Development of health-system inpatient pharmacy clinical metrics

2019 ◽  
Vol 76 (23) ◽  
pp. 1958-1964
Author(s):  
Stacy Cassat ◽  
Lindsay Massey ◽  
Stephanie Buckingham ◽  
Tamara Kemplay ◽  
Jeff Little
Keyword(s):  
Clinical Outcome ◽  
Health System ◽  
Outcome Measures ◽  
Patient Outcomes ◽  
Assessment Tool ◽  
Time Frame ◽  
Pharmacy Services ◽  
Systematic Process ◽  
Institutional Review Board Review ◽  
The Impact

Abstract Purpose To describe a process to identify metrics that represent the impact of inpatient pharmacy services on patient outcomes across a health system. Summary The authors describe a systematic process of identifying inpatient clinical outcome measures that could represent pharmacists’ impact on patient outcomes and eventually be displayed in a dashboard within the electronic medical record (EMR). A list was generated through literature review, assessment of practices at other sites, evaluation of current pharmacy services, and collaboration with the quality department and System Pharmacy Clinical User Group. The project team narrowed the list through assessment against standardized criteria. An assessment tool was designed and distributed to stakeholders to prioritize clinical outcome measures for inclusion on the dashboard. The clinical outcome measures were transformed into metrics by determining measurement criteria, inclusion and exclusion parameters, and review time frame. After validation, the metrics are planned to be displayed on an inpatient pharmacy EMR dashboard. Exemption from institutional review board review was granted for this project. Conclusion A systematic process was developed and used to identify inpatient clinical outcome metrics.

Disease progression in multiple sclerosis: combining physicians’ and patients’ perspectives?

2010 ◽  
Vol 17 (2) ◽  
pp. 234-240 ◽  
Author(s):  
JJ Kragt ◽  
JM Nielsen ◽  
FAH van der Linden ◽  
CH Polman ◽  
BMJ Uitdehaag
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Outcome ◽  
Disease Progression ◽  
Outcome Measures ◽  
Added Value ◽  
Impact Scale ◽  
Disability Status ◽  
The Impact ◽  
Nine Hole Peg Test ◽  
Combine Outcome

Background: To assess disease progression in multiple sclerosis (MS) several outcome measures are available. The interrelation of changes on different scales has not been studied extensively and the concept of combining scales has only recently been introduced in MS. Objective: To explore combining different clinical outcome measures in the evaluation of disease progression in MS. Methods: In 553 patients we studied the presence of relevant changes according to standard definitions on the Expanded Disability Status Scale (EDSS), Nine-Hole Peg Test (9HPT), Timed 25-Foot Walk (T25FW) and the Multiple Sclerosis Impact Scale (MSIS-29). We examined ‘exclusive worsening’ (worsening on one measure while not worsening on any other measure) and ‘opposing changes’ (worsening on one measure while improving on another measure). Finally, we investigated the impact of combining assessments. Results: Based on the EDSS alone, 140 patients progressed. However, almost twice as many (275) showed worsening on any of the clinical outcome measures. Exclusive worsening was observed in 37 patients on the EDSS, 13 on the 9HPT, 39 on the T25FW and 44 on the MSIS physical. Of all worsened patients 76 (28%) showed opposing changes, a phenomenon predominantly observed when combining physician-based and patient-derived outcome measures. Conclusion: When assessing disease progression in MS, sensitivity to change can be increased by combining different outcome measures. The added value is especially present when combining measures from different perspectives. However, further research is needed to evaluate the optimal way to combine outcome measures before implementing this strategy in clinical studies.

Physiotherapy-led arthroplasty review clinic: a preliminary outcomes analysis

2014 ◽  
Vol 38 (5) ◽  
pp. 510 ◽  
Author(s):  
Kate E. Large ◽  
Carolyn J. Page ◽  
Kim Brock ◽  
Michelle M. Dowsey ◽  
Peter F. M. Choong
Keyword(s):  
Outcome Measures ◽  
Patient Outcomes ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Short Form ◽  
Joint Arthroplasty ◽  
Orthopaedic Surgeon ◽  
Healthcare Sector ◽  
Harris Hip Score ◽  
The Impact

Objective With the rising demand for Orthopaedics in the healthcare sector, service delivery innovations need to be explored to accommodate the increasing workload. Senior Musculoskeletal Physiotherapists have the specialised skills in the assessment of musculoskeletal conditions to determine the impact of surgery on patient outcomes. The aim of the present study was to compare outcomes between a physiotherapy-led arthroplasty review clinic (PT clinic) and the traditional model of orthopaedic surgeon review (OS clinic) after hip and knee replacement. Methods This study was a retrospective case-controlled audit using a comprehensive database. Twenty-four patients who had a hip arthroplasty and 52 patients who had a knee arthroplasty were reviewed solely by the PT clinic at 3, 6 and 12 months after surgical reviews. These patients were matched 1 : 2 against patients seen only by the OS clinic. The outcome measures included International Knee Score (IKS), Harris Hip Score (HHS) and the Short Form (SF)-12. Results There were no significant differences in HHS or SF-12 scores for patients after hip arthroplasty. Significant differences for knee arthroplasty were observed favouring the PT clinic; IKS, PT clinic 147.6 (37.07), OS clinic 135.4 (35.68), P ≤ 0.01, and physical component of the SF-12, PT clinic 41.98 (10.45), OS clinic 37.20 (10.44), P < 0.01. Conclusion Implementation of a physiotherapy-led arthroplasty review clinic appears to be a safe and effective service alternative to reviews conducted by orthopaedic surgeons. What is known about the topic? Osteoarthritis (OA) is a leading cause of musculoskeletal pain and disability and the burden of the disease is rapidly increasing. Joint arthroplasty surgery is the mainstay of treatment for people with end-stage OA; it is a high-cost, high-volume procedure that dominates surgical wait lists around Australia. Long-term follow up is encouraged by the Arthroplasty Society of Australia and endorsed by the Australian Orthopaedics Association, but it is acknowledged that it is impossible to achieve this with solely orthopaedic surgeon reviews, an issue that is only going to worsen with the increased demand for surgery. Physiotherapists have become involved in many advanced scope roles within public health care, and emerging research suggests that patients are highly satisfied with their care in these types of clinics. What does this paper add? Although it has been shown that patients are satisfied in physiotherapy-led advanced clinics, there is a paucity of evidence in the outcomes of patients attending these clinics. Implementation of a physiotherapy-led arthroplasty review clinic demonstrated that outcome measures in this patient cohort were not compromised and, following knee joint arthroplasty, may even be improved. What are the implications for practitioners? The findings of this study indicate that joint review clinics involving physiotherapists acting in an advanced scope role are unlikely to compromise patient outcomes. The use of this role substitution on a broader scale can be recommended.

The impact of 2006 guidance on nutrition support, in clinical outcome measures

2008 ◽  
Vol 67 (OCE3) ◽  
Author(s):  
R. P. Vincent ◽  
C. H. Goo ◽  
P. F. Wu ◽  
C. W. Le Roux
Keyword(s):  
Clinical Outcome ◽  
Outcome Measures ◽  
Nutrition Support ◽  
The Impact

scholarly journals The impact of 2006 guidance on nutrition support, in clinical outcome measures

2008 ◽  
Vol 67 (OCE3) ◽  
Author(s):  
R. P. Vincent ◽  
C. H. Goo ◽  
P. F. Wu ◽  
C. W. Le Roux
Keyword(s):  
Clinical Outcome ◽  
Outcome Measures ◽  
Nutrition Support ◽  
The Impact

Ambulatory Care Pharmacy Services: The Incomplete Agenda

1992 ◽  
Vol 26 (5) ◽  
pp. 701-708 ◽  
Author(s):  
Barry L. Carter ◽  
Dennis K. Helling
Keyword(s):  
Ambulatory Care ◽  
Patient Outcomes ◽  
Clinical Pharmacy ◽  
English Language ◽  
Data Extraction ◽  
Pharmacy Services ◽  
Clinical Pharmacy Services ◽  
Standards Of Practice ◽  
Study Selection ◽  
The Impact

OBJECTIVE: To review studies that document the impact of clinical pharmacy services in ambulatory care settings and to propose standards of practice and resource allocation needs in ambulatory care. DATA SOURCES: English-language literature from 1970 through 1991 was reviewed and the representative literature is described. STUDY SELECTION: Studies were selected that examined the impact of clinical pharmacy services on patient outcomes and costs. Studies that evaluated pharmacist consultations by blind peer-review panels were also evaluated. DATA EXTRACTION: Trials were assessed based on their methodologies and ability to assess the value of clinical pharmacy services on patient outcomes. DATA SYNTHESIS: Numerous studies from the past 20 years are described illustrating the impact that ambulatory care pharmacy practitioners have made on patient care. These studies demonstrate that clinical pharmacists in ambulatory care not only serve as consultants on pharmacotherapy issues, but also can improve the quality of care for individual patients. CONCLUSIONS: Based on the studies cited and the needs of ambulatory patients, this article highlights the authors' views on what the standards of practice should be for ambulatory care practitioners and where resources should be allocated as ambulatory programs are expanded.

Redesigning the clinical pharmacy practice model at a psychiatric hospital

2015 ◽  
Vol 5 (1) ◽  
pp. 50-56
Author(s):  
Monica Zolezzi ◽  
Ingo Gottstein ◽  
Benjamin Nilsson
Keyword(s):  
Clinical Practice ◽  
Patient Outcomes ◽  
Clinical Pharmacy ◽  
Pharmacy Practice ◽  
Direct Patient Care ◽  
Pharmacy Services ◽  
Practice Model ◽  
Clinical Notes ◽  
Clinical Pharmacy Services ◽  
The Impact

Introduction: Integrated, patient-centered clinical pharmacy services have been shown to improve patient outcomes in a variety of settings, including mental health. In this article, we describe and report the impact of a restructured clinical practice model that incorporated direct patient care by pharmacists implemented at a psychiatric facility in Edmonton, Canada. The purpose of redesigning the clinical pharmacy program was to deliver proactive pharmacist care through integrated clinical pharmacy services and to better align pharmacists' activities with those that have been reported to have a positive impact on patient outcomes. Methods: Pharmacists' documentation notes in medical records for patients admitted and discharged from the hospital at four different time periods were reviewed. For each time period, the number, type, and documentation rate were measured and compared using a Student t test with correction for unequal variances. Significant change was defined as P &lt; .05. Documentation rates were also compared for short-stay versus long-stay patients. Results: A consistent and statistically significant increase was found in pharmacists' clinical notes per chart from 0.15 to 1.5 (P &lt; .001) after implementation of the redesigned clinical practice model. The proportion of clinical notes also increased from 22% in the preimplementation period to up to 68% in the current period. This indicates that pharmacists were spending proportionally more time on proactive versus reactive care. Documentation rates also increased regardless of the patients' length of stay. Discussion: The redesigned clinical practice model enabled a successful transition of the pharmacists' role, from being predominantly reactive to becoming more proactive and integrated.

A 5-Year Review of Clinical Outcome Measures Published in the Journal of the American Podiatric Medical Association and the Journal of Foot and Ankle Surgery

2017 ◽  
Vol 107 (3) ◽  
pp. 176-179 ◽  
Author(s):  
Todd Hasenstein ◽  
Timothy Greene ◽  
Andrew J. Meyr
Keyword(s):  
Medical Association ◽  
Clinical Outcome ◽  
Outcome Measures ◽  
Short Form ◽  
Outcome Measurement ◽  
Time Frame ◽  
Original Research ◽  
Foot And Ankle ◽  
Ankle Surgery ◽  
American Orthopaedic

This investigation presents a review of all of the clinical outcome measures used by authors and published in the Journal of the American Podiatric Medical Association and the Journal of Foot and Ankle Surgery from January 1, 2011, to December 31, 2015. Of 1,336 articles published during this time frame, 655 (49.0%) were classified as original research and included in this analysis. Of these 655 articles, 151 (23.1%) included at least one clinical outcome measure. Thirty-seven unique clinical outcome scales were used by authors and published during this period. The most frequently reported scales in the 151 included articles were the American Orthopaedic Foot and Ankle Society scales (54.3%; n = 82), visual analog scale (35.8%; n = 54), Medical Outcomes Study Short Form Health Survey (any version) (10.6%; n = 16), Foot Function Index (5.3%; n = 8), Maryland Foot Score (4.0%; n = 6), and Olerud and Molander scoring system (4.0%; n = 6). Twenty-four articles (15.9%) used some form of original/subjective measure of patient satisfaction/expectation. The results of this investigation detail the considerable variety of clinical outcome measurement tools used by authors in the Journal of the American Podiatric Medical Association and the Journal of Foot and Ankle Surgery and might support the need for a shift toward the consistent use of a smaller number of valid, reliable, and clinically useful scales in the podiatric medical literature.

scholarly journals Frailty in major trauma study (FRAIL-T): a study protocol to determine the feasibility of nurse-led frailty assessment in elderly trauma and the impact on outcome in patients with major trauma

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e038082
Author(s):  
Heather Jarman ◽  
Robert Crouch ◽  
Mark Baxter ◽  
Elaine Cole ◽  
Bebhinn Dillane ◽  
...  
Keyword(s):  
Older People ◽  
Best Practice ◽  
Major Trauma ◽  
Assessment Tool ◽  
Traumatic Injury ◽  
Time Frame ◽  
Mortality And Morbidity ◽  
Frailty Assessment ◽  
The Uk ◽  
The Impact

IntroductionThe burden of frailty on older people is easily recognisable by increasing mortality and morbidity, longer hospital stays and adverse discharge locations. In the UK, frailty screening has recently become part of the best practice commissioning tariff within National Health Service England, yet there is no evidence or consensus as to who should carry out this assessment or within which time frame. As major trauma is an increasing burden for older people, there is a need to focus clinician’s attention on early identification of frailty in the emergency department (ED) in patients with major trauma as a way to underpin frailty specific major trauma pathways, to optimise recovery and improve patient experience. Throughout the patient with major trauma pathway, nurses are perhaps best placed to conduct timely clinical assessments working with the patient, family and multidisciplinary team to influence ongoing care. This study aims to determine the feasibility of nurse-led assessment of frailty in patients aged 65 years or more admitted to major trauma centres (MTCs).Methods and analysisThis is a prospective observational study conducted across five UK MTCs, enrolling 370 participants over 9 months. The primary aim is to determine the feasibility of nurse-led frailty assessment in MTC EDs in patients aged 65 years or more following traumatic injury. The prevalence of frailty and the best assessment tool for use in the ED will be determined. Other outcome measures include quality of life and frailty assessment 6 months after injury, mortality and discharge outcomes.Ethics and disseminationThe study was given ethical approval by the Social Care Research Ethics Committee (REC no 19/IEC08/0006). Findings will be published in scientific journals and presented to national and international conferences.Trial registration numberISRCTN10671514.

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