EPA-1426 – Implementation of new systems as part of the clinical care processes: Knowledge of operations management and the attitude of patients can make the difference

Objective To examine Canadian pediatric rheumatology workforce and care processes. Methods Pediatric rheumatologists and allied health professionals (AHPs) participated. A designee from each academic centre provided workforce information including number of providers, total and breakdown of full-time equivalents (FTE), and triage processes. We calculated the clinical care FTE (cFTE) available per 75,000 (recommended benchmark) and 300,000 (adjusted) children using 2019 census data. The national workforce deficit was calculated as the difference between current and expected cFTEs. Remaining respondents were asked about ambulatory practices. Results The response rate of survey A (workforce information) and survey B (ambulatory practice information) was 100% and 54%, respectively. The majority of rheumatologists (91%) practiced in academic centres. The median number of rheumatologists per centre was 3 (IQR:3) and median cFTE was 1.8 (IQR:1.5). The median cFTE per 75,000 was 0.2 (IQR:0.3) with a national deficit of 80 cFTEs. With the adjusted benchmark, there was no national deficit but a regional maldistribution of rheumatologists. All centres engaged in multidisciplinary practices with a median of 4 different AHPs, although the median FTE for AHPs was ≤1. Most centres (87%) utilized a centralized triage process. Of 9 (60%) centres that used an electronic triage process, 6 were able to calculate wait times. Most clinicians integrated quality improvement practices, such as pre-visit planning (68%), post-visit planning (68%), and periodic health outcome monitoring (36-59%). Conclusion This study confirms a national deficit at the current recommended benchmark. Most rheumatologists work in multidisciplinary teams, but AHP support may be inadequate.

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Research or clinical care: what’s the difference?

Journal of Medical Ethics ◽

10.1136/medethics-2018-104926 ◽

2018 ◽

Vol 44 (6) ◽

pp. 359-360

Author(s):

Nina Hallowell

Keyword(s):

Clinical Care ◽

The Difference

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Evaluating prediction of continuous clinical values: a glucose case study (Preprint)

10.2196/preprints.27048 ◽

2021 ◽

Author(s):

George Hripcsak ◽

David J Albers

Keyword(s):

Predictive Models ◽

Clinical Utility ◽

Clinical Care ◽

Glucose Measurement ◽

Care Processes ◽

Low Glucose ◽

Potential Clinical Utility ◽

Rms Error ◽

Error Grid

BACKGROUND Background: It would be useful to be able to assess the utility of predictive models of continuous values before clinical trials are carried out. OBJECTIVE Objective: To compare metrics to assess the potential clinical utility of models that produce continuous value forecasts. METHODS Methods: We ran a set of data assimilation forecast algorithms on time series of glucose measurements from intensive care unit patients. We evaluated the forecasts using four sets of metrics: glucose root mean square error, a set of metrics on a transformed glucose value, the estimated effect on clinical care based on an insulin guideline, and a glucose measurement error grid (Parkes grid). We assessed correlation among the metrics and created a set of factor models. RESULTS Results: The metrics generally correlated with each other, but those that estimated the effect on clinical care correlated with the others the least and were generally associated with their own independent factors. The other metrics appeared to separate into those that emphasized errors in low glucose versus errors in high glucose. The Parkes grid was well correlated with the transformed glucose but not the estimation of clinical care. CONCLUSIONS Discussion: Our results indicate that we need to be careful before we assume that commonly used metrics like RMS error in raw glucose or even metrics like the Parkes grid that are designed to measure importance of differences will correlate well with actual effect on clinical care processes. A combination of metrics appeared to explain the most variance between cases. As prediction algorithms move into practice, it will be important to measure actual effects.

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Impact of Personal Protective Equipment on the Performance of Emergency Pediatric Procedures by Prehospital Providers

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.128 ◽

2020 ◽

pp. 1-8

Author(s):

Maybelle Kou ◽

Aaron J. Donoghue ◽

Helen Stacks ◽

Adam Kochman ◽

Meghan Semião ◽

...

Keyword(s):

Pediatric Patient ◽

Personal Protective Equipment ◽

Clinical Care ◽

Chemical Exposure ◽

Task Completion ◽

Protective Equipment ◽

Signed Rank ◽

The Difference ◽

Simulation Center ◽

Bag Mask Ventilation

ABSTRACT Background: Personal protective equipment (PPE) is worn by prehospital providers (PHPs) for protection from hazardous exposures. Evidence regarding the ability of PHPs to perform resuscitation procedures has been described in adult but not pediatric models. This study examined the effects of PPE on the ability of PHPs to perform resuscitation procedures on pediatric patients. Methods: This prospective study was conducted at a US simulation center. Paramedics wore normal attire at the baseline session and donned full Level B PPE for the second session. During each session, they performed timed sets of psychomotor tasks simulating clinical care of a critically ill pediatric patient. The difference in time to completion between baseline and PPE sessions per task was examined using Wilcoxon signed-rank tests. Results: A total of 50 paramedics completed both sessions. Median times for task completion at the PPE sessions increased significantly from baseline for several procedures: tracheal intubation (+4.5 s; P = 0.01), automated external defibrillator (AED) placement (+9.5 s; P = 0.01), intraosseous line insertion (+7 s; P < 0.0001), tourniquet (+8.5 s; P < 0.0001), intramuscular injection (+21-23 s, P < 0.0001), and pulse oximetry (+4 s; P < 0.0001). There was no significant increase in completion time for bag-mask ventilation or autoinjector use. Conclusions: PPE did not have a significant impact on PHPs performing critical tasks while caring for a pediatric patient with a highly infectious or chemical exposure. This information may guide PHPs faced with the situation of resuscitating children while wearing Level B PPE.

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Differences in Sexually Transmitted Infections between the Precrisis Period (2000–2007) and the Crisis Period (2008–2014) in Granada, Spain

Journal of Clinical Medicine ◽

10.3390/jcm8020277 ◽

2019 ◽

Vol 8 (2) ◽

pp. 277 ◽

Cited By ~ 4

Author(s):

María Pérez-Morente ◽

María Sánchez-Ocón ◽

Encarnación Martínez-García ◽

Adelina Martín-Salvador ◽

César Hueso-Montoro ◽

...

Keyword(s):

Sexually Transmitted Infections ◽

Clinical Care ◽

Sociodemographic Factors ◽

Risk Indicators ◽

Unprotected Sexual Intercourse ◽

Crisis Period ◽

Sexually Transmitted ◽

Specialized Center ◽

Bivariate Statistical Analysis ◽

The Difference

Objective: To analyze the difference in the prevalence of sexually transmitted infections (STIs) between two time periods (2000–2007 and 2008–2014, with the latter period characterized by the economic crisis), as well as determine differences in sociodemographic factors, clinical care, and risk indicators. Methods: This was a retrospective, observational, and analytical study, reviewing 1437 medical records of subjects attending a specialized center in the province of Granada (Spain) for consultation associated with the presence or suspicion of an STI between 2000–2014. Data were collected on variables relating to the research objective. A descriptive and bivariate statistical analysis was performed by multiple logistic regression. Results: In the analysis comparing the presence of STIs between the crisis and non-crisis periods, the percentage of positive diagnoses reached 56.6% compared to 43.4% negative diagnoses during the non-crisis period, while the percentages were 75.2% and 24.8%, respectively, during the crisis period. This difference was statistically significant (p < 0.001) with an odds ratio (OR) of 2.21 after adjusting for age, sex, days since last unprotected sexual intercourse, and partners in the last year. Conclusions: There are significant differences in the prevalence of STIs between the study periods, which is consistent with the reports of some authors regarding the effect of the financial crisis on these conditions; however, it is worth considering other aspects that might explain the differences.

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Incorporating Patient Narratives to Enhance Audiological Care and Clinical Research Outcomes

American Journal of Audiology ◽

10.1044/2021_aja-20-00228 ◽

2021 ◽

Vol 30 (3S) ◽

pp. 916-921 ◽

Cited By ~ 1

Author(s):

Khaya D. Clark ◽

Angela C. Garinis ◽

Dawn Konrad-Martin

Keyword(s):

Quality Improvement ◽

Health Care Systems ◽

Clinical Care ◽

Health Conditions ◽

Patient Centered ◽

Aural Rehabilitation ◽

Experience Of Care ◽

Patient Narratives ◽

Care Processes ◽

Care Systems

Purpose The engagement of patients as key stakeholders in their experience of care processes is a critical component of quality improvement efforts for both clinical care and translational research. Increasingly, health care systems are soliciting input from patients on care processes and experiences through surveys, patient interviews, and patient video narratives. The purpose of this viewpoint article is twofold: (a) to describe the increasing role of patient narratives about their experiences with adverse health conditions to inform patient-centered research and quality improvement efforts and (b) to present three patient narratives that highlight the real-world impacts of hearing loss and tinnitus, the life enhancing impacts of aural rehabilitation, and the importance of prospective ototoxicity monitoring in individuals with complex health conditions. Conclusion Patient narratives provide individual patient perspectives that can be used to build awareness of the range of experiences and impact of hearing disorders, and to explore patient preferences for when and how to implement hearing-related clinical services.

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Operations Research And Operations Management: From Selective Optimization To System Optimization

Journal of Business & Economics Research (JBER) ◽

10.19030/jber.v3i7.2790 ◽

2011 ◽

Vol 3 (7) ◽

Author(s):

Jack A. Fuller ◽

C. Lee Martinec

Keyword(s):

Decision Making ◽

Operations Research ◽

Operations Management ◽

Service Industry ◽

System Optimization ◽

Research Paper ◽

Font Size ◽

Academic Fields ◽

The Difference ◽

Tools And Techniques

The focus of this research paper is to discuss the development of Operations Management (OM) and Operations Research (OR) with respect to their use within the organization’s decision-making structure.  In addition, the difference in the tools and techniques of the two fields is addressed.  The question is raised as to how distinct the two academic fields have become in light of the application of their models to the service industry.  Suggestions are made regarding the possibility of incorporating OM/OR models and their output into the decision making structure of the organization towards the goal of “system optimization”.

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Enhancing feedback on performance measures: the difference in outlier detection using a binary versus continuous outcome funnel plot and implications for quality improvement

BMJ Quality & Safety ◽

10.1136/bmjqs-2019-009929 ◽

2020 ◽

Vol 30 (1) ◽

pp. 38-45 ◽

Cited By ~ 1

Author(s):

Laurien Kuhrij ◽

Erik van Zwet ◽

Renske van den Berg-Vos ◽

Paul Nederkoorn ◽

Perla J Marang-van de Mheen

Keyword(s):

Intravenous Thrombolysis ◽

Sensitivity Analyses ◽

Binary Outcomes ◽

Continuous Variables ◽

Continuous Outcome ◽

Feedback Information ◽

Funnel Plot ◽

Care Processes ◽

Funnel Plots ◽

The Difference

BackgroundHospitals and providers receive feedback information on how their performance compares with others, often using funnel plots to detect outliers. These funnel plots typically use binary outcomes, and continuous variables are dichotomised to fit this format. However, information is lost using a binary measure, which is only sensitive to detect differences in higher values (the tail) rather than the entire distribution. This study therefore aims to investigate whether different outlier hospitals are identified when using a funnel plot for a binary vs a continuous outcome. This is relevant for hospitals with suboptimal performance to decide whether performance can be improved by targeting processes for all patients or a subgroup with higher values.MethodsWe examined the door-to-needle time (DNT) of all (6080) patients with acute ischaemic stroke treated with intravenous thrombolysis in 65 hospitals in 2017, registered in the Dutch Acute Stroke Audit. We compared outlier hospitals in two funnel plots: the median DNT versus the proportion of patients with substantially delayed DNT (above the 90th percentile (P90)), whether these were the same or different hospitals. Two sensitivity analyses were performed using the proportion above the median and a continuous P90 funnel plot.ResultsThe median DNT was 24 min and P90 was 50 min. In the binary funnel plot for the proportion of patients above P90, 58 hospitals had average performance, whereas in the funnel plot around the median 14 of these hospitals had significantly higher median DNT (24%). These hospitals can likely improve their DNT by focusing on care processes for all patients, not shown by the binary outcome funnel plot. Similar results were shown in sensitivity analyses.ConclusionUsing funnel plots for continuous versus binary outcomes identify different outlier hospitals, which may enhance hospital feedback to direct more targeted improvement initiatives.

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A guide for pre-procedural imaging for transcatheter aortic valve replacement patients

Perioperative Medicine ◽

10.1186/s13741-020-00165-1 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Tjörvi E. Perry ◽

Stephen A. George ◽

Belinda Lee ◽

Joyce Wahr ◽

Darrell Randle ◽

...

Keyword(s):

Cardiac Computed Tomography ◽

Clinical Care ◽

Peripheral Vasculature ◽

Team Members ◽

Transcatheter Aortic Valve ◽

Cardiac Assessment ◽

Preprocedural Imaging ◽

The Difference ◽

Clinical Care Team ◽

Review Current

AbstractSafe and accurate pre-procedural assessment of cardiovascular anatomy, physiology, and pathophysiology prior to TAVR procedures can mean the difference between success and catastrophic failure. It is imperative that clinical care team members share a basic understanding of the preprocedural imaging technologies available for optimizing the care of TAVR patients. Herein, we review current imaging technology for assessing the anatomy, physiology, and pathophysiology of the aortic valvular complex, ventricular function, and peripheral vasculature, including echocardiography, cardiac catheterization, cardiac computed tomography, and cardiac magnetic resonance prior to a TAVR procedure. The authorship includes cardiac-trained anesthesiologists, anesthesiologists with expertise in pre-procedural cardiac assessment and optimization, and interventional cardiologists with expertise in cardiovascular imaging prior to TAVRs. Improving the understanding of all team members will undoubtedly translate into safer, more coordinated patient care.

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Why Hasn't Genomic Testing Changed the Landscape in Clinical Oncology?

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2012.32.78 ◽

2012 ◽

pp. e52-e55 ◽

Cited By ~ 5

Author(s):

Daniel F. Hayes ◽

Muin J. Khoury ◽

David Ransohoff

Keyword(s):

Clinical Utility ◽

Computational Models ◽

New Technologies ◽

Clinical Care ◽

Tumor Biomarker ◽

False Discovery Rates ◽

Patients With Cancer ◽

Slow Progress ◽

The Difference ◽

Therapeutic Research

Overview: The “omics” revolution produced great optimism that tumor biomarker tests based on high-order analysis of multiple (sometimes thousands) of factors would result in truly personalized oncologic care. Unfortunately, 10 years into the revolution, the promise of omics-based research has not yet been realized. The factors behind the slow progress in omics-based clinical care are many. First, over the last 15 years, there has been a gradual recognition of the importance of conducting tumor biomarker science with the kind of rigor that has traditionally been used for therapeutic research. However, this recognition has only recently been applied widely, and therefore most tumor biomarkers have insufficiently high levels of evidence to determine clinical utility. Second, omics-based research offers its own particular set of concerns, especially in regard to overfitting computational models and false discovery rates. Researchers and clinicians need to understand the importance of analytic validity, and the difference between clinical/biologic validity and clinical utility. The latter is required to introduce a tumor biomarker test of any kind (single analyte or omics-based), and are ideally generated by carefully planned and properly conducted “prospective retrospective” or truly prospective clinical trials. Only carefully planned studies, which take all three of these into account and in which the investigators are aware and recognize the enormous risk of unintended bias and overfitting inherent in omics-based test development, will ultimately result in translation of the exciting new technologies into better care for patients with cancer.

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