scholarly journals 3220 Can you read me now? Clinician variations in managing and responding to secure messages from patients

2019 ◽  
Vol 3 (s1) ◽  
pp. 59-59
Author(s):  
Joy Li-Yueh Lee ◽  
Michael Weiner ◽  
Marianne Matthias
Keyword(s):  
Primary Care ◽  
Medical Center ◽  
Safety Net ◽  
Patient Centeredness ◽  
Cognitive Approach ◽  
Electronic Communications ◽  
Secure Messaging ◽  
Safety Net Hospital ◽  
Primary Care Clinicians

OBJECTIVES/SPECIFIC AIMS: To identify areas of variation in primary care clinician responses to secure messaging and to assess the quality of secure messages by clinicians. METHODS/STUDY POPULATION: This mixed-methods study included twenty one primary care clinicians from a Midwestern safety net hospital and Veterans Affairs medical center. Participants were presented with five short clinical vignettes and corresponding secure messages from hypothetical patients and asked to compose responses. Participants were interviewed about their cognitive approach to the responses as well as perspectives on quality of care as related to electronic communications. RESULTS/ANTICIPATED RESULTS: Every participant recalled having patients who misused secure messaging for urgent issues, suggesting the need for more patient education and the possible adverse consequences of overlooked messages. The study also uncovered key differences in several areas, include clinician timeliness, message management, the circumstances in which they would use messaging, and the content of the messages (including patient-centeredness). While participants agreed that messages about clinical issues should not be resolved via secure messaging, there was a lack of consensus regarding emotionally charged messages and messages dealing with medication adjustments. Some participants spoke of the need for more guidance in knowing when best to use secure messaging. “Sometimes,” one physician said, “it feels like we’re just making up [rules for secure messaging].” Although clinician responses were uniformly respectful, the patient-centeredness varied in the use of jargon and social talk, as well as clarity for patients. DISCUSSION/SIGNIFICANCE OF IMPACT: This study revealed variations in provider approaches to secure messaging, and the content of responses. These variations reflect lack of consensus about how care is delivered via secure messaging, and reveal the need for clinician guidance. They also suggest possible negative patient consequences if secure messaging is used ineffectively. The extent to which variations are undesirable remains unknown. Future work will explore the consequences of such variations.

Abstract 143A: Does Insurance Type Predict Quality of Anticoagulation Care in a Boston Safety Net Hospital System?

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Alok Kapoor ◽  
Nancy R Kressin ◽  
Amresh D Hanchate ◽  
Mengyun Lin ◽  
Chieh Chu ◽  
...  
Keyword(s):  
Medical Center ◽  
Safety Net ◽  
Easy Access ◽  
Uninsured Patients ◽  
Hospital System ◽  
Commercial Insurance ◽  
Safety Net Hospital ◽  
Free Care ◽  
The Impact

Background: Boston Medical Center (BMC) is the primary safety net hospital for Eastern Massachusetts and has a diverse patient population with diverse insurance types. Such types include commercial and public insurance (Medicare and Medicaid) and Free Care, limited coverage funded by money distributed to safety-net institutions to care for uninsured patients. In 2006, the state expanded Medicaid eligibility and began offering Commonwealth Care, comprehensive subsidized coverage with retail pharmacy benefits, for uninsured patients. The impact of these insurance types on individual cardiovascular conditions has not been studied. Venous thromboembolism (VTE), comprised of deep venous thrombosis and pulmonary embolism, is a condition whose clinical course is dependent on high quality anticoagulation care including easy access to medication and providers. Time in the therapeutic range (TTR), the percentage of time a patient spends with INR between 2 and 3, has emerged as the preeminent way to measure quality of anticoagulation care. In this study, we compared quality of anticoagulation among different insurance types. Methods: Using clinical data, we identified adults aged 18 to 64 with a new episode of VTE diagnosed in the years 2003 to 2010 at BMC or its affiliated health centers. To be eligible for inclusion, each patient had to have an ICD-9-CM code for VTE and an INR test in the month following VTE diagnosis. We computed TTR using all INR values from diagnosis to 12 months according to the Rosendaal method. We then measured the mean TTR for each of six insurance categories based on primary insurance at time of diagnosis. Using multiple linear regression, we adjusted measurements for sex, age, race, language preference, area poverty, VTE type, recent surgery, and number of Elixhauser comorbidities. Results: We identified 1099 patients with VTE. Twenty-three percent had commercial insurance, 37% Medicaid, 16% Medicare, 4% Commonwealth care, 18% Free Care, and 2% other. Mean TTR was 39.3%. Patients with Free Care and Commonwealth Care had similar TTR compared to those with commercial insurance. Patients with Medicaid, Medicare or other insurance had significantly lower TTR, compared to those with commercial insurance. Conclusion: Quality of anticoagulation care was low in this population. Residual confounding such as from healthy worker effect may account for higher TTR in patients with commercial insurance. In future work we plan to expand measurement of insurance effects to patients receiving anticoagulation for indications other than VTE and adjust our measurements for temporal bias

Calcium and magnesium infusions for prevention of oxaliplatin-induced peripheral neuropathy.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 387-387
Author(s):  
M. Bupathi ◽  
G. Mahmud ◽  
J. Kovar ◽  
E. Wang ◽  
T. E. O'Brien
Keyword(s):  
Peripheral Neuropathy ◽  
Cumulative Dose ◽  
Medical Center ◽  
Demographic Data ◽  
Performance Status ◽  
Safety Net ◽  
Control Group ◽  
Minority Population ◽  
Tumor Type ◽  
Safety Net Hospital

387 Background: Oxaliplatin plays an important role in chemotherapy regimens for colorectal and other GI malignancies. Debilitating peripheral neuropathy (PN) often develops with use of this drug. One study (Grothey A et al, ASCO 2009, abst #4025) has shown that pre- and post-oxaliplatin infusions with calcium (Ca) and magnesium (Mg) may reduce this toxicity. To confirm this in an unselected indigent minority population, a retrospective review was performed comparing development of PN in oxaliplatin exposed patients treated with or without Ca/Mg. Methods: Records of patients who received oxaliplatin from 1/2008 to 12/2009 at MetroHealth Medical Center, a large safety net hospital in Cleveland, OH, were reviewed. 47 patients received Ca/Mg + oxaliplatin and 46 oxaliplatin alone. Data collected included age, race, gender, insurance status, performance status, tumor type, stage, concomitant diseases (DM and EtOH), number of cycles and cumulative dose of oxaliplatin. PN was determined using the Common Terminology Criteria of Adverse Events (CTCAE) version 3.0. Patients were followed 6 months after completion of oxaliplatin. Results: Demographic data was similar between the two groups. Colorectal cancer compromised 77% of the treatment group and 85% of control group. Patients who received Ca/Mg had significantly less PN in all three grades (1-3) compared with the control group (grade 1 89.4% vs. 71.7%, grade II 10.6% vs. 19.6%, grade 3 0% vs. 8.7%, respectively). The cumulative dose of oxaliplatin did not differ between the two groups (Ca/Mg median 1,143 range 260-2,169; control median 1,425 range 137-2,635). The combined total grades 2 and 3 in both the treatment and control (10.6% vs. 28.3%, p = 0.038) favored use of Ca/Mg. Conclusions: This small, retrospective study confirms that Ca/Mg infusions reduce the incidence of clinically significant (grade 2/3) PN in pts receiving oxaliplatin. No significant financial relationships to disclose.

scholarly journals Implementing a weight-specific quality-of-life tool for young people in primary healthcare

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0052
Author(s):  
Yemi Oluboyede ◽  
Sarah Hill ◽  
Suzanne McDonald ◽  
Emily Henderson
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Young People ◽  
General Practitioners ◽  
Primary Healthcare ◽  
Global Public Health ◽  
Framework Analysis ◽  
Primary Care Clinicians ◽  
The Impact

BackgroundObesity is thought to be one of the most serious global public health challenges of the 21st century. The primary care setting is important in terms of the diagnosis, education and management of obesity in children and young people. This study explored the views of primary care clinicians on the implementation of a quality of life (QoL) tool to help young people and their families identify the impact of weight on QoL.AimTo assess the acceptability and feasibility of implementing the Weight-specific Adolescent Instrument for Economic-evaluation (WAItE) QoL tool for young people aged 11–18 years in primary care.MethodOne-to-one, semi-structured interviews were conducted with a purposive sample of primary healthcare clinicians working in practices located in areas of varying deprivation in Northern England, UK. Interview transcripts were coded and analysed using Framework Analysis in NVivo 10.ResultsParticipants (n=16 General Practitioners; n=4 practice nurses) found the WAItE tool acceptable for them and their patients and believed it was feasible for use in routine clinical practice. It was important to primary care clinicians that the tool would provide an overall QoL score that would be easy for General Practitioners and nurses to interpret, to help them identify patients most in need of specialist help.ConclusionsThis study has developed a platform for further research around QoL in overweight and obese young people. A future feasibility study will focus on implementing the tool in a small number of primary healthcare practices.

scholarly journals Factors affecting the rates of adherence to surveillance recommendations for incidental pancreatic cystic lesions in a large urban safety net hospital

2020 ◽  
Vol 7 (1) ◽  
pp. e000430
Author(s):  
Andrew Canakis ◽  
Asaf Maoz ◽  
Jaroslaw N Tkacz ◽  
Christopher Huang
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Safety Net ◽  
Multivariate Logistic Regression Model ◽  
Cystic Lesions ◽  
Factors Affecting ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Access To Primary Care

BackgroundPancreatic cystic lesions (PCLs) are a heterogenous group of lesions with varying degrees of malignant potential. PCLs are often incidentally detected on imaging. Management for patients without an immediate indication for resection or tissue sampling entails radiographic surveillance to assess for features concerning for malignant transformation. This study aims to determine the rates of adherence to surveillance recommendations for incidental PCLs, and identify factors associated with adherence or loss of follow-up.MethodsWe conducted a single-centre retrospective study of patients at a tertiary safety net hospital with incidentally discovered asymptomatic PCLs. Follow-up was defined as having undergone repeat imaging as recommended in the radiology report. Data were analysed using logistic regression.ResultsWithin our cohort (n=172), 123 (71.5%) subjects completed follow-up imaging. Attending a gastroenterology appointment was most strongly associated with completing follow-up for PCLs and remained significant (p=0.001) in a multivariate logistic regression model. Subjects without a documented primary care provider were less likely to have follow-up (p=0.028). Larger cyst size was associated with completion of follow-up in univariate only (p=0.067).ConclusionWe found that follow-up of an incidentally discovered PCLs was completed in the majority of our subjects. Incomplete follow-up for PCLs occurred in up to one in three to four patients in our cohort. Access to primary care and utilisation of subspecialty gastroenterology care are associated with completion of follow-up for PCLs. If validated, our findings can guide potential interventions to improve follow-up rates for PCLs.

scholarly journals Predicting diabetes-related hospitalizations based on electronic health records

2018 ◽  
Vol 28 (12) ◽  
pp. 3667-3682 ◽  
Author(s):  
Theodora S Brisimi ◽  
Tingting Xu ◽  
Taiyao Wang ◽  
Wuyang Dai ◽  
Ioannis Ch Paschalidis
Keyword(s):  
New England ◽  
Medical Center ◽  
Computational Cost ◽  
Safety Net ◽  
New Method ◽  
Supervised Machine Learning ◽  
Support Vector ◽  
Large Set ◽  
Machine Learning Classification ◽  
Safety Net Hospital

Objective: To derive a predictive model to identify patients likely to be hospitalized during the following year due to complications attributed to Type II diabetes. Methods: A variety of supervised machine learning classification methods were tested and a new method that discovers hidden patient clusters in the positive class (hospitalized) was developed while, at the same time, sparse linear support vector machine classifiers were derived to separate positive samples from the negative ones (non-hospitalized). The convergence of the new method was established and theoretical guarantees were proved on how the classifiers it produces generalize to a test set not seen during training. Results: The methods were tested on a large set of patients from the Boston Medical Center – the largest safety net hospital in New England. It is found that our new joint clustering/classification method achieves an accuracy of 89% (measured in terms of area under the ROC Curve) and yields informative clusters which can help interpret the classification results, thus increasing the trust of physicians to the algorithmic output and providing some guidance towards preventive measures. While it is possible to increase accuracy to 92% with other methods, this comes with increased computational cost and lack of interpretability. The analysis shows that even a modest probability of preventive actions being effective (more than 19%) suffices to generate significant hospital care savings. Conclusions: Predictive models are proposed that can help avert hospitalizations, improve health outcomes and drastically reduce hospital expenditures. The scope for savings is significant as it has been estimated that in the USA alone, about $5.8 billion are spent each year on diabetes-related hospitalizations that could be prevented.

ChemoPalRx: Development and implementation of a chemotherapy mobile provider order entry system in a safety net hospital.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18071-e18071
Author(s):  
Kin Wai (Tony) Hung ◽  
Natasha Banerjee
Keyword(s):  
Los Angeles ◽  
Mobile Application ◽  
Medical Center ◽  
Hospital Setting ◽  
Safety Net ◽  
Quality Improvement Initiative ◽  
Order Entry ◽  
Development Environment ◽  
Safety Net Hospital ◽  
Safety Parameters

e18071 Background: Computerized provider order entry (CPOE) systems have been shown to enhance the safety and efficiency of prescribing chemotherapy over the handwritten ordering process. However, many institutions lack the financial ability, technological capability, or operational flexibility to invest in and implement such a system. In particular, Olive View-UCLA Medical Center (OVMC), a Los Angeles County safety net hospital, is among these institutions with unique restrictions that preclude the use of chemotherapy CPOE and mandate handwritten orders. Methods: In an effort to bridge the gap for safe chemotherapy prescribing, we aimed to develop and implement an effective, scalable, and sustainable chemotherapy provider order entry solution that was operationally sensitive to institutions without a chemotherapy CPOE. The solution was designed as a mobile application using Xcode, the integrative development environment of Apple Inc., with the Swift programing language. Results: On September 5th, 2018, we launched a free, chemotherapy provider order entry solution on the worldwide Apple App Store – ChemoPalRx. Using ChemoPalRx, providers can search, customize, and print common chemotherapy regimens in prescription format. Along with a reference library of over 120 order set and 450 medications, ChemoPalRx is equipped with the functions to automate dosage calculation, suggest pre-medications and safety parameters, and trigger alerts for missing prescribing information. As a quality improvement initiative, we implemented ChemoPalRx at OVMC. Implementation stages include obtaining administrative buy-in, consulting with multidisciplinary staffs, investing $100 USD for a prescription printer, and encouraging providers to download ChemoPalRx on their own mobile devices. An ongoing prospective cohort study is being conducted to determine ChemoPalRx effectiveness in reducing errors compared to handwritten orders. Conclusions: ChemoPalRx is developed to enhance the safety and efficiency of chemotherapy prescribing. Implementation of this mobile application is feasible in the safety-net hospital setting and has the potential to transform oncology practices globally.

Identifying Actionable Causes of Potentially Avoidable Readmissions to an Oncology Service at a Safety Net Hospital

2020 ◽  
pp. OP.20.00593
Author(s):  
Vishal K. Gupta ◽  
Michael Dennis ◽  
Emily Mann ◽  
Joseph O. Jacobson ◽  
Naomi Y. Ko
Keyword(s):  
Pleural Fluid ◽  
Cancer Progression ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Retrospective Chart Review ◽  
Safety Net ◽  
Outpatient Setting ◽  
Oncology Service ◽  
Safety Net Hospital ◽  
Avoidable Readmissions

PURPOSE: Hospital readmissions occur commonly in those receiving cancer care and result in impaired quality of life and increased costs. Causes of readmission in safety net hospitals that serve vulnerable populations are not well understood. The primary goal of this project was to identify potentially avoidable and intervenable causes of readmissions to an urban safety net hospital. METHODS: A retrospective chart review was performed on patients who were readmitted within 30 days of discharge from the hematology and oncology service at Boston Medical Center over the 6-month period between October 2018 and March 2019. Charts were reviewed by three internal medicine residents and discussed under the supervision of an attending oncologist. RESULTS: Two hundred ninety-one patient encounters involving 203 unique patients were identified in the 6-month study period. Of these 291 encounters, 80 encounters (27.5%) were followed by a readmission within 30 days and occurred in 61 (30.0%) unique patients. Nineteen (31.1%) of these 61 patients experienced two readmissions within 30 days of discharge. Twenty-five readmissions (31.3%) were classified as potentially avoidable, with the most common cause of potentially avoidable readmissions attributed to ascitic or pleural fluid reaccumulation (8, 32%). The majority of presumed nonpreventable readmissions were due to expected complications of cancer progression and treatment-related side effects. DISCUSSION: In conclusion, readmissions were common, and a modifiable reason for 30-day readmissions was identified. Addressing recurrent ascitic and pleural fluid reaccumulation in the outpatient setting could help to reduce inpatient hospital readmission on an inpatient oncology service.

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