Healthcare-The Journal of Delivery Science and Innovation最新文献

{"title":"Sustaining effective research/operational collaborations: Lessons learned from a National Partnered Evaluation Initiative","authors":"Nicholas W. Bowersox ,&nbsp;Veronica Williams ,&nbsp;Linda Kawentel ,&nbsp;Amy M. Kilbourne","doi":"10.1016/j.hjdsi.2021.100588","DOIUrl":"10.1016/j.hjdsi.2021.100588","url":null,"abstract":"<div><h3>Introduction</h3><p>Effective research-operational partnerships require that researchers ask questions targeting top clinical operational priorities. However, disconnects exist between healthcare researchers and operational leadership that result in significant delays between discovery and implementation of breakthroughs in healthcare.</p></div><div><h3>Objective</h3><p>Using the Veterans Health Administration Quality Enhancement Research Initiative (QUERI) Partnered Evaluation Initiative (PEI) as a case study, we identified relationship characteristics of collaborative research projects designed to address the research/operations gap.</p></div><div><h3>Methods</h3><p>An interview guide was developed focusing on areas identified as essential for effective research/operational partnerships from previous research. Investigators (N = 14) and their operational leadership partners (N = 14) representing 16 PEIs were interviewed by phone related to the characteristics of their partnerships. All investigators had had advanced degrees in fields related to healthcare delivery and administration and were affiliated with VHA research institutes. All operational partners served in national leadership roles within VHA operational offices. Detailed interview notes collected from interviews were coded and themes identified using thematic analysis.</p></div><div><h3>Results</h3><p>Eight relationship themes were identified: leadership support, shared understanding, investment, trust, agreement on products, mutual benefit, adaptability, and collaboration. Most operational and investigator partners discussed the importance of leadership support, shared understanding, investment, trust and product agreement, suggesting that these may be more essential than other areas in supporting effective operations/research collaborations. One theme (mutual benefit) was mentioned by most investigators but only some operations partners, pointing to potential differences related to this area between the two groups. Facilitators of effective collaboration included obtaining formal leadership support, developing a shared understanding of partner priorities and needs, ongoing discussions about resource needs, expanding collaborations beyond the initial project, having a clearly defined plan, planning for flexibility, plans for regular communication, and active participation in project meetings.</p></div><div><h3>Conclusions</h3><p>Partnership characteristics that facilitate effective collaboration include leadership support, shared understanding of planned work, investment, trust, and product agreement. Future research should assess the overall impact of partnered approaches to healthcare improvement within other large healthcare systems.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"9 4","pages":"Article 100588"},"PeriodicalIF":2.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39911855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the quality of randomization methods in randomized control trials","authors":"Deborah Lai ,&nbsp;Daniel Wang ,&nbsp;Matthew McGillivray ,&nbsp;Shadi Baajour ,&nbsp;Ali S Raja ,&nbsp;Shuhan He","doi":"10.1016/j.hjdsi.2021.100570","DOIUrl":"10.1016/j.hjdsi.2021.100570","url":null,"abstract":"<div><h3>Importance</h3><p><span>The randomization process is considered among the most important components of a randomized control trial<span> (RCTs) and a core advantage of RCTs. Proper randomization should eliminate most population biases, in which some populations, or members of a population are more likely to be selected or not selected than others, such that similar comparison groups are produced to evaluate treatments.</span></span><span>⁴</span>^,<span>⁵</span></p></div><div><h3>Objective</h3><p>To assess the methodologic quality of the descriptions of randomization methods used to allocate participants to comparison groups in randomized controlled trials.</p></div><div><h3>Evidence review</h3><p><span>A cross-sectional review of phase 3 clinical trials reported in </span><span>Clinicaltrials.gov</span><svg><path></path></svg>.</p><p><span>Beginning at all records available (n = 345,278) we included studies only listed for stage 3 RCTs in the U.S. National Library of Medicine database. A total of 1528 protocols were identified as of June 1, 2020. Exclusion criteria involved no protocol listed or non-randomized studies, of which 517 were excluded. There were 693 text articles excluded due to unclear methods of randomization. Inclusion criteria involved randomization methods based on “A review of randomization methods in clinical trials” by Berger and Antsygina.</span><span>1</span></p><p>Each study protocol was extracted to identify the randomization methods described by three independent reviewers. Classification of randomization methods described in the study protocols for randomized clinical trials.</p></div><div><h3>Findings</h3><p>Only 20.8 % of the study protocols described a method for randomly assigning participants to groups. Of this subset that defined protocols, the Permuted-Block Design was used most often (85.9 %). More than three quarters of all study protocols (77.7 %) provided incomplete descriptions about the type of randomization method (i.e. no protocol, n/a, unclear).</p></div><div><h3>Conclusions</h3><p>and Relevance:Proper randomization is required to generate unbiased comparison groups in controlled trials, yet the majority of study protocols for RCTs currently in <span>Clinicaltrials.gov</span><svg><path></path></svg> provide inadequate or unacceptable information regarding their randomization methods.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"9 4","pages":"Article 100570"},"PeriodicalIF":2.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.hjdsi.2021.100570","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39272085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a person-centered, population based measure of “home time”: Perspectives of older patients and unpaid caregivers","authors":"Nina R. Sperber ,&nbsp;Abigail Shapiro ,&nbsp;Nathan A. Boucher ,&nbsp;Kasey P. Decosimo ,&nbsp;Megan Shepherd-Banigan ,&nbsp;Chelsea Whitfield ,&nbsp;Susan N. Hastings ,&nbsp;Courtney H. Van Houtven","doi":"10.1016/j.hjdsi.2021.100591","DOIUrl":"10.1016/j.hjdsi.2021.100591","url":null,"abstract":"<div><p>Measuring “home time,” number of days not in facility-based care, with medical claims is a promising approach to assess person-centered outcomes on a population level. Generally, spending more time at home matches long-term care preferences and improves quality of life<span>. However, existing “home time” measures have not incorporated key stakeholder perspectives. We sought to understand how patients and family caregivers<span> value time spent in diverse facility-based health care settings (Emergency Department, Nursing Home, Post-Acute Care/Skilled Nursing, Inpatient Hospital) to help determine whether various settings have different effects on quality of life and thus merit different weighting in a “home time” measure. We conducted three focus groups among patients and family caregivers within the U.S. Veterans Health Care System. We identified themes pertaining to patients’ quality of life in each of the four facility-based care settings. Discussions about both emergency department and post-acute/skilled nursing care reflected loss of personal control, counterbalanced by temporary stay. Inpatient hospital care evoked discussion about greater loss of personal control due to the intensity of care. Nursing homes ultimately signified decline. These findings illuminate differences in quality of life across health-care settings and help justify the need for different weights in a measure of “home time.”</span></span></p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"9 4","pages":"Article 100591"},"PeriodicalIF":2.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10064480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leadership communication, stress, and burnout among frontline emergency department staff amid the COVID-19 pandemic: A mixed methods approach","authors":"Rohit B. Sangal MD, MBA ,&nbsp;Alexandra Bray ,&nbsp;Eleanor Reid MD ,&nbsp;Andrew Ulrich MD ,&nbsp;Beth Liebhardt RN, MSN ,&nbsp;Arjun K. Venkatesh MD, MBA, MHS ,&nbsp;Marissa King PhD","doi":"10.1016/j.hjdsi.2021.100577","DOIUrl":"10.1016/j.hjdsi.2021.100577","url":null,"abstract":"<div><h3>Background</h3><p>Organizations have a key role to play in supporting healthcare workers (HCWs) and mitigating stress during COVID-19. We aimed to understand whether perceptions of support and communication by local leadership were associated with reduced reports of stress and burnout among frontline HCWs.</p></div><div><h3>Methods</h3><p>We conducted cross-sectional surveys embedded within emergency department (ED) workflow during the first wave of COVID-19 from April 9, 2020 to June 15th, 2020 within three EDs of a multisite health system in the Northeast United States. All ED HCWs were administered electronic surveys during shift via text message. We simultaneously conducted 64 qualitative interviews to better characterize and validate survey responses. Primary survey outcomes were levels of work stress and burnout.</p></div><div><h3>Results</h3><p>Over 10 week study, 327 of 431 (76%) frontline HCWs responded to at least one round of the survey. More useful communication mediated through higher perception of support was significantly associated with lower work stress (<em>B</em> = −0.33, p &lt; 0.001) and burnout (<em>B</em> = −7.84, p &lt; 0.001). A one-point increase on the communication Likert scale was associated with a 9% reduction in stress and a 19% reduction in burnout. Three themes related to effective crisis communication during COVID-19 emerged in interviews: (1) information consolidation prior to dissemination, (2) consistency of communication, and (3) bi-directional communication.</p></div><div><h3>Conclusion</h3><p>This work suggests that effective local leadership communication, characterized by information consolidation, consistency, and bi-directionality, leads to higher perceptions of support and lower stress and burnout among ED frontline workers. As the pandemic continues, these results present an evidence-based framework for leaders to support frontline HCWs through effective crisis communication.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"9 4","pages":"Article 100577"},"PeriodicalIF":2.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.hjdsi.2021.100577","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39327567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification and management of pragmatic clinical trial collateral findings: A current understanding and directions for future research","authors":"Stephanie R. Morain ,&nbsp;Debra J.H. Mathews ,&nbsp;Gail Geller ,&nbsp;Juli Bollinger ,&nbsp;Kevin Weinfurt ,&nbsp;Jeffrey G. Jarvik ,&nbsp;Elizabeth May ,&nbsp;Jeremy Sugarman","doi":"10.1016/j.hjdsi.2021.100586","DOIUrl":"10.1016/j.hjdsi.2021.100586","url":null,"abstract":"<div><p>While the embedded nature of pragmatic clinical trials (PCTs) can improve the efficiency and relevance of research for multiple stakeholders, embedding research into ongoing clinical care can also involve ethical and regulatory challenges. An emergent challenge is the management of pragmatic clinical trial collateral findings (PCT-CFs). While PCT-CFs share some features with incidental or secondary findings that are encountered in conventional clinical trials and clinical care, the PCT context differs in ethically relevant ways that complicate PCT-CF identification and management. We report on the results of a two-year multi-method investigation of PCT-CFs. Overall, five core themes emerged: 1) the liminal nature of PCTs and the implications of this for PCT-CFs; 2) the context-specific nature of PCT-CF management; 3) the centrality of institutions; 4) the importance of prospective planning; and 5) patient expectations. Among the central lessons of this work are that prior ethics guidance from other settings cannot easily be adapted to address PCT-CFs, nor can a single approach readily accommodate all PCT-CFs. Moving forward, stakeholders, including researchers, institutions, ethics oversight bodies, and funders, should anticipate and plan for PCT-CFs in the design, conduct, and analysis of PCTs. Future scholarship is needed to examine experiences with PCT-CFs, and the practical and conceptual issues they raise for the future conduct of PCTs.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"9 4","pages":"Article 100586"},"PeriodicalIF":2.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39479584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving smoking history documentation in the electronic health record for lung cancer risk assessment and screening in primary care: A case study","authors":"Elizabeth Peterson ,&nbsp;Kathryn Harris ,&nbsp;Farhood Farjah ,&nbsp;Nkem Akinsoto ,&nbsp;Leah M. Marcotte","doi":"10.1016/j.hjdsi.2021.100578","DOIUrl":"10.1016/j.hjdsi.2021.100578","url":null,"abstract":"<div><p>Improving risk factor documentation in the electronic health record (EHR) is important in order to determine patient eligibility for lung cancer screening.</p><p>System-level prioritization combined with a clinic-level initiative can improve risk factor documentation rates.</p><p>Multi-faceted interventions that include training, process improvement, data management, and continuous performance feedback are effective and can be integrated into existing workflows.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"9 4","pages":"Article 100578"},"PeriodicalIF":2.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.hjdsi.2021.100578","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39358892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STAT: Mobile app helps clinicians manage inpatient emergencies","authors":"Andrew L. Chu ,&nbsp;Joshua C. Ziperstein ,&nbsp;Blake A. Niccum ,&nbsp;Melvin G. Joice ,&nbsp;Eric M. Isselbacher ,&nbsp;Jared Conley","doi":"10.1016/j.hjdsi.2021.100590","DOIUrl":"10.1016/j.hjdsi.2021.100590","url":null,"abstract":"<div><p>In response to the unprecedented surge of patients with COVID-19, Massachusetts General Hospital created both repurposed and de-novo COVID-19 inpatient general medicine and intensive care units. The clinicians staffing these new services included those who typically worked in these care settings (e.g., medicine residents, hospitalists, intensivists), as well as others who typically practice in other care environments (e.g., re-deployed outpatient internists, medical subspecialists, and other physician specialties). These surge clinicians did not have extensive experience managing low frequency, high acuity emergencies, such as those that might result from COVID-19. Physician-innovators, in collaboration with key hospital stakeholders, developed a comprehensive strategy to design, develop, and distribute a digital health solution to address this problem. MGH STAT is an intuitive mobile application that empowers clinicians to respond to medical emergencies by providing immediate access to up-to-date clinical guidelines, consultants, and code-running tools at the point-of-care. 100% of surveyed physicians found STAT to be easy to use and would recommend it to others. Approximately 1100 clinicians have downloaded the app, and it continues to enjoy consistent use over a year after the initial COVID-19 surge. These results suggest that STAT has helped clinicians manage life threatening emergencies during and after the pandemic, although formal studies are necessary to evaluate its direct impact on patient care.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"9 4","pages":"Article 100590"},"PeriodicalIF":2.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8536501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39561049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Social Vulnerability, COVID-19 vaccine site density, and vaccination rates in the United States","authors":"Nitya Thakore ,&nbsp;Rohan Khazanchi ,&nbsp;E. John Orav ,&nbsp;Ishani Ganguli","doi":"10.1016/j.hjdsi.2021.100583","DOIUrl":"10.1016/j.hjdsi.2021.100583","url":null,"abstract":"<div><p>The COVID-19 pandemic has disproportionately impacted Americans in socially vulnerable areas. Unfortunately, these groups are also experiencing lower vaccination rates. To understand how strategic vaccine site placement may benefit high vulnerability populations, we extracted vaccine site locations for 26 U.S. states and linked these data to county-level adult vaccination rates and the CDC 2018 Social Vulnerability Index rankings. We fit quasi-Poisson regression models to compare vaccine site density between the highest and lowest SVI domain quartiles, and assessed whether greater vaccine site density mediated or modified the relationship between social vulnerability and vaccination rates. We found that high vulnerability counties by socioeconomic status had more vaccine sites per 10,000 residents, yet this higher vaccine site density did not reduce socioeconomic disparities in vaccination rates. Persistent vaccination inequities may reflect other structural barriers to access. Our results suggest that targeted vaccine site placement in high vulnerability counties may be necessary but insufficient for the goal of widespread, equitable vaccination.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"9 4","pages":"Article 100583"},"PeriodicalIF":2.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10757079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking the cycle: A public-private partnership to combat the American opioid epidemic","authors":"Derek Soled ,&nbsp;Nishant Uppal ,&nbsp;Scott G. Weiner","doi":"10.1016/j.hjdsi.2021.100592","DOIUrl":"10.1016/j.hjdsi.2021.100592","url":null,"abstract":"<div><p>There has been an increased focus on the opioid epidemic in the United States, yet policy-based interventions such as prescription limits, restrictions on doctor shopping, and notification programs for high-volume prescribers have had no significant impact. In this paper, the authors explore a novel public health<span><span> policy: a joint public-private partnership between the federal government and hospitals to establish long-term treatment centers for patients admitted to the </span>emergency department after an overdose. These centers would provide medication for opioid use disorder, give individuals the necessary support for recovery, and reduce healthcare expenditures. Similar longitudinal strategies may be used in other areas of public health.</span></p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"9 4","pages":"Article 100592"},"PeriodicalIF":2.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39593709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moving the needle on primary care burnout: Using a driver diagram to accelerate impact","authors":"Erin E. Sullivan ,&nbsp;Kathleen Dwiel ,&nbsp;Lindsay Swain Hunt ,&nbsp;Kathleen Conroy ,&nbsp;Katherine Gergen Barnett","doi":"10.1016/j.hjdsi.2021.100595","DOIUrl":"10.1016/j.hjdsi.2021.100595","url":null,"abstract":"<div><p>Prior to the COVID-19 pandemic, studies demonstrated an alarming prevalence of burnout in primary care. In the midst of the pandemic, primary care clinician wellbeing deteriorated and burnout rates increased, yet many organizational efforts to reduce burnout were put on hold due to the urgency of the pandemic. In this article, we present the “Reducing Burnout Driver Diagram” as a tool that clinical leaders and policy makers can use to address and mitigate primary care clinician burnout.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"9 4","pages":"Article 100595"},"PeriodicalIF":2.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8595316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10382913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}