Journal articles on the topic 'Family medicine Evaluation; Patient satisfaction; Medical care Evaluation'
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Aquino, Leora, Anne Ottney, Amy Odom, and Julie Phillips. "Evaluation of a Residency Peer-to-Peer Intervention in Opioid Prescribing." Family Medicine 54, no. 3 (March 1, 2022): 221–25. http://dx.doi.org/10.22454/fammed.2022.864395.
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Background and Objectives: Family physicians play a crucial role in addressing the opioid epidemic. We studied a novel peer-review opioid prescribing educational intervention for family medicine residents that incorporates guided instruction from an interdisciplinary care team. Methods: We used a mixed-methods study design in the setting of a family medicine residency program in the Midwestern United States. Residents participated in small group, peer-to-peer discussions of patients chronically prescribed opioids with guidance and input from faculty, a pharmacist, and pharmacy students. Discussions followed a structured approach to evaluation based on guidelines, and written recommendations were given to the patients’ resident primary care physician (PCP). For each patient, we reviewed electronic medical records to assess whether PCPs implemented the written recommendations. We used one-way analyses of variance to determine the statistical significance of changes made. The principal investigator interviewed seven participating residents to survey their satisfaction with the curriculum and collated suggestions for improvement. Results: Over a 3-year period, we reviewed 59 patients as part of the intervention; of these, 53 had complete records reviewed for this study. Patients’ morphine milligram equivalent dosage (MME) declined modestly (P=.035). The number and proportion of recommendations implemented was correlated with the decline in MME (P=.004 and P=.013, respectively). Interviewed residents unanimously evaluated the curriculum positively, citing that the structured approach helped align their practices with guidelines. Conclusions: The guided peer-review intervention effectively decreased chronic opioid use among patients, and residents positively evaluated the curriculum.
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Attef, Maryam, Catherine Dulude, Chantal Trudel, and Melanie Buba. "Virtual Family-Centered Rounds During the COVID-19 Pandemic – Technology Usability Analysis." Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 11, no. 1 (October 2022): 151–55. http://dx.doi.org/10.1177/2327857922111030.
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Family-centered rounds (FCR) are multidisciplinary rounds, involving patients and caregivers with the aim of shared decision making in medical care planning. In response to the COVID-19 pandemic, a tertiary care pediatric hospital re-engineered the in-person FCR process used by inpatient Pediatric Medicine teams implemented virtual family-centered rounds (vFCR). As part of a mixed methods study evaluating vFCR, naturalistic observation was used to evaluate the usability of vFCR technology. Functional and user requirements were assessed and confirmed through observation of interactions with technology intended to support vFCR. The duration of individual patient rounds and transition time between patients was also captured. Technology interactions were assessed in terms of what worked (successful interactions) and what did not work (usability issues and errors). Neilsen and Norman’s (1994) usability heuristics were used to support the evaluation and explanation of findings. While naturalistic observation yielded clear results in terms of effectiveness and efficiency, user satisfaction was not formally examined. The identified usability requirements and key characteristics for ease of use and adoption of vFCR identified in this study can be used by other hospitals looking to implement or improve inpatient virtual care technology usability.
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Henneman, EA, JB McKenzie, and CS Dewa. "An evaluation of interventions for meeting the information needs of families of critically ill patients." American Journal of Critical Care 1, no. 3 (November 1, 1992): 85–93. http://dx.doi.org/10.4037/ajcc1992.1.3.85.
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OBJECTIVE: To evaluate the effectiveness of two methods of meeting the information needs of families of critically ill patients: an open visiting hour policy and a family information booklet. SETTING: Medical intensive care unit of a university medical center. SUBJECTS: Family members (N = 147) of patients admitted to the medical intensive care unit. INTERVENTIONS: Implementation of an open visiting hour policy and information booklet. MEASUREMENTS AND MAIN RESULTS: Questionnaires were distributed to family members 24 to 48 hours after the patient's admission. The questionnaire addressed family satisfaction with having specific information needs met and posed questions that tested their knowledge of unit policies and personnel. The questionnaire was distributed to three groups: families who had restricted visiting hours and no booklet (group 1, n = 48), families who had open visiting hours but no booklet (group 2, n = 50), and families who had open visiting hours and an information booklet (Group 3, n = 49). Implementation of an open visiting hour policy increased family satisfaction. Families exposed to both the open visiting hours and the information booklet were more knowledgeable about specific details than were those exposed to only the open visiting hour policy. CONCLUSIONS: Flexible visiting hours and information booklets were two practical methods of meeting the information needs of families. Open visiting hours, as a singular intervention, significantly improved family satisfaction. The effectiveness of the booklet in assisting families to recall discrete pieces of information supports the further development and use of preprinted materials to assist in meeting family information needs.
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Taylor, Kimberly A., Deborah McQuilkin, and Ronda G. Hughes. "Medical Scribe Impact on Patient and Provider Experience." Military Medicine 184, no. 9-10 (February 27, 2019): 388–93. http://dx.doi.org/10.1093/milmed/usz030.
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Abstract Introduction The electronic health record (EHR) has created additional administrative burdens on providers to perform data entry while trying to engage with the patient during the health care visit. Providers have become frustrated and distracted with the documentation requirements which further hindered connectivity, and communication with the patient. The utilization of medical scribes in the outpatient clinical setting was a strategy shown to enhance patient and provider interaction, decrease clinician’s administrative tasks, and promote satisfaction among providers and patients. This was an innovative quality improvement pilot project to improve the patient and provider experience using scribes in an outpatient setting. Materials and Methods Two providers, to include one Family Medicine doctor and one Internal Medicine physician, and four hospital corpsmen participated in this pilot project. The four hospital corpsmen received a 2-week training of the fundamentals of the EHR and their role as scribes prior to the start of the project. Two corpsmen were designated for each provider and worked with their provider throughout the 12-week project period. The two primary aspects evaluated during the implementation of the scribes were the patient experience, and provider experience. Navy Medicine and the University of South Carolina Institutional Review Boards (IRB) considered this project exempt from full IRB review. Results The experience questionnaire results indicated a slight mean decrease, but did not negatively impact patient satisfaction or overall patient experience. The local Medical Treatment Facility patient satisfaction, obtained through the Interactive Customer Evaluation, and the Joint Outpatient Experience Survey, indicated that there was no decrease in patient satisfaction or overall experience during the project period. The providers’ experience improved with an average 50% decrease in time spent after hours documenting in the EHR, enhanced engagement with patient, staff, and ancillary team members, and improved work life balance. Additional findings of improved clinic efficiencies, completion of notes for both providers and positive qualitative comments from the scribes were identified. Conclusion In multiple settings, documentation requirements burden providers. The consideration of scribes could foster work life balance, retention, and wellness. The patient and provider experience was strengthened through the utilization of medical scribes, so future research centered on the provider and patient experience could be beneficial to organizations. Further study of the scribe’s experience, especially considering the positive comments from the hospital corpsmen that participated as scribes during the project, could provide beneficial outcomes. Navy Medicine is advancing every opportunity to strengthen clinical and operational readiness, health and partnerships to provide the highest quality care and promote wellness for our patients. This type of quality improvement initiative could positively support readiness, quality and wellness for our organization, providers, and patients.
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Sun, Wei, Jinxia Liu, Lihua Liu, and Xiuzhi Wang. "Management Strategy of Alzheimer’s Patients under the Medical-Care Integration Model Based on Big Data Evaluation." BioMed Research International 2022 (October 11, 2022): 1–11. http://dx.doi.org/10.1155/2022/9896935.
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In the context of the era of big data, the management of Alzheimer’s patients has aroused widespread concern in the society. What should the elderly and people with dementia do and how the society should accommodate these special groups have aroused heated discussions in the society. The goal of the medical-nursing integration model is to realize the integrated model of medical care-nursing-rehabilitation-old care, and to better satisfy the needs by providing medical services, rehabilitation care, and health management. The medical needs of the elderly can help the elderly maintain a healthy state; the elderly care needs can be better met through elderly care services, and the burden on families and society can be reduced. With the advancement of the medical-care integration model, new solutions have been provided for the management of senile dementia patients. Therefore, under the medical-care integration model, this paper managed Alzheimer’s patients based on the big data algorithm based on association rules and compared it with the management of Alzheimer’s patients under the traditional model, and drew the following conclusions: compared with the management satisfaction of Alzheimer’s patients under the traditional model, family members and patients’ total satisfaction with nursing management under the medical-care integration model was greatly improved; compared with the management of Alzheimer’s patients under the traditional model, the incidence of adverse events in the management of Alzheimer’s patients under the medical-care integration model was greatly reduced, which was reduced to 17.6%; under the medical-care integration model, the anxiety and depression scores of the elderly patients with dementia decreased rapidly; under the medical-care integration model, the living ability of senile dementia patients has been greatly improved; the use of the medical-care integration model to manage senile dementia patients has greatly improved the sleep quality, mental quality, and quality of life of senile dementia patients.
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Al Shdaifat, Amjad, and Therese Zink. "Pilot study to build capacity for family medicine with abbreviated, low-cost training programme with minimal impact on patient care for a cohort of 84 general practitioners caring for Palestinian refugees in Jordan." BMJ Open 9, no. 8 (August 2019): e028240. http://dx.doi.org/10.1136/bmjopen-2018-028240.
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PurposeStudies document that primary care improves health outcomes and controls costs. In regions of the world where primary care is underdeveloped, building capacity is essential. Most capacity building programmes are expensive and take physicians away from their clinical settings. We describe a programme created, delivered and evaluated from 2013 to 2014 in Jordan.DesignCohort study.SettingPhysicians providing primary care in the United Nations Relief and Works Agency for Palestine Refugees clinics in Jordan.ParticipantsEighty-four general practitioners (GPs) were invited to participate and completed the training and evaluation. GPs are physicians who have a license to practice medicine after completing medical school and a 1 year hospital-based rotating internship. Although GPs provide care in the ambulatory setting, their hospital-based education provides little preparation for delivering ambulatory primary care.Intervention/ProgrammeThis three-stage programme included needs assessment, didactics and on-the-job coaching. First, the learning needs and baseline knowledge of the trainees were assessed and the findings guided curriculum development. During the second stage, 48 hours of didactics covered topics such as communications skills and disease management. The third stage was delivered one on one in the trainee’s clinical setting for a 4 to 6-hour block. The first, middle and final patient interactions were evaluated.Primary and secondary outcome measuresPreknowledge and postknowledge assessments were compared. The clinical checklist, developed for the programme, assessed eight domains of clinical skills such as communication and history taking on a five-point Likert scale during the patient interaction.ResultsPreknowledge and postknowledge assessments demonstrated significantly improved scores, 46% to 81% (p<0.0001). Trainee’s clinical checklist scores improved over the assessment intervals. Satisfaction with the training was high.ConclusionThis programme is a potential model for building primary care capacity at low cost and with little impact on patient care that addresses both knowledge and clinical skills on the job.
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Cupit, Caroline, and Emma Redman. "Supporting people to implement a reduced carbohydrate diet: a qualitative study in family practice." BMJ Nutrition, Prevention & Health 4, no. 1 (May 10, 2021): 226–34. http://dx.doi.org/10.1136/bmjnph-2021-000240.
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IntroductionMuch of the science behind dietary guidelines for risk reduction and chronic disease management is equivocal, and there are well-accepted uncertainties and complexities relating to diet in everyday life, as well as physiological processes. Guidelines have therefore stopped short of aligning with one particular approach, instead highlighting several evidence-based options. However, reduced carbohydrate, or ‘low-carb’, diets have increasing traction in the media and with patients, practitioners and the general public. This qualitative study examines healthcare practitioner (HCP) experiences of implementing a reduced carbohydrate diet.MethodsSemistructured, qualitative interviews were conducted with 19 HCPs in the UK family practice (including general practitioners, practice nurses and non-medical practitioners), recruited through a special interest forum, and social media. Data analysis employed social science theory and methods to produce key themes.ResultsAll participants self-identified as ‘low-carb practitioners’ who, over time, had introduced a specific focus around carbohydrate reduction into their work. They reported transformations in patients’ metabolic markers, patient enthusiasm for the approach and renewed job satisfaction. Key themes highlight experiences of: (1) discovering low-carb as a new ‘tool-in-the-box’; (2) promoting and supporting incremental low-carb experimentation; and (3) diverging from established dietary guidelines.ConclusionsThis study provides important experience-based evidence on a topical dietary intervention. Participants strongly advocated for the use of low-carb diets. The successes described draw attention to the need for pragmatic, formative evaluation of low-carb advice and support as a ‘complex intervention’ (alongside physiological research), to justify, challenge and/or shape low-carb intervention in clinical practice. The findings raise important questions about the contribution of particular care practices to the apparent success of low-carb. Social science analyses can elucidate how dietary intervention is carried out across different healthcare settings (eg, dietetics, endocrinology) and patient groups, how healthcare practices intersect with people’s everyday self-management and how different forms of evidence are invoked and prioritised.
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Sivaprasad, Sobha, Gopalakrishnan Netuveli, Raphael Wittenberg, Rajan Khobragade, Rajeev Sadanandan, Bipin Gopal, Lakshmi Premnazir, et al. "Complex interventions to implement a diabetic retinopathy care pathway in the public health system in Kerala: the Nayanamritham study protocol." BMJ Open 11, no. 6 (June 2021): e040577. http://dx.doi.org/10.1136/bmjopen-2020-040577.
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Introduction Using a type 2 hybrid effectiveness-implementation design, we aim to pilot a diabetic retinopathy (DR) care pathway in the public health system in Kerala to understand how it can be scaled up to and sustained in the whole state. Methods and analysis Currently, there is no systematic DR screening programme in Kerala. Our intervention is a teleophthalmology pathway for people with diabetes in the non-communicable disease registers in 16 family health centres. The planned implementation strategy of the pathway will be developed based on the discrete Expert Recommendations for Implementing Change taxonomy. We will use both quantitative data from a cross-sectional study and qualitative data obtained from structured interviews, surveys and group discussions with stakeholders to report the effectiveness of the DR care pathway and evaluation of the implementation strategy. We will use logistic regression models to assess crude associations DR and sight-threatening diabetic retinopathy and fractional polynomials to account for the form of continuous covariates to predict uptake of DR screening. The primary effectiveness outcome is the proportion of patients in the non-communicable disease register with diabetes screened for DR over 12 months. Other outcomes include cost-effectiveness, safety, efficiency, patient satisfaction, timeliness and equity. The outcomes of evaluation of the implementation strategies include acceptability, feasibility, adoption, appropriateness, fidelity, penetration, costs and sustainability. Addition of more family health centres during the staggered initial phase of the programme will be considered as a sign of acceptability and feasibility. In the long term, the state-wide adoption of the DR care pathway will be considered as a successful outcome of the Nayanamritham study. Ethics and dissemination The study was approved by Indian Medical Research Council (2018-0551) dated 13 March 2019. Study findings will be disseminated through scientific publications and the report will inform adoption of the DR care pathway by Kerala state in future. Trial registration number NCT28942696.
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Shelton, D., and W. Thomas-Boaz. "P030: Assessment of lab results on emergency department patients that leave without seeing a physician." CJEM 22, S1 (May 2020): S75. http://dx.doi.org/10.1017/cem.2020.237.
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Background: Most emergency departments (ED) utilize medical directives to initiate lab investigations for patients prior to physician assessment. This practice facilitates expedited patient care in the ED, resulting in safer and efficient care. However, some patients choose to leave the ED prior to seeing a physician due to prolonged waiting. Previously, at our hospital there was no defined process for identifying and following up on abnormal test results on patients that leave without being seen (LWBS), resulting in lab results often not being reviewed by a nurse or physician. Aim Statement: By April 2020, we aim to have 90% of ED LWBS patients with abnormal results identified and followed up. Measures & Design: A series of consultations and information gathering occurred that included an environmental scan of other EDs and discussions with emergency nurses, emergency physicians, Risk Management, Legal Department, College of Nurses of Ontario and Canadian Medical Protective Association. A process map was developed collaboratively to standardize the process to identify and follow up on abnormal investigations of LWBS patients and a new hospital policy was developed to officially outline this process. The following are the family of measures: Outcome measure – % LWBS patients with abnormal tests that had follow-up documented in chart Process measure – Number LWBS patients with investigations initiated by medical directive, Number LWBS patients, % LWBS patients Balancing measure – Satisfaction of nurses with new process for LWBS patients Evaluation/Results: At baseline, 29% of LWBS patients with abnormal lab results had follow up documented in the chart. After implementation of the new standardized process and policy, the follow up rate of LWBS patients with abnormal results in August, September and October 2019 was 47%, 28% and 29% respectively. Discussion/Impact: These results indicate that standardization and new policy implementation is insufficient to change practice, even one that aims to provide safer patient care. Nevertheless, these interventions are important first steps to improving the safety for ED LWBS patients. We plan to implement an audit and feedback approach to encourage nursing staff to routinely check lab results on LWBS patients.
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Hunter, Kimberly Anne, and Ben Thomson. "A scoping review of social determinants of health curricula in post-graduate medical education." Canadian Medical Education Journal 10, no. 3 (July 21, 2019): e61-71. http://dx.doi.org/10.36834/cmej.61709.
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Social determinants of health are responsible for 50% of ill health. The Royal College of Physicians and Surgeons of Canada CanMEDS role of “physician advocate” requires physicians to attain competency in this particular domain, but physician trainees feel this is not well covered in their training programs. This study performed a scoping review of social determinants of health curricula that had been described, implemented and evaluated in post-graduate medical education. A search using MEDLINE(OvidSP) database, with search terms “residency,” ”curriculum,” and “social determinants” with no age, language, and publication date restrictions was done.Researchers identified a total of 12 studies, all from the United States, in internal medicine (n=4), pediatrics (n=4), family medicine (n=2), or multiple (n=2) residency programs. Most curricula (n=8, 67%), were longitudinal, and most contained both patient or community exposure (n=11, 92%) and/or classroom-based components (n=10, 83%). Most (78%) curricula improved participant related outcomes, including exam performance, awareness regarding personal practice, confidence, improved screening for social determinants of health and referral to support services. Program specific outcomes were frequently positive (50%) and included resident satisfaction and high course evaluation scores, high representation of resident and faculty from minority groups, applicability of training to underserviced populations, and improved engagement of marginalized community members. When evaluated, academic outcomes were always positive, and included acceptance of scholarly projects to national conferences, publication of research work, grants earned to support health projects, local or national awards for leadership and community engagement, and curriculum graduates later pursuing related Masters degrees and/or establishing medical practices in underserved areas. Only one study reported a patient-related outcome, with advice provided by health care providers considered by patients to be helpful. Researchers used these results to design recommendations for creation of a post-graduate curriculum to address social determinants of health were provided.
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Evans, Bridie, Mark Kingston, Alison Porter, Leigh Keen, Lesley Griffiths, Mari James, and Stephanie Green. "PP34 Collecting experience-based expertise when planning prehospital care research: a stakeholder event about evaluating paramedics working in care homes." Emergency Medicine Journal 37, no. 10 (September 25, 2020): e16.2-e16. http://dx.doi.org/10.1136/emermed-2020-999abs.34.
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BackgroundDue to medical advances, the population of care homes is becoming increasingly frail, often with co-morbidities. Recent innovations have seen paramedics take on non-emergency roles within or supporting care homes. This workforce innovation requires urgent evaluation, taking account of the multiple perspectives at stake. Research is more relevant, feasible and accountable if those who commission, deliver and use healthcare services are able to input their professional and personal insights.MethodWe conducted a stakeholder event as part of research development work for paramedics working in care homes (PERCH: Preliminary Exploration of paramedic Roles in Care Homes). We invited representatives from care homes, including Enabling Research in Care Homes (ENRICH) network members, ambulance services, primary and secondary care, patient/resident and public members, and the research community. To inform discussion, we presented examples of paramedics working in care homes. We then facilitated small-group discussions about how to evaluate such innovations and recorded views on sticky notes and flipcharts.Results23 people attended the event. Clarity of roles and communication processes were considered important to implement the pilot project. Attendees agreed that research outcome measures should include changes in avoidable hospital admissions, emergency department attendances and 999 calls plus staff, patient and family satisfaction. They identified some potential benefits to ambulance services and general practice, such as time saved for other patients, but believed these could be difficult to measure.DiscussionGaining the insights of a wide range of stakeholders prior to research being designed is an important, but under-utilised approach in research development. People who deliver and receive community-based care have insight derived from personal and professional experience which complements research expertise. Research in care home settings is challenging, and insights from stakeholders were significant in the development of a research proposal about the role of paramedics in care homes (PERCH study). We submitted this to the Health and Care Research Wales Research for Public and Patient Benefit funding scheme in 2019.
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Rocque, Brandon G., Alexandra Cutillo, Kathrin Zimmerman, Anastasia Arynchyna, Susan Davies, Wendy Landier, and Avi Madan-Swain. "Distress and psychosocial risk in families with newly diagnosed pediatric brain tumors." Journal of Neurosurgery: Pediatrics 23, no. 1 (January 2019): 40–47. http://dx.doi.org/10.3171/2018.7.peds18297.
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OBJECTIVEHospitalization for a newly diagnosed pediatric brain tumor is an extremely stressful time for a family, but this period has not been the focus of rigorous study. The purpose of this study was to quantify distress and psychosocial risk in this population to improve psychosocial care delivery.METHODSThe authors administered the National Comprehensive Cancer Network Distress Thermometer (DT) and the Psychosocial Assessment Tool 2.0 (PAT) to primary caregivers of all children admitted to Children’s of Alabama with a new brain tumor between April 2016 and August 2017. The DT is a single-item measure of distress (scale range 0–10). The PAT (range 0–7) stratifies families by risk level: a score less than 1.0 indicates universal risk level (risk typically experienced during hospitalization); a score of 1.0–2.0 indicates targeted risk (specific psychosocial difficulties that impact medical treatment); and a score higher than 2.0 indicates clinically significant risk. Demographic and clinical information was abstracted from each child’s medical record. A correlation matrix using nonparametric statistics was created between abstracted data and the DT and PAT scores.RESULTSForty primary caregivers were enrolled (of 49 eligible), with the patient age ranging from newborn to 17 years (mean 7.7 years). Twenty-five (63%) of the children were male, and 24 (60%) were white, non-Hispanic. Mean and median DT scores were 7.2 (SD 2.6) and 7, respectively. However, 12 (30%) rated their distress 10/10, and 85% rated distress 5 or greater. PAT scores ranged from 0.0 to 2.36 with mean and median scores of 0.89 (SD 0.50) and 0.86, respectively. PAT results for 16 (40%) families were in the targeted or clinical range, indicating psychosocial factors that have the potential to interfere with medical treatment. No clinical or demographic variable correlated significantly with the DT or PAT score.CONCLUSIONSFamilies of children with newly diagnosed brain tumors experience high levels of distress and psychosocial risk. This work will serve as the foundation for efforts to standardize psychosocial evaluation for newly diagnosed pediatric neurosurgical patients, and to create protocols that organize existing hospital-based psychosocial support services. These efforts have the potential to improve patient and family satisfaction as well as treatment outcomes.
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Meyerheim, Marcel, Christina Karamanidou, Sheila Payne, Tina Garani-Papadatos, Annette Sander, Julia Downing, Kostas Stamatopoulos, et al. "MyPal-Child study protocol: an observational prospective clinical feasibility study of the MyPal ePRO-based early palliative care digital system in paediatric oncology patients." BMJ Open 11, no. 4 (April 2021): e045226. http://dx.doi.org/10.1136/bmjopen-2020-045226.
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IntroductionElectronic patient-reported outcomes (ePROs) have tremendous potential to optimise palliative and supportive care for children with cancer, their families and healthcare providers. Particularly, these children and their families are subjected to multiple strains caused by the disease and its treatment. The MyPal digital health platform is designed to address these complex demands by offering pursuant ePRO-based functionalities via two mobile applications, one developed for children and the other for their parents.Methods and analysisIn this observational prospective feasibility study, 100 paediatric oncology patients aged between 6 and 17 years and at least one of their parents/legal guardians will be recruited at three clinical sites in two European countries (Germany and Czech Republic). They will use the mobile applications which are part of the novel digital health platform. During a 6-month study period, participants will complete various ePROs via the applications addressing quality of life, satisfaction with care and impact of the disease on the family at monthly intervals. Additionally, priority-based symptom reporting is integrated into a serious game for children. Outcomes that will be assessed concern the feasibility and the evaluation of the newly designed digital health platform to contribute to the evidence base of clinical ePRO use in paediatric oncology and palliative care process.Ethics and disseminationThe MyPal-Child study obtained ethical approval from the Ethics Committee responsible for the University of Saarland, that is, the Ärztekammer des Saarlandes, the Ethics Committee of the Medical School Hannover and the Ethics Committee of the University of Brno. Study results will be disseminated through scientific publications, presentations at international conferences, congresses and a final report to the European Commission. General publicly accessible information can be found on the project website (www.mypal-project.eu) and social media.Trial registration numbersU1111-1251-0043, DRKS00021458, NCT04381221.
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Lottenberg, Richard, Robert Krywicki, Gurinder Doad, Witemba Kabange, Monisola Modupe, Gregory Steele, Zerettia K. McGriff, et al. "Implementation of a Community Hospital-Based Fast Track Pathway for the Treatment of Acute Pain Episodes in Adults with Sickle Cell Disease." Blood 124, no. 21 (December 6, 2014): 4854. http://dx.doi.org/10.1182/blood.v124.21.4854.4854.
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Abstract Background: A growing number of adult patients with sickle cell disease (SCD) receive care in a community setting and often lack access to physicians with sickle cell expertise. To address this healthcare disparity we are testing a co-management medical home model with Hematology/Oncology (H/O) and Family Medicine (FM) physicians to facilitate evidence-based acute and chronic care. An Emergency Department (ED) Observation Unit based pathway for treatment of sickle cell pain developed at an academic medical center with a Comprehensive Sickle Cell Center (CSCC) has been adopted and modified to fit the needs of a community multi-specialty hospital with an unopposed FM residency program. The hospital serves a large sickle cell population in a predominantly rural setting with the closest CSCC 180 miles away. Methods: Pathway development was facilitated by having a formal meeting for the community hospital physicians and staff at the academic medical center and sickle cell experts providing ongoing on site consultation at the community hospital. Protocols for the community hospital were produced with input from physicians, nurses, advanced practice providers, and support services at multiple meetings. Adult patients with SCD presenting to the ED with pain are triaged at Emergency Severity Index Level 2 for evaluation by the ED physician. The ED protocol uses specific criteria to identify patients with uncomplicated pain. Patients presenting with abnormal vital signs (other than mild tachycardia), fever, pregnancy, or apparent other sickle cell-related complications are excluded. Patients qualifying for the pathway are directly admitted to the SCD unit (a hospital room with 4 infusion chairs on the H/O floor exclusively designated for care of sickle cell patients). Following intake evaluation by the nurse, a clinician is notified to evaluate the patient and provide orders for intravenous fluids and opioid patient controlled analgesia (PCA) which is administered according to hospital guidelines. PCA by the subcutaneous route is used if intravenous access is not readily available. A CBC is obtained whereas other laboratory testing and imaging studies are ordered based on clinical indications. H/O physicians and nurse practitioners cover the unit weekdays 8:00am-5:00pm and FM residents cover nights and weekends with back up by the on call H/O physician. Patients can be treated in the SCD unit up to 23 hours. For patients discharged home a follow up phone call by an H/O nurse will be placed within 3 days and an outpatient clinic appointment is scheduled to be within 7 days. Monthly quality assurance meetings are attended by H/O, FM, and ED physicians as well as nursing, pharmacy and administrative staff from the ED and H/O inpatient service to review process issues and patient outcomes. Consultation is provided by academic physicians with sickle cell expertise (H/O and ED) who attend each meeting in person or by conference call. Results: From March 5-June 30, 2014, 67 patients accounted for 271 visits to the SCD unit. The mean time in the unit was 13.6 hours. The mean pain score on admission was 8.7/10 and reduced to 4.9 upon discharge. PCA drug, pump setting, and dosage are recorded to be used for future visits. Over the 4 months 91.1% of the patients were discharged home from the unit. Six patients accounted for 31% (84) of the visits with only 4 hospital admissions. Conclusions: A fast track pathway for the treatment of acute sickle cell pain coordinated between ED, H/O, and FM physicians has been implemented at a community hospital using an Observation Unit based treatment program. During the entire initial experience the majority of patients have been discharged home with adequate pain relief. In the future the impact of the program will be evaluated including effect on frequency of hospitalizations, outpatient follow up, patient satisfaction, and cost effectiveness. The pathway can be adapted to other community hospital settings where sickle cell expertise is not locally available. Disclosures Kutlar: NIH/NIMHD: Research Funding.
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Pan, Na, Yu Ye Luo, and Qiu Xia Duan. "The Influence of PDCA Cycle Management Mode on the Enthusiasm, Efficiency, and Teamwork Ability of Nurses." BioMed Research International 2022 (July 8, 2022): 1–7. http://dx.doi.org/10.1155/2022/9352735.
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Background. The PDCA cycle consists of four stages: P (plan), D (design), C (check), and A (action). With the wide acceptance of PDCA cycle, there is an urgent need to verify the effect of combining this concept with clinical nursing work. Therefore, on the basis of in-depth study of a large number of related literature, the influence of PDCA cycle management mode on nurses’ work efficiency, work enthusiasm, and teamwork ability was explored, so as to provide reference experience for exploring the nursing quality management model adapted to the development of medicine. Objective. To explore the application of PDCA circulation management mode in clinical nursing work and to explore its influence on the work efficiency, enthusiasm, and team cooperation ability of nurses. Methods. From January 2019 to January 2021, the patients were divided into two groups. The control group received routine nursing care, and the research group received the PDCA circulation management mode. Both groups of nurses received one-year training. The nursing quality, the ability of teamwork, the scores of personal quality control in clinical departments, the scores of nursing satisfaction, the number of problems in nursing document quality management, and nurses’ enthusiasm were compared between the two groups. Results. The scores of relationships and family and work balance were greater than those of the control group. The nursing quality result suggested the nursing quality of gynecological operation area, emergency operation area, comprehensive operation area, and surgical operation area in research nurses was significantly better than the control cases ( P < 0.05 ). The quality management of nursing documents showed that the number of problems in nursing documents such as nursing record displayed fewer than control group ( P < 0.05 ). The personal quality-controlled checking in medical department showed that the points of ward governance, head nurse management quality control examination, first-level nursing, recovery, publications on therapeutics, pill governance, and healthcare documentation in the research group were higher than control group ( P < 0.05 ). The teamwork ability implied the scores of interpersonal communications, problem definition, project division, team evaluation assistance and motivation, data collection, interpretation, and extraction of results in the observation group were remarkably greater than those of control group ( P < 0.05 ). The satisfaction mark showed that the scores of care information exchange, advanced technologies, attitude towards care providing, healthcare establishing, knowledge publicity, and learning in the researches were markedly more than those of the control group ( P < 0.05 ). Conclusion. Compared with the traditional clinical nursing management, the use of the PDCA circulation management mode can effectively improve the quality of hospital nursing work, strengthen nurses’ ability of teamwork, improve nurses’ work efficiency and enthusiasm, enhance their sense of achievement of clinical nursing work, then improve patient satisfaction, and enhance the reputation and competitiveness of hospitals. Therefore, the PDCA management model is worth popularizing and applying in clinic.
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Pathipati, Akhilesh S., and Justin M. Ko. "Implementation and evaluation of Stanford Health Care direct-care teledermatology program." SAGE Open Medicine 4 (January 1, 2016): 205031211665908. http://dx.doi.org/10.1177/2050312116659089.
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Introduction: Teledermatology has proven to be an effective means of providing dermatologic care. The existing research has primarily evaluated its usefulness in a consultative model. Few academic centers have evaluated a patient-initiated model, and direct-to-consumer services remain the subject of controversy. Stanford Health Care recently launched a direct-care, patient-initiated teledermatology pilot program. This article evaluates the viability and patient satisfaction with this service. Materials and Methods: During the pilot period, patients were able to seek remote dermatologic care using an eVisit tool in their MyHealth account. Patients initiated the consultation, answered questions regarding their complaint, and uploaded a picture if relevant. A Stanford dermatologist reviewed each eVisit and responded with an assessment and plan. The dermatologist noted whether they were able to make a diagnosis and their level of confidence in it. After the study, 10 patients participated in a focus group to provide feedback on the service. Results: In all, 38 patients sought care during the pilot period. A dermatologist was able to make a diagnosis in 36 of 38 (95%) cases, with an average confidence level of 7.9 of 10. The average time to consultation was 0.8 days. Patients indicated high levels of satisfaction with the service although they had suggestions for improvement. Discussion: Patients provided clinically useful images and information in a direct-care teledermatology model. Such services allow dermatology providers to increase access while maintaining high-quality care in an academic medical center. Further research is needed on standalone services that cannot integrate encounters with the patient’s existing medical record.
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Cartin, Andrea, Sonia Ocampo, Adriana Méndez, Yandali Murillo, Daniela Zeledón, Rodbin Campos, María Luisa Rebolledo, et al. "Evaluation of family perceptions of palliative medicine department family meetings: Before, during, and after." Journal of Clinical Oncology 35, no. 31_suppl (November 1, 2017): 156. http://dx.doi.org/10.1200/jco.2017.35.31_suppl.156.
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156 Background: A Palliative Medicine Department (PMD) began in March of 2011 at a national hospital in Costa Rica. Treatment has focused on patient care, and attending the needs of the patients’ family; therefore, an integral approach to the family unit has been performed by a program of Family Meetings(FM). The program has allowed the families of Hematooncological disease patients to be involved in advanced care planning, and defining primary goals of treatment, while receiving information and psychological support. This study reports the families´ perception of the PMD FM before and after the meeting; and the evaluation of the family by the Palliative Care team, during the meeting. Methods: Information was gathered between of April and July of 2015 using a set of three questionnaires - one before, one during and one after - the meetings in the PMD. The information included population characteristics, the family’s feelings and concerns, and their level of satisfaction of their doubts being addressed and answered. Also, information was obtained concerning the agreed upon care plan and the diagnosis of the family established by the team. Results: A total of 47 family members ware included the study. Before, the interviewees most commonly referred feeling anxious (67.4%), sad (19%) and powerless (14%); the information they wanted to obtain was associated with the evolution and prognosis of the disease, and the best moment to initiate hospice care. Afterwards, families referred feeling anxious (35%), sad (34%) and powerless (31%). The most common family diagnosis was anticipatory grief (59%), and an adequate support network was identified in 38.5% of families. The agreed upon care plan mainly included education of coping and communication methods with the patient, patient homecare education, and immediate referral to hospice care. Conclusions: This study concluded that despite an increase in feelings of sadness and powerlessness, families reported a decrease in anxiousness; this was associated with families’ reporting that their doubts were addressed and answered in 97.9% of cases. Also, the set of questionnaires used during the Family meetings are a useful tool for patients’ family evaluation and diagnosis.
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Dourado, Bruna Macedo, Bianca Fernandes Távora Arruda, Vivian Brito Salles, Sérgio André de Souza Júnior, Virgílio Macedo Dourado, and Joel Porfírio Pinto. "Evaluation of family caregiver satisfaction with a mental health inpatient service." Trends in Psychiatry and Psychotherapy 40, no. 4 (December 2018): 300–309. http://dx.doi.org/10.1590/2237-6089-2017-0137.
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Abstract Objective To evaluate the satisfaction of family caregivers with a mental health inpatient service in Brazil. Methods This was a cross-sectional study with a quantitative approach. A sample of 80 caretaking family members answered the abbreviated version of the Brazilian Mental Health Services’ Family Satisfaction scale (SATIS-BR) and a sociodemographic questionnaire. Categorical variables were expressed as frequencies and percentages and quantitative variables as means and standard deviations. Interactions among variables and indexes of the scale were analyzed using the Student’s t test, Pearson correlation coefficient and analysis of variance. Results The results showed a high mean overall satisfaction score when considering the categorization of the items of the scale, with higher satisfaction indexes in the ‘Treatment results’ subscale and lower ones in the ‘Reception and competence of staff’ and ‘Privacy and confidentiality’ subscales. In the comparison of the samples studied, greater scores were observed in general satisfaction and in factors in the medical residency care model than in the attending psychiatrist model. There were no significant differences in terms of family member satisfaction in relation to sociodemographic variables. Conclusion Family member satisfaction was high. The need for improvement in aspects related to the infrastructure of services was evident. This paper underlines the importance of continuous and regular evaluations of the services provided, focusing on the satisfaction of users and family members in order to better understand the factors that contribute towards the quality of care provided.
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Toal, Deborah, and DrPatricia McCaffrey. "266 Patient and Carers Experience of an Acute Care at Home Team: A Service Evaluation." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.166.
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Abstract Background The Aim of the Acute Care at Home Team is to provide acute care to over 65's in the patient's own home, providing assessment and treatment of acute conditions such as pneumonia, urinary sepsis and heart failure. It is a multidisciplinary team that works together to streamline services to enable a patient to stay safely in their own home. A full comprehensive geriatric assessment is carried out in all patients to help improve patient outcomes. The patients have full access to in patient services such as scans, and x-rays. All blood tests are treated as urgent to ensure the patient is in no way disadvantaged by being treated by acute care at home compared with hospital care. The aims and objectives are to explore patient and family experiences and identify any areas for improvement. Methods A service users and carers experience Questionnaire (N=31) was used to gain insight into how satisfied the patient or family were with the service and what the experience was like having the team come into their home. Results Patient satisfaction with this Acute Care at Home Team was reported at 100%. Patients were happy with the care they received, 100% of patients were happy with staff's knowledge of their condition and treatment plan. All of the respondents stated they would both recommend the service and use it again. The qualitative responses were in keeping with 100% satisfaction in that they were positive in nature. Conclusion This service evaluation has shown that patient and carer experience of this Acute Care at Home Team is a positive one, with 100% satisfaction levels. There are some small areas to be improved upon, however the results show this service is providing the over 65 population with a good experience of being treated at home as an alternative to hospital care when acutely unwell.
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Downey, Lois, Ruth A. Engelberg, Sarah E. Shannon, and J. Randall Curtis. "Measuring Intensive Care Nurses’ Perspectives on Family-Centered End-of-Life Care: Evaluation of 3 Questionnaires." American Journal of Critical Care 15, no. 6 (November 1, 2006): 568–79. http://dx.doi.org/10.4037/ajcc2006.15.6.568.
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• Background Attempts to improve end-of-life care increasingly focus on family-centered care, but few validated assessment tools exist. • Objectives To evaluate 3 new short questionnaires measuring nurses’ perspectives on family-centered end-of-life care in the intensive care unit and to show the usefulness of the questionnaires. • Methods Principal components analysis of data from 141 critical care nurses evaluating care given to families of 218 patients was used to develop domain scores for number of nursing activities with each family, number of barriers experienced, and nurses’ satisfaction that the family’s needs were met. Random effects models were used to test associations between critical care processes and outcome. • Results Nursing activities fell into 2 domains: general and culture-related communication/support. Barriers consisted of 2 domains: patient/family barriers and system/team barriers. Meeting the needs of patients’ families represented a single dimension. In a path model based on domain scores, general activities had significant associations with both nurse communication and meeting families’ needs; patient/family barriers, with nurse communication; and nurse and physician communication, with meeting families’ needs. In a path model based on total activities and barriers scores, total activities and total barriers had significant associations with nurse communication ratings and meeting families’ needs. Patients’ and nurses’ characteristics were not significant independent predictors of meeting the needs of patients’ families. • Conclusions The 3 questionnaires provide a consistent, valid picture of nurses’ perspectives on family-centered critical care and may be useful in evaluating family care processes and outcomes and in targeting areas for improvement.
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Miller, Nathaniel, Kurt B. Angstman, Michelle van Ryn, Gregory M. Garrison, Kristin Fischer, and Sean Phelan. "The Association of Direct Observation of Medical Students With Patient-Centered Care for Obesity." Family Medicine 52, no. 4 (April 3, 2020): 271–77. http://dx.doi.org/10.22454/fammed.2020.314090.
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Background and Objectives: Teaching medical students patient-centered approaches to weight loss counseling occurs in myriad ways. We examined lectures and direct faculty observation to see which was associated with better patient-centered care in medical students, measured by both self-perception and independent observer evaluation. Methods: Third- and fourth-year students attending one medical school were surveyed regarding their education in (1) weight loss and health behavior counseling, (2) obesity stigma, and (3) whether they had experienced direct faculty observation of their weight loss counseling. Several weeks later, the students were observed during a standardized patient encounter for obesity and an obesity-relevant comorbidity. A postencounter survey assessed overall student satisfaction with the encounter and with the care they provided. Independent coders rated their patient-centered communication using a validated measure. Results: There was no consistent association between any dependent variable and student ratings of adequacy of instruction, nor with instructional content. Direct faculty observation was not associated with overall encounter satisfaction or their overall patient-centeredness. However, experiences with direct faculty observation were significantly and positively associated with students’ perceptions of patient engagement (b=0.1, P=.05), and with independent coders’ ratings of student friendliness (b=0.13, P=.01), responsiveness (b=0.113, P=.03), and lower student anxiety (b=-0.1, P=.01). Conclusions: Independent observation and self-report of instruction adequacy and content had no consistent association with care quality. However, direct faculty observation predicted improvement in both student self-reports and independent observer ratings of students’ interpersonal quality of care. Further work is needed to define optimal methods of imparting patient-centered care.
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Jeong, Seungwon, Yusuke Inoue, Yasuyuki Arai, Hideki Ohta, and Takao Suzuki. "What Should Be Considered When Evaluating the Quality of Home Care? A Survey of Expert Opinions on the Evaluation of the Quality of Home Care in Japan." International Journal of Environmental Research and Public Health 19, no. 4 (February 18, 2022): 2361. http://dx.doi.org/10.3390/ijerph19042361.
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Intending to obtain scientific evidence to use in developing indicators for evaluating the quality of home care, we surveyed doctors, nurses, and other home care professionals to determine the points they consider to be essential in evaluating home care. We investigated all 901 clinics registered to the National Association of Medical Institutions Supporting Home Care and a random sample of 600 Visiting Nurse Service stations registered to the National Association for Visiting Nurse Service in Japan. A total of 539 questionnaire responses were received (response rate: 35.9%). In this study, a factor analysis revealed four factors to be considered when evaluating the quality of home care: (1) patients’ and family members’ level of satisfaction, (2) home care process, (3) structure of home care, and (4) medical outcomes. The factor of the satisfaction of patients and family members identified in the present study was not considered in previous studies for evaluating the quality of care in Japan. Satisfaction is the point of difference in goals between hospital-based care and home care, and it requires different measurement indicators. Home care professionals expect to help relieve the physical and psychological burden felt by the patient and their family. Thus, on the evaluation indicators of quality of home care, their perspectives from the present study are valuable.
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Koley, Munmun, Subhranil Saha, Shubhamoy Ghosh, Rajarshi Mukherjee, Bapi Kundu, Ramkumar Mondal, Rajib Purkait, Jogendra Singh Arya, and Gurudev Choubey. "Evaluation of patient satisfaction in a Government Homeopathic Hospital in West Bengal, India." International Journal of High Dilution Research - ISSN 1982-6206 12, no. 43 (December 2, 2021): 52–61. http://dx.doi.org/10.51910/ijhdr.v12i43.629.
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Background and aims – Discovering the degree of patient satisfaction in a medical practice setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires.
Methodology – An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a 5-point Likert scale was used. The questionnaire generated 5 subscales – overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100mm were provided with each single question item and each subscale.
Results – The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s α were between 0.7-0.9 and test-retest reliability Cohen’s κ was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, P < 0.001; each subscale scores 0.8 < r < 0.9, P < 0.0001, and each question score 0.8 < r < 0.9, P < 0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (P < 0.05, df = 4, 95% CI) establishing discriminant validity.
Conclusions – Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages.
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Patterson, Emily S., Elizabeth B. N. Sanders, Carolyn M. Sommerich, Steven A. Lavender, Jing Li, and Kevin D. Evans. "Meeting Patient Expectations During Hospitalization: A Grounded Theoretical Analysis of Patient-Centered Room Elements." HERD: Health Environments Research & Design Journal 10, no. 5 (March 15, 2017): 95–110. http://dx.doi.org/10.1177/1937586717696700.
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Objectives: To identify patient needs and expectations that can be utilized to inform the design or renovation of medical–surgical patient rooms in a hospital. Background: There is an increased interest in supportive room design to increase patient satisfaction and improve the healing process. Methods: Patients’ and family caregivers’ reactions were elicited to intentional room elements embedded in a set of five full-scale simulated room prototypes. Small groups of patients and caregivers toured two of the five rooms and provided verbal and written evaluations of room features. A grounded theory approach was employed to generate a codebook, identify the frequency of codes, and to group codes and memos into emerging themes. Insights from emergent themes were compared with findings from written surveys on the importance of various room design elements completed at the beginning of each session. Results: A theoretical design framework was generated, showing patients expect a hospital room that provides them with the core components of comfort to support healing, facilitates a strong sense of connection to people and the outside world, enables quick and independent access to the patient’s things, and offers suitable levels of control to the patient throughout their hospital stay. Conclusions: The implications for assisting architects, healthcare planners, and interior space designers are described using this framework, as well as its potential for design guidance. In addition, the connection between patient-centered room elements and relevant survey questions in publicly reported patient satisfaction scores for hospitals is discussed.
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Ferderber, Megan L., Kaitlyn Vann, Athanasios Tzaras, Noam Hadadi, and Rebecca M. Gilbird. "Evaluation of a Musculoskeletal Ultrasound Workshop in the Family Medicine Clerkship." Family Medicine 54, no. 1 (January 4, 2022): 54–57. http://dx.doi.org/10.22454/fammed.2022.378370.
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Background and Objectives: The family medicine (FM) clerkship is appropriate for incorporating musculoskeletal ultrasound (MSKUS) education, as many outpatient visits in primary care occur for musculoskeletal (MSK) concerns. Despite rising popularity of point-of-care imaging in primary care, ultrasound (US) training in medical education is limited due to lack of resources and time. The purpose of this study is to evaluate the effects of an MSKUS workshop in the FM clerkship through student self-evaluations. Methods: Seventy-five medical students enrolled in the FM clerkship during the 2019-2020 academic year participated in hands-on MSKUS workshops staffed by faculty, residents, and a fellow. Workshops coincided with FM residency didactic teaching, allowing for protected time to host US training. Of workshop participants, 98.6% completed both pre- and postworkshop evaluations assessing confidence and acceptability of the workshop (rated on a 0-10 Likert scale, where higher scores represent more confidence or greater benefit, respectively). Results: Students noted increased confidence with use of ultrasound, recognition of MSK structures, and performance of landmark-guided procedures (preworkshop 2.6±1.6; postworkshop 7.4±1.1). Students endorsed high levels of agreement in the benefit of the workshop to their education (9.4±1.3) and MSK understanding (9.4±1.2). Conclusions: This study demonstrates the benefit of an MSKUS workshop as part of the FM clerkship and addresses previously identified challenges to providing US education. Results suggest a short-term benefit from an MSKUS workshop in confidence in MSKUS knowledge and satisfaction with the curriculum.
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Macedo, Giselle Pinto de Oliveira Sá, and Maria D’Innocenzo. "Family members’ satisfaction with the care flow in the Pediatric Emergency Department." Revista Brasileira de Enfermagem 72, no. 2 (April 2019): 435–41. http://dx.doi.org/10.1590/0034-7167-2018-0388.
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ABSTRACT Objective: To evaluate the satisfaction index of the pediatric patient’s caregiver (person responsible for the child) regarding the waiting time for the care flow in an emergency service. Method: A prospective, cross-sectional, quantitative study with 300 family members in the Pediatric Emergency Department of a general hospital. An instrument was used to analyze the service flow, waiting time and satisfaction evaluation. Descriptive statistical analysis was performed. Results: The satisfaction index of caregivers was statistically significant (p<0.05) the lower was the waiting time for patient screening, care by the doctors and for receiving the prescribed medication. Caregivers who took their children to the emergency department because of the disease (p -0.029) or because they did not find doctors in other hospitals (p-0.021) were satisfied with the waiting time for this service. Conclusion: The quality of care is evaluated as satisfactory by caregivers when children are treated quickly in the Pediatric Emergency Department.
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Lee-Miller, Cathy A., Renee Connor, Lynnette Acosta, and Cynthia Wetmore. "Initiation of family-centered bedside rounds at Phoenix Children's Hospital Center for Cancer and Blood Disorders." Journal of Clinical Oncology 36, no. 30_suppl (October 20, 2018): 170. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.170.
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170 Background: There has been a national trend towards a family/patient-centered care model in an effort to achieve many goals: earlier discharges, enhanced collaboration and patient safety, and improved satisfaction among medical care teams, patients and families. While most of the services at Phoenix Children’s Hospital (PCH) utilized a family-centered rounding model, the hematology/oncology service used table rounds. In December 2017, the Center for Cancer and Blood Disorders (CCBD) initiated family-centered rounds (FCR) on the inpatient service. Methods: FCR participants include patient, parent(s), bedside nurse, clinical supervisor, residents, fellow, attending, nurse practitioners, pharmacist, dietitian and child life specialist. One unique aspect of our FCR model is using scheduled rounds, whereby each patient is allotted a specific length of time and each family is given a time range within which to expect the team. Patients are scheduled every 10 minutes and if more time is needed, the attending/fellow return later for discussion. Staying on a schedule allows for improved nursing workflow and for consulting teams and interpreters to join rounds for specific patients. Outcome measures include patient, family and employee satisfaction. Results: Patient satisfaction is measured using NRC Real-time electronic survey. Scores have increased from a baseline of 70% (Oct/Nov 2017) to 87.5% (April 2018) after the initiation of FCR. From a qualitative standpoint, families have expressed gratitude for the new rounding model. Staff have expressed increased satisfaction at the efficiency and thoroughness of communication on rounds and the multidisciplinary team allows for real-time collaboration. Conclusions: FCR have led to increases in patient satisfaction both quantitatively and qualitatively. Ongoing initiatives include adding family-centered night rounds and a more extensive evaluation of FCR’s impact on employee satisfaction, patient safety, length of stay and lower overall costs. We are continuously evaluating the structure and efficacy of FCR to achieve the best possible care for our patients.
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Nasser, Laila, Alix Stosic, and David Price. "Evaluation of the McMaster Family Health Team: results and practical implications for quality improvement." BMJ Open Quality 7, no. 4 (November 2018): e000259. http://dx.doi.org/10.1136/bmjoq-2017-000259.
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PurposeTo evaluate the McMaster Family Health Team (MFHT) as part of a Continuous Quality Improvement initiative using a set of provincial performance metrics to demonstrate which measures of assessment are actually clinically meaningful in context and where system-level changes might be implemented to improve operational practice.MethodsMeasures were selected from the Primary Care Performance Measurement Framework based on data availability for the MFHT and provincial comparators. The measures explored in this paper are those that were deemed to have actionable properties. Data were extracted from billing reports, electronic medical records and information collated for the Association of Family Health Teams of Ontario Data to Decisions database. Metrics were then examined to demonstrate the importance of interpretation in clinical context.ConclusionsQuantitative assessment of performance based on standardised measures is a suitable starting point when evaluating a practice, however it is not appropriate as a stand-alone report card of practice performance. Rather, quantitative measures must be of clinical relevance and applicable to the patient populations of interest in order to create conversation and impact change. Thus, the focus of quality improvement should not be to improve numbers relating to efficiency, patient satisfaction and continuity of care, but rather to determine what drives those numbers and how changes might be made at a system or practice level that will optimise clinician buy-in.
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Juraskova, Ilona, R. Laidsaar-Powell, Rachael Keast, Penelope Schofield, Daniel SJ Costa, Judy Kay, Sandra Turner, et al. "eTRIO trial: study protocol of a randomised controlled trial of online education modules to facilitate effective family caregiver involvement in oncology." BMJ Open 11, no. 5 (May 2021): e043224. http://dx.doi.org/10.1136/bmjopen-2020-043224.
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ObjectiveInformal family caregivers play a crucial role in cancer care. Effective caregiver involvement in cancer care can improve both patient and caregiver outcomes. Despite this, interventions improving the caregiver involvement are sparse. This protocol describes a randomised controlled trial evaluating the combined effectiveness of novel online caregiver communication education modules for: (1) oncology clinicians (eTRIO) and (2) patients with cancer and caregivers (eTRIO-pc).Methods and analysisThirty medical/radiation/surgical oncology or haematology doctors and nurses will be randomly allocated to either intervention (eTRIO) or control (an Australian State Government Health website on caregivers) education conditions. Following completion of education, each clinician will recruit nine patient–caregiver pairs, who will be allocated to the same condition as their recruiting clinician. Eligibility includes any new adult patient diagnosed with any type/stage cancer attending consultations with a caregiver. Approximately 270 patient–caregiver pairs will be recruited. The primary outcome is caregiver self-efficacy in triadic (clinician–patient–caregiver) communication. Patient and clinician self-efficacy in triadic communication are secondary outcomes. Additional secondary outcomes for clinicians include preferences for caregiver involvement, perceived module usability/acceptability, analysis of module use, satisfaction with the module, knowledge of strategies and feedback interviews. Secondary outcomes for caregivers and patients include preferences for caregiver involvement, satisfaction with clinician communication, distress, quality of life, healthcare expenditure, perceived module usability/acceptability and analysis of module use. A subset of patients and caregivers will complete feedback interviews. Secondary outcomes for caregivers include preparedness for caregiving, patient–caregiver communication and caring experience. Assessments will be conducted at baseline, and 1 week, 12 weeks and 26 weeks post-intervention.Ethics and disseminationEthical approval has been received by the Sydney Local Health District Human Research Ethics Committee (REGIS project ID number: 2019/PID09787), with site-specific approval from each recruitment site. Protocol V.7 (dated 1 September 2020) is currently approved and reported in this manuscript. Findings will be disseminated via presentations and peer-reviewed publications. Engagement with clinicians, media, government, consumers and peak cancer groups will facilitate widespread dissemination and long-term availability of the educational modules.Trial registration numberACTRN12619001507178.
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Qureshi, Farhan Muhammad, Samira Faiz Bari, Hamid Jamal Siddiqui, Muhammad Tahir, Kanwal Khalid, and Saba Rizwan. "EVALUATION OF PATIENT SATISFACTION LEVEL WITH DIFFERENT OUTPATIENT DEPARTMENT SERVICES: A SITUATIONAL ANALYSIS IN A TERTIARY CARE HOSPITAL." Pakistan Armed Forces Medical Journal 72, no. 2 (May 2, 2022): 695–99. http://dx.doi.org/10.51253/pafmj.v72i2.5774.
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Objective: To evaluate satisfaction of outpatients with respect to administrative services and the level of satisfaction towards the various facilities available in an outpatient department of a tertiary care hospital.
Study Design: Hospital based transverse situational analysis.
Place and Duration of Study: Combined Military Hospital, Malir Cantt, from Nov 2018 to Dec 2019.
Methodology: Data was collected from 756 participants, using an “Outpatient Feedback Form” to evaluate the satisfaction level of patients. Nonprobability, convenient sampling technique was used to select study participants. Data was analyzed in Statistical Package of Social Sciences, version 22.
Result: The patient satisfaction was present in 388 (51%) followed by 235 (31%) participants graded the Outpatient department facilities (OPD) as excellent and good respectively. However, only 16 (3%) were disgruntled with the present OPD administrative and medical service of the hospital.
Conclusion: Overall the study showed a good satisfaction level of patients with OPD services received from the hospital. Hospital administration has managed to deliver excellent quality services towards betterment in every discipline and created an example for other hospitals to become an effective part of the healthcare delivery system.
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Liu, Alison, Arlen Suarez, Jamie Lehnen, Dalia Mitchell, Garrett Ray, Heather Lanier, Chandana Golla, et al. "Training Students as Navigators for Patients Experiencing Homelessness." Family Medicine 55, no. 1 (January 6, 2023): 45–50. http://dx.doi.org/10.22454/fammed.55.143409.
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Background and Objectives: Despite the significant effects of homelessness on health, medical and health professions students rarely receive formal education in caring for individuals experiencing homelessness. We describe the implementation and evaluation of a novel student-run Patient Navigator Program (PNP) and its prerequisite elective that trains students in patient navigation principles specific to homelessness in the local community. Methods: We analyzed pre- and postsurvey matched responses from students immediately before and after course completion. The survey utilizes the externally-validated instruments Health Professional Attitudes Toward the Homeless Inventory (HPATHI) and the Student-Run Free Clinic Project (SRFCP) survey. We examined differences using paired t tests and Wilcoxon signed-rank tests. Students also completed separate end-of-curriculum evaluation forms assessing satisfaction with the course. Results: After completing the elective, students (n=45) demonstrated improvement in self-assessed attitude towards individuals experiencing homelessness (P=.03), specifically an increase in reported social advocacy (P<.001); and an increase in self-perceived knowledge about (P<.001), efficacy in working with (P=.01), and skills in caring for (P<.001) underserved groups. The elective also received high student satisfaction ratings. Conclusions: Formal education in patient navigation and caring for individuals experiencing homelessness improves self-assessed preparedness of future health care providers in serving homeless and underserved populations.
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Min, Rui, Lu Li, Chunyan Zi, Pengqian Fang, Biyan Wang, and Changmin Tang. "Evaluation of patient experience in county-level public hospitals in China: a multicentred, cross-sectional study." BMJ Open 9, no. 11 (November 2019): e034225. http://dx.doi.org/10.1136/bmjopen-2019-034225.
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ObjectivesPatient experience is being widely considered in the evaluation of healthcare service quality, which is a key target for public hospitals under China’s New Healthcare Reform. This study aimed to illustrate patients’ experiences in county-level public hospitals, and identify aspects that need to be improved.Setting and participantsBetween 2016 and 2018, a cross-sectional study with 500 outpatients and 800 inpatients was conducted in 10 county-level public hospitals from Shandong Province, Hubei Province and Chongqing Municipality.MethodA three-part questionnaire was used to evaluate patients’ experiences during their visits to hospitals. It comprised a questionnaire for basic information, the Picker Patient Experience (PPE-15) Questionnaire and the overall evaluation (a 3-point Likert scale to express patients’ satisfaction and patient loyalty). Patients’ experiences were classified according to six dimensions (information transmission and patient education, respect for patient preference, emotional support, physical comfort, involvement of family or friends and continuity of medical service). Both univariate and multivariate analyses were performed to evaluate patient experience.ResultsA total of 1241 valid questionnaires were analysed. The mean PPE-15 score was 41.33 (range, 23–56). The better the patient experience and satisfaction, the higher the patient loyalty (p<0.001). Except for hospital disparities, patients’ age and occupation status had a significant impact on patient experience (p<0.05). Of the six dimensions, the physical comfort score was the highest, while the respect for patient preference score was the lowest. Additionally, a strong correlation was found between the respect for patient preference dimension and patients’ overall satisfaction with their treatment experience.ConclusionsHospital managers and staff members should pay close attention to the preferences of patients and their families to improve patient experience.
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Goldman, Roberta E., Joanna Brown, Patricia Stebbins, Donna R. Parker, Victoria Adewale, Renee Shield, Mary B. Roberts, Charles B. Eaton, and Jeffrey M. Borkan. "What matters in patient-centered medical home transformation: Whole system evaluation outcomes of the Brown Primary Care Transformation Initiative." SAGE Open Medicine 6 (January 1, 2018): 205031211878193. http://dx.doi.org/10.1177/2050312118781936.
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Objectives: Patient-centered medical home transformation initiatives for enhancing team-based, patient-centered primary care are widespread in the United States. However, there remain large gaps in our understanding of these efforts. This article reports findings from a contextual, whole system evaluation study of a transformation intervention at eight primary care teaching practice sites in Rhode Island. It provides a picture of system changes from the perspective of providers, staff, and patients in these practices. Methods: Quantitative/qualitative evaluation methods include patient, provider, and staff surveys and qualitative interviews; practice observations; and focus groups with the intervention facilitation team. Results: Patient satisfaction in the practices was high. Patients could describe observable elements of patient-centered medical home functioning, but they lacked explicit awareness of the patient-centered medical home model, and their activation decreased over time. Providers’ and staff’s emotional exhaustion and depersonalization increased slightly over the course of the intervention from baseline to follow-up, and personal accomplishment decreased slightly. Providers and staff expressed appreciation for the patient-centered medical home as an ideal model, variously implemented some important patient-centered medical home components, increased their understanding of patient-centered medical home as more than specific isolated parts, and recognized their evolving work roles in the medical home. However, frustration with implementation barriers and the added work burden they associated with patient-centered medical home persisted. Conclusion: Patient-centered medical home transformation is disruptive to practices, requiring enduring commitment of leadership and personnel at every level, yet the model continues to hold out promise for improved delivery of patient-centered primary care.
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Taidouch, Amal, Marie-José Crouwers, and Mark Spigt. "Complex wound care by a nurse practitioner in primary care: a quality improvement evaluation on healing rates, costs and patient satisfaction." British Journal of Community Nursing 26, Sup12 (December 1, 2021): S14—S21. http://dx.doi.org/10.12968/bjcn.2021.26.sup12.s14.
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Complex wounds are a major burden for healthcare professionals. Patients with complex wounds are often referred to hospitals or wound expertise centres. Complex wound care could be organised in primary care, but very little published evidence for this is available. In this study, members of a primary healthcare organisation were interviewed to ascertain how the wound care was organised. Patient characteristics and data regarding wound care, healing rates and costs were collected from medical records. Patients filled in a questionnaire concerning accessibility, communication, medical counselling and the overall experience of their treatment. This study followed 25 patients with a total of 42 wounds. Some 82% of the wounds were healed within a mean treatment duration of 9.7 weeks. Mean treatment costs were calculated at €155 (£130) for healed patients. Patients were generally very satisfied with their treatment, illustrated by an overall 8.7 out of 10 scoring on an amended survey based on the Consumer Quality Index. Treating complex wounds in primary care seemed adequate, with high patient satisfaction and tolerable costs.
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Li, Kevin L., Christina H. Fang, Denisa Ferastraoaru, Nadeem A. Akbar, Elina Jerschow, and Waleed M. Abuzeid. "Patient Satisfaction and Efficiency Benefits of a Novel Multidisciplinary Rhinology and Allergy Clinic." Annals of Otology, Rhinology & Laryngology 129, no. 7 (February 14, 2020): 699–706. http://dx.doi.org/10.1177/0003489420905859.
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Background: Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the sinonasal mucosa and with strong associations to other immune-mediated comorbidities. Patients often require referral to both an otolaryngologist and an allergist/immunologist. This study is the first in the literature to describe a multidisciplinary clinic that offers patient care by subspecialists in rhinology and in allergy/immunology. Methods: One hundred twenty-nine patients were seen in the Comprehensive Sinus and Allergy Clinic (CSAC) between January 2016 and June 2017 and 43 selected patients were seen in both the standalone allergy and rhinology clinics over the same time period. Patient satisfaction was retrospectively assessed using a modified Press-Ganey satisfaction survey. Time to evaluation and time to follow up appointment were compared between the CSAC and both the standalone rhinology and allergy/immunology clinics. Results: Patients seen in the CSAC reported high satisfaction with the amount of time spent with the physicians (98.3%), quality of medical care (9.3 ± 1.0), and most importantly, the convenience of seeing two physicians in one day (9.5 ± 1.2). Time from referral placement to clinic evaluation ( P ≤ .02) and time to follow up appointment ( P ≤ .002) was significantly shorter for the CSAC than for the standalone Rhinology or Allergy clinics. Conclusion: Patients reported high satisfaction with the medical care provided and were also seen much faster in our multidisciplinary clinic as compared to standalone rhinology or allergy/immunology clinics. Overall, a multidisciplinary approach may be beneficial to patients presenting to tertiary referral centers with CRS and atopic conditions.
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Rabow, Michael W., Marilyn McGowan, Rebecca Small, Redwing Keyssar, and Hope S. Rugo. "Advance Care Planning in Community: An Evaluation of a Pilot 2-Session, Nurse-Led Workshop." American Journal of Hospice and Palliative Medicine® 36, no. 2 (August 28, 2018): 143–46. http://dx.doi.org/10.1177/1049909118797612.
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Background: Engaging patients in advance care planning (ACP) is challenging but crucial to improving the quality of end-of-life care. Group visits and multiple patient–clinician interactions may promote advance directive (AD) completion. Objective: Facilitate ACP discussions with patients and caregivers and the creation of notarized AD’s at a comprehensive cancer center. Design: Two-session, nurse-led ACP workshops for patients and their family caregivers. Setting/Participants: The workshop was offered to patients with cancer at a comprehensive cancer center and their family caregivers. Measurements: Validated 4-question ACP engagement survey, creation of a notarized AD by end of the workshop, and semistructured interviews. Results: Thirty-five patients participated in 10 workshops held March 2017 to February 2018. Median age was 52. Of 35, 24 (68.5%) patients completed pre- and postworkshop evaluation surveys. Mean preworkshop ACP readiness was 3.64 of 5; postworkshop readiness increased to 4.26 of 5 ( P = .001). Of 26, 17 (65.4%) of the patients who attended both workshop sessions had a new notarized AD scanned into the electronic medical record at the completion of the workshop series. Three family caregivers completed and had their own ADs notarized. Patient and family member response was overwhelmingly positive, with participants citing opportunities for group discussion and inclusion of family caregivers as important. Conclusions: The ACP workshop was well received by participants and increased ACP readiness, discussion, and completion. Attendance at the workshop was low and barriers to attending workshops must be explored.
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Ramchandran, Kavitha, Derek Galligan, Erika L. Tribett, Melissa Valentine, Meryl Selig, Douglas W. Blayney, and Steven M. Asch. "Building a patient-centered model: Palliative medicine and cancer care." Journal of Clinical Oncology 32, no. 31_suppl (November 1, 2014): 75. http://dx.doi.org/10.1200/jco.2014.32.31_suppl.75.
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75 Background: Palliative medicine (PM) improves outcomes for cancer patients. Still, there is limited evidence around components of an efficient, patient-centered model for integrating PM into oncologic care. While PM is committed to aligning with a patient's goals of care, very few programs incorporate their input into design or evaluation. The aim of this project is to combine best practice in PM with perspectives of patients, families and providers to develop an empathic PM service. We hypothesize that collaboration with stakeholders and user experience experts will result in a feasible, impactful and translatable model of care that aligns with patient and family goals. Methods: We are conducting semi-structured interviews with 30 patients, family members and 30 oncologists. Patient interviews assess needs and coping mechanisms. Provider interviews assess perceptions and experiences around PM. We will conduct observations to understand how patients and providers interact and how current protocols are operationalized. Data will be coded and analyzed for major themes. An expert panel of patients, family members, health care providers and design experts will assimilate the data and make recommendations for the prototype care model design. The model will be piloted and evaluated in fall 2014. Outcome metrics include patient satisfaction, symptom management, utilization, mortality, and others identified during development. Data from the pilot will inform intervention improvements in preparation for a large-scale, 12- month pilot in an outpatient PM clinic. Results: Preliminary work includes the development of a novel patient and family interview protocol that integrates cutting-edge research on PM with best practices for conducting empathic interviews. We will present initial results from these interviews at the symposium, as well as our iterative design process. Conclusions: This project integrates data on patient and family experience with known best practices to develop a patient-centered model for palliative cancer care. The development process and potential outcomes hold significant promise for the design of patient and provider-centered care models, especially those related to chronic and serious illnesses.
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Sudario, Gabriel, Warren Wiechmann, Julie Youm, and Khanh-Van Le-Bucklin. "An Effective COVID-19 Medical Student Elective." Western Journal of Emergency Medicine 23, no. 1 (January 3, 2022): 40–46. http://dx.doi.org/10.5811/westjem.2021.11.53656.
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Background: The COVID-19 pandemic has revealed the importance of teaching medical students pandemic preparedness and COVID-19 related clinical knowledge. To fill the gap of COVID-19 instruction backed by evaluation data, we present a comprehensive COVID-19 pilot curriculum with multiple levels of evaluation data. Methods: In the spring of 2020, the University of California, Irvine (UCI) School of Medicine piloted a two-week, primarily asynchronous COVID-19 elective course for medical students. The goal of the course is to provide a foundation in clinical care for COVID-19 while introducing students to emerging issues of a modern pandemic. Objectives align with institutional objectives, and instruction is delivered in thematic modules. Our curriculum utilizes numerous instructional strategies effective in distance learning including independent learning modules (ILM), reading, video lectures, discussion board debates, simulation and evidence-based argument writing. We designed a three-level, blended evaluation plan grounded in the Kirkpatrick and Kirkpatrick evaluation model that assessed student satisfaction, relevance, confidence, knowledge and behavior. Results: Our end of course survey revealed that students had high levels of satisfaction with the curriculum, and felt the course was relevant to their clinical education. Various assessment tools showed excellent levels of knowledge attainment. All respondents rated themselves as highly confident with the use of personal protective equipment, though fewer were confident with ventilator management. Conclusion: Overall our pilot showed that we were able to deliver relevant, satisfying COVID-19 instruction while allowing students to demonstrate knowledge and desired behaviors in COVID-19 patient care.
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Kent, Elaine. "Care of the High Dependency Patient." British Journal of Anaesthetic and Recovery Nursing 3, no. 2 (May 2002): 6–12. http://dx.doi.org/10.1017/s1742645600000863.
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ABSTRACTRecent government changes to Critical Care in the Health Service have resulted in an increase in the numbers of critical care patients being nursed in Post Anaesthetic Care Units (PACU). Many recovery nurses have had to increase their knowledge and skills accordingly. This article will analyse the high dependency nursing care given to a patient in the PACU necessitated by the haemodynamic compromise of the patient's cardiovascular system following surgery. The need for admission to a high dependency bed will be discussed along with the assessment of shock, tissue perfusion, fluid replacement, and any pharmacological intervention. Psychological, social and ethical issues relating to the patient and family will also be identified. Concentrating on the first 24 hours post-operatively, a careful discussion and analysis of the clinical management given will be made, with reference to the clinical and physiological measurements. After an evaluation and reflection of the medical and nursing care given to the patient, this article will conclude with a brief reiteration of the key issues.
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Zoëga, S., S. Gunnarsdóttir, and D. B. Gordon. "Quality pain management in the hospital setting—A concept evaluation." Scandinavian Journal of Pain 5, no. 3 (July 1, 2014): 212–13. http://dx.doi.org/10.1016/j.sjpain.2014.05.026.
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AbstractAimsTo gain an understanding of the concept of quality pain management (QPM) in the hospital setting, and to define the concept.MethodsA concept evaluation based on the method by Morse and colleagues was done. The literature was searched according to selected key words in five databases. Over 5000 articles were found but data were limited to 37 articles directly related to both quality and pain management in adults in the hospital setting, and published in peer-reviewed journals or by an official organization. Data were extracted from these articles and then synthesized according to definition, characteristics, boundaries, preconditions, and outcomes of QPM.ResultsQPM is a multidimensional concept that is commonly used but remains vaguely defined. A common understanding of the concept is nonetheless evident in the literature. QPM refers to the structure, process, and outcomes of care rooted in equitable, effective, patient-centered, safe, and efficient services. The structure encompasses competent staff and staff accountability, organizationally supported evidence-based policies, and access to interprofessional and specialized care. The process consists of screening, assessing and reassessing pain, individualized and evidence-based treatment, communication of pain and pain treatment, and patient and family education. Finally, outcomes include increase in patient satisfaction, reduced pain severity, less functional interferences, and decrease in both prevalence and severity of adverse effects from pain or its treatment.ConclusionsQPM is a complex concept that despite common use lacks a clear definition. The relationship between structure, process, and outcome needs to be studied in order to improve QPM. The conceptual model put forward in this study needs to be further refined and tested.
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Caswell, Angela, and Joyce Kenkre. "Primary Healthcare in Saudi Arabia: An Evaluation of Emergent Health Trends." Global Journal on Quality and Safety in Healthcare 4, no. 3 (August 1, 2021): 96–104. http://dx.doi.org/10.36401/jqsh-20-33.
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ABSTRACT Introduction The Kingdom of Saudi Arabia (KSA) is experiencing an increasing demand for healthcare due to a growing population and unhealthy changes in lifestyle, fostering the need for critical examination of the current status of primary healthcare in the KSA with analysis of health-related trends among its growing population. Methods A review of the literature was therefore undertaken, followed by a survey of primary healthcare centers at three facilities in Riyadh, to assess the current activities, understand challenges, compare existing practices with international best practices, and asses the level of patient satisfaction. The level of satisfaction with primary care services was examined by using observational surveys and retrospective reviews from the previous 20 years. Results The more rural areas with populations with lower education and income ranked factors such as cleanliness, competence of staff, and environment the highest (82–95%), whereas urban areas with populations with higher education and income rated their level of satisfaction lower (74–82%). The influence of population diversity and the country's unique cultural sensitivities on the awareness and uptake of cancer surveillance services available in the community was examined. The incidence of diabetes, asthma, obesity, along with breast and cervical cancer trends, has illustrated the importance of health education and disease prevention. Conclusion An investment in resources for primary healthcare staff and medical facilities is strongly recommended to support primary care providers in becoming the accepted and preferred community frontline for healthcare needs' assessment and care delivery. With its nursing staff comprised predominantly of expatriates, the emphasis needs to be on recruitment and training of a Saudi national workforce in line with succession planning strategy toward a sustainable Saudi workforce.
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Xiaoli, Shi, Hao Weiyan, and Dandan Li. "Construction of Neonatal PICC Nursing Quality Evaluation System." Applied Bionics and Biomechanics 2022 (January 31, 2022): 1–7. http://dx.doi.org/10.1155/2022/8290526.
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Objective. In order to improve the quality of neonatal care, this study analyzed the construction of PICC and scientifically evaluated the quality of PICC. Methods. A total of 100 neonatal patients admitted to the Pediatric Medical Intensive Care Unit of the People’s Hospital in Laizhou City of Shandong Province between January 2015 and December 2018 were selected for nursing intervention. They were randomly divided into 50 cases in the observation group and 50 cases in the reference group. In the observation group, 50 were neonatal patients who received and completed PICC catheterization care, and in the reference group, 50 were neonatal patients with traditional conventional puncture care, PICC nursing quality evaluation index system, and nursing quality standard were applied, and questionnaire survey and patient satisfaction survey were conducted in the treatment. The two groups were compared for the success rate of one puncture, catheter detachment, treatment of local bleeding, incidence of nursing risk during other treatment, and other related nursing quality results. Results. The incidence of related medical and nursing risks in neonatal patients such as one-time puncture success rate, catheter detachment during treatment, and local bleeding was significantly lower than those in neonatal patients receiving conventional nursing methods. The incidence of nursing risk events during puncture was effectively reduced. It is shown in the comparison of adverse events in neonatal pediatric nursing in the fourth quarter of 2017 and 2018. In 2018, the proportion of adverse events in neonatal nursing is decreasing, the quality index of nursing is improving, and the satisfaction of patients’ families and relevant personnel in treatment is increasing. Conclusion. The construction and application of neonatal PICC nursing quality evaluation system can improve the success rate of one-time puncture, reduce the pain of newborns, improve the nursing quality evaluation system, scientifically and reasonably provide effective methods and basis for hospital PICC nursing, and play an important role in the development of pediatric nursing.
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Peralta, Luis Mauricio Pinet. "The Prehospital Emergency Care System in Mexico City: A System's Performance Evaluation." Prehospital and Disaster Medicine 21, no. 2 (April 2006): 104–11. http://dx.doi.org/10.1017/s1049023x00003447.
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AbstractIntroduction:Mexico City has one of the highest mortality rates in Mexico, with non-intentional injuries as a leading cause of death among persons 1–44 years of age. Emergency medical services (EMS) in Mexico can achieve high levels of efficiency by offering high quality medical care at a low cost through adequate system design.Objective:The objective of this study was to determine whether the prehospital EMS system in Mexico City meets the criteria standards established by the American Ambulance Association Guide for Contracting Emergency Medical Services (AAA Guide) for highly efficient EMS systems.Methods:This retrospective, descriptive study, evaluated the structure of Mexico City's EMS system and analyzed EMS response times, clinical capacity, economic efficiency, and customer satisfaction. These results were compared with the AAA guide, according to the social, economic, and political context in Mexico. This paper describes the healthcare system structure in Mexico, followed by a description of the basic structure of EMS in Mexico City, and of each tenet described in the AAA guide. The paper includes data obtained from official documents and databases of government agencies, and operative and administrative data from public and private EMS providers.Results:The quality of the data for response times (RT) were insufficient and widely varied among providers, with a minimum RT of 6.79 minutes (min) and a maximum RT of 61 min. Providers did not define RT clearly, and measured it with averages, which can hide potentially poor performance practices. Training institutions are not required to follow a standardized curriculum. Certifications are the responsibility of the individual training centers and have no government regulation. There was no evidence of active medical control involvement in direct patient care, and providers did not report that quality assurance programs were in place. There also are limited career advancement opportunities for EMS personnel. Small economies of scale may not allow providers to be economically efficient, unit hours are difficult to calculate, and few economic data are available.There is no evidence of customer satisfaction data.Conclusions:Emergency medical services in Mexico City did not meet the AAA requirements for high-quality, prehospital, emergency care. Coordination among EMS providers is difficult to achieve, due, in part, to the lack of: (1) an authoritative structure; (2) sound system design; and (3) appropriate legislation. The government, EMS providers, stakeholders, and community members should work together to build a high quality EMS system at the lowest possible cost.
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Adelman, Megan, Shauna Assadzandi, and Jun Xiang. "Improving Bisphosphonate Use and Evaluation in a Rural Family Medicine Practice." Senior Care Pharmacist 36, no. 3 (March 1, 2021): 152–58. http://dx.doi.org/10.4140/tcp.n.2021.152.
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Objective To evaluate the prevalence of bisphos-phonate use without a drug holiday and to assess the success of an interdisciplinary approach to manage and discontinue bisphosphonate therapy. Setting The study was completed at one rural family medicine center. Practice Description The practice employs two fulltime pharmacists. Clinical pharmacists' responsibilities include chronic care management as well as collaboration with the team during interdisciplinary clinics. Clinical pharmacists frequently collaborate with other professionals on medication evaluations and quality improvement projects. Practice Innovation The pharmacy team and medical resident collaborated to determine appropriateness of bisphosphonate use. This was a two-phase evaluation. In the first phase, therapies were evaluated based on duration and consistency with guideline recommendations based on a retrospective chart review. In the second phase, the pharmacy and medicine team determined if therapy warranted further continuation or if a drug holiday was needed. The team reached out to providers proactively and provided patient and provider education on discontinuing therapy. Main Outcome Measurements Patient demographics, bisphosphonate regimen and duration of prescription, frequency of drug holidays, and success rate of therapy discontinuation. Results Bisphosphonates were prescribed for an average of 4.2 years with 56 patients prescribed therapy for >5 years. Twenty-one of the 56 patients had a history of a drug holiday, and 13 of the 35 remaining patients had therapy discontinued or a drug holiday was initiated based on the team's recommendation. Patients were more likely to be prescribed therapy for >5 years if they were older and had more provider appointments.
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Brown, Janie, Helen Myers, Derek Eng, Lucy Kilshaw, Jillian Abraham, Grace Buchanan, Liz Eggimann, and Michelle Kelly. "Evaluation of the ‘Talking Together’ simulation communication training for ‘goals of patient care’ conversations: a mixed-methods study in five metropolitan public hospitals in Western Australia." BMJ Open 12, no. 8 (August 2022): e060226. http://dx.doi.org/10.1136/bmjopen-2021-060226.
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IntroductionIn partnership with Cancer Council Western Australia (WA), the East Metropolitan Health Service in Perth, WA has developed a clinical simulation training programme ‘Talking Together’ using role play scenarios with trained actors as patients/carers. The aim of the training is to improve clinicians’ communication skills when having challenging conversations with patients, or their carers, in relation to goals of care in the event of clinical deterioration.Methods and analysisA multisite, longitudinal mixed-methods study will be conducted to evaluate the impact of the communication skills training programme on patient, family/carer and clinician outcomes. Methods include online surveys and interviews. The study will assess outcomes in three areas: evaluation of the ‘Talking Together’ workshops and their effect on satisfaction, confidence and integration of best practice communication skills; quality of goals of patient care conversations from the point of view of clinicians, carers and family/carers; and investigation of the nursing/allied role in goals of patient care.Ethics and disseminationThis study has received ethical approval from the Royal Perth Hospital, St John of God and Curtin University Human Research Ethics Committees. The outputs from this project will be a series of research papers and conference presentations.
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Särchen, Franziska, Susanne Springborn, Achim Mortsiefer, and Jan Ehlers. "Patient Care via Video Consultations: Piloting and S.W.O.T. Analysis of a Family Medicine Digitally Synchronous Seminar for Medical Students." International Journal of Environmental Research and Public Health 19, no. 15 (July 22, 2022): 8922. http://dx.doi.org/10.3390/ijerph19158922.
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Background: There is a need to familiarize medical students with the specifics of video consultations. This paper presents the concept and tests of a digitally synchronous distance seminar in which medical students practice video consultations as an aid to a family physician’s activity in a patient-oriented manner. The aim of the evaluation was to analyze the strengths, weaknesses, opportunities, and threats (S.W.O.T.) of the teaching concept. Methods: A total of 12 students carried out video consultations independently and under medical supervision. The seminar included two elements: (A) All students and teachers were video consulted in a family practice; (B) A small group performed a video consultation in a patient´s home environment. The students’ evaluation was conducted with two questionnaires (pre/post), which were analyzed with descriptive statistics and qualitative content analysis. The S.W.O.T. analysis was elaborated by the author team based on the results of the questionnaires and the interviews with the teachers. Results: Students learned the limits and possibilities of teleconsultations and deepened their family medical knowledge. Strengths: Among others; increase interest in video consultations, patient contact, focused work. Weaknesses: Among others; technical difficulties and the time it requires. Opportunities: Among others; involve students with multiple workloads in patient teaching. Risks: Among others; no integration into the curriculum yet, few personnel resources. Conclusions: The learning model familiarizes medical students with competences in family medical patient care using video communication. The results of S.W.O.T. analyses can be weighted differently. Project groups can decide individually if they want to integrate the learning concept into their curriculum and which further improvements are necessary.
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Hasley, Peggy B., Deborah Simak, Elan Cohen, and Raquel Buranosky. "Training Residents to Work in a Patient-Centered Medical Home: What Are the Outcomes?" Journal of Graduate Medical Education 8, no. 2 (May 1, 2016): 226–31. http://dx.doi.org/10.4300/jgme-d-15-00281.1.
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ABSTRACT The patient-centered medical home (PCMH) provides a setting to enhance resident training in systems-based practice. Few studies have addressed the impact of PCMHs on resident knowledge and confidence.Background The goal of this study was to evaluate resident knowledge, confidence, behavior, and patient outcomes in a PCMH.Objective Our curriculum emphasized patient panel report card interpretation, a telephone medicine curriculum, and interdisciplinary team-based care of chronic medical conditions. We measured resident satisfaction, knowledge, and confidence. Patient outcomes included hemoglobin A1c (HbA1c) and blood pressures. Prescores and postscores were compared using paired t tests for continuous measures and McNemar's test for binary measures.Methods A total of 154 residents were eligible for the curriculum. All residents participated in the curriculum, though not all residents completed the evaluation. Completion rates for paired pre-post knowledge and confidence surveys were 38% and 37%, respectively. Nearly 80% (69 of 87) of residents indicated that the curriculum was above average or outstanding. Our evaluation revealed very small immediate improvements in knowledge and confidence. No significant improvement in patients' HbA1cs or blood pressures occurred after the curriculum.Results Explicit training to work in a PCMH was feasible and resulted in high levels of resident satisfaction and immediate small improvements in knowledge and confidence.Conclusions
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Tubic, Teodora, Dunja Mihajlovic, Jelica Petrovic, Sanja Vickovic, Jelena Nikolic, Vladimir Dolinaj, and Nada Andjelic. "The influence of anesthesiologist postoperative visit on patient satisfaction with anesthesia for reconstruction of the anterior cruciate knee ligament." Vojnosanitetski pregled, no. 00 (2021): 74. http://dx.doi.org/10.2298/vsp210422074t.
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Background / Aim. Patient satisfaction, when it comes to anesthesia, is more difficult to assess than in any other medical specialty. The aim of this study was to construct a tool for assessing patients' satisfaction with anesthesia, and then examine the effects of post-operative care provided by anesthesiologists on patients? satisfaction. Methods: The study included patients undergoing general anesthesia, who were considered ASA 1 and ASA 2 class. Patients were divided into three groups: Group 1 included 74 patients who had postoperative visit performed by an attending anesthesiologist; Group 2 included 70 patients who had postoperative visit performed by a nurse anesthetist after surgery; and Group 3 included 74 patients who did not have postoperative visit during post-operative care by an anesthesiologist nor a nurse anesthetist. The tools used in the research were Anesthesia patient satisfaction questionnaire specially designed for this study and Post Anesthetic Recovery Scoring System (PAS). ANOVA and Pearson?s correlation coefficient were used for estimating the statistical significance of the obtained results between the groups. Results: Association between an objective assessment of the post-operative status of patients on day zero and satisfaction with the anesthesiologist's patient management shows statistical significance (p<0.05). Patients who had a post-operative visit by an anesthesiologists tolerated better preoperative and postoperative physical symptoms. Patients visited by an anesthesiologist were most satisfied with post-operative care (p<0.05). Conclusion: Use of a highly reliable questionnaire for evaluation of patient?s satisfaction with anesthesia could improve the post-operative condition of patients and enable faster recovery during post-operative period.
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Sattoe, Jane N. T., Mariëlle A. C. Peeters, Jannie Haitsma, AnneLoes van Staa, Victorien M. Wolters, and Johanna C. Escher. "Value of an outpatient transition clinic for young people with inflammatory bowel disease: a mixed-methods evaluation." BMJ Open 10, no. 1 (January 2020): e033535. http://dx.doi.org/10.1136/bmjopen-2019-033535.
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ObjectiveDeveloping and evaluating effective transition interventions for young people (16–25 years) with inflammatory bowel disease (IBD) is a high priority. While transition clinics (TCs) have been recommended, little is known about their operating structures and outcomes. This study aimed to gain insight into the value of a TC compared with direct handover care.DesignControlled mixed-methods evaluation of process outcomes, clinical outcomes and patient-reported outcomes.SettingTwo outpatient IBD clinics in the Netherlands.ParticipantsData collection included: semistructured interviews with professionals (n=8), observations during consultations with young people (5×4 hours), medical chart reviews of patients transferred 2 to 4 years prior to data collection (n=56 in TC group; n=54 in control group) and patient questionnaires (n=14 in TC group; n=19 in control group).OutcomesData were collected on service structures and daily routines of the TC, experienced barriers, facilitators and benefits, healthcare use, clinical outcomes, self-management outcomes and experiences and satisfaction of young people with IBD.ResultsAt the TC, multidisciplinary team meetings and alignment of care between paediatric and adult care providers were standard practice. Non-medical topics received more attention during consultations with young people at the TC. Barriers experienced by professionals were time restrictions, planning difficulties, limited involvement of adult care providers and insufficient financial coverage. Facilitators experienced were high professional motivation and a high case load. Over the year before transfer, young people at the TC had more planned consultations (p=0.015, Cohen’s d=0.47). They showed a positive trend in better transfer experiences and more satisfaction. Those in direct handover care more often experienced a relapse before transfer (p=0.003) and had more missed consultations (p=0.034, Cohen’s d=−0.43) after transfer.ConclusionA TC offer opportunities to improve transitional care, but organisational and financial barriers need to be addressed before guidelines and consensus statements in healthcare policy and daily practice can be effectively implemented.
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Lee-Lewandrowski, Elizabeth, Daniel Corboy, Kent Lewandrowski, Julia Sinclair, Steven McDermot, and Theodore I. Benzer. "Implementation of a Point-of-Care Satellite Laboratory in the Emergency Department of an Academic Medical Center." Archives of Pathology & Laboratory Medicine 127, no. 4 (April 1, 2003): 456–60. http://dx.doi.org/10.5858/2003-127-0456-ioapsl.
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Abstract Context.—Emergency department (ED) overcrowding has reached crisis proportions in the United States. Many hospitals are seeking to identify process reengineering efforts to reduce crowding and ED patient length of stay (LOS). Objectives.—To investigate the impact of a point-of-care testing (POCT) satellite laboratory in the ED of a large academic medical center. Setting.—The ED of the Massachusetts General Hospital, Boston, Mass. Design and Outcome Measures.—Evaluation of physician satisfaction, turnaround time (TAT), and ED LOS before and after implementation of a POCT laboratory. ED LOS was measured by patient chart audits. TAT was assessed by manual and computer audits. Clinician satisfaction surveys measured satisfaction with test TAT and test accuracy. Results.—Blood glucose, urine human chorionic gonadotropin, urine dipstick, creatine kinase–MB, and troponin tests were performed in the ED POCT laboratory. Test TAT declined an average of 87% after the institution of POCT. The ED LOS decreased for patients who received pregnancy testing, urine dipstick, and cardiac markers. Although these differences were not significant for individual tests, when the tests were combined, the decreased LOS was, on average, 41.3 minutes (P = .006). Clinician satisfaction surveys documented equivalent satisfaction with test accuracy between the central laboratory and the POCT laboratory. These surveys also documented dissatisfaction with central laboratory TAT and increased satisfaction with TAT of the POCT program (P < .001). Conclusions.—The POCT satellite laboratory decreased test TAT and decreased ED LOS. There was excellent satisfaction with test accuracy and TAT.