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

{"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}

{"title":"COBALT: Supporting the mental well-being of the health care workforce with technology-facilitated care during Covid-19 and beyond","authors":"Cecilia Livesey,&nbsp;Kelley Kugler,&nbsp;Jack J. Huang,&nbsp;Eleanor Burton,&nbsp;Avanti Rangnekar,&nbsp;Grace Vojta,&nbsp;Maria A. Oquendo,&nbsp;Lisa Bellini,&nbsp;David A. Asch","doi":"10.1016/j.hjdsi.2022.100640","DOIUrl":"10.1016/j.hjdsi.2022.100640","url":null,"abstract":"<div><p>Two-thirds of health professionals facing the clinical demands of responding to the Covid-19 pandemic experience psychiatric symptoms, including post-traumatic stress, anxiety, substance use, depression, insomnia, and suicide.¹^,² Compounding matters, access to mental health services is poor, quality is variable, and stigma is prevalent. COBALT, a digital mental health and wellness platform developed at Penn Medicine, was designed to support health care workers, offering a combination of self-directed resources, virtual group sessions, and individual appointments with a stepped care model of providers, including peers, resilience coaches, psychotherapists, and psychiatrists. In COBALT's first 11 months, the platform saw approximately 10,000 users, 200,000 page views, 1,400 one-on-one appointment bookings, over 1,000 group appointment reservations, and 158 interceptions of employees contemplating self-harm. COBALT reveals the unmet demand for mental health support among health professionals and provides a model for both expanding the supply of and streamlining access to services.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 3","pages":"Article 100640"},"PeriodicalIF":2.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9257144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40595934","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":"Putting the design in health system redesign: Accounting for anchoring effects","authors":"Joseph H. Joo ,&nbsp;Joshua M. Liao","doi":"10.1016/j.hjdsi.2022.100644","DOIUrl":"10.1016/j.hjdsi.2022.100644","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 3","pages":"Article 100644"},"PeriodicalIF":2.5,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40679669","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":"Patient selection strategies in an intensive primary care program","authors":"Elizabeth Hulen ,&nbsp;Avery Z. Laliberte ,&nbsp;Marian L. Katz ,&nbsp;Karleen F. Giannitrapani ,&nbsp;Evelyn T. Chang ,&nbsp;Susan E. Stockdale ,&nbsp;Jessica A. Eng ,&nbsp;Elvira Jimenez ,&nbsp;Samuel T. Edwards","doi":"10.1016/j.hjdsi.2022.100627","DOIUrl":"10.1016/j.hjdsi.2022.100627","url":null,"abstract":"<div><h3>Background</h3><p>Intensive primary care programs have had variable impacts on clinical outcomes, possibly due to a lack of consensus on appropriate patient-selection. The US Veterans Health Administration (VHA) piloted an intensive primary care program, known as Patient Aligned Care Team Intensive Management (PIM), in five medical centers. We sought to describe the PIM patient selection process used by PIM teams and to explore perspectives of PIM team members regarding how patient selection processes functioned in context.</p></div><div><h3>Methods</h3><p>This study employs an exploratory sequential mixed-methods design. We analyzed qualitative interviews with 21 PIM team and facility leaders and electronic health record (EHR) data from 2,061 patients screened between July 2014 and September 2017 for PIM enrollment. Qualitative data were analyzed using a hybrid inductive/deductive approach. Quantitative data were analyzed using descriptive statistics.</p></div><div><h3>Results</h3><p>Of 1,887 patients identified for PIM services using standardized criteria, over half were deemed inappropriate for PIM services, either because of not having an ambulatory care sensitive condition, living situation, or were already receiving recommended care. Qualitative analysis found that team members considered standardized criteria to be a useful starting point but too broad to be relied on exclusively. Additional data collection through chart review and communication with the current primary care team was needed to adequately assess patient complexity. Qualitative analysis further found that differences in conceptualizing program goals led to conflicting opinions of which patients should be enrolled in PIM.</p></div><div><h3>Conclusions</h3><p>A combined approach that includes clinical judgment, case review, standardized criteria, and targeted program goals are all needed to support appropriate patient selection processes.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100627"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45346683","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":"International Medical Graduates and practice rates in underserved communities in Florida","authors":"Nishant Uppal ,&nbsp;Elizabeth T. Chin ,&nbsp;Caroline H. Lee ,&nbsp;Parsa Erfani ,&nbsp;Katherine R. Peeler","doi":"10.1016/j.hjdsi.2022.100628","DOIUrl":"10.1016/j.hjdsi.2022.100628","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100628"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42102313","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":"Increasing value and facilitating adoption of telehealth in the post-COVID era: An interview with chair of the American Telemedicine Association Joseph Kvedar","authors":"Kaushik P. Venkatesh MBA, MPH,&nbsp;Nathan Mallipeddi BS","doi":"10.1016/j.hjdsi.2022.100624","DOIUrl":"10.1016/j.hjdsi.2022.100624","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100624"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45411603","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":"Putting the design in health system redesign: Minimizing cognitive load","authors":"Joshua M. Liao","doi":"10.1016/j.hjdsi.2022.100625","DOIUrl":"10.1016/j.hjdsi.2022.100625","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100625"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45337556","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}