Patient Care Needs Assessment: An Evidence-Based Process to Inform Quality Care and Decision Making

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

Download Full-text

Accountable Care and Evidence-Based Decision Making

Health Care Delivery and Clinical Science ◽

10.4018/978-1-5225-3926-1.ch017 ◽

2017 ◽

pp. 360-369

Author(s):

Nilmini Wickramasinghe ◽

Steve Goldberg

Keyword(s):

Decision Making ◽

Quality Care ◽

Evidence Based ◽

Accountable Care ◽

Web Based ◽

For Profit ◽

Not For Profit ◽

Global Priority ◽

Critical Issues ◽

Evidence Based Decision Making

In today's cost challenged healthcare environment accountable care and evidence-based decision making have become important considerations. Contemporaneous to this is the fact that the superior management of diabetes has become a global priority especially given the exponential increase in the number of diabetes patients as well as the financial implications of treating this silent epidemic. Thus, this research focuses on trying to address these respective yet critical issues by examining the possibility of using a mobile web-based reporting system that taps into existing widely available resources to monitor and manage gestational diabetes. To test this solution, we adopted a randomized control trial with two-arm cross over applied to a not-for profit hospital in Victoria, Australia. From the perspective of practice, we have uncovered far reaching implications for hospital management's cost vs. quality care to patients. In particular, it appears that the adoption of smartphones to support many aspects of care and patient-clinician interactions is prudent.

Download Full-text

Accountable Care and Evidence-Based Decision Making

Handbook of Research on Healthcare Administration and Management - Advances in Healthcare Information Systems and Administration ◽

10.4018/978-1-5225-0920-2.ch034 ◽

2017 ◽

pp. 567-576

Author(s):

Nilmini Wickramasinghe ◽

Steve L Goldberg

Keyword(s):

Decision Making ◽

Quality Care ◽

Evidence Based ◽

Accountable Care ◽

Web Based ◽

For Profit ◽

Not For Profit ◽

Global Priority ◽

Critical Issues ◽

Evidence Based Decision Making

In today's cost challenged healthcare environment accountable care and evidence-based decision making have become important considerations. Contemporaneous to this is the fact that the superior management of diabetes has become a global priority especially given the exponential increase in the number of diabetes patients as well as the financial implications of treating this silent epidemic. Thus, this research focuses on trying to address these respective yet critical issues by examining the possibility of using a mobile web-based reporting system that taps into existing widely available resources to monitor and manage gestational diabetes. To test this solution, we adopted a randomized control trial with two-arm cross over applied to a not-for profit hospital in Victoria, Australia. From the perspective of practice, we have uncovered far reaching implications for hospital management's cost vs. quality care to patients. In particular, it appears that the adoption of smartphones to support many aspects of care and patient-clinician interactions is prudent.

Download Full-text

Real-world data and patient perspectives on quality care and maintenance therapy (MT) decision-making for recurrent ovarian cancer (ROC).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19174 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19174-e19174

Author(s):

Robert L. Coleman ◽

Rebecca R Crawford ◽

Jeffrey D. Carter ◽

Tamar Sapir

Keyword(s):

Ovarian Cancer ◽

Decision Making ◽

Brca Mutation ◽

Parp Inhibitor ◽

Quality Care ◽

Patient Treatment ◽

Evidence Based ◽

Real World Data ◽

Related Factors ◽

High Level

e19174 Background: Despite clinical evidence illustrating the efficacy of MT for ROC, complexities, such as patient-, treatment-, and disease-related factors, and team-based care coordination, limit its optimal use in ROC. In a quality improvement (QI) program, conducted at 2 oncology systems, we evaluated gaps in evidence-based, quality ROC care. Methods: Between 09/2019-02/2020, retrospective EMR audits of 200 patients with ovarian cancer were analyzed for demographics, disease characteristics, treatment history, and shared decision-making (SDM) involving MT. Surveys were administered to evaluate challenges, barriers and experiences of healthcare professionals (HCP; N = 35) and their patients with ROC (N = 21). The HCP teams participated in audit-feedback sessions and developed action plans for resolving identified gaps. Results: EMR audits revealed low utility of MT among patients with ROC (Table), and only 20% of patients reported that MT was discussed as a treatment option. Lack of access to newer therapies was most commonly identified (27%) by HCP as the biggest challenge in treating patients with ROC. Furthermore, survey results revealed that HCP are challenged to correctly integrate guidelines for patient selection for PARP inhibitor MT based on BRCA mutation status (18% of HCP answered correctly), response to previous chemotherapy (49% correct), and line of therapy (46% correct). Data indicated a low level of SDM – none of the patients indicated a high level involvement in treatment decisions and only 20% indicated a high level of agreement that their care team understood their treatment goals. EMR audits also illustrate low documentation of multiple aspects of SDM (Table). Oncology team members formulated plans to develop guidance documents to assist in therapy sequencing and tools to improve patient education. Conclusions: Overall, data from this QI program indicate gaps, challenges, and barriers in evidence-based, MT decision-making and engagement of patients in SDM. These areas for improvement may be relevant for future interventions to improve the provision of quality ROC care. [Table: see text]

Download Full-text

POS0579 LOCAL ADAPTATION OF RECOMMENDATION-BASED MATERIALS FOR SHARED DECISION-MAKING AND MANAGEMENT OF COMORBIDITY IN RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3922 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 523.1-523

Author(s):

J. M. Alvaro-Gracia ◽

C. Barbazan ◽

J. F. Garcia Llorente ◽

S. Muñoz-Fernández ◽

A. Gomez-Centeno ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Decision Making ◽

Patient Care ◽

Shared Decision Making ◽

Unmet Needs ◽

Easy Access ◽

Successful Implementation ◽

Evidence Based ◽

Shared Decision ◽

Educational Tools

Background:Evolving the management of rheumatoid arthritis (eRA) is a European-wide educational initiative aiming to support improved patient care through practical and educational tools addressing specific unmet needs. The aims of the eRA program were: (1) To identify priority unmet needs with the greatest impact on disease outcomes; (2) To develop practical, educational and guidance tools in line with EULAR recommendations to address identified unmet needs; and (3) To improve RA management and patient care.Objectives:To describe the process by which local adaptations were made of materials derived from evidence-based recommendations in a training programme in rheumatoid arthritis (RA).Methods:A multidisciplinary Steering Committee (17 members, 12 countries) identified unmet needs within the management of RA and prioritised those with the greatest impact on patient outcomes. Practical educational tools addressing priority needs were then developed for dissemination and implementation by the rheumatology community across Europe, including shared decision making practises and a checklist for managing comorbidity in RA, among others. These materials were evaluated in detailed and discussed in small regional groups by practicing rheumatologists. Voting, open discussions and recommendations were extracted from the meetings.Results:Thirty-five Spanish rheumatologists from diverse geographic regions discussed a comorbidity checklist and a shared decision making tool. The results of the local meetings were synthesised as (1) a judicious commitment to check agreed comorbidities, and (2) a list of barriers and facilitators for the implementation of shared decision making at the local settings. With regards to ways to implement the agreed list and periodicity, two issues standed-out: (1) patient education and (2) the need of easy access to information and the use of local organisational systems in place. With respect to shared decision-making, issues raised included messages for self-awareness, challenges, and practical facilitators.Conclusion:Discussion, adaptation, and planning are needed before implementing any evidence-based recommendation and materials if we want to achieve a successful implementation. Further studies should demonstrate whether this initiative was successful in achieving the goals of improved patient care. Our experience could be used as a guidance or example for implementation elsewhere.Disclosure of Interests:None declared

Download Full-text

S42. QUALITATIVE ANALYSIS OF CLINICIANS’ PERSPECTIVES ON THE USE OF A COMPUTERIZED DECISION AID IN THE TREATMENT OF PSYCHOTIC DISORDERS

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.108 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S48-S48

Author(s):

Lukas Roebroek ◽

Jojanneke Bruins ◽

Henderikus Knegtering ◽

Philippe Delespaul ◽

Albert Boonstra ◽

...

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Qualitative Analysis ◽

Decision Aid ◽

Clinical Decision ◽

Daily Clinical Practice ◽

Evidence Based ◽

Shared Decision ◽

Care Needs ◽

Evidence Based Treatments

Abstract Background People with a psychotic illness have varying care needs in different areas of their life, often over prolonged periods. Symptomatic, medical or psychosocial problems can go undetected and therefore remain untreated. Routine outcome monitoring (ROM) is way to systematically monitor these problems. In addition, multidisciplinary guidelines and standards of care provide suitable evidence-based treatments for most care needs. However, the integration of ROM results and the implementation of guidelines in daily clinical care can still be improved. Clinical decision aids (CDAs) can be used as tools to ingrate ROM results and to implement guidelines into daily clinical practice within psychosis care. Despite the effectiveness of CDAs in different medical disciplines, their use in psychiatric care is rare. Our goal is to successfully implement a clinical decision aid in psychosis care, which can promote the use of evidence-based treatments, based on care need identified by ROM. Methods We developed TReatment E-AssisT (TREAT), a computerized clinical decision aid that combines ROM outcomes with evidence-based guidelines in order to generate personalised treatment recommendations. A pilot study was conducted to test the feasibility for implementation in daily clinical practice. Currently, a multicenter trial is conducted to investigate the effects of TREAT on day-to-day patient care. As part of this trial, we have conducted a qualitative analysis of clinicians’ experiences of working with the TREAT application. We interviewed eight psychiatrist and five nurse practitioners who had worked with the application multiple times with different patients during their consultations. Our goal was to gain insight in the way clinicians used TREAT, to uncover implementation barriers and facilitators and to find ways to improve the application for future use. We analysed the data by using a thematic analysis. Results The five themes we identified from the data were; the visual structuring of ROM results, guideline based treatment recommendations, facilitating and obstructing factors, patient effects and shared decision-making. We also identified a clear distinction in the general appraisal of TREAT. Eight clinicians experienced the application as overall benefiting their clinical encounters, while five experienced no additional benefits or sometimes even a negative impact on their daily clinical practice. Clinicians with a more favourable opinion towards TREAT experienced the visual structuring of ROM results and the guideline based recommendations as more positive as opposed to the clinicians with a less favourable opinion. This in turn influenced their clinical reasoning and in some cases their clinical decisions. Different facilitating and obstructing factors were identified, for example; treatment offer within teams, time management and supporting staff. The application did not work equally well for all patient. However, all clinicians agreed that TREAT positively affected shared decision-making during consolations. Discussion With TREAT, we have developed an innovative digital tool in psychosis care. A majority of clinicians found the application beneficial for their daily clinical practice. However not all clinicians experienced additional benefits and not all patients seemed fit for TREAT. We identified different barriers and facilitators for implementation and received multiple point of improvement for the future development of the application.

Download Full-text

MANAGING HUMAN RESOURCES IN NURSING: THE RELATIONSHIP OF NURSES’ WORKING TIME AND PATIENTS’ INDEPENDENCE LEVEL

Journal of Business Economics and Management ◽

10.3846/jbem.2019.8339 ◽

2019 ◽

Vol 20 (1) ◽

pp. 192-207

Author(s):

Ramunė Čiarnienė ◽

Roberta Suprikienė ◽

Rūta Čiutienė ◽

Asta Daunorienė ◽

Olga Riklikienė

Keyword(s):

Health Status ◽

Human Resources ◽

Patient Care ◽

Quality Care ◽

Relative Number ◽

Working Time ◽

Direct Patient Care ◽

Nursing Time ◽

Care Needs ◽

Time And Motion

A skilled, competent, and motivated nursing workforce is crucial for a well-functioning health care system. Nurses’ professional activities done on a regular basis, their workload, and occupancy are related to the patient’s health status, dependence level and care needs. Therefore, managing human resources in nursing by effectively distributing nurses’ working time and monitoring their workload for safe and high quality care, managers should rely on the severity of patients’ health status and their independence level. In this article the results on how nurses’ working time depends on patients’ independence are provided. The research was carried out at a regional hospital, in departments of medical profile. The time-and-motion study was implemented with 72 observations made in total, which amounted to 777.2 hours of nursing time. A questionnaire was used to assess the level of patients’ independence by assessing the four activities of the patient’s daily living. The results revealed that the largest amount of nurses’ working time, i.e. almost half of a day’s shift, was spent on direct patient care by administrating medication use and performing various nursing procedures. Nurses would spend almost half of the time for direct patient care on completely dependent patients, while one third would be spent on dependent patients. The relative number of nurses’ contacts with a patient is directly proportional to patient’s level of independence; a strong or fairly strong linear relationship was established betweenn the level of patients’ independence and the relative amount of nurses’ working time.

Download Full-text

Identifying factors that nurses consider in the decision-making process related to patient care during the COVID-19 pandemic

PLoS ONE ◽

10.1371/journal.pone.0254077 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254077

Author(s):

Nicholas Anton ◽

Tera Hornbeck ◽

Susan Modlin ◽

Md Munirul Haque ◽

Megan Crites ◽

...

Keyword(s):

Decision Making ◽

Patient Care ◽

Resource Constraints ◽

Limited Information ◽

Sources Of Information ◽

Clinical Environment ◽

Care Needs ◽

Workload Management ◽

Experienced Nurses ◽

The Impact

Background Nurse identification of patient deterioration is critical, particularly during the COVID-19 pandemic, as patients can deteriorate quickly. While the literature has shown that nurses rely on intuition to make decisions, there is limited information on what sources of data experienced nurses utilize to inform their intuition. The objectives of this study were to identify sources of data that inform nurse decision-making related to recognition of deteriorating patients, and explore how COVID-19 has impacted nurse decision-making. Methods In this qualitative study, experienced nurses voluntarily participated in focused interviews. During focused interviews, expert nurses were asked to share descriptions of memorable patient encounters, and questions were posed to facilitate reflections on thoughts and actions that hindered or helped their decision-making. They were also asked to consider the impact of COVID-19 on nursing and decision-making. Interviews were transcribed verbatim, study team members reviewed transcripts and coded responses, and organized key findings into themes. Results Several themes related to decision-making were identified by the research team, including: identifying patient care needs, workload management, and reflecting on missed care opportunities to inform learning. Participants (n = 10) also indicated that COVID-19 presented a number of unique barriers to nurse decision-making. Conclusions Findings from this study indicate that experienced nurses utilize several sources of information to inform their intuition. It is apparent that the demands on nurses in response to pandemics are heightened. Decision-making themes drawn from participants’ experiences can to assist nurse educators for training nursing students on decision-making for deteriorating patients and how to manage the potential barriers (e.g., resource constraints, lack of family) associated with caring for patients during these challenging times prior to encountering these issues in the clinical environment. Nurse practice can utilize these findings to increase awareness among experienced nurses on recognizing how pandemic situations can impact to their decision-making capability.

Download Full-text

Abstraction: An alternative neurocognitive account of recognition, prediction, and decision making

Behavioral and Brain Sciences ◽

10.1017/s0140525x19003017 ◽

2020 ◽

Vol 43 ◽

Author(s):

Valerie F. Reyna ◽

David A. Broniatowski

Keyword(s):

Decision Making ◽

Software Engineering ◽

Systems Engineering ◽

Evidence Based ◽

Extensive Literature ◽

Trace Theory ◽

Fuzzy Trace Theory ◽

Abstract Representations ◽

Technical Systems

Abstract Gilead et al. offer a thoughtful and much-needed treatment of abstraction. However, it fails to build on an extensive literature on abstraction, representational diversity, neurocognition, and psychopathology that provides important constraints and alternative evidence-based conceptions. We draw on conceptions in software engineering, socio-technical systems engineering, and a neurocognitive theory with abstract representations of gist at its core, fuzzy-trace theory.

Download Full-text