The patient journey in knee osteoarthritis-variations in diagnosis, patient characteristics, and treatment by physician specialty

2021 ◽  
Vol 29 ◽  
pp. S281-S282
Author(s):  
A.V. Bedenbaugh ◽  
G. Oderda ◽  
V.C. Lee ◽  
J. Moller ◽  
D. Brixner ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Patient Characteristics ◽  
Physician Specialty ◽  
Patient Journey

Abstract 378: Using Lean Methodology to Reduce Variation in Care of Acute Coronary Syndrome Patients

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Guy Fradet ◽  
Carol Laberge ◽  
Andrew Kmetic ◽  
Ronnalea Hamman
Keyword(s):  
Decision Making ◽  
Acute Coronary Syndrome ◽  
Regional Variation ◽  
Coronary Revascularization ◽  
Patient Characteristics ◽  
Care Utilization ◽  
Process Of Care ◽  
Patient Journey ◽  
Coronary Syndrome ◽  
Decision Points

Background: Regional variation in the utilization of health services is a well-documented phenomenon in health care with numerous studies reporting substantial and unexplained variations in coronary revascularization. In the Canadian province of British Columbia (BC), five cardiac centers provide coronary revascularization services. In 2011 Cardiac Services BC (CSBC) undertook a study that identified substantial regional variation in coronary revascularization that could not be explained by patient characteristics or risk factors. Following this initial project, CSBC launched an initiative to help better understand the regional variations and possibly devise and implement strategies to reduce them. To get a better understanding of the different processes of care/utilization, one of the approaches used is the application of Lean methodology to the care of acute coronary syndrome (ACS) patients. Methods: Lean methodology is being applied to the patient journey of ACS patients. At each revascularization center Value Steam Maps process maps (VSM) are being prepared through a series of meetings with support, frontline, administrative and clinical staff (see attached example). For each VSM the goal is to identify key decision points in the process of care for ACS patients and to drill down on (Root Cause Analysis) on the decision making environment and criteria used to determine the utilization of coronary revascularization services. Once VSM have been completed they will be compared across sites for similarities and differences. The differences in decision making will then be assessed to determine their effect on variation in utilization across the centers. Discussion: BC is attempting to reduce unexplained variation in coronary revascularization using the Lean methodology to take a systematic approach to the analysis of the process of ACS care across the province. The next step will be to determine to what extent it is possible to standardize decision making at the key decision points across the HAs. Standardization will be achieved through a mix of best practices, evidence and application of guidelines. While the undertaking is still in the early stages it is expected that it will lead to, at the very least, ACS patients receiving the same care regardless of where they receive their care in BC.

Frequency of Use of Imaging Tests in the Diagnosis of Pulmonary Embolism: Effects of Physician Specialty, Patient Characteristics, and Region

2010 ◽  
Vol 194 (4) ◽  
pp. 1018-1026 ◽  
Author(s):  
Mythreyi Bhargavan ◽  
Jonathan H. Sunshine ◽  
Rebecca S. Lewis ◽  
Saurabh Jha ◽  
Jean B. Owen ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Patient Characteristics ◽  
Physician Specialty ◽  
Frequency Of Use

scholarly journals Specialized Dermatological - Rheumatological Patient Management Improves Diagnostic Outcome and Patient Journey: A Four-Year Analysis

2021 ◽  
Author(s):  
Jana Ziob ◽  
Charlotte Behning ◽  
Peter Brossart ◽  
Thomas Bieber ◽  
Dagmar Wilsmann-Theis ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Clinical Signs ◽  
Interdisciplinary Approach ◽  
Signs And Symptoms ◽  
Patient Characteristics ◽  
Classification Criteria ◽  
Close Collaboration ◽  
Patient Journey ◽  
Before And After ◽  
Rheumatological Diseases

Abstract Background:Management of psoriatic arthritis (PsA) and other rheumatological diseases requires an interdisciplinary approach involving dermatologists and rheumatologists. The aim of the study was to analyze the specialized dermatological-rheumatological management before and after foundation of a PsA center. Methods:A retrospective cohort study of all dermatology-rheumatology consultations during two periods was conducted. Period one, from April 1st, 2016 to February 28th, 2018 versus period two, from March 1st, 2018 to January 31st, 2020, after foundation of a PsA center. Clinical data on patient characteristics including psoriasis subtypes, clinical symptoms and signs, disease activity scores, classification criteria and comorbidities as well as patient journey were extracted and analyzed.Results: 404 consultations were studied. Close collaboration in a PsA center lead to a relevantly shortened patient journey concerning rheumatological complaints: period 1: median (IQR): 36.0 (10.0-126.0) months, period 2: median (IQR): 24.0 (6.0-60.0) months. Established scores and classification criteria such as GEPARD or CASPAR did not assist in diagnosis of PsA. Arthralgia (p=0.0407), swollen joints (p=0.0151), morning stiffness (p=0.0451) and dactylitis (p=0.0086) helped to distinguish between osteoarthritis and PsA.Conclusions: Clinical signs and symptoms, scores and classification criteria usually assessed were less helpful than expected in diagnosis of PsA and other rheumatological diseases. Close collaboration in a specialized PsA center yielded the fastest way of diagnosis.

Abstract 268: Using Lean Methodology to Reduce Variation in Care of Acute Coronary Syndrome Patients

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Andrew Kmetic ◽  
Guy Fradet ◽  
Ronnalea Hamman ◽  
Carol Laberge ◽  
Carol Galte
Keyword(s):  
Regional Variation ◽  
Best Practice ◽  
Point Of Care ◽  
Coronary Revascularization ◽  
Patient Characteristics ◽  
Care Staff ◽  
Multiple Sources ◽  
Patient Journey ◽  
Coronary Syndrome ◽  
Decision Points

Background: Regional variation in the utilization of health services is a well-documented phenomenon in health care with numerous studies reporting substantial and unexplained variations in coronary revascularization. In the Canadian province of British Columbia (BC), five cardiac centers provide coronary revascularization services. In 2011 Cardiac Services BC (CSBC) undertook a study that identified substantial regional variation in coronary revascularization that could not be explained by patient characteristics or risk factors. Following this initial project, CSBC launched an initiative to help better understand the regional variations and possibly devise and implement strategies to reduce them. Methods: Using Lean methodology, we are mapping the key processes of care for ACS patients across BC (initially excluding emergent STEMI and cardiogenic shock) at each cardiac centre. The ACS patient journey will be mapped from admission to discharge through several key decision points that determine whether they will continue through to diagnostic catheterization and revascularization or to be medically managed alone. The key decision points are: 1. Decision to refer to diagnostic catheterization and subsequent transfer if necessary. 2. Decision to continue to a revascularization procedure (PCI or CABG) after diagnostic catheterization. The map will summarized these key decision points using multiple sources of data: 1. Flow and patient volumes into and out of each of these decision 2. Times between decision points and key care processes 3. Clinical influencers (ex: standard orders, best practice, established patterns of referral, and consultations) and non-clinical influencers (ex: resource capacity, transportation) that are considered at each decision point (process mapping and interview data). Discussion: BC is attempting to reduce unexplained variation in coronary revascularization using the Lean methodology to take a systematic approach to the analysis of the process of ACS care across the province. Involving physicians and point of care staff in the detailed mapping process has proven to be a significant step in engaging key stakeholders in the project by allowing input into the process of describing the factors affecting variation of practice at each site. The next step is to convene provincially to determine where to improve standardized practice in order to improve patient outcomes at key points along the value stream.

Patient Characteristics Independently Associated With Knee Osteoarthritis Symptom Severity at Initial Orthopedic Consultation

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Harel G. Schwartzberg ◽  
Ryan Roy ◽  
Kyle Wilson ◽  
Hunter Starring ◽  
Claudia Leonardi ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Symptom Severity ◽  
Patient Characteristics

scholarly journals Patient characteristics associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis: a multisite prospective longitudinal study in an advanced practice physiotherapist-led tertiary service

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037070
Author(s):  
Shaun O'Leary ◽  
Maree Raymer ◽  
Peter Window ◽  
Patrick Swete Kelly ◽  
Bula Elwell ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Knee Osteoarthritis ◽  
Tertiary Care ◽  
Poor Response ◽  
Patient Characteristics ◽  
Secondary Outcome ◽  
Advanced Practice ◽  
Multidisciplinary Management ◽  
Point Score ◽  
Prospective Longitudinal

ObjectivesTo explore patient characteristics recorded at the initial consultation associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis (KOA) in tertiary care.DesignProspective multisite longitudinal study.SettingAdvanced practice physiotherapist-led multidisciplinary orthopaedic service within eight tertiary hospitals.Participants238 patients with KOA.Primary and secondary outcome measuresStandardised measures were recorded in all patients prior to them receiving non-surgical multidisciplinary management in a tertiary hospital service across multiple sites. These measures were examined for their relationship with a poor response to management 6 months after the initial consultation using a 15-point Global Rating of Change measure (poor response (scores −7 to +1)/positive response (scores+2 to+7)). Generalised linear models with binomial family and logit link were used to examine which patient characteristics yielded the strongest relationship with a poor response to management as estimated by the OR (95% CI).ResultsOverall, 114 out of 238 (47.9%) participants recorded a poor response. The odds of a poor response decreased with higher patient expectations of benefit (OR 0.74 (0.63 to 0.87) per 1/10 point score increase) and higher self-reported knee function (OR 0.67 (0.51 to 0.89) per 10/100 point score increase) (p<0.01). The odds of a poor response increased with a greater degree of varus frontal knee alignment (OR 1.35 (1.03 to 1.78) per 5° increase in varus angle) and a severe (compared with mild) radiological rating of medial compartment degenerative change (OR 3.11 (1.04 to 9.3)) (p<0.05).ConclusionsThese characteristics may need to be considered in patients presenting for non-surgical multidisciplinary management of KOA in tertiary care. Measurement of these patient characteristics may potentially better inform patient-centred management and flag the need for judicious monitoring of outcome for some patients to avoid unproductive care.

scholarly journals Specialized dermatological-rheumatological patient management improves diagnostic outcome and patient journey in psoriasis and psoriatic arthritis: a four-year analysis

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Jana Ziob ◽  
Charlotte Behning ◽  
Peter Brossart ◽  
Thomas Bieber ◽  
Dagmar Wilsmann-Theis ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Interdisciplinary Approach ◽  
Signs And Symptoms ◽  
Patient Characteristics ◽  
Classification Criteria ◽  
Close Collaboration ◽  
Patient Journey ◽  
Before And After

Abstract Background Management of psoriasis patients with arthralgia suffering from suspected psoriatic arthritis (PsA) requires an interdisciplinary approach involving dermatologists and rheumatologists. The aim of the study was to analyze the specialized dermatological-rheumatological management of these patients before and after foundation of a PsA center. Methods A retrospective cohort study of all dermatological-rheumatological consultations during two periods was conducted. Period one, from April 1st, 2016 to February 28th, 2018 versus period two, from March 1st, 2018 to January 31st, 2020, after foundation of a PsA center. Clinical data on patient characteristics including psoriasis subtypes, clinical symptoms and signs, disease activity scores, classification criteria and comorbidities as well as patient journey were extracted and analyzed. Results Four hundred four consultations were studied. Close collaboration in a PsA center lead to a relevantly shortened patient journey concerning rheumatological complaints: period 1: median (IQR): 36.0 (10.0–126.0) months, period 2: median (IQR): 24.0 (6.0–60.0) months. Established scores and classification criteria such as GEPARD or CASPAR did not assist in diagnosis of PsA. Arthralgia (p = 0.0407), swollen joints (p = 0.0151), morning stiffness (p = 0.0451) and dactylitis (p = 0.0086) helped to distinguish between osteoarthritis and PsA. Conclusions Clinical signs and symptoms, scores and classification criteria usually assessed were less helpful than expected in diagnosis of PsA. Close collaboration in a specialized PsA center yielded the fastest way of diagnosis.

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