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Campelia GD, Bann M, Kirkpatrick JN, Dudzinski DM. Structures of Safety in Hospital Disposition: Five Ethical Responsibilities. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2025:1-12. [PMID: 40354188 DOI: 10.1080/15265161.2025.2497973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2025]
Abstract
Complex hospital disposition is categorized by the difficulty or impossibility, despite efforts, to secure a medically safe discharge option for a patient. Discharge planning should negotiate limited inpatient resources that must be distributed justly, while also considering failures of outpatient and social resources to meet the patient's needs. This essay argues that recognition of these structural insufficiencies, which are inequitably distributed, must be a starting point for addressing safe hospital disposition. This recognition grounds five ethical responsibilities for navigating complex disposition planning: justice, common good, respect for persons, harm reduction, and care. Each responsibility is applied to common complex disposition vignettes, with attention to practical guidelines for implementation in clinical spaces.
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Affiliation(s)
- Georgina D Campelia
- The University of Washington School of Medicine
- UW Medicine Ethics Consultation Service
| | | | - James N Kirkpatrick
- The University of Washington School of Medicine
- UW Medicine Ethics Consultation Service
| | - Denise M Dudzinski
- The University of Washington School of Medicine
- UW Medicine Ethics Consultation Service
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Parikh P, Jaisinghani P, Kaloth S, Konakanchi A, Yanamala N, Kim S. Enhancing Patient Understanding of Hospitalization and Post-Discharge Needs: The Impact of Physician-Led Verbal Communication and Teach-Back Method. J Gen Intern Med 2025:10.1007/s11606-025-09510-w. [PMID: 40268834 DOI: 10.1007/s11606-025-09510-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 04/04/2025] [Indexed: 04/25/2025]
Abstract
BACKGROUND Safe transitions of care post inpatient hospitalization require robust communication practices during the discharge process to ensure patient understanding. OBJECTIVE To determine if physician-led patient communication, inclusive of written and verbal instructions with the teach-back method, improves patient understanding of hospitalization and post-discharge needs. DESIGN This pre-post study was piloted at an urban, 600-bed, academic tertiary care hospital over a 3-month period. PARTICIPANTS Study participants included adult patients admitted to the hospitalist medical teaching service (MTS). INTERVENTION Study participants received both a written summary and verbal instruction reinforced with teach-back method. The instruction included the four core domains of patient education: reason for admission, inpatient management, medication changes, and follow-up plan. MAIN MEASURES Changes in mean patient understandings scores from pre- to post-intervention were evaluated on a 3-point scale (no, partial, or full understanding) in addition to basic demographics, level of schooling, and primary language spoken to better ascertain the drivers of improved health literacy. KEY RESULTS Among 120 study participants, mean survey scores in all four testing domains showed improvement in patient understanding of "admitting diagnosis" (21.5%, 95% CI, 0.21 to 0.40; P < 0.0001), "treatment undergone" (35.1%, 95% CI, 0.34 to 0.58; P < 0.0001), "medication changes" (45.8%, 95% CI, 0.40 to 0.67; P < 0.0001), and "discharge follow-up" (38.1%, 95% CI, 0.39 to 0.63; P < 0.0001). Mean scores improved more in patients with lower levels of schooling in all testing domains, except for "understanding of medication changes," showing more improvement in patients with high education achievement (95% CI, 0.08 to 1.09; P = 0.027). CONCLUSIONS While standard discharge practice involves only a printed discharge packet, the use of a written summary of instructions and verbal reinforcement using teach-back methods improves patient understanding and health literacy of post-discharge needs during transitions of care.
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Affiliation(s)
- Payal Parikh
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA.
| | - Priya Jaisinghani
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | | | | | - Naveena Yanamala
- Division of Cardiovascular Diseases and Hypertension, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Sarang Kim
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
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Kokotovic D, í Soylu L, Hansen TL, Knoblauch JB, Balle CB, Jensen L, Kiørboe A, Amled S, Jensen TK, Burcharth J. Impact of a transition of care bundle on health-related quality of life after major emergency abdominal surgery: before-and-after study. BJS Open 2025; 9:zraf020. [PMID: 40099557 PMCID: PMC11914972 DOI: 10.1093/bjsopen/zraf020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 11/26/2024] [Accepted: 01/10/2025] [Indexed: 03/20/2025] Open
Abstract
INTRODUCTION The transition from hospital to home can be challenging. This study investigated whether a standardized transition of care bundle could enhance health-related quality of life (HRQoL), reduce readmission rates, and increase days alive and out of hospital after major emergency abdominal surgery. METHODS A single-centre before-and-after study including consecutive patients undergoing major emergency abdominal surgery was conducted at Copenhagen University Hospital Herlev from 1 January 2022 to 31 December 2023. A transition of care bundle including standardized discharge coordination, written material, and multidisciplinary information meetings for patients and relatives was implemented on 1 January 2023. Patients were followed up by phone interviews and hospital records. HRQoL was assessed by the EQ-5D-5L questionnaire. RESULTS A total of 667 patients were included (before group 333 patients (median age 70.9), after group 335 patients (median age 72.2)). The predominant surgical procedure was emergency laparotomy for bowel obstruction (before group: n = 187, 56.2%, after group: n = 171, 51.5%). HRQoL was significantly higher in the after group compared with the before group at postoperative day (POD) 30 (0.846 versus 0.750, P < 0.001), postoperative day 90 (0.925 versus 0.847, P < 0.001), and at postoperative day 180 (0.907 versus 0.875, P = 0.039). No difference in days alive and out of hospital or readmission was found between the groups. A significant reduction in patients transitioning to a rehabilitation facility at discharge was found in the after group versus before group (12.5% versus 23.3%). CONCLUSIONS A transition of care bundle with coordination, written material, and multidisciplinary efforts increased HRQoL up to 180 days after major emergency abdominal surgery.
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Affiliation(s)
- Dunja Kokotovic
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
- Emergency Surgery Research Group (EMERGE) Copenhagen, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Liv í Soylu
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
- Emergency Surgery Research Group (EMERGE) Copenhagen, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Therese L Hansen
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
| | - Julie B Knoblauch
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
- Emergency Surgery Research Group (EMERGE) Copenhagen, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Camilla B Balle
- Emergency Surgery Research Group (EMERGE) Copenhagen, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Lisbeth Jensen
- EATEN, Dietetic and Nutritional Research Unit, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
| | - Andrea Kiørboe
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
| | - Simon Amled
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
| | - Thomas K Jensen
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
- Emergency Surgery Research Group (EMERGE) Copenhagen, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Jakob Burcharth
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
- Emergency Surgery Research Group (EMERGE) Copenhagen, Copenhagen University Hospital Herlev, Herlev, Denmark
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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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Hommes S, Vromans R, de Jongh M, Houwen T, Bol N, de Groot E, Antheunis M, Krahmer E. Trauma patients' perspectives on the needs, understanding and usefulness of personalized predictions for life after injury: a qualitative interview study using thematic analysis. Disabil Rehabil 2025:1-11. [PMID: 39895410 DOI: 10.1080/09638288.2025.2453638] [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: 09/14/2023] [Revised: 01/06/2025] [Accepted: 01/07/2025] [Indexed: 02/04/2025]
Abstract
PURPOSE To explore trauma patients' perspectives on the need, understanding and usefulness of personalized predictions after injury to assist in rehabilitation. METHODS We performed semi-structured online interviews. Participants (N = 30 trauma patients, admitted to the hospital for an injury in the past 5 years) were exposed to a support tool that provides personalized predictions on recovery after injury. Interview data were transcribed verbatim and thematically analyzed. RESULTS Four themes were identified. Patients expressed (1) a need for personal information and felt that information about recovery was lacking. The most important (2) reasons for needing to receive personalized predictions were reassurance and managing expectations. However, (3) understanding the prediction model was challenging. Patients expressed receiving relatively poor predictions would not undermine (4) usefulness in practice, as they would rather know about what life has in store for them so they can prepare for life after injury better. CONCLUSIONS Trauma patients have a need for receiving personalized predictions as they perceive them to be a useful addition to clinical practice. Understanding such predictions might be challenging, so more time should be spent on how these can be communicated.
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Affiliation(s)
- Saar Hommes
- Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands
| | - Ruben Vromans
- Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands
| | - Mariska de Jongh
- Network Emergency Care Brabant, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | - Thymen Houwen
- Network Emergency Care Brabant, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | - Nadine Bol
- Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands
| | - Eveline de Groot
- Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands
| | - Marjolijn Antheunis
- Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands
| | - Emiel Krahmer
- Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands
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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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Islam SMS, Singh A, Moreno SV, Akhter S, Chandir Moses J. Perceptions of healthcare professionals and patients with cardiovascular diseases on mHealth lifestyle apps: A qualitative study. Int J Med Inform 2025; 194:105706. [PMID: 39581013 DOI: 10.1016/j.ijmedinf.2024.105706] [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: 12/21/2023] [Revised: 10/30/2024] [Accepted: 11/13/2024] [Indexed: 11/26/2024]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death globally and is predominantly associated with a cluster of lifestyle risk factors. Mobile health (mHealth) apps offer the potential to overcome traditional barriers by supporting healthy lifestyle behaviours. However, knowledge about perceptions of mHealth lifestyle apps among healthcare professionals and people with CVD is sparse. This study examined barriers and facilitators of using the mHealth apps for healthy lifestyle support among healthcare professionals and CVD patients. METHODS We conducted an in-depth qualitative study employing individual semi-structured interviews with 8 CVD healthcare professionals and 4 patients with CVD in Australia. Participants were asked open-ended questions about their perceptions and experiences with mHealth lifestyle apps. A thematic analysis approach was used to establish perceived barriers and facilitators for mHealth lifestyle apps. RESULTS Most participants perceived mHealth lifestyle apps as useful. The key perceptions of facilitators included features for tailoring to personal needs, low costs and wide availability of the apps and addressing barriers to use like reminders. Both healthcare professionals and patients identified the strengths and weaknesses regarding the usefulness of mHealth lifestyle apps. Healthcare professionals and patients perceived several barriers to mHealth app use including trustworthiness, scientific validity, language barriers, the capability of using an app or digital literacy, costs for some commercial apps, and accessibility of an app for low-income groups. CONCLUSION Lifestyle apps provide an opportunity for better patient and healthcare professional communications, however, several barriers including improving digital health literacy and scientific validations of the apps are required before being recommended in clinical practice. Findings from this study can inform potential mHealth lifestyle app design to meet the demands of users. Addressing these barriers effectively can enhance the adoption and efficacy of mHealth apps, ultimately contributing to improved CVD management and healthier lifestyle behaviours.
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Affiliation(s)
| | - Ashal Singh
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Sebastiat V Moreno
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Sadika Akhter
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Jeban Chandir Moses
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
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Tamblyn R, Habib B, Buckeridge DL, Weir DL, Frolova E, Alattar R, Rogozinsky J, Beauchamp C, Pupo R, Bartlett SJ, McDonald E. Evaluating the effectiveness of the Smart About Meds (SAM) mobile application among patients discharged from hospital: protocol of a randomised controlled trial. BMJ Open 2024; 14:e084492. [PMID: 39581737 PMCID: PMC11590805 DOI: 10.1136/bmjopen-2024-084492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 09/16/2024] [Indexed: 11/26/2024] Open
Abstract
INTRODUCTION Almost half of patients discharged from hospital are readmitted or return to the emergency department (ED) within 90 days. Non-adherence to medication changes made during hospitalisation and the use of potentially inappropriate medications (PIMs) both contribute to postdischarge adverse events. We developed Smart About Meds (SAM), a patient-centred mobile application that targets medication non-adherence and PIMs use. This protocol describes a randomised controlled trial (RCT) to evaluate SAM. METHODS AND ANALYSIS A pragmatic, stratified RCT will evaluate SAM among 3250 adult patients discharged from hospital. At discharge, consenting participants will be randomised 1:1 to usual care or SAM. SAM integrates novel patient-centred features with pharmacist monitoring to manage non-adherence to new medication regimens. SAM also notifies patients of PIMs in their regimen, with advice to discuss with their physician.Following discharge, patients will be followed for 90 days to measure the primary composite outcome of ED visits, hospital readmissions and death. Secondary outcomes will include primary adherence to medication changes, secondary adherence to disease-modifying medications, patient empowerment and health-related quality of life.The primary outcome will be analysed according to intention-to-treat. Multivariable logistic regression will estimate differences between treatment groups in the proportion of patients experiencing the primary outcome and will assess modification of intervention effects by hospital, unit, age, sex and comorbidity burden. With a sample size of 3250, the study will have 80% power to detect a 5% absolute reduction in the primary outcome. Binary and continuous secondary outcomes will be assessed using multivariable logistic and linear regression, respectively. ETHICS AND DISSEMINATION The Research Ethics Board of the McGill University Health Centre in Montréal, Canada has approved this study. Results will be submitted for publication in a peer-reviewed journal and presented at scientific conferences. If effective, SAM will be made available in app stores. TRIAL REGISTRATION NUMBER NCT05371548.
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Affiliation(s)
- Robyn Tamblyn
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Bettina Habib
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - David L Buckeridge
- Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Daniala L Weir
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Elizaveta Frolova
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - Rolan Alattar
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - Jessica Rogozinsky
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | | | - Rosalba Pupo
- Clinical and Health Informatics Research Group, McGill University, Montreal, Quebec, Canada
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Emily McDonald
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Clinical Practice Assessment Unit, McGill University Health Centre, Montreal, Quebec, Canada
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Bülow C, Clausen SS, Thøgersen PL, Dalin DA, Hansen JM, Johansson KS, Lundh A, Christensen MB. Patients' knowledge of the indications for their medications - a scoping review. BMC Health Serv Res 2024; 24:1195. [PMID: 39375664 PMCID: PMC11460199 DOI: 10.1186/s12913-024-11685-7] [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: 04/24/2024] [Accepted: 09/30/2024] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND Inadequate medication knowledge may contribute to inappropriate medication use and treatment harms. We aimed to map and synthesise the existing evidence on patients' knowledge of the indications for their medications. METHOD We searched MEDLINE, Embase, CINAHL, PsychInfo and the Cochrane Library for studies that assessed patients' knowledge of the indications for their medications from inception to June 16, 2022. A pair of reviewers independently screened and extracted data on study characteristics, aims, and methods used to assess and report patients' knowledge of the indications for their medications. RESULTS We included 99 studies conducted in 33 countries, published between 1979 and 2021, with 42,377 participants in total (median 126 participants [Interquartile range: 63-338]). Studies were observational (n = 77), experimental (n = 18), or qualitative interviews (n = 4). The exact question used to assess knowledge of the indications was reported in 27 studies and was phrased in 25 different ways. Knowledge of the indications was reported as a proportion of either 1) all participants (n = 65) or 2) the total number of medications used by all patients (n = 13). Sixteen studies used both reporting methods, while five only reported a proportion without specifying the denominator. Fourteen studies in various populations reported the number of participants with correct knowledge of all their medications, ranging from 19% (long-term psychiatric in-patients) to 87% (general practice patients). CONCLUSION We did not identify any established scientific standard for assessing patients' knowledge of the indications for their medications. The wide range of study methodologies and reporting styles observed call for a methodological consensus in this research field. Estimates of correct knowledge varied widely between studies, but whether this was due to differences in study populations or study methodology could not be determined. Furthermore, we did not identify any study investigating whether participants' knowledge of the indications for their medications was associated with the quality, e.g. appropriateness, of their treatment.
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Affiliation(s)
- Cille Bülow
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
| | - Stine Søndersted Clausen
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Patrick Lundholm Thøgersen
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Dagmar Abelone Dalin
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Johanne Mølby Hansen
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Karl Sebastian Johansson
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Andreas Lundh
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Cochrane Denmark & Centre for Evidence-Based Medicine Odense (CEBMO), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mikkel Bring Christensen
- Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Cox C, Hatfield T, Willars J, Fritz Z. Identifying Facilitators and Inhibitors of Shared Understanding: An Ethnography of Diagnosis Communication in Acute Medical Settings. Health Expect 2024; 27:e14180. [PMID: 39180375 PMCID: PMC11344224 DOI: 10.1111/hex.14180] [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: 04/08/2024] [Revised: 07/10/2024] [Accepted: 07/31/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND AND AIMS Communication is important in determining how patients understand the diagnostic process. Empirical studies involving direct observation of communication within diagnostic processes are relatively limited. This ethnographic study aimed to identify communicative practices facilitating or inhibiting shared understanding between patients and doctors in UK acute secondary care settings. METHODS Data were collected in acute medical sectors of three English hospitals. Researchers observed doctors as they assessed patients; semistructured interviews were undertaken with doctors and patients directly afterwards. Patients were also interviewed 2-4 weeks later. Case studies of individual encounters (consisting of these interviews and observational notes) were created, and were cross-examined by an interdisciplinary team to identify divergence and convergence between doctors' and patients' narratives. These data were analysed thematically. RESULTS We conducted 228 h of observation, 24 doctor interviews, 32 patient interviews and 15 patient follow-up interviews. Doctors varied in their communication. Patient diagnostic understanding was sometimes misaligned with that of their doctors; interviews revealed that they often made incorrect assumptions to make sense of the fragmented information received. Thematic analysis identified communicative practices that seemed to facilitate, or inhibit, shared diagnostic understanding between patient and doctor, revealing three themes: (1) communicating what has been understood from the medical record, (2) sharing the thought process and diagnostic reasoning and (3) closing the loop and discharge communication. Shared understanding was best fostered by clear communication about the diagnostic process, what had already been done and what was achievable in acute settings. Written information presents an underutilised tool in such communication. CONCLUSIONS In UK acute secondary settings, the provision of more information about the diagnostic process often fostered shared understanding between doctor and patient, helping to minimise the confusion and dissatisfaction that can result from misaligned expectations or conclusions about the diagnosis, and the uncertainty therein. PATIENT/PUBLIC CONTRIBUTION A patient and public involvement group (of a range of ages and backgrounds) was consulted. They contributed to the design of the protocol, including the timing of interviews, the acceptability of a follow-up telephone interview, the development of the interview guides and the participant information sheets.
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Affiliation(s)
- Caitríona Cox
- The Healthcare Improvement Studies InstituteCambridgeUK
| | - Thea Hatfield
- The Healthcare Improvement Studies InstituteCambridgeUK
| | - Janet Willars
- The Healthcare Improvement Studies InstituteCambridgeUK
| | - Zoë Fritz
- The Healthcare Improvement Studies InstituteCambridgeUK
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11
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Han Y, Chen J, Xu Y, Huang P, Hou L. Nurse-led medication management as a critical component of transitional care for preventing drug-related problems. Aging Clin Exp Res 2024; 36:151. [PMID: 39060872 PMCID: PMC11282160 DOI: 10.1007/s40520-024-02799-3] [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: 04/23/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
Drug-related problems (DRPs) are critical medical issues during transition from hospital to home with high prevalence. The application of a variety of interventional strategies as part of the transitional care has been studied for preventing DRPs. However, it remains challenging for minimizing DRPs in patients, especially in older adults and those with high risk of medication discrepancies after hospital discharge. In this narrative review, we demonstrated that age, specific medications and polypharmacy, as well as some patient-related and system-related factors all contribute to a higher prevalence of transitional DPRs, most of which could be largely prevented by enhancing nurse-led multidisciplinary medication reconciliation. Nurses' contributions during transitional period for preventing DRPs include information collection and evaluation, communication and education, enhancement of medication adherence, as well as coordination among healthcare professionals. We concluded that nurse-led strategies for medication management can be implemented to prevent or solve DRPs during the high-risk transitional period, and subsequently improve patients' satisfaction and health-related outcomes, prevent the unnecessary loss and waste of medical expenditure and resources, and increase the efficiency of the multidisciplinary teamwork during transitional care.
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Affiliation(s)
- Yingting Han
- Department of Nursing, Renhe Hospital, Baoshan District, No. 1999, West Changjiang Rd, Baoshan District, Shanghai, 200431, China.
| | - Jia Chen
- Department of Nursing, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No. 639, Zhizaoju Rd, Huangpu District, Shanghai, 200011, China
| | - Yulei Xu
- Department of Nursing, Renhe Hospital, Baoshan District, No. 1999, West Changjiang Rd, Baoshan District, Shanghai, 200431, China
| | - Peihua Huang
- Department of Nursing, Renhe Hospital, Baoshan District, No. 1999, West Changjiang Rd, Baoshan District, Shanghai, 200431, China
| | - Lili Hou
- Department of Nursing, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No. 639, Zhizaoju Rd, Huangpu District, Shanghai, 200011, China.
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12
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Cushnahan A, Sie BS, Wadhwa V. Impact of a codesigned and coproduced patient-centred discharge form on communication and understanding. Singapore Med J 2024:00077293-990000000-00125. [PMID: 38967376 DOI: 10.4103/singaporemedj.smj-2019-224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/17/2020] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Adverse clinical outcomes and patient dissatisfaction with care often have elements of poor communication. Factors such as illness and pharmacotherapy can affect cognition, and overestimation of patients' health literacy may contribute to suboptimal communication with patients regarding their hospitalisation and post-discharge instructions. Improved patient understanding and recall of their diagnoses and treatment is critical for adherence to treatment, follow-up and optimal clinical outcomes. The aim of the study was to assess whether a coproduced and codesigned patient-centred discharge form (PCDF) improves patients' understanding of their discharge diagnosis, in-hospital treatment and post-discharge plan. METHODS A sample of 111 patients was enrolled through simple randomisation by admission to one of two identically operating general medicine wards. Over a 3-month period, 59 patients received the coproduced and codesigned form and 52 patients were controls. Assessment of patients' understanding of diagnosis, in-hospital management, post-discharge instructions and overall experience of care was undertaken by a blinded phone survey conducted approximately 6 days after discharge. RESULTS Patients who received PCDF were significantly more likely to report adequate understanding of their hospital management (P < 0.001) and the post-discharge plan (P < 0.001). There was no statistically significant difference between the intervention and control groups in terms of understanding of diagnosis. Patients who received PCDF reported better understanding of care and recall of admission. CONCLUSION The use of PCDF is associated with improved patient understanding with respect to their hospital management and post-discharge instructions. It is also associated with high levels of satisfaction as assessed by measures of patient experience.
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Affiliation(s)
- Aiden Cushnahan
- Department of Medicine, Eastern Health, Monash and Deakin Universities, Melbourne, Victoria, Australia
| | - Boon Shih Sie
- Department of Medicine, Eastern Health, Monash and Deakin Universities, Melbourne, Victoria, Australia
| | - Vikas Wadhwa
- Department of Medicine, Eastern Health, Monash and Deakin Universities, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash and Deakin Universities, Melbourne, Victoria, Australia
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13
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Aynaszyan S, Lonza GC, Sambare TD, Son SJ, Alvarez I, Tomasek G, Bryman J, Shymon SJ, Andrawis JP. Limited Health Literacy Among Patients With Orthopedic Injuries: A Cross-sectional Survey of Patients Who Underwent Orthopedic Trauma Surgery in a County Hospital Setting. Orthopedics 2024; 47:249-255. [PMID: 38810131 DOI: 10.3928/01477447-20240520-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Patients with limited health literacy have difficulty understanding their injuries and postoperative treatment, which can negatively affect their outcomes. MATERIALS AND METHODS This cross-sectional questionnaire-based study of 103 adult patients sought to quantify patients' health literacy at a single county hospital's orthopedic trauma clinic and to examine their ability to understand injuries and treatment plans. Demographics, Newest Vital Sign (NVS) health literacy assessment, and knowledge scores were used to assess patients' comprehension of their injuries and treatment plan. Patients were grouped by NVS score (NVS <4: limited health literacy). Fisher's exact tests and t tests were used to compare demographic and comprehension scores. Multivariate logistic regression analysis was used to examine the association among low health literacy, sociodemographic variables, and knowledge scores. RESULTS Of the 103 patients, 75% were determined to have limited health literacy. Patients younger than 30 years were more likely to have adequate literacy (50% vs 23%, P=.01). Patients who spoke Spanish as their primary language were 8.77 times more likely to have limited health literacy with respect to sociodemographic factors (odds ratio, 8.77; 95% CI, 1.03-76.92; P=.04). Low health literacy was 3.52 and 4.14 times more likely to predict discordance in answers to specific bone fractures and the narcotics prescribed (P=.04 and P=.02, respectively). CONCLUSION Spanish-speaking patients have demonstrated limited health literacy and difficulty understanding their injuries and postoperative treatment plans compared with English-speaking patients. Patients with low health literacy are more likely to be unsure regarding which bone they fractured or their prescribed opiates. [Orthopedics. 2024;47(4):249-255.].
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14
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Silberzan L, Bajos N, Kelly‐Irving M. Unveiling the gaps: Hypertension control beyond the cascade of care framework. J Clin Hypertens (Greenwich) 2024; 26:861-866. [PMID: 38852065 PMCID: PMC11232448 DOI: 10.1111/jch.14849] [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: 03/08/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 06/10/2024]
Abstract
This study examines hypertension control beyond the cascade of care framework, which assesses awareness, treatment, and control sequentially. The analysis included 52 434 hypertensive adults (blood pressure (BP) ≥140/90 mm Hg and/or treatment in the past 6 months), aged 25-69, from the French population-based CONSTANCES cohort from 2012 to 2021. The authors assessed the typical "awareness, treatment, and control" scenario and characterized other possible control patterns. The authors found that 13% achieved control. This percentage rose to 19% when considering individuals who were not aware but treated and controlled. This alternative control scenario was associated with female sex, younger age, higher education, Northern-African origin, and reporting prior cardiovascular diseases (CVD). Sub-Saharan African origin, diabetes and overweight/obesity were associated with the typical control scenario. This study highlights that applying a typical sequential cascade of care approach may lead to the exclusion of some specific groups of participants who do not fit into the defined categories.
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Affiliation(s)
- Léna Silberzan
- INSERM, IRIS (UMR8156‐U997)AubervilliersFrance
- UMR1295, Equity research teamToulouse III University‐Paul SabatierToulouseFrance
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15
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Rehman S, Almasri W, Shaik M, Zakria YF, Alazawi N, Warren BJ. Analysis of Popular Gastroesophageal Reflux Disease Content on TikTok. Cureus 2024; 16:e62762. [PMID: 39036142 PMCID: PMC11260078 DOI: 10.7759/cureus.62762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Abstract
Researchers used the TikTok platform to investigate the quality of select TikTok educational content regarding gastroesophageal reflux disease (GERD). One hundred TikTok videos that fit the inclusion criteria were analyzed using DISCERN, a tool that evaluates the quality of consumer health information on the internet. There was no substantial difference in DISCERN scores between physicians and non-physician content creators. Nevertheless, both groups consistently scored low (<3) in areas such as providing sources of information, indicating the publication date of their sources, discussing treatment risks, and outlining potential consequences if no treatment is pursued.
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Affiliation(s)
- Sheema Rehman
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | - Wesam Almasri
- Pre-Clerkship, Oakland University William Beaumont School of Medicine, Auburn Hills, USA
| | - Moaid Shaik
- College of Osteopathic Medicine, Michigan State University, East Lansing, USA
| | - Yusra F Zakria
- Pre-Clerkship, Oakland University William Beaumont School of Medicine, Auburn Hills, USA
| | - Neam Alazawi
- Gastroenterology, Ascension Providence Hospital, Southfield, USA
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16
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Campbell M, McEvoy JW, Calpin G, Concannon F, Redfern S. Perspectives of Healthcare Professionals on Clinician-Patient Communication of Cardiovascular Disease Risk. J Patient Exp 2024; 11:23743735241257386. [PMID: 38807917 PMCID: PMC11131389 DOI: 10.1177/23743735241257386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
When the consultation is predominantly verbal, existing research in clinician-patient communication indicates that many patients struggle to understand and recall medical consultations or may not understand the extent of their illness or the purpose of their treatment plan. When the clinician-patient discussion centers around the risk of a repeated cardiovascular disease (CVD) related event, qualitatively assessing what factors affect the communication of this risk may guide the creation of effective communication solutions. Semi-structured interviews were conducted with 17 clinicians treating patients at stages along the cardiac rehabilitation patients' journey. Thematic analysis identified factors that prevent patients from understanding the risk they face of experiencing a repeated cardiac event. Results indicate a clearer understanding of the cardiac rehabilitation patient journey by means of a patient journey map; an overview of how CVD risk is currently communicated; and the factors that affect communication of these risks in the form of themes and sub-themes. Findings shape the proposal of an evidence informed model of opportunities for enhanced digital media supported communication in cardiac rehabilitation.
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17
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Brandt S, Lauer HC, Güth JF, Bühling S, Sayahpour B, Romanos G, Winter A. Impact of two different patient decision aids in prosthodontic consultations: a prospective randomized controlled study. Clin Oral Investig 2023; 27:7841-7849. [PMID: 38010423 PMCID: PMC10713710 DOI: 10.1007/s00784-023-05375-7] [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: 07/28/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Different approaches to prosthodontic consultation, all involving a strong focus on shared decision-making, were analyzed from the perspective of patients by inter-group comparisons. No patient decision aid (PDA) was used in the control group, a paper-based PDA in test group 1, and a software-based PDA in test group 2. MATERIALS AND METHODS Seventy-five patients were prospectively randomized to the control group or a test group. All patients then rated the consultation on a questionnaire, six key items of which were analyzed, along with the time spent on each consultation. RESULTS Overall satisfaction was highest in test group 2, with a significant difference from the control group (p = 0.015). Test group 2 showed the most favorable ratings for all six questionnaire items, which invariably was significant compared to the control group (p = 0.032). Test group 1 significantly differed from test group 2 based on two items (consultation was adequately intelligible: p = 0.011; consultation was adequately comprehensive: p = 0.034) but not from the control group based on any item (p = 0.070). CONCLUSIONS Within the limitations of this study, the use of a software-based PDA, in particular, can be recommended based on patient satisfaction and was associated with the shortest sessions for consultation. CLINICAL RELEVANCE Patients are routinely faced with a wealth of information in dental offices and may be overwhelmed especially by prosthetic treatment options and decision requirements. Our findings shed some light on the nature of aids that may truly be helpful in the process of shared decision-making. TRIAL REGISTRATION ClinicalTrials.gov.Identifier: ISRCTN11472465.
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Affiliation(s)
- Silvia Brandt
- Department of Prosthodontics, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 29, 60596, Frankfurt am Main, Germany.
| | - Hans-Christoph Lauer
- Department of Prosthodontics, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 29, 60596, Frankfurt am Main, Germany
| | - Jan-Frederik Güth
- Department of Prosthodontics, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 29, 60596, Frankfurt am Main, Germany
| | - Sarah Bühling
- Department of Prosthodontics, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 29, 60596, Frankfurt am Main, Germany
| | - Babak Sayahpour
- Department of Prosthodontics, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Theodor-Stern-Kai 7, Building 29, 60596, Frankfurt am Main, Germany
| | - Georgios Romanos
- Department of Periodontics and Endodontics, Stony Brook School of Dental Medicine, New York, NY, USA
| | - Anna Winter
- Department of Prosthodontics, University Hospital Würzburg, Würzburg, Germany
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18
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Huth K, Hotz A, Emara N, Robertson B, Leaversuch M, Mercer AN, Khan A, Campos ML, Liss I, Hahn PD, Graham DA, Rossi L, Thomas MV, Elias N, Morris M, Glader L, Pinkham A, Bardsley KM, Wells S, Rogers J, Berry JG, Mauskar S, Starmer AJ. Reduced Postdischarge Incidents After Implementation of a Hospital-to-Home Transition Intervention for Children With Medical Complexity. J Patient Saf 2023; 19:493-500. [PMID: 37729645 DOI: 10.1097/pts.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVES Prior research suggests that errors occur frequently for patients with medical complexity during the hospital-to-home transition. Less is known about effective postdischarge communication strategies for this population. We aimed to assess rates of 30-day (1) postdischarge incidents and (2) readmissions and emergency department (ED) visits before and after implementing a hospital-to-home intervention. METHODS We conducted a prospective intervention study of children with medical complexity discharged at a children's hospital from April 2018 to March 2020. A multistakeholder team developed a bundled intervention incorporating the I-PASS handoff framework including a postdischarge telephone call, restructured discharge summary, and handoff communication to outpatient providers. The primary outcome measure was rate of postdischarge incidents collected via electronic medical record review and family surveys. Secondary outcomes were 30-day readmissions and ED visits. RESULTS There were 199 total incidents and the most common were medication related (60%), equipment issues (15%), and delays in scheduling/provision of services (11%). The I-PASS intervention was associated with a 36.4% decrease in the rate of incidents per discharge (1.51 versus 0.95, P = 0.003). There were fewer nonharmful errors and quality issues after intervention (1.27 versus 0.85 per discharge, P = 0.02). The 30-day ED visit rate was significantly lower after intervention (12.6% versus 3.4%, per 100 discharges, P = 0.05). Thirty-day readmissions were 15.8% versus 10.2% postintervention (P = 0.32). CONCLUSIONS A postdischarge communication intervention for patients with medical complexity was associated with fewer postdischarge incidents and reduced 30-day ED visits. Standardized postdischarge communication may play an important role in improving quality and safety in the transition from hospital-to-home for vulnerable populations.
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Affiliation(s)
| | | | - Norah Emara
- From the Department of Pediatrics, Boston Children's Hospital
| | | | | | | | | | | | - Isabella Liss
- From the Department of Pediatrics, Boston Children's Hospital
| | - Phillip D Hahn
- Program for Patient Safety and Quality, Boston Children's Hospital
| | | | | | - Margaret V Thomas
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Nahel Elias
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Marie Morris
- From the Department of Pediatrics, Boston Children's Hospital
| | - Laurie Glader
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Amy Pinkham
- From the Department of Pediatrics, Boston Children's Hospital
| | | | - Sarah Wells
- From the Department of Pediatrics, Boston Children's Hospital
| | - Jayne Rogers
- From the Department of Pediatrics, Boston Children's Hospital
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19
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Lewandowski KE, Ongur D, Cohen BM. Recall of treatment information by patients in a first episode psychosis outpatient clinic. Schizophr Res 2023; 258:58-60. [PMID: 37487328 DOI: 10.1016/j.schres.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/12/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Kathryn E Lewandowski
- McLean Hospital, Schizophrenia and Bipolar Disorder Program, United States of America; Department of Psychiatry, Harvard Medical School, United States of America.
| | - Dost Ongur
- McLean Hospital, Schizophrenia and Bipolar Disorder Program, United States of America; Department of Psychiatry, Harvard Medical School, United States of America
| | - Bruce M Cohen
- McLean Hospital, Schizophrenia and Bipolar Disorder Program, United States of America; Department of Psychiatry, Harvard Medical School, United States of America
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20
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Patel R, Judge A, Johansen A, Marques EMR, Chesser T, Griffin XL, Javaid MK, Ben-Shlomo Y, Gregson CL. Patients' recovery of mobility and return to original residence after hip fracture are associated with multiple modifiable components of hospital service organisation: the REDUCE record-linkage cohort study in England and Wales. BMC Geriatr 2023; 23:459. [PMID: 37501122 PMCID: PMC10375618 DOI: 10.1186/s12877-023-04038-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/12/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Hip fractures are devastating injuries causing disability, dependence, and institutionalisation, yet hospital care is highly variable. This study aimed to determine hospital organisational factors associated with recovery of mobility and change in patient residence after hip fracture. METHODS A cohort of patients aged 60 + years in England and Wales, who sustained a hip fracture from 2016 to 2019 was examined. Patient-level Hospital Episodes Statistics, National Hip Fracture Database, and mortality records were linked to 101 factors derived from 18 hospital-level organisational metrics. After adjustment for patient case-mix, multilevel models were used to identify organisational factors associated with patient residence at discharge, and mobility and residence at 120 days after hip fracture. RESULTS Across 172 hospitals, 165,350 patients survived to discharge, of whom 163,230 (99%) had post-hospital discharge destination recorded. 18,323 (11%) died within 120 days. Among 147,027 survivors, 58,344 (40%) across 143 hospitals had their residence recorded, and 56,959 (39%) across 140 hospitals had their mobility recorded, at 120 days. Nineteen organisational factors independently predicted residence on hospital discharge e.g., return to original residence was 31% (95% confidence interval, CI:17-43%) more likely if the anaesthetic lead for hip fracture had time allocated in their job plan, and 8-13% more likely if hip fracture service clinical governance meetings were attended by an orthopaedic surgeon, physiotherapist or anaesthetist. Seven organisational factors independently predicted residence at 120 days. Patients returning to their pre-fracture residence was 26% (95%CI:4-42%) more likely if hospitals had a dedicated hip fracture ward, and 20% (95%CI:8-30%) more likely if treatment plans were proactively discussed with patients and families on admission. Seventeen organisational factors predicted mobility at 120 days. More patients re-attained their pre-fracture mobility in hospitals where (i) care involved an orthogeriatrician (15% [95%CI:1-28%] improvement), (ii) general anaesthesia was usually accompanied by a nerve block (7% [95%CI:1-12%], and (iii) bedside haemoglobin testing was routine in theatre recovery (13% [95%CI:6-20%]). CONCLUSIONS Multiple, potentially modifiable, organisational factors are associated with patient outcomes up to 120 days after a hip fracture, these factors if causal should be targeted by service improvement initiatives to reduce variability, improve hospital hip fracture care, and maximise patient independence.
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Affiliation(s)
- Rita Patel
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Antony Johansen
- School of Medicine, Cardiff University and University Hospital of Wales, Cardiff, UK
- National Hip Fracture Database, Royal College of Physicians, London, UK
| | - Elsa M R Marques
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Tim Chesser
- Department of Trauma and Orthopaedics, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Xavier L Griffin
- Barts Bone and Joint Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Muhammad K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration West (ARC West) at University of Bristol and United Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, UK.
- Older People's Unit, Royal United Hospital NHS Foundation Trust Bath, Combe Park, Bath, UK.
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Zota D, Diamantis DV, Katsas K, Karnaki P, Tsiampalis T, Sakowski P, Christophi CA, Ioannidou E, Darias-Curvo S, Batury VL, Berth H, Zscheppang A, Linke M, Themistokleous S, Veloudaki A, Linos A. Essential Skills for Health Communication, Barriers, Facilitators and the Need for Training: Perceptions of Healthcare Professionals from Seven European Countries. Healthcare (Basel) 2023; 11:2058. [PMID: 37510499 PMCID: PMC10379454 DOI: 10.3390/healthcare11142058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
Many healthcare professionals are unaware of the necessary skills and barriers hindering interpersonal health communication. This study aimed to evaluate the healthcare professional's perception regarding health communication training's necessity, barriers, facilitators and critical skills in health communication. Data from a cross-sectional online survey in the framework of the H-Com project were utilized. The study included 691 healthcare professionals (physicians, nurses, students and allied health professionals) from seven European countries. Only 57% of participants had participated in health communication training, while 88.1% of them indicated a willingness to be trained in health communication. Nurses were more likely (OR = 1.84; 95% CI 1.16, 2.91) to have received such training, compared to physicians. Most examined communication skills, barriers and facilitators of effective communication, and perceived outcomes of successful communication were considered crucial for most participants, although physicians overall seemed to be less concerned. Most agreed perceived outcomes were improved professional-patient relations, patient and professional satisfaction, physical and psychological health amelioration and patients' trust. Nurses evaluated the importance of these communication skills and communication barriers, facilitators and outcomes higher than physicians. Physicians may underestimate the importance of communication skills more than nurses. Health communication should become an integral part of training for all health professionals.
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Affiliation(s)
- Dina Zota
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece
| | - Dimitrios V Diamantis
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece
| | - Konstantinos Katsas
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Pania Karnaki
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, Harokopio University, 17676 Athens, Greece
| | | | - Costas A Christophi
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3041, Cyprus
| | - Eleni Ioannidou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3041, Cyprus
| | - Sara Darias-Curvo
- Centro de Estudios de Desigualdad Social y Gobernanza, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain
| | - Victoria-Luise Batury
- Research Group Medical Psychology and Medical Sociology, Division of Psychological and Social Medicine and Developmental Neurosciences, Technische Universitaet Dresden, D-01307 Dresden, Germany
| | - Hendrik Berth
- Research Group Medical Psychology and Medical Sociology, Division of Psychological and Social Medicine and Developmental Neurosciences, Technische Universitaet Dresden, D-01307 Dresden, Germany
| | - Anja Zscheppang
- Research Group Medical Psychology and Medical Sociology, Division of Psychological and Social Medicine and Developmental Neurosciences, Technische Universitaet Dresden, D-01307 Dresden, Germany
| | - Maike Linke
- Research Group Medical Psychology and Medical Sociology, Division of Psychological and Social Medicine and Developmental Neurosciences, Technische Universitaet Dresden, D-01307 Dresden, Germany
| | | | - Afroditi Veloudaki
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece
| | - Athena Linos
- PROLEPSIS Civil Law Non-Profit Organization of Preventive Environmental and Occupational Medicine, 15121 Athens, Greece
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22
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Makaryus AN. The Reply. Am J Med 2023; 136:e130-e131. [PMID: 37230604 DOI: 10.1016/j.amjmed.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Amgad N Makaryus
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Cardiology, Nassau University Medical Center, East Meadow, NY.
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23
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Piniella NR, Fuller TE, Smith L, Salmasian H, Yoon CS, Lipsitz SR, Schnipper JL, Dalal AK. Early Expected Discharge Date Accuracy During Hospitalization: A Multivariable Analysis. J Med Syst 2023; 47:63. [PMID: 37171484 PMCID: PMC10175905 DOI: 10.1007/s10916-023-01952-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/15/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Accurate estimation of an expected discharge date (EDD) early during hospitalization impacts clinical operations and discharge planning. METHODS We conducted a retrospective study of patients discharged from six general medicine units at an academic medical center in Boston, MA from January 2017 to June 2018. We retrieved all EDD entries and patient, encounter, unit, and provider data from the electronic health record (EHR), and public weather data. We excluded patients who expired, discharged against medical advice, or lacked an EDD within the first 24 h of hospitalization. We used generalized estimating equations in a multivariable logistic regression analysis to model early EDD accuracy (an accurate EDD entered within 24 h of admission), adjusting for all covariates and clustering by patient. We similarly constructed a secondary multivariable model using covariates present upon admission alone. RESULTS Of 3917 eligible hospitalizations, 890 (22.7%) had at least one accurate early EDD entry. Factors significantly positively associated (OR > 1) with an accurate early EDD included clinician-entered EDD, admit day and discharge day during the work week, and teaching clinical units. Factors significantly negatively associated (OR < 1) with an accurate early EDD included Elixhauser Comorbidity Index ≥ 11 and length of stay of two or more days. C-statistics for the primary and secondary multivariable models were 0.75 and 0.60, respectively. CONCLUSIONS EDDs entered within the first 24 h of admission were often inaccurate. While several variables from the EHR were associated with accurate early EDD entries, few would be useful for prospective prediction.
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Affiliation(s)
- Nicholas R Piniella
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA.
| | - Theresa E Fuller
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Laura Smith
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Hojjat Salmasian
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Cathy S Yoon
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Stuart R Lipsitz
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey L Schnipper
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anuj K Dalal
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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24
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Byrd JN, Huynh KA, Cho HE, Chung KC. Improving Perioperative Preparation for Patients Undergoing Surgical Treatment for Distal Radius Fractures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4995. [PMID: 37360230 PMCID: PMC10287137 DOI: 10.1097/gox.0000000000004995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/23/2023] [Indexed: 06/28/2023]
Abstract
We aimed to review common patient concerns after surgical repair of distal radius fracture (DRF) to identify potential interventions to improve the gap between expectation and education for DRF patients. Methods We conducted a retrospective cohort study of 100 consecutive patients who underwent surgical repair of DRF at a level I trauma center. Patient-initiated communication notes were reviewed with thematic analysis to identify the common reasons patients required additional information. We used the Patient Education Materials Assessment Tool to score the available educational resources for DRF patients for the understandability and actionability of the educational materials provided to the patients. Results Of 165 patient communication episodes, 88.5% occurred postoperatively. The most common concerns were pain (30, 15.4%) and surgical site changes (24, 12.3%). Most communications (171, 83.4%) were resolved with patient education through instruction or reassurance. The reviewed materials did not address pain or surgical site changes. No reviewed materials provided actionable steps patients could take to facilitate recovery. Conclusions Pain management and normal wound healing were the most common surgical concerns of DRF patients. We identify opportunities to improve expectation-setting in online materials and during face-to-face education to create a more patient-centered perioperative experience.
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Affiliation(s)
- Jacqueline N. Byrd
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich
- Department of Surgery, University of Texas Southwestern Medical School, Dallas, Tex
| | - Kristine A. Huynh
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich
- Department of Plastic Surgery, University of Texas Southwestern Medical School, Dallas, Tex
| | - Hoyune E. Cho
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich
- Department of Plastic Surgery, University of California, Irvine, School of Medicine, Orange, Calif
| | - Kevin C. Chung
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich
- Department of Surgery, University of Texas Southwestern Medical School, Dallas, Tex
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25
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Huang CW, Wu BCY, Nguyen PA, Wang HH, Kao CC, Lee PC, Rahmanti AR, Hsu JC, Yang HC, Li YCJ. Emotion recognition in doctor-patient interactions from real-world clinical video database: Initial development of artificial empathy. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 233:107480. [PMID: 36965299 DOI: 10.1016/j.cmpb.2023.107480] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE The promising use of artificial intelligence (AI) to emulate human empathy may help a physician engage with a more empathic doctor-patient relationship. This study demonstrates the application of artificial empathy based on facial emotion recognition to evaluate doctor-patient relationships in clinical practice. METHODS A prospective study used recorded video data of doctor-patient clinical encounters in dermatology outpatient clinics, Taipei Municipal Wanfang Hospital, and Taipei Medical University Hospital collected from March to December 2019. Two cameras recorded the facial expressions of four doctors and 348 adult patients during regular clinical practice. Facial emotion recognition was used to analyze the basic emotions of doctors and patients with a temporal resolution of 1 second. In addition, a physician-patient satisfaction questionnaire was administered after each clinical session, and two standard patients gave impartial feedback to avoid bias. RESULTS Data from 326 clinical session videos showed that (1) Doctors expressed more emotions than patients (t [326] > = 2.998, p < = 0.003), including anger, happiness, disgust, and sadness; the only emotion that patients showed more than doctors was surprise (t [326] = -4.428, p < .001) (p < .001). (2) Patients felt happier during the latter half of the session (t [326] = -2.860, p = .005), indicating a good doctor-patient relationship. CONCLUSIONS Artificial empathy can offer objective observations on how doctors' and patients' emotions change. With the ability to detect emotions in 3/4 view and profile images, artificial empathy could be an accessible evaluation tool to study doctor-patient relationships in practical clinical settings.
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Affiliation(s)
- Chih-Wei Huang
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Taipei Medical University Ringgold standard institution - Center for Simulation in Medical Education, Taipei 116, Taiwan
| | - Bethany C Y Wu
- National Taiwan University Children and Family Research Center Sponsored by CTBC Charity Foundation, Taipei, Taiwan
| | - Phung Anh Nguyen
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan; Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsiao-Han Wang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, TMU Da'an Campus 15 F, No. 172-1, Kee lung Road, Section 2, Da-an District, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Dermatology, Wanfang Hospital, Taipei Medical University, Taiwan; Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Pei-Chen Lee
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
| | - Annisa Ristya Rahmanti
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, TMU Da'an Campus 15 F, No. 172-1, Kee lung Road, Section 2, Da-an District, Taipei, Taiwan; Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jason C Hsu
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan; International PhD Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan; Research Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Hsuan-Chia Yang
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, TMU Da'an Campus 15 F, No. 172-1, Kee lung Road, Section 2, Da-an District, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Yu-Chuan Jack Li
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, TMU Da'an Campus 15 F, No. 172-1, Kee lung Road, Section 2, Da-an District, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Dermatology, Wanfang Hospital, Taipei Medical University, Taiwan.
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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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Holmes CT, Huggins C, Knowles H, Swoboda TK, Kirby R, Alanis N, Bulga A, Schrader CD, Dunn C, Wang H. The Association of Name Recognition, Empathy Perception, and Satisfaction With Resident Physicians' Care Amongst Patients in an Academic Emergency Department. J Clin Med Res 2023; 15:225-232. [PMID: 37187709 PMCID: PMC10181348 DOI: 10.14740/jocmr4901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Recognition of the provider's name, provider empathy, and the patient's satisfaction with their care are patient-provider rapport measures. This study aimed to determine: 1) resident physicians' name recognition by patients in the emergency department; and 2) name recognition in association with patient perception of the resident's empathy and their satisfaction with the resident's care. METHODS This was a prospective observational study. A patient recognizing a resident physician was defined as the patient remembering a resident's name, understanding the level of training, and understanding a resident's role in patient care. A patient's perception of resident physician empathy was measured by the Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE). Patient satisfaction of the resident was measured utilizing a real-time satisfaction survey. Multivariate logistic regressions were performed to determine the association amongst patient recognition of resident physicians, JSPPPE, and patient satisfaction after adjustments were made for demographics and resident training level. RESULTS We enrolled 30 emergency medicine resident physicians and 191 patients. Only 26% of studied patients recognized resident physicians. High JSPPPE scores were given by 39% of patients recognizing resident physicians compared to 5% of those who were not recognized (P = 0.013). High patient satisfaction scores were recorded in 31% of patients who recognized resident physicians compared to 7% who did not (P = 0.008). The adjusted odds ratios of patient recognition of resident physicians to high JSPPPE and high satisfaction scores were 5.29 (95% confidence interval (CI): 1.33 - 21.02, P = 0.018) and 6.12 (1.84 - 20.38, P = 0.003) respectively. CONCLUSIONS Patient recognition of resident physicians is low in our study. However, patient recognition of resident physicians is associated with a higher patient perception of physician empathy and higher patient satisfaction. Our study suggests that resident education advocating for patient recognition of their healthcare provider's status needs to be emphasized as part of patient-centered health care.
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Affiliation(s)
- Chad T. Holmes
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
| | - Charles Huggins
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
| | - Heidi Knowles
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
| | - Thomas K. Swoboda
- Department of Emergency Medicine, The Valley Health System, Touro University Nevada School of Osteopathic Medicine, Las Vegas, NV 89144, USA
| | - Ryan Kirby
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
| | - Naomi Alanis
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
| | - Alexandra Bulga
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
| | - Chet D. Schrader
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
| | - Cita Dunn
- TCU and UNTHSC School of Medicine, Fort Worth, TX 76107, USA
| | - Hao Wang
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
- Department of Emergency Medicine, The Valley Health System, Touro University Nevada School of Osteopathic Medicine, Las Vegas, NV 89144, USA
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Doss ER, Vogel TR, Kruse RL, Camazine M, Schlesselman C, Popejoy LL. Discharge process challenges of an academic vascular surgery service: A qualitative study. Res Nurs Health 2023; 46:210-219. [PMID: 36582026 DOI: 10.1002/nur.22292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/23/2022] [Accepted: 12/14/2022] [Indexed: 12/31/2022]
Abstract
Vascular surgery patients have a high incidence of unplanned hospital readmissions and complications. Previous research has not fully examined specific elements of the hospital discharge process for vascular surgery patients to identify issues that may contribute to readmissions. The objective of this qualitative descriptive study was to explore challenges identified by healthcare providers and patients regarding the discharge process from an academic vascular surgery service. Data were collected from eight focus group interviews and analyzed for relevant themes. Patients and healthcare providers identified several challenges within the standard discharge process, including ineffective communication, insufficient time for discharge education, and limitations accessing providers with post-discharge concerns. These obstacles may be ameliorated in part by specialized coordinators, caregiver support, and use of adaptive strategies outside of the current discharge process. The discharge challenges described by study participants likely contribute to adverse post-hospitalization outcomes, including unplanned hospital readmissions. A multifaceted approach that incorporates standardized discharge processes, as well as informal problem-solving strategies, is recommended to improve hospital discharge and outcomes for vascular surgery patients.
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Affiliation(s)
- Elizabeth R Doss
- Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Todd R Vogel
- Division of Vascular Surgery, School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Robin L Kruse
- Department of Family and Community Medicine, School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Maraya Camazine
- Division of Vascular Surgery, School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Chase Schlesselman
- Division of Vascular Surgery, School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Lori L Popejoy
- Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri, USA
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Evaluating patient recall following operative orthopaedic trauma. Injury 2023:S0020-1383(23)00269-3. [PMID: 36931966 DOI: 10.1016/j.injury.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Orthopedic trauma patients may have poor recall of their injuries and treatment. This may lead to poor adherence to instructions. The purposes of this project were to quantify recall about injury and treatment information, and to assess adherence to postoperative instructions and satisfaction with care. METHODS A prospective cohort of 110 consecutive adult orthopaedic trauma patients treated for acute injury at a Level 1 trauma center were included. All had undergone surgical treatment of fractures of the pelvis or lower extremity. A brief survey to assess patient recall about injury and treatment knowledge, adherence to weightbearing and DVT recommendations and to evaluate patient satisfaction was administered during the first post-hospital clinic visit. RESULTS Patients correctly answered 64% of recall-oriented questions. 82% and 83% of patients, respectively, reported adherence to their weightbearing restrictions and their DVT prophylaxis regimen, while 66% of patients reported adherence to both. Forty-two percent of non-adherent patients could not remember their weightbearing restrictions, while 78% of non-adherent patients could not remember their DVT prophylaxis regimen. Average patient satisfaction was 4.3 (range 1-5), with 15% of patients indicating neutral sentiment or dissatisfaction with their care. CONCLUSION Orthopaedic trauma patients have poor recall, which likely reduces postoperative adherence and may impair patient satisfaction. A postoperative educational protocol focused on improving patient recall may be useful. LEVEL OF EVIDENCE Level 4, prognostic.
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31
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Townshend R, Grondin C, Gupta A, Al-Khafaji J. Assessment of Patient Retention of Inpatient Care Information Post-Hospitalization. Jt Comm J Qual Patient Saf 2023; 49:70-78. [PMID: 36494268 DOI: 10.1016/j.jcjq.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patient understanding of medical care improves readmission rates and patient satisfaction, yet the literature suggests patients often have poor retention of care information post-hospitalization. Although multiple interventions have been implemented to facilitate this process, the cumulative durability of their benefit remains unclear. The authors conducted this study to more objectively understand how well patients retain care information after hospital discharge and to assess patient perspectives on facilitators of this process (for example, whiteboards and patient portals). METHODS Semistructured phone interviews of patients admitted to general medicine resident teaching services were performed within 24 to 48 hours post-hospitalization. Recall of four key domains of care (diagnoses addressed, inpatient treatment, postdischarge treatment plans, and medication changes) was elicited. Chart review was performed to verify patient responses. Responses were then categorized by independent reviewers as correct, partially correct, or incorrect. Patient perspectives on facilitators to help with information retention were also assessed. RESULTS Fifty-three patients participated. The vast majority (> 90%) were confident in their knowledge of their diagnoses and treatment, yet independent review revealed only 58.5%, 64.2%, 50.9%, and 43.4% of patients correctly recalled each respective key domain. Whiteboards were the most frequently used facilitator (96.2%), yet their content was rated least helpful for retaining care information. Patients suggested several areas for improvement, including prioritizing bedside pen and paper along with updating whiteboards with diagnostic and therapeutic information. CONCLUSION Patient recall of their inpatient care after discharge, despite modern facilitators, remains poor. Further efforts are needed to enhance or implement facilitators based on patient feedback.
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Khedr S, D'Angelo D, Santos AT, Kwong L, Park S, Khariton K, Chen CC, Kopp M. Identification of Clinical Risk Factors Affecting Patient-Physician Communication. J Surg Res 2023; 282:246-253. [PMID: 36332303 DOI: 10.1016/j.jss.2022.09.032] [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: 03/07/2022] [Revised: 08/23/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Patient satisfaction is an important indicator of quality in health care and is linked to clinical outcomes, patient retention, and professional satisfaction. Patients admitted to the hospital from the emergency department may not understand their diagnosis, reason for admission or plan of care, which can adversely impact their hospital experience. We aim to identify risk factors that contribute to poor patient-physician communication and to assess the effects of raising awareness of these issues to hospital providers. METHODS From November 2020 to April 2021, patients admitted to the surgical floor were surveyed within 24 h of admission. Relevant data were extracted through retrospective chart review. Residents and attendings were debriefed regarding the improving communication. Surveys answered before and after the brief intervention were compared. RESULTS One hundred thirty one patients who were admitted to the surgical floor were surveyed. Nineteen did not know their diagnoses (14.5%), 29 could not explain their diagnoses (22.1%), and 28 did not know their treatment plans (21.4%). A total of 38 (29.0%) patients answered "no" to at least one question. Trauma patients (P = 0.034), patients with pain score >4 at time of admission (P = 0.038), age >65 y (P = 0.047), and patients with >3 comorbidities were more likely to answer "no" to at least one of the questions. Postintervention, a 10% reduction in number of patients answering "no" was observed. CONCLUSIONS Trauma patients, patients with poor pain control, the elderly, and those with multiple comorbidities are more likely to experience poor patient-physician communication. Raising awareness of the importance of this matter resulted in an improvement in communication.
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Affiliation(s)
- Shahenda Khedr
- Department of Surgery, NewYork-Presbyterian/Queens, Queens, New York.
| | - Debra D'Angelo
- Weill Cornell Medicine, Department of Population Health Sciences, Division of Biostatistics, New York, New York
| | | | - Leona Kwong
- Department of Surgery, NewYork-Presbyterian/Queens, Queens, New York
| | - Soobin Park
- Department of Surgery, NewYork-Presbyterian/Queens, Queens, New York
| | - Konstantin Khariton
- Department of Surgery, Weill Cornell Medicine, NewYork-Presbyterian, New York, New York
| | - Chun-Cheng Chen
- Department of Surgery, Weill Cornell Medicine, NewYork-Presbyterian, New York, New York
| | - Miroslav Kopp
- Department of Surgery, Weill Cornell Medicine, NewYork-Presbyterian, New York, New York
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Makaryus AN. 'Who Are You Calling a Used Car Salesman!?!' 'Selling' the Patient Experience to Physicians in Training. Am J Med 2022; 135:1397-1398. [PMID: 35882285 DOI: 10.1016/j.amjmed.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Amgad N Makaryus
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Department of Cardiology Nassau University Medical Center, East Meadow, NY.
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Sharp M, Williams N, Tackett S, Hanyok LA, Christmas C, Rand CS, Ziegelstein RC, Record JD. Observation tool to measure patient-centered behaviors on rounds in an academic medical center. MEDICAL EDUCATION ONLINE 2022; 27:2024115. [PMID: 34994682 PMCID: PMC8745350 DOI: 10.1080/10872981.2021.2024115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 06/03/2023]
Abstract
OBJECTIVE As part of a quality improvement project, we developed and employed an observation checklist to measure patient-centered behaviors during daily rounds to assess the frequency of patient-centered behaviors among a patient-centered care (PCC) team and standard team (ST) rounds. PATIENTS AND METHODS On four general medicine service (GMS) teaching teams at an urban academic medical center in which housestaff rotate, we utilized an observation checklist to assess the occurrence of eight behaviors on inpatient daily rounds. The checklist covered domains of patient-centered communication, etiquette-based behaviors, and shared decision-making. One GMS team is guided by a PCC curriculum that emphasizes patient-centered communication strategies, but not specifically behaviors during bedside rounds. RESULTS Between August 2018 and May 2019 a trained observer completed 448 observations of patient rounding encounters using the checklist. Across all teams, 46.0% of the 8 behaviors were performed when possible, with more done on the PCC team (58.0%) than ST (42.0%), p < 0.01. CONCLUSIONS Performance of patient-centered behaviors during daily rounds was low overall. Despite having no specific instruction on daily rounds, patient-centered behaviors were more frequent among the teams which were part of a PCC curriculum. However, the frequency of observed behaviors was modest, suggesting that more explicit efforts to change rounding behaviors are needed. Our observational checklist may be a tool to assist in future interventions to improve patient-centered behaviors on daily rounds.
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Affiliation(s)
- Michelle Sharp
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicole Williams
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sean Tackett
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Laura A. Hanyok
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Colleen Christmas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cynthia S. Rand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Roy C. Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Janet D. Record
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Backman C, Papp S, Harley A, Houle S, Skidmore B, Poitras S, Green M, Shah S, Berdusco R, Beaulé P, French-Merkley V. Protocol for a scoping review of patient-clinician digital health interventions for the population with hip fracture. BMJ Open 2022; 12:e064988. [PMID: 36418125 PMCID: PMC9685264 DOI: 10.1136/bmjopen-2022-064988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/26/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Patient-clinician digital health interventions can potentially improve the care of patients with hip fracture transitioning from hospital to rehabilitation to home. Assisting older patients with a hip fracture and their caregivers in managing their postsurgery care is crucial for ensuring the best rehabilitation outcomes. With the increased availability and wide uptake of mobile devices, the use of digital health to better assist patients in their care has become more common. Among the older adult population, hip fractures are a common occurrence and integrated postsurgery care is key for optimal recovery. The overall aims are to examine the available literature on the impact of hip fracture-specific patient-clinician digital health interventions on patient outcomes and healthcare delivery processes; to identify the barriers and enablers to the uptake and implementation of these digital health interventions; and to provide strategies for improved use of digital health technologies. METHODS AND ANALYSIS We will conduct a scoping review using Arksey and O'Malley's methodology framework and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for the Scoping Reviews reporting format. A search strategy will be developed, and key databases will be searched until approximately May 2022. A two-step screening process and data extraction of included studies will be performed by two reviewers. Any disagreement will be resolved by consensus or by a third reviewer. For the included studies, a narrative data synthesis will be conducted. Barriers and enablers identified will be mapped to the domains of the Theoretical Domains Framework and related strategies will be provided to guide the uptake of future patient-clinician digital health interventions. ETHICS AND DISSEMINATION This review does not require ethics approval. The results will be presented at a scientific conference and published in a peer-reviewed journal. We will also involve relevant stakeholders to determine appropriate approaches for dissemination.
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Affiliation(s)
- Chantal Backman
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Steve Papp
- Division of Orthopaedic Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Anne Harley
- Department of Care of the Elderly, Bruyere Continuing Care, Ottawa, Ontario, Canada
| | - Sandra Houle
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Stephane Poitras
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Maeghn Green
- Division of Orthopaedic Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Soha Shah
- Department of Care of the Elderly, Bruyere Continuing Care, Ottawa, Ontario, Canada
| | - Randa Berdusco
- Division of Orthopaedic Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul Beaulé
- Orthopaedic Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
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Kim OT. Patient safety as a global health priority. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patient safety is a discipline that has arisen in response to the increasing complexity of health care delivery and the associated increase in patient harm. Adverse health care events are a serious problem, causing significant harm to the patient and increasing health care costs. The World Health Organization has identified patient safety as one of the key priorities for world health. The current review presents the historical background that led to the formation of the discipline of patient safety, the determinants of adverse events in medical practice, and the main tools for dealing with them.
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Affiliation(s)
- O. T. Kim
- National Medical Research Center for Therapy and Preventive Medicine
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Perera T, Grewal E, Ghali WA, Tang KL. Perceived discharge quality and associations with hospital readmissions and emergency department use: a prospective cohort study. BMJ Open Qual 2022; 11:bmjoq-2022-001875. [PMID: 36375857 PMCID: PMC9664267 DOI: 10.1136/bmjoq-2022-001875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background At hospital discharge, care is handed over from providers to patients. Discharge encounters must prepare patients to self-manage their health, but have been found to be suboptimal. Our study objectives were to describe and determine the correlates of perceived discharge quality and to explore the association between perceived discharge quality and postdischarge outcomes. Methods We conducted a prospective cohort study in medical inpatients admitted to a tertiary care hospital in Calgary, Canada. Perceived discharge quality was measured by the Care Transitions Measure (CTM). Linkage to administrative databases provided data for the composite outcome—90-day hospital readmission or emergency department visit. Logistic regression modelling was used to determine the association between global CTM scores, and the individual CTM components, and the composite outcome. Results A total of 316 patients were included in the analysis. The median CTM score was 80.0 (IQR 66.6–100.0). The distribution of CTM scores were significantly different based on comorbidity burden, with the median and maximum CTM scores being lower and the IQR being narrower, for those with six or more comorbidities compared with those with fewer comorbidities. CTM scores were not associated with the composite outcome, though a single CTM item—not understanding warning signs and symptoms—was (adjusted OR 3.46 (95% CI 1.02 to 11.73)). Conclusion Perceived quality of discharge varies based on patient burden of comorbidities. While global perceived discharge quality was not associated with postdischarge outcomes, lack of patient understanding of warning symptoms was. Discharging healthcare teams should pay special attention to these priority patient groups and specific discharge process components.
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Affiliation(s)
- Tefani Perera
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Eshleen Grewal
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - William A Ghali
- Office of the Vice President (Research), University of Calgary, Calgary, Alberta, Canada.,O' Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Karen L Tang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada .,O' Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Wesevich A, Key-Solle M, Kandakatla A, Feeney C, Pollak KI, LeBlanc TW. Utilization of Text Messages to Supplement Rounding Communication: a Randomized Feasibility Study. J Gen Intern Med 2022; 37:2991-2997. [PMID: 35212877 PMCID: PMC9485328 DOI: 10.1007/s11606-021-07285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fragmented communication with patients and families during hospitalizations often leaves patients confused about the daily plan. OBJECTIVE To pilot a supplemental text message-based platform for improving bidirectional communication about the clinical plan and patients' goals. DESIGN Randomized controlled trial PARTICIPANTS: Thirty adult patients, thirty caregivers of pediatric patients, and the interns caring for them on inpatient general medicine and pediatric services. INTERVENTIONS Patients and caregivers were texted or emailed daily to report their personal goal and assess their understanding of the team's clinical plan. Interns were texted daily to report the team's clinical plan and to assess their understanding of the patient's personal goal. MAIN MEASURES Primary outcomes were feasibility, defined as survey response rates, and acceptability. Secondary outcomes were patient comprehension of the clinical plan, trainee comprehension of the patient's goal, patient-centered communication scores, and educational satisfaction scores. KEY RESULTS Thirty adult patients, thirty caregivers of pediatric patients, fourteen general medicine interns, and six general pediatric interns enrolled. Intervention feasibility was met, with survey response rates of 80% for general medicine trainees, 67% for general pediatric trainees, 58% for adult patients, and 70% for caregivers. Patients and caregivers in the intervention arm had higher understanding of medication changes (76% vs 50%, p = 0.02) and new consultations (90% vs 61%, p = 0.002). Interns had higher understanding of patients' goals in the intervention arm (93% vs 40%, p < 0.001), particularly for adult patients (97% vs 17%, p < 0.001). Caregivers rated communication higher regarding information to help make decisions (p = 0.04). Interviews demonstrated high acceptability. CONCLUSIONS Our text message-based communication intervention was feasible and acceptable to all involved participants, with preliminary signals of efficacy. The intervention may contribute to improved understanding of medication changes and new consultations, as well as help in making decisions. A large, randomized efficacy trial of this intervention is warranted. Graphical abstract.
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Affiliation(s)
- Austin Wesevich
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA.
| | - Mikelle Key-Solle
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | | | - Colby Feeney
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Kathryn I Pollak
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC, USA
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Lunghi C, Trevisan C, Fusaroli M, Giunchi V, Raschi E, Sangiorgi E, Domenicali M, Volpato S, De Ponti F, Poluzzi E. Strategies and Tools for Supporting the Appropriateness of Drug Use in Older People. Pharmaceuticals (Basel) 2022; 15:977. [PMID: 36015125 PMCID: PMC9412319 DOI: 10.3390/ph15080977] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/26/2022] Open
Abstract
Through this structured review of the published literature, we aimed to provide an up-to-date description of strategies (human-related) and tools (mainly from the digital field) facilitating the appropriateness of drug use in older adults. The evidence of each strategy and tool's effectiveness and sustainability largely derives from local and heterogeneous experiences, with contrasting results. As a general framework, three main steps should be considered in implementing measures to improve appropriateness: prescription, acceptance by the patient, and continuous monitoring of adherence and risk-benefit profile. Each step needs efforts from specific actors (physicians, patients, caregivers, healthcare professionals) and dedicated supporting tools. Moreover, how to support the appropriateness also strictly depends on the particular setting of care (hospital, ambulatory or primary care, nursing home, long-term care) and available economic resources. Therefore, it is urgent assigning to each approach proposed in the literature the following characteristics: level of effectiveness, strength of evidence, setting of implementation, needed resources, and issues for its sustainability.
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Affiliation(s)
- Carlotta Lunghi
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
- Centre of Studies and Research on Older Adults, University of Bologna, 40126 Bologna, Italy
- Department of Health Sciences, Université du Québec à Rimouski, Lévis, QC G5L 3A1, Canada
| | - Caterina Trevisan
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Michele Fusaroli
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Valentina Giunchi
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Elisa Sangiorgi
- Pharmacy Service, Local Health Authority of Ferrara, 44121 Ferrara, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
- Centre of Studies and Research on Older Adults, University of Bologna, 40126 Bologna, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Fabrizio De Ponti
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
- Centre of Studies and Research on Older Adults, University of Bologna, 40126 Bologna, Italy
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
- Centre of Studies and Research on Older Adults, University of Bologna, 40126 Bologna, Italy
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Tatara AW, Ji C, Jacob S, Marshall J. Implementation of Daily Pharmacy Student New Medication Education During Hospitalization to Improve Patient Satisfaction. Hosp Pharm 2022; 57:482-487. [PMID: 35898242 PMCID: PMC9310310 DOI: 10.1177/00185787211051644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Introduction: Studies have shown that patients would like to receive more medication education while hospitalized. Higher patient satisfaction has been correlated with lower mortality and fewer hospital readmissions. Methods: This was a quasi-experimental study. Four Doctor of Pharmacy students were assigned 1 medicine inpatient unit to provide education on new medications during the study period, June to September. The primary endpoint was the change in HCAHPS scores for the medication communication domain composite for the intervention unit and a similar control unit that was not receiving the intervention from the pre-intervention to the intervention periods. Results: A total of 124 patients were educated during the intervention period, with an average age of 65 and 2.2 new medications. Average HCAHPS scores for the medication communication domain for the intervention unit increased from 68% pre-intervention to 91% during the intervention (P = .389) while the control unit remained unchanged at 78% both pre- and during the intervention (P = .13). Conclusion: An increase in the medication communication HCAHPS score for the intervention unit was observed, while the control unit remained stable. This study has the potential to drive change by implementing pharmacy students throughout inpatient units to educate patients on new medications thereby improving patient satisfaction.
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Affiliation(s)
| | | | - Susan Jacob
- Massachusetts General Hospital, Boston, MA, USA
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Shahid A, Sept B, Kupsch S, Brundin-Mather R, Piskulic D, Soo A, Grant C, Leigh JP, Fiest KM, Stelfox HT. Development and pilot implementation of a patient-oriented discharge summary for critically Ill patients. World J Crit Care Med 2022; 11:255-268. [PMID: 36051938 PMCID: PMC9305680 DOI: 10.5492/wjccm.v11.i4.255] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 06/18/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients leaving the intensive care unit (ICU) often experience gaps in care due to deficiencies in discharge communication, leaving them vulnerable to increased stress, adverse events, readmission to ICU, and death. To facilitate discharge communication, written summaries have been implemented to provide patients and their families with information on medications, activity and diet restrictions, follow-up appointments, symptoms to expect, and who to call if there are questions. While written discharge summaries for patients and their families are utilized frequently in surgical, rehabilitation, and pediatric settings, few have been utilized in ICU settings. AIM To develop an ICU specific patient-oriented discharge summary tool (PODS-ICU), and pilot test the tool to determine acceptability and feasibility. METHODS Patient-partners (i.e., individuals with lived experience as an ICU patient or family member of an ICU patient), ICU clinicians (i.e., physicians, nurses), and researchers met to discuss ICU patients' specific informational needs and design the PODS-ICU through several cycles of discussion and iterative revisions. Research team nurses piloted the PODS-ICU with patient and family participants in two ICUs in Calgary, Canada. Follow-up surveys on the PODS-ICU and its impact on discharge were administered to patients, family participants, and ICU nurses. RESULTS Most participants felt that their discharge from the ICU was good or better (n = 13; 87.0%), and some (n = 9; 60.0%) participants reported a good understanding of why the patient was in ICU. Most participants (n = 12; 80.0%) reported that they understood ICU events and impacts on the patient's health. While many patients and family participants indicated the PODS-ICU was informative and useful, ICU nurses reported that the PODS-ICU was "not reasonable" in their daily clinical workflow due to "time constraint". CONCLUSION The PODS-ICU tool provides patients and their families with essential information as they discharge from the ICU. This tool has the potential to engage and empower patients and their families in ensuring continuity of care beyond ICU discharge. However, the PODS-ICU requires pairing with earlier discharge practices and integration with electronic clinical information systems to fit better into the clinical workflow for ICU nurses. Further refinement and testing of the PODS-ICU tool in diverse critical care settings is needed to better assess its feasibility and its effects on patient health outcomes.
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Danijela Piskulic
- Department of Psychiatry, Hotchkiss Brain Institute, Calgary T2N 4Z6, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Christopher Grant
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
- School of Health Administration, Dalhousie University, Halifax B3H 4R2, Nova Scotia, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
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Pérez-Martín AM, García Madrid MGDP, Ruiz-Moral R, Crespo-Cañizares A, Mena CGDL, Caballero-Martínez F. Ibero-American Consensus on Communication Skills for Nursing Degree students. Rev Lat Am Enfermagem 2022; 30:e3565. [PMID: 35613251 DOI: 10.1590/1518-8345.5653.3565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/10/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE as a health care profession focused on caring for people, Nursing requires sound communication skills. Based on an international expert consensus, a proposal on learning outcomes in clinical communication for undergraduate Nursing education curricula in Spanish speaking countries is presented. METHOD a steering committee, consisting of 5 nurses and experts in communication in health care sciences, drew up the first list of communication skills specific to the Nursing degree. Their proposal was reviewed and improved by a committee of 7 international scientific advisers. 70 experts from 14 countries were selected using a snowball sampling procedure and invited to participate in a distance modified Delphi consensus process in two survey rounds. Statistical analysis was carried out to establish the final consensus level for each item. RESULTS a questionnaire with 68 learning outcomes in clinical communications was submitted for panel assessment. In the first Delphi round, the panel reached a statistical consensus on all the items assessed. There was no need for a second round to reconcile positions. CONCLUSION an academic proposal, approved by a high level of international consensus, is presented to guide and unify the learning outcomes on the clinical communication curriculum for undergraduate Nursing studies in Spanish speaking countries.
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Affiliation(s)
| | | | - Roger Ruiz-Moral
- Universidad Francisco de Vitoria, Facultad de Medicina, Madrid, Espanha
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Harary M, Bommakanti K, Nakhla MN, Kosaraju N, Heaney A, Kim W, Lee JT, Suh JD, Bergsneider M, Wang MB. Audit of postoperative readmissions and patient messages following endoscopic transnasal transsphenoidal surgery. Skull Base Surg 2022; 83:611-617. [DOI: 10.1055/a-1840-9874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
Objectives:To identify the reasons for patient messages, phone calls and Emergency Department (ED) visits prior to the first postoperative visit following discharge after endoscopic transnasal transsphenoidal (eTNTS) surgery.
Design: Retrospective review of patients at a tertiary care academic center who underwent eTNTS for resection of a sellar region tumor between May 2020-August 2021. Patient, tumor, and surgical characteristics were collected, along with post-operative, post-discharge, and readmission information. Regression analyses were performed to investigate risk factors associated with post-discharge phone calls, messages, ED visits, and readmissions.
Main Outcome Measures: Number of and reasons for phone calls, patient messages, and ED visits between hospital discharge and the first postoperative visit. We additionally determined whether these reasons were addressed in each patient’s discharge instructions.
Results: A total of 98 patients underwent eTNTS during the study period. Median length of hospital stay was 2-days (Interquartile range [IQR] 1-4days), at which point most patients (82%) were provided with eTNTS-specific discharge instructions. First postoperative visit took place 9-days after discharge (IQR 7-10days). Within that time, 54% of patients made/sent at least one phone call or electronic message and 17% presented to the ED. Most common reasons for call/message were nasal care, appointment scheduling, symptom and medication questions.
Conclusions: Through this work, we highlight the most common reasons for resource utilization via patient phone calls, messages, and ED visits among our cohort to better understand any shortfall or gap in the discharge process that may reduce these events.
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Affiliation(s)
| | | | | | | | | | - Won Kim
- , Los Angeles, United States
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Wang Y, Veltkamp DMJ, van der Boog PJM, Hemmelder MH, Dekker FW, de Vries APJ, Meuleman Y. Illness Perceptions and Medication Nonadherence to Immunosuppressants After Successful Kidney Transplantation: A Cross-Sectional Study. Transpl Int 2022; 35:10073. [PMID: 35185376 PMCID: PMC8842226 DOI: 10.3389/ti.2022.10073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022]
Abstract
Background: Medication nonadherence to immunosuppressants is a well-known risk factor for suboptimal health outcomes in kidney transplant recipients (KTRs). This study examined the relationship between illness perceptions and medication nonadherence in prevalent Dutch KTRs and whether this relationship depended on post-transplant time. Methods: Eligible KTRs transplanted in Leiden University Medical Center were invited for this cross-sectional study. The illness perceptions and medication nonadherence were measured via validated questionnaires. Associations between illness perceptions and medication nonadherence were investigated using multivariable logistic regression models. Results: For the study, 627 participating KTRs were analyzed. 203 (32.4%) KTRs were considered nonadherent to their immunosuppressants with “taking medication more than 2 h from the prescribed dosing time” as the most prevalent nonadherent behaviour (n = 171; 27.3%). Three illness perceptions were significantly associated with medication nonadherence: illness identity (adjusted odds ratio [ORadj] = 1.07; 95% confidence interval [CI], 1.00–1.14), concern (ORadj = 1.07; 95%CI,1.00–1.14), and illness coherence (ORadj = 1.11; 95%CI,1.01–1.22). The relationships between illness perceptions and medication nonadherence did not differ depending on post-transplant time (p-values ranged from 0.48 to 0.96). Conclusion: Stronger negative illness perceptions are associated with medication nonadherence to immunosuppressants. Targeting negative illness perceptions by means of psychoeducational interventions could optimize medication adherence and consequently improve health outcomes in KTRs.
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Affiliation(s)
- Yiman Wang
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: Yiman Wang,
| | - Denise M. J. Veltkamp
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, Netherlands
| | - Paul J. M. van der Boog
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, Netherlands
- Transplant Center, Leiden University Medical Center, Leiden, Netherlands
| | - Marc H. Hemmelder
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM School for Cardiovascular Research, University Maastricht, Maastricht, Netherlands
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Aiko P. J. de Vries
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, Netherlands
- Transplant Center, Leiden University Medical Center, Leiden, Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
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45
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Diehl TM, Barrett JR, Abbott DE, Cherney Stafford LM, Hanlon BM, Yang Q, Van Doorn R, Weber SM, Voils CI. Protocol for the MobiMD trial: A randomized controlled trial to evaluate the effect of a self-monitoring mobile app on hospital readmissions for complex surgical patients. Contemp Clin Trials 2022; 113:106658. [PMID: 34954099 PMCID: PMC8844087 DOI: 10.1016/j.cct.2021.106658] [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: 09/13/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hospital readmissions are estimated to cost $17.4 billion per year in the Medicare population alone, with readmission rates as high as 30% for patients undergoing complex abdominal surgery. Improved transitional care and self-monitoring may reduce preventable readmissions for such high-risk populations. In this study, we will conduct a single-institution randomized controlled trial (RCT) to assess the effect of a novel transitional care mobile app, MobiMD, on hospital readmission in complex abdominal surgery patients. METHODS Three hundred patients will be randomized 1:1 to standard of care (SOC) versus SOC plus MobiMD app in a parallel, single-blinded, two-arm RCT. Eligible patients are those who undergo complex abdominal surgery in the division of Surgical Oncology, Colorectal Surgery or Transplant Surgery. The MobiMD app provides push notification reminders directly to the patient's smart device, prompting them to enter clinical data and patient-reported outcomes. Clinical data collected via the MobiMD app include vital signs, red flag symptoms, daily wound and surgical drain images, ostomy output, drain output, medication compliance, and wound care compliance. These data are reviewed daily by a physician. The primary outcome is the proportion of participants readmitted to the hospital within 30 days of surgery. Secondary outcomes are 90-day hospital readmission, emergency department and urgent care visits, complication severity, and total readmission cost. DISCUSSION If effective, mobile health apps such as MobiMD could be routinely integrated into surgical transitional care programs to minimize unnecessary hospital readmissions, emergency department visits and healthcare resource utilization. Clinical trials identifier: NCT04540315.
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Affiliation(s)
- Thomas M Diehl
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - James R Barrett
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Daniel E Abbott
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Linda M Cherney Stafford
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Bret M Hanlon
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA; Department of Biostatistics and Medical Informatics, University of Wisconsin, WARF Room 201, 610 Walnut Street, Madison, WI 53726, USA.
| | - Qiuyu Yang
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA; Department of Biostatistics and Medical Informatics, University of Wisconsin, WARF Room 201, 610 Walnut Street, Madison, WI 53726, USA.
| | - Rachel Van Doorn
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Sharon M Weber
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA.
| | - Corrine I Voils
- University of Wisconsin, School of Medicine and Public Health, 750 Highland Ave, Madison, WI 53726, USA; William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace (151), Madison, WI 53705, USA.
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46
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Shapiro MH, Goodman DM, Rodriguez VA. The Perfect Discharge: A Framework for High-Quality Hospital Discharges. Hosp Pediatr 2022; 12:108-117. [PMID: 34961884 DOI: 10.1542/hpeds.2021-006100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Matthew H Shapiro
- Department of Pediatrics, School of Medicine, University of California, Irvine, Irvine, California.,Children's Hospital of Orange County, Orange, California
| | - Denise M Goodman
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Victoria A Rodriguez
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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47
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Pérez-Martín AM, García Madrid MGDP, Ruiz-Moral R, Crespo-Cañizares A, Mena CGDL, Caballero-Martínez F. Ibero-American Consensus on Communication Skills for Nursing Degree students. Rev Lat Am Enfermagem 2022. [PMID: 35613251 PMCID: PMC9132134 DOI: 10.1590/1518-8345.5653.3523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: as a health care profession focused on caring for people, Nursing requires sound communication skills. Based on an international expert consensus, a proposal on learning outcomes in clinical communication for undergraduate Nursing education curricula in Spanish speaking countries is presented. Method: a steering committee, consisting of 5 nurses and experts in communication in health care sciences, drew up the first list of communication skills specific to the Nursing degree. Their proposal was reviewed and improved by a committee of 7 international scientific advisers. 70 experts from 14 countries were selected using a snowball sampling procedure and invited to participate in a distance modified Delphi consensus process in two survey rounds. Statistical analysis was carried out to establish the final consensus level for each item. Results: a questionnaire with 68 learning outcomes in clinical communications was submitted for panel assessment. In the first Delphi round, the panel reached a statistical consensus on all the items assessed. There was no need for a second round to reconcile positions. Conclusion: an academic proposal, approved by a high level of international consensus, is presented to guide and unify the learning outcomes on the clinical communication curriculum for undergraduate Nursing studies in Spanish speaking countries.
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48
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Harren DMAK, Klietz ML, Aitzetmüller DDMM, Dittrich DMF, Hirsch PDMT. Requirements for an app from the perspective of patients in plastic and reconstructive surgery. J Plast Reconstr Aesthet Surg 2022; 75:2027-2032. [DOI: 10.1016/j.bjps.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/19/2021] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
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49
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Pérez-Martín AM, García Madrid MGDP, Ruiz-Moral R, Crespo-Cañizares A, Mena CGDL, Caballero-Martínez F. Consenso Iberoamericano sobre Habilidades de Comunicación para Estudiantes de Grado de Enfermería. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5653.3564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumen Objetivo: en su carácter de profesión de atención de la salud enfocada en cuidar a las personas, la Enfermería requiere habilidades de comunicación sólidas. Sobre la base de un consenso internacional de expertos, se presenta una propuesta sobre resultados de aprendizaje en la comunicación clínica para planes de estudio de las carreras de grado de Enfermería en países de habla hispana. Método: un comité orientador, compuesto por 5 enfermeros y expertos en comunicación en ciencias de atención de la salud, elaboró la primera lista de habilidades de comunicación específicas para la carrera de Enfermería. Un comité de 7 asesores científicos internacionales revisó y mejoró dicha propuesta. Se seleccionó a 70 expertos de 14 países a través del procedimiento de muestreo “bola de nieve”, y se los invitó a participar en un proceso de consenso Delphi modificado a distancia en dos rondas de encuesta. Se realizó un análisis estadístico para establecer el nivel de consenso final correspondiente a cada ítem. Resultados: se presentó un cuestionario con 68 resultados de aprendizaje en comunicaciones clínicas para que lo evaluara el panel. En la primera ronda Delphi, el panel llegó a un consenso estadístico en todos los ítems evaluados. No fue necesaria una segunda ronda para conciliar posiciones. Conclusión: se presenta una propuesta académica, aprobada con un elevado nivel de consenso internacional, a fin de orientar y unificar los resultados de aprendizaje en los planes de estudio sobre comunicación clínica para carreras de grado de Enfermería en países de habla hispana.
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50
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Grandchamp S, Blanc AL, Roussel M, Tagan D, Sautebin A, Dobrinas-Bonazzi M, Widmer N. Pharmaceutical Interventions on Hospital Discharge Prescriptions: Prospective Observational Study Highlighting Challenges for Community Pharmacists. Drugs Real World Outcomes 2021; 9:253-261. [PMID: 34971408 PMCID: PMC9114175 DOI: 10.1007/s40801-021-00288-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/28/2022] Open
Abstract
Background Transition between hospital and ambulatory care is a delicate step involving several healthcare professionals and presenting a considerable risk of drug-related problems. Objective To investigate pharmaceutical interventions made on hospital discharge prescriptions by community pharmacists. Method This observational, prospective study took place in 14 community pharmacies around a Swiss acute care hospital. We recruited patients with discharge prescriptions (minimum three drugs) from the internal medicine ward of the hospital. The main outcome measures were: number and type of pharmaceutical interventions made by community pharmacists, time spent on discharge prescriptions, number of medication changes during the transition of care. Results The study included 64 patients discharged from the hospital. Community pharmacists made a total of 439 interventions; a mean of 6.9 ± 3.5 (range 1–16) interventions per patient. All of the discharge prescriptions required pharmaceutical intervention, and 61 (95%) necessitated a telephone call to the patients’ hospital physician for clarifications. The most frequent interventions were: confirming voluntary omission of a drug (31.7%), treatment substitution (20.5%), dose adjustment (16.9%), and substitution for reimbursement issues (8.8%). Roughly half (52%) of all discharge prescriptions required 10–20 min for pharmaceutical validation. The mean number of medication changes per patient was 16.4: 9.6 changes between hospital admission and discharge, 2.6 between hospital discharge and community pharmacy, and 4.2 between community pharmacy and a general practitioner’s appointment. Conclusion Hospital discharge prescriptions are complex and present a significant risk of medication errors. Community pharmacists play a key role in preventing and identifying drug-related problems.
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Affiliation(s)
- Sophie Grandchamp
- Pharmacy of the Eastern Vaud Hospitals, Route du Vieux Séquoia 20, 1847, Rennaz, Switzerland
| | - Anne-Laure Blanc
- Pharmacy of the Eastern Vaud Hospitals, Route du Vieux Séquoia 20, 1847, Rennaz, Switzerland
| | - Marine Roussel
- Pharmacy of the Eastern Vaud Hospitals, Route du Vieux Séquoia 20, 1847, Rennaz, Switzerland
| | - Damien Tagan
- Riviera-Chablais Hospital, Vaud-Valais, Rennaz, Switzerland
| | | | - Maria Dobrinas-Bonazzi
- Pharmacy of the Eastern Vaud Hospitals, Route du Vieux Séquoia 20, 1847, Rennaz, Switzerland.
| | - Nicolas Widmer
- Pharmacy of the Eastern Vaud Hospitals, Route du Vieux Séquoia 20, 1847, Rennaz, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
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