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

{"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}

{"title":"Massachusetts General Hospital Revere Food Pantry: Addressing hunger and health at an academic medical center community clinic","authors":"Jacob B. Mirsky ,&nbsp;Rachel M. Zack ,&nbsp;Seth A. Berkowitz ,&nbsp;Lauren Fiechtner","doi":"10.1016/j.hjdsi.2021.100589","DOIUrl":"10.1016/j.hjdsi.2021.100589","url":null,"abstract":"<div><p>Food insecurity is defined by limited access to adequate food. As a result, it is associated with chronic disease for millions of Americans. Healthcare systems take responsibility for improving patient health and thus are well positioned to create food security interventions that improve health. Given that dietary recommendations now emphasize plant-based foods (such as vegetables, fruits, legumes, and whole grains), interventions could prioritize distributing plant-based foods that promote health and reduce food insecurity. We developed a plant-based food pantry at the Massachusetts General Hospital Revere Healthcare Center, an academic medical center-affiliated community clinic that serves many patients with food insecurity. We partnered with a local food bank and used a color-coded nutrition ranking system to prioritize healthy foods. What began as a pilot program for patients with food insecurity and chronic disease expanded to serve the entire clinic population in response to rising community level food insecurity resulting from the COVID-19 pandemic. We developed and modified a workflow that provided an average of 384 recipients (i.e., patients and their household members) with food monthly during the 10-month study period. A total of 117,742 pounds of food was distributed. Next steps for the food pantry will include investigating health outcomes, assessing patient satisfaction with plant-based foods, and securing sustainable funding. Our experience can be used to guide other health organizations interested in the intersection of food security and chronic disease management.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"9 4","pages":"Article 100589"},"PeriodicalIF":2.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39502074","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":"Rapid analysis of local data to inform off-label tocilizumab use early in the COVID-19 pandemic","authors":"Camille E. Morgan ,&nbsp;Casey A. Rimland ,&nbsp;Griffin J. Bell ,&nbsp;Min K. Kim ,&nbsp;Tanner Hedrick ,&nbsp;Ashley Marx ,&nbsp;Brian Bramson ,&nbsp;Heidi Swygard ,&nbsp;Sonia Napravnik ,&nbsp;John L. Schmitz ,&nbsp;Shannon S. Carson ,&nbsp;William A. Fischer ,&nbsp;Joseph J. Eron ,&nbsp;Cynthia L. Gay ,&nbsp;Jonathan B. Parr","doi":"10.1016/j.hjdsi.2021.100581","DOIUrl":"10.1016/j.hjdsi.2021.100581","url":null,"abstract":"<div><p>The interleukin-6 receptor antagonist tocilizumab became widely used early in the coronavirus disease 2019 (COVID-19) pandemic based on small observational studies that suggested clinical benefit in COVID-19 patients with a hyperinflammatory state. To inform our local treatment algorithms in the absence of randomized clinical trial results, we performed a rapid analysis of the first 11 hospitalized COVID-19 patients treated with tocilizumab at our academic medical center. We report their early clinical outcomes and describe the process by which we assembled a team of diverse trainees and stakeholders to extract, analyze, and disseminate data during a time of clinical uncertainty.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"9 4","pages":"Article 100581"},"PeriodicalIF":2.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.hjdsi.2021.100581","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39502147","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":"Whose value is it anyway? Reconciling conflicting perceptions of patients and payers","authors":"Matthew L. Maciejewski ,&nbsp;Abby Hoffman ,&nbsp;Jeffrey T. Kullgren","doi":"10.1016/j.hjdsi.2021.100596","DOIUrl":"10.1016/j.hjdsi.2021.100596","url":null,"abstract":"<div><p>A promising pathway to achieving greater value in health care is to increase use of “high-value” services and decrease use of “low-value” services. Sometimes the value judgments of patients and payers are well-aligned, creating opportunities for policymakers to more forcefully influence use of services for which perceived value is concordant. More difficult situations arise when patients and payers have discordant value perceptions. We propose a novel framework for navigating situations where payers and patients agree or disagree on the relative value of services, and potential solutions for improving value under different conditions.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"9 4","pages":"Article 100596"},"PeriodicalIF":2.5,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39882732","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}