Observation tool to measure patient-centered behaviors on rounds in an academic medical center

Background: Primary care is playing an ever increasing role in the design and implementation of new models of healthcare focused on achieving policy ends as put forth by government at both the state and federal level. The Patient Centered Medical Home (PCMH) model is a leading design in this endeavor.Objective: We sought to transform family medicine offices at an academic medical center into the PCMH model of care with improvements in patient outcomes as the end result.Results: Transformation to the PCMH model of care resulted in improved rates of control of diabetes and hypertension and improved prevention measures such as smoking cessation, mammograms, Pneumovax administration, and Tdap vaccination. Readmission rates also improved using a care coordination model.Conclusions: It is possible to transform family medicine offices at academic medical centers in methods consistent with newer models of care such as the PCMH model and to improve patient outcomes. Lessons learned along the way are useful to any practice or system seeking to undertake such transformation.

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Analysis of the Effects of a Patient-Centered Rideshare Program on Missed Appointments and Timeliness for MRI Appointments at an Academic Medical Center

Journal of the American College of Radiology ◽

10.1016/j.jacr.2020.05.037 ◽

2020 ◽

Author(s):

Debra S. Whorms ◽

Anand K. Narayan ◽

Ali Pourvaziri ◽

Randy C. Miles ◽

McKinley Glover ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Missed Appointments ◽

Patient Centered ◽

Academic Medical

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Patients Who Take Home Their Surgical Pathology Specimens: A Preliminary Study

Academic Pathology ◽

10.1177/2374289519832502 ◽

2019 ◽

Vol 6 ◽

pp. 237428951983250

Author(s):

Blake A. Gibson ◽

Richard E. Sobonya

Keyword(s):

Medical Center ◽

Cultural Beliefs ◽

Costal Cartilage ◽

Academic Medical Center ◽

Cervix Uterus ◽

Surgical Pathology ◽

Patient Centered ◽

Academic Medical ◽

Products Of Conception ◽

Patient Advocates

Patients regularly request to take possession of their human tissues after they have become surgical pathology specimens. To date, few formal research studies have examined the prevalence of this practice or the reasoning patients’ request that their specimens to be returned to them. This study interviews patients from 2015 to 2017 at one US academic medical center who requested their surgical pathology specimens. Of the 22 eligible patients, 8 patients agreed to be interviewed. Interviews lasted 10 to 30 minutes and included 5 questions. The questions were: (1) What motivated your decision to obtain your surgical pathology specimen, (2) What, if anything, did you do with your specimen, (3) What were positive aspects of your experience, (4) What were negative aspects of your experience, (5) What can the pathology department change to better support patients who request their surgical pathology specimens? Verbatim transcripts were generated and a mixed-methods analysis was performed. The type of specimens included products of conception, placenta and cord, costal cartilage and ribs, loop explant recorder, pacemaker, below knee amputation, and cervix, uterus, Fallopian tubes, and ovaries. The dominant themes included adversity, medical interest, souvenir, cultural beliefs, and curiosity. Subthemes included becoming whole in the afterlife, preservation, my body, restoration, honoring, and regret. In conclusion, pathologists can expand their role as patient advocates and advance patient-centered pathology by supporting patient’s individual needs, motivations, and goals, when they request their surgical pathology specimens.

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Intensive Care Unit Sedation Practices at a Large, Tertiary Academic Center

Journal of Intensive Care Medicine ◽

10.1177/08850666211067515 ◽

2021 ◽

pp. 088506662110675

Author(s):

Mikaela M. Hofer ◽

Patrick M. Wieruszewski ◽

Scott D. Nei ◽

Kristin Mara ◽

Nathan J. Smischney

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Cross Sectional Study ◽

Primary Objective ◽

Patient Centered ◽

Cross Sectional ◽

Academic Center ◽

Academic Medical ◽

Surgical Icu ◽

Light Sedation

Background Sedatives are frequently administered in an ICU and are often dependent on patient population and ICU type. These differences may affect patient-centered outcomes. Objective Our primary objective was to identify differences in sedation practice among three different ICU types at an academic medical center. Methods This was a retrospective cross-sectional study of adult patients (≥18 years) requiring a continuous sedative for ≥6 h and admitted to a medical ICU, surgical ICU, and medical/surgical ICU at a single academic medical center in Rochester Minnesota from June 1, 2018 to May 31, 2020. We extracted baseline characteristics; sedative type, dose, and duration; concomitant therapies; and patient outcomes. Summary statistics are presented. Results A total of 2154 patients met our study criteria (1010 from medical ICU, 539 from surgical ICU, 605 from medical/surgical ICU). Propofol was the most frequently used sedative in all ICU settings (74.1% in medical ICU, 53.8% in surgical ICU, 68.9% in medical/surgical ICU, and 67.5% in all ICUs). The mortality rate was highest in the medical/surgical ICU (40.2% in medical ICU, 26.0% in surgical ICU, 40.7% in medical/surgical ICU, and 36.8% in all ICUs). 90.7% of all patients required mechanical ventilation (92.9% in medical ICU, 88.5% in surgical ICU, and 89.1% in medical/surgical ICU). Overall, patients spent more time in light sedation than deep sedation, 75% versus 10.3%, during their ICU admission. Patients in the medical ICU spent a greater proportion of time positive for delirium than the other ICU settings (35.7% in medical ICU, 9.8% in surgical ICU, and 20% in medical/surgical ICU). Similar amounts of opioids (morphine milligram equivalents) were used during the continuous sedative infusion between the three settings. Conclusions We observed that patients in the medical ICU spent more time deeply sedated with multiple agents which was associated with a higher proportion of delirium.

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Patient-Centered Measurement at an Academic Medical Center

The Joint Commission Journal on Quality Improvement ◽

10.1016/s1070-3241(16)30449-7 ◽

1999 ◽

Vol 25 (7) ◽

pp. 343-351 ◽

Cited By ~ 3

Author(s):

Tracey Dinan Gooding ◽

Laura Newcomb ◽

Kathy Mertens

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Patient Centered ◽

Academic Medical

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Evaluation of a novel metric for personalized opioid prescribing after hospitalization

PLoS ONE ◽

10.1371/journal.pone.0244735 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244735

Author(s):

Nicholas R. Iverson ◽

Catherine Y. Lau ◽

Yumiko Abe-Jones ◽

Margaret C. Fang ◽

Kirsten N. Kangelaris ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Absolute Difference ◽

Opioid Use ◽

Patient Centered ◽

Electronic Health Record Data ◽

Opioid Prescription ◽

Academic Medical ◽

Maximum Absolute Difference ◽

Marked Variability

Background The duration of an opioid prescribed at hospital discharge does not intrinsically account for opioid needs during a hospitalization. This discrepancy may lead to patients receiving much larger supplies of opioids on discharge than they truly require. Objective Assess a novel discharge opioid supply metric that adjusts for opioid use during hospitalization, compared to the conventional discharge prescription signature. Design, setting, & participants Retrospective study using electronic health record data from June 2012 to November 2018 of adults who received opioids while hospitalized and after discharge from a single academic medical center. Measures & analysis We ascertained inpatient opioids received and milligrams of opioids supplied after discharge, then determined days of opioids supplied after discharge by the conventional prescription signature opioid-days (“conventional days”) and novel hospital-adjusted opioid-days (“adjusted days”) metrics. We calculated descriptive statistics, within-subject difference between measurements, and fold difference between measures. We used multiple linear regression to determine patient-level predictors associated with high difference in days prescribed between measures. Results The adjusted days metric demonstrates a 2.4 day median increase in prescription duration as compared to the conventional days metric (9.4 vs. 7.0 days; P<0.001). 95% of all adjusted days measurements fall within a 0.19 to 6.90-fold difference as compared to conventional days measurements, with a maximum absolute difference of 640 days. Receiving a liquid opioid prescription accounted for an increased prescription duration of 135.6% by the adjusted days metric (95% CI 39.1–299.0%; P = 0.001). Of patients who were not on opioids prior to admission and required opioids during hospitalization but not in the last 24 hours, 325 (8.6%) were discharged with an opioid prescription. Conclusions The adjusted days metric, based on inpatient opioid use, demonstrates that patients are often prescribed a supply lasting longer than the prescription signature suggests, though with marked variability for some patients that suggests potential under-prescribing as well. Adjusted days is more patient-centered, reflecting the reality of how patients will take their prescription rather than providers’ intended prescription duration.

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Healthcare workforce transformation: implementing patient-centered medical home standards in an academic medical center

BMC Medical Education ◽

10.1186/s12909-021-02775-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rebecca Gendelman ◽

Heidi Preis ◽

Latha Chandran ◽

Robyn J. Blair ◽

Maribeth Chitkara ◽

...

Keyword(s):

Medical Students ◽

Medical Home ◽

Large Scale ◽

Medical Center ◽

Academic Medical Center ◽

Healthcare Delivery ◽

Patient Centered Medical Home ◽

Patient Centered ◽

Healthcare Workforce ◽

Academic Medical

Abstract Background Large scale implementation of new strategies and healthcare delivery standards in academic medical centers (AMCs) requires training of healthcare workforce at different stages of their medical career. The patient-centered medical home (PCMH) model for healthcare delivery involves adoption by all members of the healthcare workforce, including seasoned professionals and trainees. Though widely known, the PCMH model has been implemented sporadically at large AMCs and methods to implement the model across healthcare workforce have not been well-documented. Methods To meet all PCMH standards and achieve sustainable level 3 recognition, the authors implemented in 2014–2015 a multi-pronged approach that capitalized on existing educational infrastructure among faculty, residents, and medical students. Within 18 months, the authors applied new interdisciplinary practices and policies, redesigned residency training in continuity practices and extensively modified medical school curricula. Results These innovative transformational education efforts addressed the six PCMH standards for faculty, residents, and undergraduate medical students. Faculty played a major role as system change agents and facilitators of learning. Residents learned to better understand patients’ cultural needs, identify ‘at-risk’ patients, ensure continuity of care, and assess and improve quality of care. Medical students were exposed to PCMH core standards throughout their training via simulations, training in the community and with patients, and evaluation tasks. By implementing these changes across the healthcare workforce, the AMC achieved PCMH status in a short time, changed practice culture and improved care for patients and the community. Since then, the AMC has been able to maintain PCMH recognition annually with minimal effort. Conclusions Successful strategies that capitalize on existing strengths in infrastructure complemented by innovative educational offerings and inter-professional partnerships can be adapted by other organizations pursuing similar transformation efforts. This widespread transformation across the healthcare workforce facilitate a deep-rooted change that enabled our academic medical center to sustain PCMH recognition.

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