motivation [-0.01, 95% CI (-0.3, 0.3), p = 0.9] at follow-up. Tailored fall prevention education is recommended around hospital discharge. Participants still needed to overcome barriers to falls prevention engagement post hospitalization. Thus, tailored education along with direct clinical services such as physiotherapy and social supports is warranted for older people to avoid falls and regain function following hospitalization.
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Affiliation(s)
- Chiara Naseri
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Faculty of Health, School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, QLD, Australia
| | - Meg E Morris
- Healthscope Academic and Research Collaborative in Health, La Trobe University, Bundoora, VIC, Australia.,College of Healthcare Sciences, James Cook University, Douglas, QLD, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Christopher Etherton-Beer
- Royal Perth Hospital, Perth, WA, Australia.,Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, WA, Australia
| | - Ronald Shorr
- Malcom Randall Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center, Gainesville, FL, United States.,College of Medicine, University of Florida, Gainesville, FL, United States
| | - Leon Flicker
- Royal Perth Hospital, Perth, WA, Australia.,Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, WA, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Den-Ching A Lee
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Jacqueline Francis-Coad
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Nicholas Waldron
- Department of Geriatric Rehabilitation, Armadale Health Service, Department of Health, Perth, WA, Australia
| | - Anne-Marie Hill
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
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16
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Gleason K, Dahm MR. How patients describe their diagnosis compared to clinical documentation. ACTA ACUST UNITED AC 2021; 9:250-254. [PMID: 34391215 DOI: 10.1515/dx-2021-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/28/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To explore how patients describe their diagnoses following Emergency Department (ED) discharge, and how this compares to electronic medical record (EMR) documentation. METHODS We conducted a cohort study of patients discharged from three EDs. Patients completed questionnaires regarding their understanding of their diagnosis. Inclusion criteria: adult ED patients aged 18 and older seen within the last seven days. We independently compared patient-reported new diagnoses following discharge to EMR-documented diagnoses regarding diagnostic content (identical, insignificantly different, different, not enough detail) and the level of technical language in diagnostic description (technical, semi-technical, lay). RESULTS The majority of participants (n=95 out of 137) reported receiving a diagnosis and stated the given diagnosis. Of those who reported their diagnosis, 66%, were females (n=62), the average age was 43 (SD 16), and a fourth (n=24) were Black and 66% (n=63) were white. The majority (84%) described either the same or an insignificantly different diagnosis. For 11% the patient-reported diagnosis differed from the one documented. More than half reported their diagnosis using semi-technical (34%) or technical language (26%), and over a third (40%) described their diagnosis in lay language. CONCLUSIONS Patient-reported diagnoses following ED discharge had moderate agreement with EMR-documented diagnoses. Findings suggest that patients might reproduce verbatim semi-technical or technical diagnoses they received from clinicians, but not fully understood what the diagnosis means for them.
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Affiliation(s)
- Kelly Gleason
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Maria R Dahm
- Institute for Communication in Health Care, Australian National University, Canberra, ACT, Australia
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17
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Trivedi SP, Kopp Z, Williams PN, Hupp D, Gowen N, Horwitz LI, Schwartz MD. Who is Responsible for Discharge Education of Patients? A Multi-Institutional Survey of Internal Medicine Residents. J Gen Intern Med 2021; 36:1568-1575. [PMID: 33532957 PMCID: PMC8175511 DOI: 10.1007/s11606-020-06508-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Safely and effectively discharging a patient from the hospital requires working within a multidisciplinary team. However, little is known about how perceptions of responsibility among the team impact discharge communication practices. OBJECTIVE Our study attempts to understand residents' perceptions of who is primarily responsible for discharge education, how these perceptions affect their own reported communication with patients, and how residents envision improving multidisciplinary communication around discharges. DESIGN A multi-institutional cross-sectional survey. PARTICIPANTS Internal medicine (IM) residents from seven US residency programs at academic medical centers were invited to participate between March and May 2019, via email of an electronic link to the survey. MAIN MEASURES Data collected included resident perception of who on the multidisciplinary team is primarily responsible for discharge communication, their own reported discharge communication practices, and open-ended comments on ways discharge multidisciplinary team communication could be improved. KEY RESULTS Of the 613 resident responses (63% response rate), 35% reported they were unsure which member of the multidisciplinary team is primarily responsible for discharge education. Residents who believed it was either the intern's or the resident's primary responsibility had 4.28 (95% CI, 2.51-7.30) and 3.01 (95% CI, 1.66-5.71) times the odds, respectively, of reporting doing discharge communication practices frequently compared to those who were not sure who was primarily responsible. To improve multidisciplinary discharge communication, residents called for the following among team members: (1) clarifying roles and responsibilities for communication with patients, (2) setting expectations for communication among multidisciplinary team members, and (3) redefining culture around discharges. CONCLUSIONS Residents report a lack of understanding of who is responsible for discharge education. This diffusion of ownership impacts how much residents invest in patient education, with more perceived responsibility associated with more frequent discharge communication.
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Affiliation(s)
- Shreya P Trivedi
- Department of Population Health, New York University School of Medicine, New York, NY, USA.
- Department of Medicine, Beth Israel Deaconess Medical Center, 550 Brookline Avenue, Boston, MA, 02215, USA.
| | - Zoe Kopp
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Paul N Williams
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Derek Hupp
- Department of Medicine, University of Iowa, Iowa, IA, USA
| | - Nick Gowen
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Leora I Horwitz
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Mark D Schwartz
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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18
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Gleason KT, Peterson S, Himmelfarb CRD, Villanueva M, Wynn T, Bondal P, Berg D, Jerde W, Newman-Toker D. Feasibility of patient-reported diagnostic errors following emergency department discharge: a pilot study. Diagnosis (Berl) 2021; 8:187-192. [PMID: 33006949 PMCID: PMC8019684 DOI: 10.1515/dx-2020-0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/22/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The National Academy of Medicine identified diagnostic error as a pressing public health concern and defined failure to effectively communicate the diagnosis to patients as a diagnostic error. Leveraging Patient's Experience to improve Diagnosis (LEAPED) is a new program for measuring patient-reported diagnostic error. As a first step, we sought to assess the feasibility of using LEAPED after emergency department (ED) discharge. METHODS We deployed LEAPED using a cohort design at three EDs within one academic health system. We enrolled 59 patients after ED discharge and queried them about their health status and understanding of the explanation for their health problems at 2-weeks, 1-month, and 3-months. We measured response rates and demographic/clinical predictors of patient uptake of LEAPED. RESULTS Of those enrolled (n=59), 90% (n=53) responded to the 2-week post-ED discharge questionnaire (1 and 3-month ongoing). Of the six non-responders, one died and three were hospitalized at two weeks. The average age was 50 years (SD 16) and 64% were female; 53% were white and 41% were black. Over a fifth (23%) reported they were not given an explanation of their health problem on leaving the ED, and of those, a fourth (25%) did not have an understanding of what next steps to take after leaving the ED. CONCLUSIONS Patient uptake of LEAPED was high, suggesting that patient-report may be a feasible method of evaluating the effectiveness of diagnostic communication to patients though further testing in a broader patient population is essential. Future research should determine if LEAPED yields important insights into the quality and safety of diagnostic care.
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Affiliation(s)
- Kelly T. Gleason
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Susan Peterson
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Cheryl R. Dennison Himmelfarb
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA; School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Taylor Wynn
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Paula Bondal
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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19
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Chuen VL, Chan ACH, Ma J, Alibhai SMH, Chau V. The frequency and quality of delirium documentation in discharge summaries. BMC Geriatr 2021; 21:307. [PMID: 33980170 PMCID: PMC8117503 DOI: 10.1186/s12877-021-02245-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The National Institute for Health and Care Excellence recommends documenting all delirium episodes in the discharge summary using the term "delirium". Previous studies demonstrate poor delirium documentation rates in discharge summaries and no studies have assessed delirium documentation quality. The aim of this study was to determine the frequency and quality of delirium documentation in discharge summaries and explore differences between medical and surgical services. METHODS This was a multi-center retrospective chart review. We included 110 patients aged ≥ 65 years identified to have delirium during their hospitalization using the Chart-based Delirium Identification Instrument (CHART-DEL). We assessed the frequency of any delirium documentation in discharge summaries, and more specifically, for the term "delirium". We evaluated the quality of delirium discharge documentation using the Joint Commission on Accreditation of Healthcare Organization's framework for quality discharge summaries. Comparisons were made between medical and surgical services. Secondary outcomes included assessing factors influencing the frequency of "delirium" being documented in the discharge summary. RESULTS We identified 110 patients with sufficient chart documentation to identify delirium and 80.9 % of patients had delirium documented in their discharge summary ("delirium" or other acceptable term). The specific term "delirium" was reported in 63.6 % of all delirious patients and more often by surgical than medical specialties (76.5 % vs. 52.5 %, p = 0.02). Documentation quality was significantly lower by surgical specialties in reporting delirium as a diagnosis (23.5 % vs. 57.6 %, p < 0.001), documenting delirium workup (23.4 % vs. 57.6 %, p = 0.001), etiology (43.3 % vs. 70.4 %, p = 0.03), treatment (36.7 % vs. 66.7 %, p = 0.02), medication changes (44.4 % vs. 100 %, p = 0.002) and follow-up (36.4 % vs. 88.2 %, p = 0.01). CONCLUSIONS The frequency of delirium documentation is higher than previously reported but remains subpar. Medical services document delirium with higher quality, but surgical specialties document the term "delirium" more frequently. The documentation of delirium in discharge summaries must improve to meet quality standards.
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Affiliation(s)
- Victoria L Chuen
- Faculty of Medicine, University of Toronto, Ontario, Toronto, Canada.,Faculty of Medicine, McMaster University, Ontario, Hamilton, Canada
| | - Adrian C H Chan
- Faculty of Medicine, University of Toronto, Ontario, Toronto, Canada.,Faculty of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jin Ma
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Division of General Internal Medicine and Geriatrics, Department of Medicine, University Health Network, Toronto, Ontario, Canada.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Sinai Health System, Ontario, Toronto, Canada
| | - Vicky Chau
- Division of General Internal Medicine and Geriatrics, Department of Medicine, University Health Network, Toronto, Ontario, Canada. .,Division of General Internal Medicine and Geriatrics, Department of Medicine, Sinai Health System, Ontario, Toronto, Canada.
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Impact of an electronic medical record-based appointment order on outpatient cardiology follow-up after hospital discharge. NPJ Digit Med 2021; 4:77. [PMID: 33958680 PMCID: PMC8102598 DOI: 10.1038/s41746-021-00443-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/09/2021] [Indexed: 11/09/2022] Open
Abstract
Outpatient follow-up after hospital discharge improves continuity of care and reduces readmissions, but rates of follow-up remain low. It is not known whether electronic medical record (EMR)-based tools improve follow-up. The aim of this study was to determine if an EMR-based order to secure cardiology follow-up appointments at hospital discharge would improve follow-up rates and hospital readmission rates. A pre-post interventional study was conducted and evaluated 39,209 cardiovascular medicine discharges within an academic center between 2012 and 2017. Follow-up rates and readmission rates were compared during 2 years prior to EMR-order implementation (pre-order era 2012-2013, n = 12,852) and 4 years after implementation (EMR-order era 2014-2017, n = 26,357). The primary endpoint was 90-day cardiovascular follow-up rates within our health system. In the overall cohort, the mean age of patients was 69.3 years [SD 14.7] and 60.7% (n = 23,827) were male. In the pre-order era, 90-day follow-up was 56.7 ± 0.4% (7286 of 12,852) and increased to 67.9 ± 0.3% (17,888 of 26,357, P < 0.001) in the EMR-order era. The use of the EMR follow-up order was independently associated with increased outpatient follow-up within 90 days after adjusting for patient demographics and payor status (OR 3.28, 95% CI 3.10-3.47, P < 0.001). The 30-day readmission rate in the pre-order era was 12.8% (1642 of 12,852) compared with 13.7% (3601 of 26,357, P = 0.016) in the EMR-order era. An EMR-based appointment order for follow-up appointment scheduling was associated with increased cardiovascular medicine follow-up, but was not associated with an observed reduction in 30-day readmission rates.
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Ratelle JT, Herberts M, Miller D, Kumbamu A, Lawson D, Polley E, Beckman TJ. Relationships Between Time-at-Bedside During Hospital Ward Rounds, Clinician-Patient Agreement, and Patient Experience. J Patient Exp 2021; 8:23743735211008303. [PMID: 34179432 PMCID: PMC8205390 DOI: 10.1177/23743735211008303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Hospital medicine ward rounds are often conducted away from patients' bedsides, but it is unknown if more time-at-bedside is associated with improved patient outcomes. Our objective is to measure the association between "time-at-bedside," patient experience, and patient-clinician care agreement during ward rounds. Research assistants directly observed medicine services to quantify the amount of time spent discussing each patient's care inside versus outside the patient's room. "Time-at-bedside" was defined as the proportion of time spent discussing a patient's care in his or her room. Patient experience and patient-clinician care agreement both were measured immediately after ward rounds. Results demonstrated that the majority of patient and physicians completely agreement on planned tests (66.3%), planned procedures (79.7%), medication changes (50.6%), and discharge location (66.9%), but had no agreement on the patient's main concern (74.4%) and discharge date (50.6%). Time-at-bedside was not correlated with care agreement or patient experience (P > .05 for all comparisons). This study demonstrates that spending more time at the bedside during ward rounds, alone, is insufficient to improve patient experience.
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Affiliation(s)
- John T Ratelle
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michelle Herberts
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Donna Miller
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ashok Kumbamu
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of
Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Donna Lawson
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric Polley
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Thomas J Beckman
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc J, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/HRS/EHRA/APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. J Arrhythm 2021; 37:271-319. [PMID: 33850572 PMCID: PMC8022003 DOI: 10.1002/joa3.12461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Affiliation(s)
| | | | | | | | - Yufeng Hu
- Taipei Veterans General HospitalTaipeiTaiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of RochesterRochesterNYUSA
| | - Rod Passman
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de MedicinaCentro de TelessaúdeHospital das Clínicasand Departamento de Clínica MédicaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | | | | | - David Slotwiner
- Cardiology DivisionNewYork‐Presbyterian Queensand School of Health Policy and ResearchWeill Cornell MedicineNew YorkNYUSA
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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc J, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. Ann Noninvasive Electrocardiol 2021; 26:e12795. [PMID: 33513268 PMCID: PMC7935104 DOI: 10.1111/anec.12795] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/ Heart Rhythm Society/ European Heart Rhythm Association/ Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Affiliation(s)
| | | | | | | | - Yufeng Hu
- Taipei Veterans General HospitalTaipeiTaiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of RochesterRochesterNYUSA
| | - Rod Passman
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de MedicinaCentro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica MédicaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | | | | | - David Slotwiner
- Cardiology DivisionNewYork‐Presbyterian Queens, and School of Health Policy and ResearchWeill Cornell MedicineNew YorkNYUSA
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Burgdorf JG, Fabius CD, Riffin C, Wolff JL. Receipt of Posthospitalization Care Training Among Medicare Beneficiaries' Family Caregivers. JAMA Netw Open 2021; 4:e211806. [PMID: 33724393 PMCID: PMC7967076 DOI: 10.1001/jamanetworkopen.2021.1806] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/23/2021] [Indexed: 01/25/2023] Open
Abstract
Importance Medicare conditions of participation require hospitals to provide training to family and unpaid caregivers when their support is necessary to enact the postdischarge care plan. However, caregivers often report feeling unprepared for this role. Objective To describe the characteristics of caregivers who assist with posthospitalization care transitions and assess the prevalence of and factors associated with receipt of adequate transitional care training. Design, Setting, and Participants This cross-sectional study analyzed data from the 2017 National Health and Aging Trends Study and its linked National Study of Caregiving, surveys of Medicare beneficiaries and their family and unpaid caregivers. The present study included family caregivers for community-living Medicare beneficiaries 65 years or older with disabilities. Data analysis was performed from June to September 2020. Main Outcomes and Measures Characteristics of family caregivers by whether they assisted during a posthospitalization care transition in the year preceding the survey interview. Unweighted frequencies and weighted percentages, as well as the results of weighted Pearson and Wald tests for differences between groups, are reported. Receipt of the training needed to manage the older adult's posthospitalization care transition (hereafter referred to as adequate transitional care training) as a function of individual caregiver characteristics was modeled using multivariable, weighted logistic regression. Results Of 1905 family caregivers, 618 (58.9%) were 60 years or older, 1288 (63.8%) were female, and 796 (41.7%) assisted with a posthospitalization care transition. Those who assisted with a posthospitalization care transition were more likely to report experiencing financial (154 [18.3%] vs 123 [10.1%]; P < .001), emotional (344 [41.3%] vs 342 [31.1%]; P < .001), and physical (200 [22.2%] vs 170 [14.6%]; P = .001) difficulty associated with caregiving. Among caregivers who assisted during a posthospitalization care transition, 490 (59.1%) reported receiving adequate transitional care training. Caregivers were less likely to report receiving adequate training if they assisted an older adult who was female (316 [62.3%] vs 227 [73.2%]; P = .02), Black (163 [14.0%] vs 121 [19.8%]; P = .02), or enrolled in Medicaid (127 [21.2%] vs 90 [31.9%]; P = .01). After adjusting for older adult characteristics, caregivers were half as likely to report receiving adequate training if they were Black (adjusted odds ratio [aOR], 0.52; 95% CI, 0.31-0.89) or experienced financial difficulty (aOR, 0.50; 95% CI, 0.31-0.81). Caregivers were more than twice as likely to report receiving adequate training if they were female (aOR, 2.44; 95% CI, 1.65-3.61) or spoke with the older adult's clinician about his or her care in the past year sometimes or often vs never (aOR, 1.93; 95% CI, 1.19-3.12). Conclusions and Relevance In this cross-sectional study, caregivers were less likely to receive adequate transitional care training if they were Black; experienced financial difficulty; or cared for a Black, female, or Medicaid-enrolled older adult. These findings suggest that changes to the discharge process, such as using standardized caregiver assessments, may be necessary to ensure equitable support of family caregivers.
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Affiliation(s)
- Julia G. Burgdorf
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Chanee D. Fabius
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Catherine Riffin
- Department of Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Jennifer L. Wolff
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Varma N, Cygankiewicz I, Turakhia MP, Heidbuchel H, Hu YF, Chen LY, Couderc JP, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini JP, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society. Circ Arrhythm Electrophysiol 2021; 14:e009204. [PMID: 33573393 PMCID: PMC7892205 DOI: 10.1161/circep.120.009204] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society describes the current status of mobile health technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mobile health. The promises of predictive analytics but also operational challenges in embedding mobile health into routine clinical care are explored.
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Affiliation(s)
- Niraj Varma
- Cleveland Clinic, OH (N.V., J.D.E., R.M., R.E.R.)
| | | | | | | | - Yu-Feng Hu
- Taipei Veterans General Hospital, Taiwan (Y.-F.H.)
| | | | | | | | | | | | | | - Reena Mehra
- Cleveland Clinic, OH (N.V., J.D.E., R.M., R.E.R.)
| | - Alex Page
- University of Rochester, NY (J.-P.C., A.P., J.S.S.)
| | - Rod Passman
- Northwestern University Feinberg School of Medicine, Chicago, IL (R. Passman)
| | | | - Ewa Piotrowicz
- National Institute of Cardiology, Warsaw, Poland (E.P., R. Piotrowicz)
| | | | | | - Antonio Luiz Ribeiro
- Faculdade de Medicina, Centro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.)
| | | | - Andrea M. Russo
- Cooper Medical School of Rowan University, Camden, NJ (A.M.R.)
| | - David Slotwiner
- Cardiology Division, New York-Presbyterian Queens, NY (D.S.)
| | | | - Emma Svennberg
- Karolinska University Hospital, Stockholm, Sweden (E.S.)
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26
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Bhamidipati VS, Hicks LS, Caplan R, Ingraham B, Rn PM, Robinson EJ. Predictors and Outcomes of Patient Knowledge of Plan of Care in Hospital Medicine: A Quality Improvement Study. Jt Comm J Qual Patient Saf 2021; 47:176-184. [PMID: 33454235 DOI: 10.1016/j.jcjq.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patient understanding of plan of care is associated with positive outcomes in ambulatory settings. In hospital medicine settings, patient-physician agreement on plan of care (concordance) has been limited and difficult to improve. This study examined the impact of adding a hospitalist to interdisciplinary rounds (IDR) on physician-patient-nurse concordance and the relationship between concordance and outcomes. METHODS IDR were conducted by core teams made up of unit-based nurses, a case manager, and a pharmacist. Over time, with cohorting, hospitalists were included in IDR (hospitalist IDR) for some patients assigned to unit-based hospitalists. In developing hospitalist IDR, the researchers emphasized using an IDR checklist, including a patient communication plan. Patient-nurse-physician interviews were used to assess concordance in the domains of diagnosis, tests and procedures, and expected discharge date. Using two-hospitalist review, agreement was rated as none, partial, or complete, and a total concordance score was calculated for each patient in both IDR groups. Multivariate analysis was used to examine the relationship between concordance, IDR type, patient factors, and utilization outcomes. RESULTS For 658 patients, the mean concordance score was 11.71 out of a possible 18. There was no difference in concordance between hospitalist and core IDR groups (11.68 vs. 11.84, p = 0.7). Higher total concordance score was associated with lower lengths of stay (p < 0.001) and readmission rates (p = 0.001). Total concordance had a negative association with patient age (p = 0.04). CONCLUSION Concordance did not change with IDR type. Higher concordance appears to be related to positive utilization outcomes. Future studies are needed to evaluate potential interventions to improve concordance.
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27
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Ishimoto H, Ikeda T, Kadooka Y. Factors related to satisfaction of cancer patients with transfer arrangements made by university hospitals at the end-of-life in Japan: a cross-sectional questionnaire survey of bereaved family members. Support Care Cancer 2020; 29:3091-3101. [PMID: 33057817 DOI: 10.1007/s00520-020-05822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Cancer patients in university hospitals often face a difficult decision regarding transfer to other care settings at the end-of-life. Arrangements for a satisfying transfer are important for reducing the psychosocial impact of the transition, but few studies have evaluated this aspect. This study aimed to identify factors related to the satisfying arrangement of transfers to other care settings from university hospitals. METHODS A total of 400 bereaved family members of cancer patients in Japan participated in this cross-sectional web-based questionnaire survey. Statistical methods including decision tree analysis were conducted to identify factors significantly associated with satisfying transfer arrangements. RESULTS More than 60% of cancer patients were satisfied with the transfer arrangements made by university hospitals. Decision tree analysis revealed that the factor most significantly associated with satisfaction with transfer arrangements was "satisfaction with contents of the explanation about transfer." The following significant factors were also extracted: "timing of being informed of transfer," "presence of primary care physician," and "presence of trustworthy staff." "Satisfaction with overall care from university hospital staff" and "involvement of palliative care team" were identified as factors contributing to a high degree of satisfaction with transfer arrangements. CONCLUSION In order to make satisfying transfer arrangements from university hospitals for cancer patients at the end-of-life, healthcare professionals should provide satisfactory explanations about the transfer process in order to meet the information needs of patients. To be effective, healthcare professionals should initiate transfer arrangements prior to cancer treatment, while simultaneously building trusting relationships with patients.
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Affiliation(s)
- Hiroko Ishimoto
- Department of Bioethics, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Tokunori Ikeda
- Laboratory of Clinical Pharmacology and Therapeutics, Sojo University Faculty of Pharmaceutical Sciences, 4-22-1 Ikeda, Nishi-ku, Kumamoto, 860-0082, Japan
- Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yasuhiro Kadooka
- Department of Bioethics, Kumamoto University Faculty of Life Sciences, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan
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Weerahandi H, Li L, Bao H, Herrin J, Dharmarajan K, Ross JS, Kim KL, Jones S, Horwitz LI. Risk of Readmission After Discharge From Skilled Nursing Facilities Following Heart Failure Hospitalization: A Retrospective Cohort Study. J Am Med Dir Assoc 2020; 20:432-437. [PMID: 30954133 DOI: 10.1016/j.jamda.2019.01.135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Discharge to skilled nursing facilities (SNFs) is common in patients with heart failure (HF). It is unknown whether the transition from SNF to home is risky for these patients. Our objective was to study outcomes for the 30 days after discharge from SNF to home among Medicare patients hospitalized with HF who had subsequent SNF stays of 30 days or less. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS All Medicare fee-for-service beneficiaries 65 and older admitted during 2012-2015 with a HF diagnosis discharged to SNF then subsequently discharged home. MEASURES Patients were followed for 30 days following SNF discharge. We categorized patients by SNF length of stay: 1 to 6 days, 7 to 13 days, and 14 to 30 days. For each group, we modeled time to a composite outcome of unplanned readmission or death after SNF discharge. Our model examined 0-2 days and 3-30 days post-SNF discharge. RESULTS Our study included 67,585 HF hospitalizations discharged to SNF and subsequently discharged home. Overall, 16,333 (24.2%) SNF discharges to home were readmitted within 30 days of SNF discharge. The hazard rate of the composite outcome for each group was significantly increased on days 0 to 2 after SNF discharge compared to days 3 to 30, as reflected in their hazard rate ratios: for patients with SNF length of stay 1 to 6 days, 4.60 (4.23-5.00); SNF length of stay 7 to 13 days, 2.61 (2.45-2.78); SNF length of stay 14 to 30 days, 1.70 (1.62-1.78). CONCLUSIONS/IMPLICATIONS The hazard rate of readmission after SNF discharge following HF hospitalization is highest during the first 2 days home. This risk attenuated with longer SNF length of stay. Interventions to improve postdischarge outcomes have primarily focused on hospital discharge. This evidence suggests that interventions to reduce readmissions may be more effective if they also incorporate the SNF-to-home transition.
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Affiliation(s)
- Himali Weerahandi
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, New York, NY.
| | - Li Li
- Center for Outcomes Research & Evaluation, Yale University, New Haven, CT
| | - Haikun Bao
- Center for Outcomes Research & Evaluation, Yale University, New Haven, CT
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Joseph S Ross
- Center for Outcomes Research & Evaluation, Yale University, New Haven, CT; Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Kunhee Lucy Kim
- Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, NY
| | - Simon Jones
- Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, NY
| | - Leora I Horwitz
- Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, NY
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Delisle DR, Dajani J, Overton L. An Integrated Model to Accelerate Patient Satisfaction Improvement. Am J Med Qual 2020; 36:255-262. [PMID: 32911952 DOI: 10.1177/1062860620953213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient satisfaction is gaining traction in the strategic direction and daily operations of hospital executives. The financial penalty/incentive tied to patient satisfaction scores creates a burning platform to accelerate progress. Previous studies have shown the effectiveness of various improvement strategies including leadership rounding and employee training, among others. There has not been a study utilizing an integrated model that incorporates known best practices into a holistic approach. The integrated model included service excellence training, nursing unit-specific action plans, and weekly leadership rounding. Implementation of the model led to significant and sustainable improvements in patient satisfaction in the community hospital setting. This approach can be leveraged and scaled in other organizations to accelerate the pace of change.
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Gleason K, McDonald KM. In response to Ledford and colleagues Toward a Model of Shared Meaningful Diagnosis: How to capture a shared, meaningful diagnosis? PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30461-4. [PMID: 32891469 PMCID: PMC7914276 DOI: 10.1016/j.pec.2020.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 05/11/2023]
Affiliation(s)
- Kelly Gleason
- School of Nursing, Johns Hopkins University, Baltimore, MD USA.
| | - Kathryn M McDonald
- School of Nursing, Johns Hopkins University, Baltimore, MD USA; School of Medicine (General Internal Medicine), Bloomberg School of Public Health, and Carey School of Business Johns Hopkins University, Baltimore, MD USA
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Naureckas Li C, Camargo CA, Faridi M, Espinola JA, Hayes BD, Porter S, Cohen A, Samuels-Kalow M. Medication Education for Dosing Safety: A Randomized Controlled Trial. Ann Emerg Med 2020; 76:637-645. [PMID: 32807539 DOI: 10.1016/j.annemergmed.2020.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/01/2020] [Accepted: 05/08/2020] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE This study sought to determine whether a brief intervention at the time of emergency department (ED) discharge can improve safe dosing of liquid acetaminophen and ibuprofen by parents or guardians. METHODS We performed a randomized controlled trial in the ED of parents and guardians of children 90 days to 11.9 years of age who were discharged with acetaminophen or ibuprofen, or both. Families were randomized to standard care or a teaching intervention combining lay language, simplified handouts, provision of an unmarked dosing syringe, and teach-back to confirm correct dosing. Participants were called 48 to 72 hours and 5 to 7 days after ED discharge to assess understanding of correct dosing. The primary outcome was defined as parent or guardian report of safe dosing at the time of first follow-up call. Our primary hypothesis was that the intervention would decrease the rate of error from 30% to 10% at 48- to 72-hour follow-up. RESULTS We enrolled 149 of 259 (58%) eligible subjects; 97 of 149 (65%) were reached at first follow-up call, of whom 35 of 97 (36%) received the intervention. Among those participants receiving the intervention, 25 of 35 (71%) were able to identify a safe dose for their child at the time of the first call compared with 28 of 62 (45%) of those in the control arm. The difference in proportions was 26% (95% confidence interval [CI] 7% to 46%). There was a 58% increase in reporting safe dosing in the intervention group compared with the control roup (relative risk 1.58; 95% CI 1.12 to 2.24), and it remained significant after adjustment for health literacy and language (adjusted relative risk 1.50; 95% CI 1.06 to 2.13). CONCLUSIONS A multifaceted intervention at the time of ED discharge-consisting of a simplified dosing handout, a teaching session, teach-back, and provision of a standardized dosing device-can improve parents' knowledge of safe dosing of liquid medications at 48 to 72 hours.
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Affiliation(s)
- Caitlin Naureckas Li
- Division of Pediatric Infectious Diseases, Boston Children's Hospital, Boston, MA.
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Mohammad Faridi
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Janice A Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Bryan D Hayes
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Pharmacy, Massachusetts General Hospital, Boston, MA
| | - Stephen Porter
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, OH
| | - Ari Cohen
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
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Yang MM, Liang W, Zhao HH, Zhang Y. Quality analysis of discharge instruction among 602 hospitalized patients in China: a multicenter, cross-sectional study. BMC Health Serv Res 2020; 20:647. [PMID: 32652990 PMCID: PMC7353724 DOI: 10.1186/s12913-020-05518-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to understand the quality of discharge guidance for patients with chronic diseases, to clarify the gap between patient needs and the content of discharge guidance, and to provide a reference for health education and clinical path management of patients with chronic diseases in the future. METHODS A total of 602 inpatients with stroke, coronary heart disease, cancer, chronic obstructive pulmonary disease and diabetes from the chronic disease-related departments of 7 tertiary general hospitals in China were selected by convenience sampling. Measures included a demographic questionnaire and the Quality of Discharged Teaching Scale(QDTS). Descriptive analysis ANOVA and paired t-test were completed by SPSS 22.0 software. RESULTS The overall average score of QDTS in this survey was 155.79 ± 23.29. The total score of QDTS in chronic obstructive pulmonary disease was lower than coronary heart disease (P < 0.001) and cancer (P = 0.02). While coronary heart disease was higher than stroke (P = 0.01) and diabetes (P = 0.01). And the scores of patients on discharge guidance skills and effects were higher than 8.50. CONCLUSIONS The level of the patients' perception of quality of discharge insrtuction is middle to high. Managers should understand the characteristics of various departments, give corresponding guidance and help, and clinical nurses should understand the characteristics of ward patients and pay more attention to individual guidance.
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Affiliation(s)
- Miao-Miao Yang
- Department of nursing, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Wei Liang
- Department of nursing, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Hui Hua Zhao
- Department of nursing, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Ying Zhang
- Department of nursing, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
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Weetman K, Dale J, Spencer R, Scott E, Schnurr S. GP perspectives on hospital discharge letters: an interview and focus group study. BJGP Open 2020; 4:bjgpopen20X101031. [PMID: 32398346 PMCID: PMC7330207 DOI: 10.3399/bjgpopen20x101031] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Written discharge communication following inpatient or outpatient clinic discharge is essential for communicating information to the GP, but GPs' opinions on discharge communication are seldom sought. Patients are sometimes copied into this communication, but the reasons for this variation, and the resultant effects, remain unclear. AIM To explore GP perspectives on how discharge letters can be improved in order to enhance patient outcomes. DESIGN & SETTING The study used narrative interviews with 26 GPs from 13 GP practices within the West Midlands, England. METHOD Interviews were transcribed and data were analysed using corpus linguistics (CL) techniques. RESULTS Elements pivotal to a successful letter were: diagnosis, appropriate follow-up plan, medication changes and reasons, clinical summary, investigations and/or procedures and outcomes, and what information has been given to the patient. GPs supported patients receiving discharge letters and expounded a number of benefits of this practice; for example, increased patient autonomy. Nevertheless, GPs felt that if patients are to receive direct discharge letter copies, modifications such as use of lay language and avoidance of acronyms may be required to increase patient understanding. CONCLUSION GPs reported that discharge letters frequently lacked content items they assessed to be important; GPs highlighted that this can have subsequent ramifications on resources and patient experiences. Templates should be devised that put discharge letter elements assessed to be important by GPs to the forefront. Future research needs to consider other perspectives on letter content, particularly those of patients.
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Affiliation(s)
- Katharine Weetman
- Unit of Academic Primary Care, University of Warwick, Warwick Medical School, Coventry, UK
| | - Jeremy Dale
- Unit of Academic Primary Care, University of Warwick, Warwick Medical School, Coventry, UK
| | - Rachel Spencer
- Unit of Academic Primary Care, University of Warwick, Warwick Medical School, Coventry, UK
| | - Emma Scott
- Unit of Academic Primary Care, University of Warwick, Warwick Medical School, Coventry, UK
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Spaulding EM, Marvel FA, Lee MA, Yang WE, Demo R, Wang J, Xun H, Shah L, Weng D, Fashanu OE, Carter J, Sheidy J, McLin R, Flowers J, Majmudar M, Elgin E, Vilarino V, Lumelsky D, Bhardwaj V, Padula W, Allen JK, Martin SS. Corrie Health Digital Platform for Self-Management in Secondary Prevention After Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2020; 12:e005509. [PMID: 31043065 DOI: 10.1161/circoutcomes.119.005509] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Unplanned readmissions after hospitalization for acute myocardial infarction are among the leading causes of preventable morbidity, mortality, and healthcare costs. Digital health interventions could be an effective tool in promoting self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction. A digital health intervention developed at Johns Hopkins-the Corrie Health Digital Platform (Corrie)-includes the first cardiology Apple CareKit smartphone application, which is paired with an Apple Watch and iHealth Bluetooth-enabled blood pressure cuff. Corrie targets: (1) self-management of cardiac medications, (2) self-tracking of vital signs, (3) education about cardiovascular disease through articles and animated videos, and (4) care coordination that includes outpatient follow-up appointments. METHODS AND RESULTS The 3 phases of the MiCORE study (Myocardial infarction, Combined-device, Recovery Enhancement) include (1) the development of Corrie, (2) a pilot study to assess the usability and feasibility of Corrie, and (3) a prospective research study to primarily compare time to first readmission within 30 days postdischarge among patients with Corrie to patients in the historical standard of care comparison group. In Phase 2, the feasibility of deploying Corrie in an acute care setting was established among a sample of 60 patients with acute myocardial infarction. Phase 3 is ongoing and patients from 4 hospitals are being enrolled as early as possible during their hospital stay if they are 18 years or older, admitted with acute myocardial infarction (ST-segment-elevation myocardial infarction or type I non-ST-segment-elevation myocardial infarction), and own a smartphone. Patients are either being enrolled with their own personal devices or they are provided an iPhone and/or Apple Watch for the duration of the study. Phase 3 started in October 2017 and we aim to recruit 140 participants. CONCLUSIONS This article will provide an in-depth understanding of the feasibility associated with implementing a digital health intervention in an acute care setting and the potential of Corrie as a self-management tool for acute myocardial infarction recovery.
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Affiliation(s)
- Erin M Spaulding
- Johns Hopkins University School of Nursing, Baltimore, MD (E.M.S., J.K.A.)
| | - Francoise A Marvel
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (F.A.M., O.E.F., S.S.M.)
| | - Matthias A Lee
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD (M.A.L., R.D., S.S.M.)
| | - William E Yang
- Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
| | - Ryan Demo
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (F.A.M., O.E.F., S.S.M.)
| | - Jane Wang
- Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
| | - Helen Xun
- Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
| | - Lochan Shah
- Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
| | - Daniel Weng
- Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
| | - Oluwaseun E Fashanu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (F.A.M., O.E.F., S.S.M.)
| | | | - Julie Sheidy
- Reading Hospital, West Reading, PA (J.S., R.M., J.F., E.E.)
| | - Renee McLin
- Reading Hospital, West Reading, PA (J.S., R.M., J.F., E.E.)
| | | | | | - Eric Elgin
- Reading Hospital, West Reading, PA (J.S., R.M., J.F., E.E.)
| | - Valerie Vilarino
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD (V.V., D.L.)
| | - David Lumelsky
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD (V.V., D.L.)
| | - Vinayak Bhardwaj
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (V.B., W.P., J.K.A.)
| | - William Padula
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (V.B., W.P., J.K.A.)
| | - Jerilyn K Allen
- Johns Hopkins University School of Nursing, Baltimore, MD (E.M.S., J.K.A.).,Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.).,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (V.B., W.P., J.K.A.)
| | - Seth S Martin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (F.A.M., O.E.F., S.S.M.).,Whiting School of Engineering, Johns Hopkins University, Baltimore, MD (M.A.L., R.D., S.S.M.).,Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
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Iversen ED, Wolderslund MO, Kofoed PE, Gulbrandsen P, Poulsen H, Cold S, Ammentorp J. Codebook for rating clinical communication skills based on the Calgary-Cambridge Guide. BMC MEDICAL EDUCATION 2020; 20:140. [PMID: 32375756 PMCID: PMC7201796 DOI: 10.1186/s12909-020-02050-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The aim of the study was to confirm the validity and reliability of the Observation Scheme-12, a measurement tool for rating clinical communication skills. METHODS The study is a sub-study of an intervention study using audio recordings to assess the outcome of communication skills training. This paper describes the methods used to validate the assessment tool Observation Scheme-12 by operationalizing the crude 5-point scale into specific elements described in a codebook. Reliability was tested by calculating the intraclass correlation coefficients for interrater and intrarater reliability. RESULTS The validation of the Observation Scheme-12 produced a rating tool with 12 items. Each item has 0 to 5 described micro-skills. For each item, the codebook described the criteria for delivering a rating from 0 to 4 depending on how successful the different micro-skills (or number of used jargon words) was accomplished. Testing reliability for the overall score intraclass correlation coefficients was 0.74 for interrater reliability and 0.86 for intrarater reliability. An intraclass correlation coefficient greater than 0.5 was observed for 10 of 12 items. CONCLUSION The development of a codebook as a supplement to the assessment tool Observation Scheme-12 enables an objective rating of audiotaped clinical communication with acceptable reliability. The Observation Scheme-12 can be used to assess communication skills based on the Calgary-Cambridge Guide.
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Affiliation(s)
- Else Dalsgaard Iversen
- Health Services Research Unit, Lillebaelt Hospital, Beriderbakken 4, DK-7100, Vejle, Denmark.
- Institute for Regional Health Research, University of Southern Denmark, Winsløwparken 19, Odense, Denmark.
- OPEN, Odense Patient data Explorative Network, J. B. Winsløws Vej 9a, 5000, Odense, Denmark.
| | - Maiken Overbeck Wolderslund
- Health Services Research Unit, Lillebaelt Hospital, Beriderbakken 4, DK-7100, Vejle, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Winsløwparken 19, Odense, Denmark
| | - Poul-Erik Kofoed
- Department of Paediatrics, Lillebaelt Hospital, Sygehusvej 24, DK-6000, Kolding, Denmark
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, 1478 Nordbyhagen, Oslo, Norway
- HØKH, Akershus University Hospital, Sykehusveien 25, 1478, Nordbyhagen, Norway
| | - Helle Poulsen
- Department of Gastrointestinal Surgery, Lillebaelt Hospital, Sygehusvej 24, DK-6000, Kolding, Denmark
| | - Søren Cold
- Department of Oncology, Odense University Hospital, J. B. Winsløws Vej 4, DK-5000, Odense, Denmark
| | - Jette Ammentorp
- Health Services Research Unit, Lillebaelt Hospital, Beriderbakken 4, DK-7100, Vejle, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Winsløwparken 19, Odense, Denmark
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Humphries C, Jaganathan S, Panniyammakal J, Singh S, Dorairaj P, Price M, Gill P, Greenfield S, Lilford R, Manaseki-Holland S. Investigating discharge communication for chronic disease patients in three hospitals in India. PLoS One 2020; 15:e0230438. [PMID: 32294091 PMCID: PMC7159187 DOI: 10.1371/journal.pone.0230438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/29/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Poor discharge communication is associated with negative health outcomes in high-income countries. However, quality of discharge communication has received little attention in India and many other low and middle-income countries. PRIMARY OBJECTIVE To investigate verbal and documented discharge communication for chronic non-communicable disease (NCD) patients. SECONDARY OBJECTIVE To explore the relationship between quality of discharge communication and health outcomes. METHODS DESIGN Prospective study. SETTING Three public hospitals in Himachal Pradesh and Kerala states, India. PARTICIPANTS 546 chronic NCD (chronic respiratory disease, cardiovascular disease or diabetes) patients. Piloted questionnaires were completed at admission, discharge and five and eighteen-week follow-up covering health status, discharge communication practices and health-seeking behaviour. Logistic regression was used to explore the relationship between quality of discharge communication and health outcomes. OUTCOME MEASURES PRIMARY Patient recall and experiences of verbal and documented discharge communication. SECONDARY Death, hospital readmission and self-reported deterioration of NCD/s. RESULTS All patients received discharge notes, predominantly on sheets of paper with basic pre-printed headings (71%) or no structure (19%); 31% of notes contained all the following information required for facilitating continuity of care: diagnosis, medication information, lifestyle advice, and follow-up instructions. Patient reports indicated notable variations in verbal information provided during discharge consultations; 50% received ongoing treatment/management information and 23% received lifestyle advice. Within 18 weeks of follow-up, 25 (5%) patients had died, 69 (13%) had been readmitted and 62 (11%) reported that their chronic NCD/s had deteriorated. Significant associations were found between low-quality documented discharge communication and death (AOR = 3.00; 95% CI 1.27,7.06) and low-quality verbal discharge communication and self-reported deterioration of chronic NCD/s (AOR = 0.46; 95% CI 0.25,0.83) within 18-weeks of follow-up. CONCLUSIONS Sub-optimal discharge practices may be compromising continuity and safety of chronic NCD patient care. Structured protocols, documents and training are required to improve discharge communication, healthcare integration and NCD management.
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Affiliation(s)
- Claire Humphries
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
| | - Suganthi Jaganathan
- Public Health Foundation of India, Delhi, India
- Centre for Chronic Disease Control, Delhi, India
| | - Jeemon Panniyammakal
- Public Health Foundation of India, Delhi, India
- Centre for Chronic Disease Control, Delhi, India
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, India
| | - Sanjeev Singh
- Hospital Administration, Amrita Institute of Medical Sciences, Kochi, India
| | - Prabhakaran Dorairaj
- Public Health Foundation of India, Delhi, India
- Centre for Chronic Disease Control, Delhi, India
| | - Malcolm Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, England, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, England, United Kingdom
| | - Paramjit Gill
- Academic Unit of Primary Care, University of Warwick, Coventry, England, United Kingdom
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
| | - Richard Lilford
- Centre for Applied Health Research and Delivery, University of Warwick, Coventry, England, United Kingdom
| | - Semira Manaseki-Holland
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, United Kingdom
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Richards BG, Hajduk AM, Perry J, Krumholz HM, Khan AM, Chaudhry SI. Patient-Reported Quality of Hospital Discharge Transitions: Results from the SILVER-AMI Study. J Gen Intern Med 2020; 35:808-814. [PMID: 31654359 PMCID: PMC7080904 DOI: 10.1007/s11606-019-05414-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transitions from hospital to home in older patients are a high-risk period for adverse outcomes in a population that may have more challenges navigating the healthcare system. There is little information about the association of patient-reported quality of hospital discharge processes with clinical outcomes. OBJECTIVES We evaluated whether patient-reported quality of hospital discharge processes was associated with emergency department utilization and rehospitalization within 30 days of discharge after hospitalization for acute myocardial infarction (AMI) in older adults. DESIGN Multi-center, prospective cohort study. PATIENTS The ComprehenSIVe Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction (SILVER-AMI) study was a longitudinal study of 3006 adults age 75 and older hospitalized with AMI recruited from 94 academic and community hospitals from across the USA. INTERVENTION N/A MAIN MEASURES: Patients answered a subset of questions from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Readmissions and emergency department utilization within 30 days of discharge were ascertained through medical record review. KEY RESULTS A total of 2132 patients were included in the study. Patients' median age was 81 years and the response rate to the survey of discharge quality was 87%. Patients who reported being asked about having the help they needed at home were significantly less likely to have emergency room utilization within 30 days of discharge in both the unadjusted (0.65, 95% CI 0.43-0.99) and adjusted (0.65, 95% CI 0.42-0.997) models, though there was no significant association with readmission. CONCLUSION Report of an assessment of help needed at home during hospitalization was associated with lower post-discharge emergency department utilization. Efforts to improve outcomes after hospital discharge in older patients may benefit from greater focus on assessing need of help at home.
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Affiliation(s)
- Bradley G Richards
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Alexandra M Hajduk
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Julia Perry
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Ali M Khan
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA.,CareMore Health System, Cerritos, CA, USA.,Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Hung G, Yang WE, Marvel FA, Martin SS. Mobile health application platform 'Corrie' personalises and empowers the heart attack recovery patient experience in the hospital and at home for an underserved heart attack survivor. BMJ Case Rep 2020; 13:13/2/e231801. [PMID: 32071124 PMCID: PMC7046423 DOI: 10.1136/bcr-2019-231801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide with an estimated 17.5 million deaths annually, according to the World Health Organization (WHO). CVD prevention efforts have the potential to prevent the majority of these deaths by supporting guideline-directed medical therapy (GDMT) and lifestyle modification. Mobile health (mHealth) has the potential to address this gap, but has limited evaluation in clinical studies to date. We present the case of a middle-aged patient of low socioeconomic status, with multiple comorbidities, and no prior smartphone experience, who suffered an acute myocardial infarction (MI) and was given the Corrie intervention while hospitalised. The patient demonstrated improvement in lifestyle modification, adherence to GDMT and post-MI recovery through 2.4 years follow-up. This case supports (1) the potential of mHealth interventions to enhance patient experience and outcomes, (2) intuitive design for adoption and improvement in end user experience and (3) the capability of mHealth to reach and empower underserved patients.
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Affiliation(s)
- George Hung
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA .,Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - William E Yang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Francoise A Marvel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Seth S Martin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Hu K, Liu M, Wang AJ, Zhao G, Sun Y, Yang C, Zhang Y, Hutter MM, Feng D, Sun B, Williams Z. Spine surgeon specialty differences in single-level percutaneous kyphoplasty. BMC Surg 2019; 19:163. [PMID: 31694623 PMCID: PMC6833171 DOI: 10.1186/s12893-019-0630-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 10/21/2019] [Indexed: 01/09/2023] Open
Abstract
Background Percutaneous kyphoplasty (PKP) is a procedure performed by a spine surgeon who undergoes either orthopedic or neurosurgical training. The relationship between short-term adverse outcomes and spine specialty is presently unknown. To compare short-term adverse outcomes of single-level PKP when performed by neurosurgeons and orthopedic surgeons in order to develop more concretely preventive strategies for patients under consideration for single-level PKP. Methods We evaluated patients who underwent single-level PKP from 2012 to 2014 through the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). We used univariate analysis and multivariate logistic regression to assess the association between spine surgeon specialty and short-term adverse events, including postoperative complication and unplanned readmission, and to identify different independent risk predictors between two specialties. Results Of 2248 patients who underwent single-level PKP procedure, 1229 patients (54.7%) had their operations completed by a neurosurgeon. There were no significant differences in the development of the majority of postoperative complications and the occurrence of unplanned readmission between the neurosurgical cohort (NC) and the orthopedic cohort (OC). A difference in the postoperative blood transfusion rate (0.7% NS vs. 1.7% OC, P = 0.039) was noted and may due to the differences in comorbidities between patients. Multivariate regression analysis revealed different independent predictors of postoperative adverse events for the two spine specialties. Conclusions By comparing a large range of demographic feature, preoperative comorbidities, and intraoperative factors, we find that short-term adverse events in single-level PKP patients does not affect by spine surgeon specialty, except that the OC had higher postoperative blood transfusion rate. In addition, the different perioperative predictors of postoperative complications and unplanned readmissions were identified between the two specialties. These findings can lead to better evidence-based patient counseling and provide valuable information for medical evaluation and potentially devise methods to reduce patients’ risk.
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Affiliation(s)
- Kejia Hu
- Center of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. .,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA. .,Department of Orthopedics, Wuxi People's Hospital, Nanjing Medical University, Wuxi, 214023, China.
| | - Motao Liu
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
| | - Amy J Wang
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Gexin Zhao
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Yuhao Sun
- Center of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Chaoqun Yang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yiwang Zhang
- Department of Neurosurgery, No. 910th Hospital of The People's Liberation Army Joint Logistics Support Force, Quanzhou, China
| | - Matthew M Hutter
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Dehong Feng
- Department of Orthopedics, Wuxi People's Hospital, Nanjing Medical University, Wuxi, 214023, China.
| | - Bomin Sun
- Center of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Ziv Williams
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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Siew ED, Parr SK, Wild MG, Levea SL, Mehta KG, Umeukeje EM, Silver SA, Ikizler TA, Cavanaugh KL. Kidney Disease Awareness and Knowledge among Survivors ofAcute Kidney Injury. Am J Nephrol 2019; 49:449-459. [PMID: 30995659 PMCID: PMC6679978 DOI: 10.1159/000499862] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/18/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) survivors are at risk for chronic kidney disease, recurrent AKI, and cardiovascular disease. The transition from hospital to ambulatory care is an opportunity to reduce these sequelae by launching self-care plans through effective patient education. How well AKI survivors are informationally prepared to apply kidney-specific self-care is unknown. The purpose of this study was to identify awareness and disease-specific knowledge among AKI survivors. METHODS We performed a cross-sectional survey of AKI-related awareness and knowledge in 137 patients with Kidney Disease Improving Global Outcomes Stage II or III AKI near the time of hospital discharge. Patients were asked (1) "Did you experience AKI while in the hospital?" and (2) "Do you have a problem with your kidney health?" Objective knowledge of AKI was evaluated with a 15-item adapted version of the validated Kidney Knowledge Survey that included topics such as common causes, risk factors, and how AKI is diagnosed. RESULTS Median age was 54 (interquartile range 43-63) and 81% were white. Eighty percent of patients were unaware that they had experienced AKI and 53% were both unaware they had experienced AKI or had a "problem with their kidneys." Multivariable logistic regression identified being male and lack of nephrology consult as predictors of unawareness with ORs of 3.92 (95% CI 1.48-10.33) and 5.10 (95% CI 1.98-13.13), respectively. Less than 50% recognized nonsteroidal anti-inflammatory drugs, contrast, or phosphate-based cathartics as risk factors for AKI. Two-thirds of patients did not agree that they knew a lot about AKI and more than 80% desired more information. CONCLUSIONS Most patients with moderate to severe AKI are unaware of their condition, lack understanding of risk factors for recurrent AKI, and desire more information. Patient-centered communication to optimize awareness, understanding, and care will require coordinated educational strategies throughout the continuum of AKI care.
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Affiliation(s)
- Edward D Siew
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Center for Kidney Diseases (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA,
- Tennessee Valley Healthcare System, Veteran's Health Administration, Nashville, Tennessee, USA,
| | - Sharidan K Parr
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Center for Kidney Diseases (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA
- Tennessee Valley Healthcare System, Veteran's Health Administration, Nashville, Tennessee, USA
| | - Marcus G Wild
- Vanderbilt University, Department of Psychological Sciences, Nashville, Tennessee, USA
| | - Swee-Ling Levea
- Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kermaan G Mehta
- Department of Surgery, New York Methodist Hospital, Brooklyn, New York, USA
| | - Ebele M Umeukeje
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Center for Kidney Diseases (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA
- Vanderbilt Center for Effective Health Communication, Nashville, Tennessee, USA
| | - Samuel A Silver
- Division of Nephrology, Queen's University, Kingston, Ontario, Canada
| | - T Alp Ikizler
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Center for Kidney Diseases (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA
- Tennessee Valley Healthcare System, Veteran's Health Administration, Nashville, Tennessee, USA
| | - Kerri L Cavanaugh
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Vanderbilt Center for Kidney Diseases (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, Tennessee, USA
- Tennessee Valley Healthcare System, Veteran's Health Administration, Nashville, Tennessee, USA
- Vanderbilt Center for Effective Health Communication, Nashville, Tennessee, USA
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Alhuwail D, Abduo H, Alqabandi N, Abu-Ghefreh A, Dawwas B, Halawa N. Engagement and Usage Patterns of a Diabetes Education Website Tailored for Arabic Speakers: A Case Study of a Diabetes Website from Kuwait. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2019. [DOI: 10.1080/15398285.2018.1547088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Dari Alhuwail
- Health Informatics Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
- College of Computing Sciences & Engineering, Kuwait University, Kuwait City, Kuwait
| | - Heba Abduo
- Pharmacotherapy Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Naeema Alqabandi
- Pharmacotherapy Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Ala’a Abu-Ghefreh
- Pharmacotherapy Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Basil Dawwas
- Pharmacotherapy Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Nadine Halawa
- Pharmacy Department, IWK Hospital, Halifax, Nova Scotia, Canada
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Sommer AE, Golden BP, Peterson J, Knoten CA, O'Hara L, O'Leary KJ. Hospitalized Patients' Knowledge of Care: a Systematic Review. J Gen Intern Med 2018; 33:2210-2229. [PMID: 30238405 PMCID: PMC6258610 DOI: 10.1007/s11606-018-4658-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/12/2018] [Accepted: 08/16/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients' comprehension of their medical conditions is fundamental to patient-centered care. Hospitalizations present opportunities to educate patients but also challenges to patient comprehension given the complexity and rapid pace of clinical care. We conducted a systematic review of the literature to characterize the current state of inpatients' knowledge of their hospitalization, assess the methods used to determine patient comprehension, and appraise the effects of interventions on improving knowledge. METHODS We searched MEDLINE, EMBASE, and the Cochrane Library for articles published from January 1, 1995 through December 11, 2017. Eligible studies included patients under inpatient or observation status on internal medicine, family medicine, or neurology services. We extracted study characteristics (author, year, country, study design, sample size, patient characteristics, methods, intervention, primary endpoints, results) in a standardized fashion. The quality of observational studies was assessed using the NIH Quality Assessment Tool for Observation Cohort and Cross-Sectional Studies and the quality of interventional studies was assessed using adapted EPOC criteria from the Cochrane Collaboration. RESULTS Twenty-eight studies met the criteria for inclusion, including 17 observational studies and 11 interventional studies. Patient knowledge of all aspects of their hospitalization was poor and patients often overestimated their knowledge. Older patients and those with lower education levels were more likely to have poorer knowledge. Intervention methods varied, but generally showed improvements in patient knowledge. Few interventional studies assessed the effect on health behaviors or outcomes and those that did were often underpowered. DISCUSSION Clinicians should be aware that comprehension is often poor among hospitalized patients, especially in those with lower education and advanced age. Our results are limited by overall poor quality of interventional studies. Future research should use objective, standardized measures of patient comprehension and interventions should be multifaceted in approach, focusing on knowledge improvement while also addressing other factors influencing outcomes.
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Affiliation(s)
- Arielle E Sommer
- Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
| | - Blair P Golden
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonna Peterson
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Lyndsey O'Hara
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Clark NP. Role of the anticoagulant monitoring service in 2018: beyond warfarin. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:348-352. [PMID: 30504331 PMCID: PMC6246023 DOI: 10.1182/asheducation-2018.1.348] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The direct oral anticoagulants (DOACs) have a wide therapeutic index, few drug interaction, no dietary interactions and do not require dose adjustment according to the results of routine coagulation testing. Despite these advantages over warfarin, the DOACs remain high risk medications. There is evidence that non-adherence, off-label dosing and inadequate care transitions during DOAC therapy increase the risk of bleeding and thromboembolic complications. Although DOACs are approved for a growing number of indications, there remain patient populations who are not good candidates. Existing expertise within an Anticoagulation Management Service (AMS) should be leveraged to optimize all anticoagulant therapies including the DOACs. The AMS can facilitate initial drug therapy selection and dose management, reinforce patient education and adherence as well as managing drug interactions and invasive procedures. In the event that a transition to warfarin is warranted, the AMS is already engaged which limits the risk of fragmented patient care and ensures that therapeutic anticoagulation is re-established in a timely manner. The AMS of the future will provide comprehensive management for all patients receiving anticoagulant medications and continue to provide anticoagulation expertise to the healthcare team.
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Affiliation(s)
- Nathan P Clark
- Kaiser Permanente Colorado, Aurora, CO; and Department of Clinical Pharmacy, Colorado University Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO
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Steckbeck J, McBain C, Terrien KL, Isom D, Stadler D, Stahl JE, Batsis JA. Implementation of a Workflow Initiative for Integrating Transitional Care Management Codes in a Geriatric Primary Care Practice. J Nurs Care Qual 2018; 33:348-353. [PMID: 29271832 PMCID: PMC6013313 DOI: 10.1097/ncq.0000000000000316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We implemented a transitional care management service led by a nurse care manager. An interdisciplinary team developed a workflow using a Plan-Do-Study-Act cycle for contacting patients. Of the 146 (97.9%) eligible patients, 143 (97.9%) had a phone call within 48 hours. There were 84 of 120 (70.0%) and 117 of 120 (97.5%) attendance rates of those attending visits within 7 and 14 days. A care manager-led workflow was successfully and easily implemented within a primary care practice.
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Affiliation(s)
- Julia Steckbeck
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Christi McBain
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Kerry L. Terrien
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David Isom
- Department of Medical Informatics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Daniel Stadler
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH
| | - James E. Stahl
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH
| | - John A. Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH
- Health Promotion Research Center at Dartmouth, Lebanon, NH
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Lamanna C. A Storytelling Approach: Insights from the Shambaa. THE JOURNAL OF MEDICAL HUMANITIES 2018; 39:377-389. [PMID: 29552699 DOI: 10.1007/s10912-018-9512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Narrative medicine explores the stories that patients tell; this paper, conversely, looks at some of the stories that patients are told. The paper starts by examining the 'story' told by the Shambaa people of Tanzania to explain the bubonic plague and contrasts this with the stories told by Ghanaian communities to explain lymphatic filariasis. By harnessing insights from memory studies, these stories' memorability is claimed to be due to their use mnemonic devices woven into stories. The paper suggests that stories can be unpatronising, informative, and appropriate vehicles for communicating medical information to all age groups across all cultures.
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Antony SM, Grau LE, Brienza RS. Qualitative study of perspectives concerning recent rehospitalisations among a high-risk cohort of veteran patients in Connecticut, USA. BMJ Open 2018; 8:e018200. [PMID: 29960998 PMCID: PMC6042565 DOI: 10.1136/bmjopen-2017-018200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Veterans Affairs (VA) patients are at risk for rehospitalisation due to their lower socioeconomic status, older age, poor social support or multiple comorbidities. The study explored inpatients' perceptions about factors contributing to their rehospitalisation and their recommendations to reduce this risk. DESIGN Thematic qualitative data analysis of interviews with 18 VA inpatients. SETTING VA Connecticut Healthcare System, West Haven Hospital medical inpatient units. PARTICIPANTS All were aged 18+ years, rehospitalised within 30 days of most recent discharge, medically stable and competent to provide consent. MEASUREMENTS Interviews assessed inpatients' health status after last discharge, reason for rehospitalisation, access to and support from primary care providers (PCP), medication management, home support systems and history of substance use or mental health disorders. RESULTS The mean age was 71.6 years (11.1 SD); all were Caucasian, living on limited budgets, and many had serious medical conditions or histories of mental health disorders. Participants considered structural barriers to accessing PCP and limited PCP involvement in medical decision-making as contributing to their rehospitalisation, although most believed that rehospitalisation had been inevitable. Peridischarge themes included beliefs about premature discharge, inadequate understanding of postdischarge plans and insufficiently coordinated postdischarge services. Most highly valued their VA healthcare but recommended increasing PCPs' involvement and reducing structural barriers to accessing primary and specialty care. CONCLUSIONS Increased PCP involvement in medical decision-making about rehospitalisation, expanded clinic hours, reduced travel distances, improved communications to patients and their families about predischarge and postdischarge plans and proactive postdischarge outreach to high-risk patients may reduce rehospitalisation risk.
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Affiliation(s)
- Sheila M Antony
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Lauretta E Grau
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Rebecca S Brienza
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Houlind MB, McNulty HBØ, Treldal C, Andersen SL, Huneck Haupt T, Petersen J, Andersen O, Kjeldsen LJ. One-Stop Dispensing: Hospital Costs and Patient Perspectives on Self-Management of Medication. PHARMACY 2018; 6:pharmacy6020046. [PMID: 29843357 PMCID: PMC6025360 DOI: 10.3390/pharmacy6020046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/12/2018] [Accepted: 05/18/2018] [Indexed: 11/30/2022] Open
Abstract
(1) Objective: To assess hospital medication costs and staff time between One-Stop Dispensing (OSD) and the Traditional Medication System (TMS), and to evaluate patient perspectives on OSD. (2) Methods: The study was conducted at Hvidovre Hospital, University of Copenhagen, Denmark in an elective gastric surgery and acute orthopedic surgery department. This study consists of three sub-studies including adult patients able to self-manage medication. In Sub-study 1, staff time used to dispense and administer medication in TMS was assessed. Medication cost and OSD staff time were collected in Sub-study 2, while patient perspectives were assessed in Sub-study 3. Medication costs with two days of discharge medication were compared between measured OSD cost and simulated TMS cost for the same patients. Measured staff time in OSD was compared to simulated staff time in TMS for the same patients. Patient satisfaction related to OSD was evaluated by a questionnaire based on a five-point Likert scale (‘very poor’ (1) to ‘very good’ (5)). (3) Results: In total, 78 elective and 70 acute OSD patients were included. Overall, there was no significant difference between OSD and TMS in medication cost per patient ($2.03 [95% CI −0.57–4.63]) (p = 0.131). Compared with TMS, OSD significantly reduced staff time by an average of 12 min (p ≤ 0.001) per patient per hospitalization. The patients’ satisfaction for OSD was high with an average score of 4.5 ± 0.7. (4) Conclusion: There were no differences in medication costs, but staff time was significantly lower in OSD and patients were overall satisfied with OSD.
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Affiliation(s)
- Morten Baltzer Houlind
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark.
| | | | - Charlotte Treldal
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark.
| | - Signe Lindgaard Andersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
| | - Thomas Huneck Haupt
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
| | - Janne Petersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- Section of Biostatistics, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark.
| | - Ove Andersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- Emergency Department, Copenhagen University Hospital, 2650 Hvidovre, Denmark.
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Uminski K, Komenda P, Whitlock R, Ferguson T, Nadurak S, Hochheim L, Tangri N, Rigatto C. Effect of post-discharge virtual wards on improving outcomes in heart failure and non-heart failure populations: A systematic review and meta-analysis. PLoS One 2018; 13:e0196114. [PMID: 29708997 PMCID: PMC5927407 DOI: 10.1371/journal.pone.0196114] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 04/08/2018] [Indexed: 12/22/2022] Open
Abstract
Background Unplanned hospital admissions in high-risk patients are common and costly in an increasingly frail chronic disease population. Virtual Wards (VW) are an emerging concept to improve outcomes in these patients. Purpose To evaluate the effect of post-discharge VWs, as an alternative to usual community based care, on hospital readmissions and mortality among heart failure and non-heart failure populations. Data sources Ovid MEDLINE, EMBASE, PubMed, the Cochrane Database of Systematic Reviews, SCOPUS and CINAHL, from inception through to Jan 31, 2017; unpublished data, prior systematic reviews; reference lists. Study selection Randomized trials of post-discharge VW versus community based, usual care that reported all-cause hospital readmission and mortality outcomes. Data extraction Data were reviewed for inclusion and independently extracted by two reviewers. Risk of bias was assessed using the Cochrane Collaboration risk of bias tool. Data synthesis In patients with heart failure, a post-discharge VW reduced risk of mortality (six trials, n = 1634; RR 0.59, 95% CI = 0.44–0.78). Heart failure related readmissions were reduced (RR 0.61, 95% CI = 0.49–0.76), although all-cause readmission was not. In contrast, a post-discharge VW did not reduce death or hospital readmissions for patients with undifferentiated high-risk chronic diseases (four trials, n = .3186). Limitations Heterogeneity with respect to intervention and comparator, lacking consistent descriptions and utilization of standardized nomenclature for VW. Some trials had methodologic shortcomings and relatively small study populations. Conclusions A post-discharge VW can provide added benefits to usual community based care to reduce all-cause mortality and heart failure-related hospital admissions among patients with heart failure. Further research is needed to evaluate the utility of VWs in other chronic disease settings.
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Affiliation(s)
- Kelsey Uminski
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Paul Komenda
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
| | - Reid Whitlock
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Thomas Ferguson
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Stewart Nadurak
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
| | - Laura Hochheim
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
- Department of Library Services, University of Manitoba, Winnipeg, Canada
| | - Navdeep Tangri
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
| | - Claudio Rigatto
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Canada
- * E-mail:
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Weerahandi H, Ziaeian B, Fogerty RL, Jenq GY, Horwitz LI. Predictors for patients understanding reason for hospitalization. PLoS One 2018; 13:e0196479. [PMID: 29702676 PMCID: PMC5922555 DOI: 10.1371/journal.pone.0196479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 04/13/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine predictors for understanding reason for hospitalization. METHODS This was a retrospective analysis of a prospective, observational cohort study of patients 65 years or older admitted for acute coronary syndrome, heart failure, or pneumonia and discharged home. Primary outcome was complete understanding of diagnosis, based on post-discharge patient interview. Predictors assessed were the following: jargon on discharge instructions, type of medical team, whether outpatient provider knew if the patient was admitted, and whether the patient reported more than one day notice before discharge. RESULTS Among 377 patients, 59.8% of patients completely understood their diagnosis. Bivariate analyses demonstrated that outpatient provider being aware of admission and having more than a day notice prior to discharge were not associated with patient understanding diagnosis. Presence of jargon was not associated with increased likelihood of understanding in a multivariable analysis. Patients on housestaff and cardiology teams were more likely to understand diagnosis compared to non-teaching teams (OR 2.45, 95% CI 1.30-4.61, p<0.01 and OR 3.83, 95% CI 1.92-7.63, p<0.01, respectively). CONCLUSIONS Non-teaching team patients were less likely to understand their diagnosis. Further investigation of how provider-patient interaction differs among teams may aid in development of tools to improve hospital to community transitions.
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Affiliation(s)
- Himali Weerahandi
- Department of Medicine, NYU School of Medicine, New York, NY, United States of America
- Department of Population Health, NYU School of Medicine, New York, New York, United States of America
- * E-mail:
| | - Boback Ziaeian
- Division of Cardiology, UCLA Medical Center, Los Angeles, CA, United States of America
- Division of Cardiology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Robert L. Fogerty
- Division of General Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Grace Y. Jenq
- Division of Geriatrics and Palliative Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Leora I. Horwitz
- Department of Medicine, NYU School of Medicine, New York, NY, United States of America
- Department of Population Health, NYU School of Medicine, New York, New York, United States of America
- Center for Healthcare Innovation and Delivery Science, NYU Langone Medical Center, New York, New York, United States of America
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Kitakata H, Kohno T, Kohsaka S, Fujino J, Nakano N, Fukuoka R, Yuasa S, Maekawa Y, Fukuda K. Patient confidence regarding secondary lifestyle modification and knowledge of 'heart attack' symptoms following percutaneous revascularisation in Japan: a cross-sectional study. BMJ Open 2018; 8:e019119. [PMID: 29549203 PMCID: PMC5857652 DOI: 10.1136/bmjopen-2017-019119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess patient perspectives on secondary lifestyle modification and knowledge of 'heart attack' after percutaneous coronary intervention (PCI) for coronary artery disease (CAD). DESIGN Observational cross-sectional study. SETTING A single university-based hospital centre in Japan. PARTICIPANTS In total, 236 consecutive patients with CAD who underwent PCI completed a questionnaire (age, 67.4±10.1 years; women, 14.8%; elective PCI, 75.4%). The survey questionnaire included questions related to confidence levels about (1) lifestyle modification at the time of discharge and (2) appropriate recognition of heart attack symptoms and reactions to these symptoms on a four-point Likert scale (1=not confident to 4=completely confident). PRIMARY OUTCOME MEASURE The primary outcome assessed was the patients' confidence level regarding lifestyle modification and the recognition of heart attack symptoms. RESULTS Overall, patients had a high level of confidence (confident or completely confident,>75%) about smoking cessation, alcohol restriction and medication adherence. However, they had a relatively low level of confidence (<50%) about the maintenance of blood pressure control, healthy diet, body weight and routine exercise (≥3 times/week). After adjustment, male sex (OR 3.61, 95% CI 1.11 to 11.8) and lower educational level (OR 3.25; 95% CI 1.70 to 6.23) were identified as factors associated with lower confidence levels. In terms of confidence in the recognition of heart attack, almost all respondents answered 'yes' to the item 'I should go to the hospital as soon as possible when I have a heart attack'; however, only 28% of the responders were confident in their ability to distinguish between heart attack symptoms and other conditions. CONCLUSIONS There were substantial disparities in the confidence levels associated with lifestyle modification and recognition/response to heart attack. These gaps need to be studied further and disseminated to improve cardiovascular care.
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Affiliation(s)
- Hiroki Kitakata
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Junko Fujino
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naomi Nakano
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ryoma Fukuoka
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Yuasa
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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