PATH-s: Predictive Validation of a Caregiving Preparedness Assessment Tool at 90-Days Post-Discharge from an IRF

2019 ◽  
Vol 100 (10) ◽  
pp. e24
Author(s):  
Michelle Camicia ◽  
Barbara Lutz ◽  
Brian Theodore
Keyword(s):  
Assessment Tool ◽  
Post Discharge ◽  
Predictive Validation

scholarly journals The TeleHealth OSCE: Preparing Trainees to Use Telemedicine as a Tool for Transitions of Care

2020 ◽  
Vol 12 (6) ◽  
pp. 764-768
Author(s):  
Daniel J. Sartori ◽  
Rachael W. Hayes ◽  
Margaret Horlick ◽  
Jennifer G. Adams ◽  
Sondra R. Zabar
Keyword(s):  
Assessment Tool ◽  
Relationship Development ◽  
Transitions Of Care ◽  
Transition Of Care ◽  
Post Discharge ◽  
Specific Knowledge ◽  
Domain Specific ◽  
Internal Medicine Residents ◽  
Specific Skill ◽  
Outpatient Settings

ABSTRACT Background Telemedicine holds promise to bridge the transition of care between inpatient and outpatient settings. Despite this, the unique communication and technical skills required for virtual encounters are not routinely taught or practiced in graduate medical education (GME) programs. Objective To develop an objective structured clinical examination (OSCE) case to assess residents' telemedicine-specific skills and identify potential gaps in our residency program's curriculum. Methods As part of a multi-station OSCE in 2019, we developed a case simulating a remote encounter between a resident and a recently discharged standardized patient. We developed an assessment tool comprising specific behaviors anchored to “not done,” “partly done,” and “well done” descriptors to evaluate core communication and telemedicine-specific skills. Results Seventy-eight NYU internal medicine residents participated in the case. Evaluations from 100% of participants were obtained. Residents performed well in Information Gathering and Relationship Development domains. A mean 95% (SD 3.3%) and 91% (SD 4.9%) of residents received “well done” evaluations across these domains. A mean 78% (SD 14%) received “well done” within Education/Counseling domain. However, only 46% (SD 45%) received “well done” evaluations within the Telemedicine domain; specific weak areas included performing a virtual physical examination (18% well done) and leveraging video to augment history gathering (17% well done). There were no differences in telemedicine-specific skill evaluations when stratified by training track or postgraduate year. Conclusions We simulate a post-discharge virtual encounter and present a novel assessment tool that uncovers telemedicine-specific knowledge gaps in GME trainees.

Abstract W P349: Bridging the Gap: Discharge to Follow-up: A Qualitative Review

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Anh Juntura ◽  
Linda Shields ◽  
Fern Cudlip
Keyword(s):  
Patient Compliance ◽  
Assessment Tool ◽  
Discharge Planning ◽  
Signs And Symptoms ◽  
Well Being ◽  
Qualitative Assessment ◽  
Phone Call ◽  
Discharge Process ◽  
Post Discharge

Background: Discharging patients from the hospital is complex and challenging. The discharge process includes discharge planning, medication reconciliation, discharge summation, and patient instruction. The enormity of information and complexity of the process directly impacts patient compliance and re-admission. Given the extent of this process, efforts toward assuring clarity of knowledge have the potential to improve patient compliance. We sought to identify and address gaps in post discharge patient awareness. Methods: A follow-up phone interview was conducted 1 week post discharge, with 26 stroke patients. All patients had received verbal and written stroke education prior to discharge. The qualitative assessment tool included 10 questions regarding general wellbeing, follow-up appointment compliance, medication utilization, and stroke knowledge. The patient responses were categorized accordingly. A copy of the patient’s discharge instructions was utilized during the interview for verification and clarification of discharge information. Results: Regarding wellbeing, 77% of the patients reported a reasonable sense of well being. The majority (77%) had scheduled follow-up appointments with the remaining 23% requiring clarification. Concerning medication compliance, 92% of the patients were able to obtain and comprehend use of their new medications. Review of stroke type confirmed 54% with understanding, whereas, 44% expressed lack of clarity regarding the subject. The same was true in regards to comprehension of stroke risk factors (56% verbalized understanding and 44% lacked awareness). Lastly, 54% of respondents were unable to identify the signs and symptoms of stroke despite the majority (60%) verbalizing a correct use of the 9-1-1 system Conclusion: Our findings imply that a post discharge phone call practice serves to identify information gaps and provide opportunity to clarify stroke awareness, thus, “bridging the gap” of understanding and compliance regarding stroke management and prevention

scholarly journals Teaching plain language to medical students: improving communication with disadvantaged patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Doron Sagi ◽  
Sivan Spitzer-Shohat ◽  
Michal Schuster ◽  
Ligat Daudi ◽  
Mary Catharine Joy Rudolf
Keyword(s):  
Health Literacy ◽  
Communication Skills ◽  
Home Visit ◽  
Assessment Tool ◽  
Medical Condition ◽  
Written Communication ◽  
Plain Language ◽  
Post Discharge ◽  
Entire Cohort ◽  
Low Health Literacy

Abstract Background Low health literacy underpins health inequality and leads to poor adherence to medical care and higher risk of adverse events and rehospitalization. Communication in plain language, therefore, is an essential skill for health professionals to acquire. Most medical education communication skill programs focus on verbal communication, while written communication training is scarce. ETGAR is a student delivered service for vulnerable patients after hospital discharge in which, amongst other duties, students ‘translate’ the medical discharge letters into plain language and share them with patients at a home visit. This study ascertains how this plain language training impacted on students’ written communication skills using a tool designed for purpose. Methods Students, in pairs, wrote three plain language discharge letters over the course of a year for patients whom they encountered in hospital. The students handed over and shared the letters with the patients during a post-discharge home visit. Structured feedback from course instructors was given for each letter. An assessment tool was developed to evaluate students’ ability to tell the hospitalization narrative using plain and clear language. First and last letters were blindly evaluated for the entire cohort (74 letters; 87 students). Results Students scored higher in all assessment categories in the third letters, with significant improvement in overall score 3.5 ± 0.8 vs 4.1 ± 0.6 Z = -3.43, p = 0.001. The assessment tool’s reliability was high α = 0.797, it successfully differentiated between plain language categories, and its score was not affected by letter length or patient’s medical condition. Conclusions Plain language discharge letters written for real patients in the context of experience-based learning improved in quality, providing students with skills to work effectively in an environment where poor health literacy is prevalent. ETGAR may serve as a model for learning written communication skills during clinical years, using the assessment tool for formative or summative evaluation.

Cognitive remediation for inpatients with psychosis: a systematic review and meta-analysis

2020 ◽  
Vol 50 (7) ◽  
pp. 1062-1076
Author(s):  
Matteo Cella ◽  
Tom Price ◽  
Holly Corboy ◽  
Juliana Onwumere ◽  
Sukhi Shergill ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Meta Analysis ◽  
Random Effect ◽  
Cognitive Remediation ◽  
Poor Response ◽  
Response To Treatment ◽  
Future Research ◽  
Post Discharge ◽  
Global Functioning ◽  
Cognitive Difficulties

AbstractCognitive difficulties are common in people with psychosis and associated with considerable disability. Cognitive remediation (CR) can reduce the burden of cognitive difficulties and improve functioning. While mental health care has predominantly shifted to the community, people with greater illness severity and complexity, and those with poor response to treatment and concomitant greater cognitive difficulties, continue to receive inpatient care. The aim of this study is to review and evaluate the acceptability and efficacy of CR for inpatients with psychosis. A systematic search was used to identify randomized controlled trials of CR for inpatients with psychosis. Demographic and clinical information was extracted by independent raters together with therapy outcomes. Study quality was assessed using the Cochrane Collaboration Risk of Bias Assessment tool. Standardized mean change for cognitive and functional outcomes was calculated using Hedges's g and used to infer therapy effects with meta-analysis. Twenty studies were identified considering 1509 participants. Results from random-effect models suggested that CR was effective in improving processing speed (g = 0.48), memory (g = 0.48) and working memory (g = 0.56). While there was an indication of improvements in the levels of vocational, social and global functioning, these were less reliable. On average, 7% of participants dropped-out of treatment. Studies methodological quality was moderate. CR is an acceptable intervention for inpatients with psychosis and can lead to significant cognitive improvements. Evidence for improvement in functioning requires more robust and converging evidence. Future research should extend the evaluation of inpatient CR to subsequent post-discharge community functioning and further need for care.

scholarly journals 3464 Readability, Understandability, and Actionability of Inpatient Discharge Instructions: A Health Literacy Perspective

2019 ◽  
Vol 3 (s1) ◽  
pp. 94-94
Author(s):  
Alexander Glick ◽  
Kyara Marquez ◽  
Michael Migotsky ◽  
Benard Dreyer ◽  
Suzy Tomopoulos ◽  
...  
Keyword(s):  
Health Literacy ◽  
Assessment Tool ◽  
Reading Level ◽  
Inpatient Setting ◽  
Medical Terminology ◽  
Plain Language ◽  
Discharge Instructions ◽  
Post Discharge ◽  
Discharge Outcomes ◽  
Pediatric Inpatient

OBJECTIVES/SPECIFIC AIMS: Parents often make errors in comprehending and executing their child’s inpatient discharge instructions, putting their child at risk for adverse post-discharge outcomes. Suboptimal provider-caregiver communication has been linked to errors in comprehension and execution of provider instructions, especially for parents with limited health literacy. Few studies have systematically examined features of pediatric inpatient written discharge instructions that may contribute to errors. Our objective was to assess the readability, understandability, and actionability of pediatric inpatient written discharge instructions. METHODS/STUDY POPULATION: This was a cross-sectional analysis of the written discharge instructions (standardized template, content not standardized) provided to parents at an urban public hospital, enrolled as part of a prospective cohort study (n=171) focused on parent ability to comprehend their child’s discharge instructions. Inclusion criteria were: English/Spanish-speaking parents of children ≤12 years old discharged on ≥1 daily medicine. Discharge instructions were assessed for: 1) Readability (Average of 5 formulas [Flesh Reading Ease, Flesch-Kincaid, Gunning Fog, Simple Measure of Gobbledygook, Forcast]), 2) Understandability and actionability (AHRQ Patient Education Materials Assessment Tool [2 independent reviewers; κ>0.8 for both]). RESULTS/ANTICIPATED RESULTS: Mean (SD) reading grade level was 11.4 (0.7); none of the instructions were written at a recommended reading level of 6th to 8th grade or below. Mean (SD) understandability was 37.7 (6.9)%; mean actionability was 41.7 (8.4)%. All 171 sets of instructions used medical terminology without adequate plain language explanations and included information that was not relevant to the child’s diagnosis and associated care (e.g., obesity counseling, smoking cessation given to a child with appendicitis). None of the sets of instructions presented information in a logical sequence (e.g., diet instructions in more than one location) or included any pictographic information or other visual aids to support the text (e.g., diagram of medication dose within a dosing tool). DISCUSSION/SIGNIFICANCE OF IMPACT: Written discharge instructions provided in the pediatric inpatient setting were suboptimal. Use of a systematic approach to improve discharge instructions, using a health literacy perspective, has the potential to improve post-discharge outcomes in children.

533 READMISSIONS TO GERIATRIC MEDICINE IN A DISTRICT GENERAL HOSPITAL, A THEMATIC ANALYSIS

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
R Whiting ◽  
R Comerford
Keyword(s):  
Assessment Tool ◽  
Geriatric Medicine ◽  
District General Hospital ◽  
Case Note ◽  
Discharge Process ◽  
Post Discharge ◽  
Pareto Analysis ◽  
Key Factor ◽  
The Right ◽  
Case Note Review

Abstract Introduction 621 patients were readmitted within 30 days of discharge from our Geriatric Medicine department between October 2019 and March 2020. This project was undertaken to better understand whether some of these readmissions could be prevented. Methods Analysis showed a clear peak of 78 patients returning at day one post discharge, and a subsequent Pareto analysis revealed that nearly 80% of these were discharged from 2 locations, our frailty unit and MAU. This cohort became the focus of our review. With support from the Acute Frailty Network, a virtual structured case note review was undertaken by a multidisciplinary team including an independent Geriatrician. This considered the patient’s case, whether they were cared for by the right team in the right place, whether they were readmitted with a new diagnosis and whether any improvements in the discharge process or wider service could have prevented their readmission. Results The case note review process was halted early as clear recurring themes emerged. Firstly, feedback showed that all frail patients were identified early in the patient pathway, were cared for by the appropriate team and a CGA was commenced promptly. Secondly, whilst the majority of day one readmissions had a diagnosis of delirium, most were not diagnosed as such until their re-attendance, despite documented confusion. Failure to recognise this, treat their delirium, and plan for fluctuations in cognition upon discharge were found to contribute to a high readmission rate. Conclusion We found that delirium identification was a key factor in early readmissions to our service. We identified clear opportunities to strengthen and formalise delirium diagnoses, and better plan patient management and discharge plans as a result. A multidisciplinary quality improvement group looking at delirium has been initiated and has already achieved a statistically significant improvement in the use of 4AT, a delirium assessment tool.

Age Norms for Auditory-Perceptual Neurophonetic Parameters: A Prerequisite for the Assessment of Childhood Dysarthria

2020 ◽  
Vol 63 (4) ◽  
pp. 1071-1082
Author(s):  
Theresa Schölderle ◽  
Elisabet Haas ◽  
Wolfram Ziegler
Keyword(s):  
Assessment Tool ◽  
Developmental Trajectories ◽  
Voice Quality ◽  
Typically Developing ◽  
Typically Developing Children ◽  
Age Norms ◽  
Elementary School Age ◽  
Speech Characteristics ◽  
Substantial Progress ◽  
Computer Based

Purpose The aim of this study was to collect auditory-perceptual data on established symptom categories of dysarthria from typically developing children between 3 and 9 years of age, for the purpose of creating age norms for dysarthria assessment. Method One hundred forty-four typically developing children (3;0–9;11 [years;months], 72 girls and 72 boys) participated. We used a computer-based game specifically designed for this study to elicit sentence repetitions and spontaneous speech samples. Speech recordings were analyzed using the auditory-perceptual criteria of the Bogenhausen Dysarthria Scales, a standardized German assessment tool for dysarthria in adults. The Bogenhausen Dysarthria Scales (scales and features) cover clinically relevant dimensions of speech and allow for an evaluation of well-established symptom categories of dysarthria. Results The typically developing children exhibited a number of speech characteristics overlapping with established symptom categories of dysarthria (e.g., breathy voice, frequent inspirations, reduced articulatory precision, decreased articulation rate). Substantial progress was observed between 3 and 9 years of age, but with different developmental trajectories across different dimensions. In several areas (e.g., respiration, voice quality), 9-year-olds still presented with salient developmental speech characteristics, while in other dimensions (e.g., prosodic modulation), features typically associated with dysarthria occurred only exceptionally, even in the 3-year-olds. Conclusions The acquisition of speech motor functions is a prolonged process not yet completed with 9 years. Various developmental influences (e.g., anatomic–physiological changes) shape children's speech specifically. Our findings are a first step toward establishing auditory-perceptual norms for dysarthria in children of kindergarten and elementary school age. Supplemental Material https://doi.org/10.23641/asha.12133380

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

2020 ◽  
Vol 29 (4) ◽  
pp. 1944-1955 ◽  
Author(s):  
Maria Schwarz ◽  
Elizabeth C. Ward ◽  
Petrea Cornwell ◽  
Anne Coccetti ◽  
Pamela D'Netto ◽  
...  
Keyword(s):  
At Risk ◽  
Allied Health ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Low Risk ◽  
False Negatives ◽  
Exact Agreement ◽  
Risk Patients ◽  
Impact Phase ◽  
Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

Measuring “Language Access Profiles” in Deaf and Hard-of-Hearing Children With the DHH Language Exposure Assessment Tool

2020 ◽  
pp. 1-25
Author(s):  
Matthew L. Hall ◽  
Stephanie De Anda
Keyword(s):  
Cluster Analysis ◽  
Exposure Assessment ◽  
Hard Of Hearing ◽  
Assessment Tool ◽  
Communication Mode ◽  
Developmental Potential ◽  
Language Access ◽  
Retest Reliability ◽  
Language Exposure ◽  
Test Retest Reliability

Purpose The purposes of this study were (a) to introduce “language access profiles” as a viable alternative construct to “communication mode” for describing experience with language input during early childhood for deaf and hard-of-hearing (DHH) children; (b) to describe the development of a new tool for measuring DHH children's language access profiles during infancy and toddlerhood; and (c) to evaluate the novelty, reliability, and validity of this tool. Method We adapted an existing retrospective parent report measure of early language experience (the Language Exposure Assessment Tool) to make it suitable for use with DHH populations. We administered the adapted instrument (DHH Language Exposure Assessment Tool [D-LEAT]) to the caregivers of 105 DHH children aged 12 years and younger. To measure convergent validity, we also administered another novel instrument: the Language Access Profile Tool. To measure test–retest reliability, half of the participants were interviewed again after 1 month. We identified groups of children with similar language access profiles by using hierarchical cluster analysis. Results The D-LEAT revealed DHH children's diverse experiences with access to language during infancy and toddlerhood. Cluster analysis groupings were markedly different from those derived from more traditional grouping rules (e.g., communication modes). Test–retest reliability was good, especially for the same-interviewer condition. Content, convergent, and face validity were strong. Conclusions To optimize DHH children's developmental potential, stakeholders who work at the individual and population levels would benefit from replacing communication mode with language access profiles. The D-LEAT is the first tool that aims to measure this novel construct. Despite limitations that future work aims to address, the present results demonstrate that the D-LEAT represents progress over the status quo.

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