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

{"title":"The case for unlearning health systems","authors":"Joseph H. Joo , Joshua A. Kim , Joshua M. Liao","doi":"10.1016/j.hjdsi.2022.100661","DOIUrl":"10.1016/j.hjdsi.2022.100661","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 4","pages":"Article 100661"},"PeriodicalIF":2.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9162234","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":"Care teams misunderstand what most upsets patients about their care","authors":"Alana L. Conner ,&nbsp;Beatrice V. Podtschaske ,&nbsp;Mary Carol Mazza ,&nbsp;Dani L. Zionts ,&nbsp;Elizabeth J. Malcolm ,&nbsp;Carey C. Thomson ,&nbsp;Sara J. Singer ,&nbsp;Arnold Milstein","doi":"10.1016/j.hjdsi.2022.100657","DOIUrl":"10.1016/j.hjdsi.2022.100657","url":null,"abstract":"<div><h3>Background</h3><p>Negative healthcare delivery experiences can cause lasting patient distress and medical service misuse and disuse. Yet no multi-site study has examined whether care-team members understand what most upsets patients about their care.</p></div><div><h3>Methods</h3><p>We interviewed 373 patients and 360 care-team members in the medical oncology and ambulatory surgery clinics of 11 major healthcare organizations across six U.S. census regions. Patients deeply upset by a service-related experience (<em>n =</em> 99, 27%) answered questions about that experience, while care-team members (n = 360) answered questions about their beliefs regarding what most upsets patients. We performed content analysis to identify memorably upsetting care (MUC) themes; a generalized estimating equation to explore whether MUC theme mention frequencies varied by participant role (care-team member vs. patient), specialty (oncology vs. surgery), facility (academic vs. community), and gender; and logistic regressions to investigate the effects of participant characteristics on individual themes.</p></div><div><h3>Results</h3><p>MUC themes included three <em>systems issues</em> (<em>inefficiencies, access barriers,</em> and <em>facilities problems)</em> and four <em>care-team issues</em> (<em>miscommunication, neglect, coldness,</em> and <em>incompetence</em>). MUC theme frequencies differed by role (all Ps &lt; 0.001), with more patients mentioning care-team coldness (OR = 0.37; 95% CI, 0.23-0.60) and incompetence (OR = 0.17; 95% CI, 0.09-0.31); but more care-team members mentioning system inefficiencies (OR = 7.01; 95% CI, 4.31–11.40) and access barriers (OR, 5.48; 95% CI, 2.81–10.69).</p></div><div><h3>Conclusions</h3><p>When considering which service experiences most upset patients, care-team members underestimate the impact of their own behaviors and overestimate the impact of systems issues.</p></div><div><h3>Implications</h3><p>Healthcare systems should reconsider how they collect, interpret, disseminate, and respond to patient service reports.</p></div><div><h3>Level of evidence</h3><p>Level III.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 4","pages":"Article 100657"},"PeriodicalIF":2.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S221307642200046X/pdfft?md5=0f7aa976f167ed7e05d0cf83f34a2434&pid=1-s2.0-S221307642200046X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40393562","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":"The art of asking “what if” in life science: Exploring Flagship Pioneering's model of innovation with Senior Partner Michael Rosenblatt","authors":"Nathan Mallipeddi,&nbsp;Kaushik P. Venkatesh","doi":"10.1016/j.hjdsi.2022.100658","DOIUrl":"10.1016/j.hjdsi.2022.100658","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 4","pages":"Article 100658"},"PeriodicalIF":2.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10600856","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":"Quality of race and ethnicity data in Medicare","authors":"Rachael B. Zuckerman,&nbsp;Wafa W. Tarazi ,&nbsp;Lok Wong Samson,&nbsp;Victoria Aysola,&nbsp;Steven H. Sheingold,&nbsp;Nancy De Lew,&nbsp;Benjamin D. Sommers","doi":"10.1016/j.hjdsi.2022.100662","DOIUrl":"10.1016/j.hjdsi.2022.100662","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 4","pages":"Article 100662"},"PeriodicalIF":2.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10607533","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":"Determinants of inter-organizational implementation success: A mixed-methods evaluation of Veteran Directed Care","authors":"Nina R. Sperber ,&nbsp;Edward J. Miech ,&nbsp;Alecia Slade Clary ,&nbsp;Kathleen Perry ,&nbsp;Merle Edwards-Orr ,&nbsp;James L. Rudolph ,&nbsp;Courtney Harold Van Houtven ,&nbsp;Kali S. Thomas","doi":"10.1016/j.hjdsi.2022.100653","DOIUrl":"10.1016/j.hjdsi.2022.100653","url":null,"abstract":"<div><h3>Background</h3><p><span>Veteran Directed Care (VDC) aims to keep Veterans at risk for nursing home placement in their communities. VA medical centers (VAMCs) purchase VDC from third-party organizational providers who then partner with them during implementation. Experiences with VDC implementation have varied. Objectives: We sought to identify conditions differentiating partnerships with higher enrollment (implementation success). Methods: We conducted a case-based study with: qualitative data on implementation determinants two and eight months after program start, directed content analysis to assign numerical scores (−2 strong barrier to +2 strong facilitator), and </span>mathematical modeling using Coincidence Analysis (CNA) to identify key determinants of implementation success. Cases consisted of VAMCs and partnering non-VAMC organizations who started VDC during 2017 or 2018. The Consolidated Framework for Implementation Research (CFIR) guided analysis. Results: Eleven individual organizations within five partnerships constituted our sample. Two CFIR determinants- Networks &amp; Communication and External Change Agent-uniquely and consistently identified implementation success. At an inter-organizational partnership level, Networks &amp; Communications and External Change Agent +2 (i.e., present as strong facilitators) were both necessary and sufficient. At a within-organization level, Networks &amp; Communication +2 was necessary but not sufficient for the non-VAMC providers, whereas External Change Agent +2 was necessary and sufficient for VAMCs. Conclusion: Networks &amp; Communication and External Change Agent played difference-making roles in inter-organizational implementation success, which differ by type of organization and level of analysis. Implications: This multi-level approach identified crucial difference-making conditions for inter-organizational implementation success when putting a program into practice requires partnerships across multiple organizations.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 4","pages":"Article 100653"},"PeriodicalIF":2.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9800859","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":"Implementation of a Medication Reconciliation Risk Stratification Tool Integrated within an electronic health record: A Case Series of Three Academic Medical Centers","authors":"Eugene S. Chu ,&nbsp;Robert El-Kareh ,&nbsp;Anthony Biondo ,&nbsp;John Chang ,&nbsp;Seth Hartman ,&nbsp;Trina Huynh ,&nbsp;Kathryn Medders ,&nbsp;Andrea Nguyen ,&nbsp;Nancy Yam ,&nbsp;Loutfi Succari ,&nbsp;Kyle Koenig ,&nbsp;Mark V. Williams ,&nbsp;Jeffrey Schnipper","doi":"10.1016/j.hjdsi.2022.100654","DOIUrl":"10.1016/j.hjdsi.2022.100654","url":null,"abstract":"<div><p>Medication errors during transitions of care are common, dangerous and costly. Medication reconciliation can help mitigate this risk, but it is a complex and time-consuming process when performed properly. Increasingly, pharmacy staff have been engaged to help improve medication reconciliation. However, many organizations lack the resources and staff required to perform accurate medication histories and other reconciliation tasks on all patients. We describe how three academic medical centers implemented risk scoring systems to allocate limited pharmacy resources to patients with the highest likelihood of medication reconciliation related errors. We found that (1) development of a tailored medication risk scoring system and integration into the electronic health record is feasible, (2) workflow around the risk calculator is critical to the success of the implementation, and (3) the complex coordination of professional disciplines during the medication reconciliation process remains an ongoing challenge at all three institutions.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 4","pages":"Article 100654"},"PeriodicalIF":2.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40372821","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":"The effect of remote scribes on primary care physicians’ wellness, EHR satisfaction, and EHR use","authors":"Mark A. Micek ,&nbsp;Brian Arndt ,&nbsp;Jeffrey J. Baltus ,&nbsp;Aimee Teo Broman ,&nbsp;Joel Galang ,&nbsp;Shannon Dean ,&nbsp;Matthew Anderson ,&nbsp;Christine Sinsky","doi":"10.1016/j.hjdsi.2022.100663","DOIUrl":"10.1016/j.hjdsi.2022.100663","url":null,"abstract":"<div><h3>Background</h3><p>Physician burnout is a major problem in the United States. Small studies suggest scribes can improve clinician satisfaction, but scribe programs have not been evaluated using separate control groups or structured measures of electronic health record (EHR) use.</p></div><div><h3>Methods</h3><p>We conducted a pre-post, non-randomized controlled evaluation of a remote scribe pilot program introduced in September 2019 in an academic primary care practice. Scribes were paired with physicians via an audio-only cellphone connection to hear and document in real-time. Physician wellness was measured with the 10-item Mini-Z and 16-item Professional Fulfillment Index. EHR use was measured using vendor-derived platforms that provide routine EHR-related data.</p></div><div><h3>Results</h3><p>37 of 38 scribe users (97.4%) and 68 of 160 potential control physicians (42.5%) completed both pre and post intervention questionnaires. Compared with controls, scribe users had improvements in Mini-Z wellness metrics including Joyful Workplace (mean improvement 2.83, 95%CI 0.60, 5.06) and a single-item dichotomized burnout measure (OR 0.15, 95%CI 0.03, 0.71). There were significant reductions among scribe users compared to controls in total EHR time per 8 scheduled hours (−1.14 h, 95%CI -1.55, −0.72), and an increase in the percentage of orders with team contribution (10.4%, 95%CI 5.2, 15.6). These findings remained significant in adjusted analyses.</p></div><div><h3>Conclusions/implications</h3><p>A remote scribe program was associated with improvements in physician wellness and reduced EHR use. Healthcare organizations can consider scribe programs to help improve wellness among their physician workforce.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 4","pages":"Article 100663"},"PeriodicalIF":2.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213076422000525/pdfft?md5=3870f1a79bdfed37819ed60b5f211c07&pid=1-s2.0-S2213076422000525-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40684910","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":"Integrating peer support services into primary care-based OUD treatment: Lessons from the Penn integrated model","authors":"Rebecca Arden Harris ,&nbsp;Kristen Campbell ,&nbsp;Tara Calderbank ,&nbsp;Patrick Dooley ,&nbsp;Heather Aspero ,&nbsp;Jessica Maginnis ,&nbsp;Nicole O'Donnell ,&nbsp;Donna Coviello ,&nbsp;Rachel French ,&nbsp;Yuhua Bao ,&nbsp;David S. Mandell ,&nbsp;Hillary R. Bogner ,&nbsp;Margaret Lowenstein","doi":"10.1016/j.hjdsi.2022.100641","DOIUrl":"10.1016/j.hjdsi.2022.100641","url":null,"abstract":"<div><p>Opioid use disorder (OUD) is a major public health emergency in the United States. In 2020, 2.7 million individuals had an OUD. Medication for opioid use disorder is the evidence-based, standard of care for treating OUD in outpatient settings, especially buprenorphine because it is effective and has low toxicity. Buprenorphine is increasingly prescribed in primary care, a setting that provides greater anonymity and convenience than substance use disorder treatment centers. Yet two-thirds of people who begin buprenorphine treatment discontinue within the first six months. Treatment dropout elevates the risks of return to use, infections, higher levels of medical care and related costs, justice system involvement, and death. One promising form of retention support is peer service programs. Peers combine their lived experience of substance use and recovery with formal training to help patients engage and persist in OUD treatment. They provide a range of services, including health education, encouragement and empathy, coping skills, recovery modeling, and concrete assistance in overcoming the situational barriers to retention. However, guidance is needed to define the peer role in primary care, the specific tasks peers should perform, the competencies those tasks require, training and professional development needs, and peer performance standards. Guidance also is needed to integrate peers into the care team, allocate and coordinate responsibilities among care team members, manage peer operations and workflow, and facilitate effective team communication. Here we describe a peer support program in the University of Pennsylvania Health System (UPHS or Penn Medicine) network of primary care practices. This paper details the program's core components, values, and activities. We also report the organizational challenges, unresolved questions, and lessons for the field in administering a peer support program to meet the needs of patients served by a large, urban medical system with an extensive suburban and rural catchment area.</p></div><div><h3>Clinical Trials Registration</h3><p><span>www.clinicaltrials.gov</span><svg><path></path></svg> registration: NCT04245423.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 3","pages":"Article 100641"},"PeriodicalIF":2.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10739327","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":"Pediatric emergency department to primary care transfer protocol: Transforming access for patients’ needs","authors":"S. Barron Frazier,&nbsp;James C. Gay,&nbsp;Shari Barkin,&nbsp;Michelle Graham,&nbsp;Michele Walsh,&nbsp;Kathryn Carlson","doi":"10.1016/j.hjdsi.2022.100643","DOIUrl":"10.1016/j.hjdsi.2022.100643","url":null,"abstract":"<div><h3>Background</h3><p><span>Previous interventions to reduce emergency department (ED) overutilization from non-urgent visits have shown little success. At our hospital, we created an ED to </span>primary care clinic (PCC) transfer protocol for non-urgent ED visits of established patients. Our study analyzed the impact of this protocol on patient encounters.</p></div><div><h3>Methods</h3><p>Chart reviews were conducted for a retrospective cohort of transfers from the ED to PCC from 9/01/17–8/31/18. Primary outcomes included length of stay (LOS), cost, and need for return to the ED. Cost savings were calculated by comparing encounters with identical primary diagnoses in the ED with internal technical and professional financial data. Secondary outcomes were final diagnoses and primary care services provided.</p></div><div><h3>Results</h3><p>374 patient encounters were transferred from ED to PCC. The five most common diagnoses were viral upper respiratory infection<span> (n=80, 21.4%), dermatologic<span><span> diagnoses (n=37, 9.9%), acute otitis media (n=35, 9.4%), </span>pharyngitis (n=34, 9.1%), and influenza (n=34, 9.1%). Overall, total cost savings equaled approximately $100,000. For the top 10 diagnoses, costs were reduced from $29-$46 per $100 of ED costs and LOS was reduced by a mean of 49 min/encounter. For 9 of these 10 conditions, costs exceeded reimbursement in both settings; however, evaluation in PCC versus ED reduced the loss of revenue by 10–68%. Sixty-four encounters (17.1%) received additional primary care services. There were no safety events or inappropriate transfers.</span></span></p></div><div><h3>Conclusions</h3><p>This protocol provided a safe, efficient method for patients to be evaluated in their medical home while reducing non-urgent emergency visits in the ED.</p></div><div><h3>Level of evidence</h3><p>VI.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 3","pages":"Article 100643"},"PeriodicalIF":2.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40718743","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":"Implementation and evaluation of IGNITE (Improving GME Nursing Interprofessional Team Experiences) to improve care in an academic health system","authors":"Vineet M. Arora ,&nbsp;Aviva Klein ,&nbsp;Alesia Coe ,&nbsp;Ajanta Patel ,&nbsp;Debra Albert ,&nbsp;Anita Blanchard ,&nbsp;For the IGNITE/PEI Steering Committee","doi":"10.1016/j.hjdsi.2022.100642","DOIUrl":"10.1016/j.hjdsi.2022.100642","url":null,"abstract":"<div><p>Engaging residents with nurses in interprofessional performance improvement teams can improve learning and care. Residents at the University of Chicago Medicine were identified by nurses, and endorsed by program directors, to serve alongside nurses in Improving GME Nursing Interprofessional Team Experiences (IGNITE) teams. Teams met monthly with improvement coaches to implement institutionally aligned improvement plans. Institutional data was used to monitor progress. The Interprofessional Collaborative Competencies Attainment Survey (ICCAS) assessed interprofessional collaboration competency. Press Ganey Clinician Engagement (PGCE) data examined year over year differences in items related to teamwork comparing IGNITE units and non-IGNITE units. Length of stay (LOS) differences were also examined. From 2015 to 2019, IGNITE spread to 9 service lines engaging over 100 residents and nurses. Unit-based teams focused on adding nurses to attending rounds, implementing nurses-resident huddles, and improving multidisciplinary rounds. ICCAS scores significantly improved. PGCE data showed year over year improvements in composite teamwork and communication scores in IGNITE units. All adult inpatient IGNITE units saw a mean LOS reduction ranging from −0.15 days to −1.16 days, equating to an estimated cost savings of nearly 3 million dollars per quarter. Lessons learned include: 1) the importance of engaging hospital leadership; 2) the need to align collaborative practices with institutional goals; 3) the critical role of coaching; and 4) practices to ensure committed, consistent participants.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 3","pages":"Article 100642"},"PeriodicalIF":2.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40588948","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}