scholarly journals Developing an evidence base of best practices for integrating computerized systems into the exam room: a systematic review

2016 ◽  
Vol 24 (e1) ◽  
pp. e207-e215 ◽  
Author(s):  
Minal R Patel ◽  
Jennifer Vichich ◽  
Ian Lang ◽  
Jessica Lin ◽  
Kai Zheng
Keyword(s):  
Systematic Review ◽  
Best Practices ◽  
Clinical Care ◽  
Strong Support ◽  
Evidence Base ◽  
Evidence Based ◽  
Patient Centered ◽  
Exam Room ◽  
Communication Practices ◽  
Electronic Health

Objective: The introduction of health information technology systems, electronic health records in particular, is changing the nature of how clinicians interact with patients. Lack of knowledge remains on how best to integrate such systems in the exam room. The purpose of this systematic review was to (1) distill “best” behavioral and communication practices recommended in the literature for clinicians when interacting with patients in the presence of computerized systems during a clinical encounter, (2) weigh the evidence of each recommendation, and (3) rank evidence-based recommendations for electronic health record communication training initiatives for clinicians. Methods: We conducted a literature search of 6 databases, resulting in 52 articles included in the analysis. We extracted information such as study setting, research design, sample, findings, and implications. Recommendations were distilled based on consistent support for behavioral and communication practices across studies. Results: Eight behavioral and communication practices received strong support of evidence in the literature and included specific aspects of using computerized systems to facilitate conversation and transparency in the exam room, such as spatial (re)organization of the exam room, maintaining nonverbal communication, and specific techniques that integrate the computerized system into the visit and engage the patient. Four practices, although patient-centered, have received insufficient evidence to date. Discussion and Conclusion: We developed an evidence base of best practices for clinicians to maintain patient-centered communications in the presence of computerized systems in the exam room. Further work includes development and empirical evaluation of evidence-based guidelines to better integrate computerized systems into clinical care.

scholarly journals Improving Patient–Provider Communication and Therapeutic Practice Through Better Integration of Electronic Health Records in the Exam Room: A Pilot Study

2018 ◽  
Vol 46 (3) ◽  
pp. 484-493 ◽  
Author(s):  
Minal R. Patel ◽  
Alyssa Smith ◽  
Harvey Leo ◽  
Wei Hao ◽  
Kai Zheng
Keyword(s):  
Electronic Health Records ◽  
Communication Skills ◽  
Provider Communication ◽  
Patient Centered ◽  
Health Records ◽  
Exam Room ◽  
Communication Practices ◽  
Asthma Outcomes ◽  
Electronic Health

Background. The rapid proliferation of electronic health records (EHRs) in clinics has had mixed impact on patient-centered communication, yet few evaluated interventions exist to train practicing providers in communication practices. Aims. We extended the evidence-based Physician Asthma Care Education (PACE) program with EHR-specific communication strategies, and tested whether training providers with the extended program (EHR-PACE) would improve provider and patient perceptions of provider communication skills and asthma outcomes of patients. Method. A pilot randomized design was used to compare EHR-PACE with usual care. Participants were providers ( n = 18) and their adult patients with persistent asthma ( n = 126). Outcomes were assessed at baseline and 3- and 6-month postintervention, including patient perception of their provider’s communication skills and provider confidence in using EHRs during clinical encounters. Results. Compared with the control group, providers who completed the EHR-PACE program reported significant improvements at 3-month follow-up in their confidence with asthma counseling practices (estimate 0.90, standard error [ SE] 0.4); p < .05) and EHR-specific communication practices (estimate 2.3, SE 0.8; p < .01), and at 6-month follow-up, a significant decrease in perception that the computer interferes with the patient–provider relationship (estimate −1.0, SE 0.3; p < .01). No significant changes were observed in patient asthma outcomes or their perception of their provider’s communication skills. Discussion. Training providers with skills to accommodate EHR use in the exam room increases provider confidence and their perceived skills in maintaining patient-centered communications in the short term. Conclusion. Evidence-supported training initiatives that can increase capacity of busy providers to manage increased computing demands shows promise. More research is needed to fully evaluate EHR-PACE on patients’ health status and their perceptions of their provider’s care through a large-scale trial.

scholarly journals Staying Current: Developing Just-in-time Evidence-Based Learning Objectives for a Maternal Cardiac Arrest Simulation Curriculum

2021 ◽  
Author(s):  
Andrea Shields ◽  
Jacqueline Battistelli ◽  
Laurie Kavanagh ◽  
Lara Ouellette ◽  
Brook Thomson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Best Practices ◽  
Life Support ◽  
Learning Objectives ◽  
Just In Time ◽  
Evidence Based ◽  
Agree Ii ◽  
Step Process ◽  
Emerging Topics

Abstract BackgroundOur objective was to review the latest evidence on resuscitation care for maternal cardiac arrest (MCA) and gain expert consensus on best practices to inform an evidence-based curriculum.MethodsWe convened a multidisciplinary panel of stakeholders in MCA to develop an evidence-based simulation training, Obstetric Life SupportTM (OBLS). To inform the learning objectives, we used a novel three-step process to achieve consensus on best practices for maternal resuscitation. First, we reaffirmed the evidence process on an existing MCA guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE II). Next, via systematic review, we evaluated the latest evidence on MCA and identified emerging topics since the publication of the MCA guideline. Finally, we applied a modified Research and Development (RAND) technique to gain consensus on emerging topics to include as additional just-in-time best practices.ResultsThe AGREE II survey results demonstrated unanimous consensus on reaffirmation of the 2015 American Heart Association (AHA) MCA guideline for inclusion into the OBLS curriculum. A systematic review with deduplication resulted in 11,871 articles for review. After categorizing and synthesizing the relevant literature, we presented twelve additional best practices to the expert panel using a modified RAND technique. Upon completion, the 2015 AHA statement and nine additional just-in-time best practices were affirmed to inform the OBLS curriculum.ConclusionsA novel three-step process including reaffirmation of evidence process, systematic review, and a modified RAND technique resulted in unanimous consensus from experts in MCA resuscitation on existing and new just-in-time best practices to inform the learning objectives for an evidence-based curriculum.

scholarly journals Trial Reporting in Immuno-Oncology (TRIO): An American Society of Clinical Oncology-Society for Immunotherapy of Cancer Statement

2019 ◽  
Vol 37 (1) ◽  
pp. 72-80 ◽  
Author(s):  
Apostolia M. Tsimberidou ◽  
Laura A. Levit ◽  
Richard L. Schilsky ◽  
Steven D. Averbuch ◽  
Daniel Chen ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Care ◽  
Evidence Base ◽  
Rapid Expansion ◽  
Evidence Based ◽  
Medical Oncologists ◽  
Immunotherapy Of Cancer ◽  
American Society ◽  
Existing Data ◽  
Support Evidence

Purpose To develop recommendations for clinical trial reporting that address the unique efficacy, toxicity, and combination and sequencing aspects of immuno-oncology (IO) treatments. Methods ASCO and the Society for Immunotherapy of Cancer (SITC) convened a working group that consisted of practicing medical oncologists, immunologists, clinical researchers, biostatisticians, and representatives from industry and government to develop Trial Reporting in Immuno-Oncology (TRIO) recommendations. These recommendations are based on expert consensus, given that existing data to support evidence-based recommendations are limited. Conclusion The TRIO recommendations are intended to improve the reporting of IO clinical trials and thus provide more complete evidence on the relative benefits and risks of an IO therapeutic approach. Given the rapid expansion of the number of IO clinical trials and ongoing improvements to the evidence base supporting the use of IO treatments in clinical care, these recommendations will likely need regular revision as the IO field develops.

Patient-Centered Standards for Medically Integrated Dispensing: ASCO/NCODA Standards

2020 ◽  
Vol 38 (6) ◽  
pp. 633-644 ◽  
Author(s):  
Melissa S. Dillmon ◽  
Erin B. Kennedy ◽  
Mary K. Anderson ◽  
Michael Brodersen ◽  
Howard Cohen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Supportive Care ◽  
Evidence Base ◽  
Patient Centered ◽  
Additional Information ◽  
Community Oncology ◽  
Included Patient ◽  
American Society ◽  
Data Documentation ◽  
Patient Relationships

PURPOSE To provide standards for medically integrated dispensing of oral anticancer drugs and supportive care medications. METHODS An Expert Panel was formed, and a systematic review of the literature on patient-centered best practices for the delivery of oral anticancer and supportive care drugs was performed to April 2019 using PubMed and Google Scholar. Available patient-centered standards, including one previously developed by the National Community Oncology Dispensing Association (NCODA), were considered for endorsement. Public comments were solicited and considered in preparation of the final manuscript. RESULTS A high-quality systematic review that was current to May 2016 was adopted into the evidence base. Five additional primary studies of multifaceted interventions met the inclusion criteria. These studies generally included a multicomponent intervention, often led by an oncology pharmacist, and also included patient education and regular follow-up and monitoring. These interventions resulted in significant improvements to patient quality and safety and demonstrated improvements in adherence and other patient outcomes. CONCLUSION The findings of the systematic review were consistent with the NCODA patient-centered standards for patient relationships and education, adherence, safety, collection of data, documentation, and other areas. NCODA standards were adopted and used as basis for these American Society of Clinical Oncology/NCODA standards. Additional information is available at www.asco.org/mid-standards .

scholarly journals Oncology Medical Home: ASCO and COA Standards

2021 ◽  
pp. OP.21.00167
Author(s):  
Kim Woofter ◽  
Erin B. Kennedy ◽  
Kerin Adelson ◽  
Ronda Bowman ◽  
Rachel Brodie ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Improvement ◽  
Medical Home ◽  
Expert Panel ◽  
Clinical Pathways ◽  
Evidence Base ◽  
Evidence Based ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Plans

PURPOSE: To provide Standards on the basis of evidence and expert consensus for a pilot of the Oncology Medical Home (OMH) certification program. The OMH model is a system of care delivery that features coordinated, efficient, accessible, and evidence-based care and includes a process for measurement of outcomes to facilitate continuous quality improvement. The OMH pilot is intended to inform further refinement of Standards for OMH model implementation. METHODS: An Expert Panel was formed, and a systematic review of the literature on the topics of OMH, clinical pathways, and survivorship care plans was performed using PubMed and Google Scholar. Using this evidence base and an informal consensus process, the Expert Panel developed a set of OMH Standards. Public comments were solicited and considered in preparation of the final manuscript. RESULTS: Three comparative peer-reviewed studies of OMH met the inclusion criteria. In addition, the results from 16 studies of clinical pathways and one systematic review of survivorship care plans informed the evidence review. Limitations of the evidence base included the small number of studies of OMH and lack of longer-term outcomes data. More data were available to inform the specific Standards for pathways and survivorship care; however, outcomes were mixed for the latter intervention. The Expert Panel concluded that in the future, practices should be encouraged to publish the results of OMH interventions in peer-reviewed journals to improve the evidence base. STANDARDS: Standards are provided for OMH in the areas of patient engagement, availability and access to care, evidence-based medicine, equitable and comprehensive team-based care, quality improvement, goals of care, palliative and end-of-life care discussions, and chemotherapy safety. Additional information, including a Standards implementation manual, is available at www.asco.org/standards .

scholarly journals One Size Does Not Fit All: A Comprehensive Clinical Approach to Reducing Suicidal Ideation, Attempts, and Deaths

2019 ◽  
Vol 16 (19) ◽  
pp. 3606 ◽  
Author(s):  
David A. Jobes ◽  
Samantha A. Chalker
Keyword(s):  
Mentally Ill ◽  
Health Management ◽  
Clinical Care ◽  
Cost Effective ◽  
Evidence Base ◽  
Stepped Care ◽  
Clinical Approach ◽  
Evidence Based ◽  
Suicidal Risk ◽  
The One

While the existence of mental illness has been documented for centuries, the understanding and treatment of such illnesses has evolved considerably over time. Ritual exorcisms and locking mentally ill patients in asylums have been fundamentally replaced by the use of psychotropic medications and evidence-based psychological practices. Yet the historic roots of mental health management and care has left a certain legacy. With regard to suicidal risk, the authors argue that suicidal patients are by definition seen as mentally ill and out of control, which demands hospitalization and the treatment of the mental disorder (often using a medication-only approach). Notably, however, the evidence for inpatient care and a medication-only approach for suicidal risk is either limited or totally lacking. Thus, the “one-size-fits-all” approach to treating suicidal risk needs to be re-considered in lieu of the evolving evidence base. To this end, the authors highlight a series of evidence-based considerations for suicide-focused clinical care, culminating in a stepped care public health model for optimal clinical of suicidal risk that is cost-effective, least-restrictive, and evidence-based.

scholarly journals Emergency Department Response to Chemical, Biological, Radiological, Nuclear, and Explosive Events: A Systematic Review

2018 ◽  
Vol 33 (5) ◽  
pp. 543-549 ◽  
Author(s):  
Saydia Razak ◽  
Sue Hignett ◽  
Jo Barnes
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Systems Approach ◽  
Clinical Care ◽  
Evidence Based ◽  
Key Factors ◽  
Publication Type ◽  
Organizational Policies ◽  
Response Planning ◽  
Explosive Events

AbstractIntroductionA Chemical, Biological, Radiological, Nuclear, and explosive (CBRNe) event is an emergency which can result in injury, illness, or loss of life. The emergency department (ED) as a health system is at the forefront of the CBRNe response with staff acting as first receivers. Emergency departments are under-prepared to respond to CBRNe events - recognizing key factors which underlie the ED CBRNe response is crucial to provide evidence-based knowledge to inform policies and, most importantly, clinical practice.ProblemChallenges in detection, decontamination, and diagnosis are associated with the ED CBRNe response when faced with self-presenting patients.MethodsA systematic review was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An in-depth search strategy was devised to identify studies which focused on the ED and CBRNe events. The inclusion criteria were stringent in terms of the environment (ED), participants (first receivers), situation (CBRNe response), and actions (detection, decontamination, and diagnosis). Fifteen databases and topic-specific journals were searched. Studies were critically appraised using the Mixed Methods Appraisal Tool (MMAT). Papers were thematically coded and synthesized using NVivo 10 (QSR International Ltd, Melbourne, Australia).ResultsSixty-seven full-text papers were critically appraised using the MMAT; 70% were included (n = 60) as medium- or high-quality studies. Data were grouped into four themes: preparedness, response, decontamination, and personal protective equipment (PPE) problems.DiscussionThis study has recognized the ED as a system which depends on four key factors - preparedness, response, decontamination, and PPE problems - which highlight challenges, uncertainties, inconsistencies, and obstacles associated with the ED CBRNe response. This review suggests that response planning and preparation should be considered at three levels: organizational (policies and procedures); technological (decontamination, communication, security, clinical care, and treatment); and individual (willingness to respond, PPE, knowledge, and competence). Finally, this study highlighted that there was a void specific to detection and diagnosis of CBRNe exposure on self-presenting patients in the ED.Conclusion:The review identified concerns for both knowledge and behaviors which suggests that a systems approach would help understand the ED response to CBRNe events more effectively. The four themes provide an evidence-based summary for the state of science in ED CBRNe response, which can be used to inform future policies and clinical procedures.RazakS,HignettS,BarnesJ.Emergency department response to chemical, biological, radiological, nuclear, and explosive events: a systematic review.Prehosp Disaster Med.2018;33(5):543–549.

scholarly journals Remote symptom monitoring integrated into electronic health records: A systematic review

2020 ◽  
Vol 27 (11) ◽  
pp. 1752-1763
Author(s):  
Julie Gandrup ◽  
Syed Mustafa Ali ◽  
John McBeth ◽  
Sabine N van der Veer ◽  
William G Dixon
Keyword(s):  
Systematic Review ◽  
Electronic Health Records ◽  
Clinical Care ◽  
Long Term Conditions ◽  
Health Records ◽  
Symptom Monitoring ◽  
Study Results ◽  
Patient Reported ◽  
Electronic Health

Abstract Objective People with long-term conditions require serial clinical assessments. Digital patient-reported symptoms collected between visits can inform these, especially if integrated into electronic health records (EHRs) and clinical workflows. This systematic review identified and summarized EHR-integrated systems to remotely collect patient-reported symptoms and examined their anticipated and realized benefits in long-term conditions. Materials and Methods We searched Medline, Web of Science, and Embase. Inclusion criteria were symptom reporting systems in adults with long-term conditions; data integrated into the EHR; data collection outside of clinic; data used in clinical care. We synthesized data thematically. Benefits were assessed against a list of outcome indicators. We critically appraised studies using the Mixed Methods Appraisal Tool. Results We included 12 studies representing 10 systems. Seven were in oncology. Systems were technically and functionally heterogeneous, with the majority being fully integrated (data viewable in the EHR). Half of the systems enabled regular symptom tracking between visits. We identified 3 symptom report-guided clinical workflows: Consultation-only (data used during consultation, n = 5), alert-based (real-time alerts for providers, n = 4) and patient-initiated visits (n = 1). Few author-described anticipated benefits, primarily to improve communication and resultant health outcomes, were realized based on the study results, and were only supported by evidence from early-stage qualitative studies. Studies were primarily feasibility and pilot studies of acceptable quality. Discussion and Conclusions EHR-integrated remote symptom monitoring is possible, but there are few published efforts to inform development of these systems. Currently there is limited evidence that this improves care and outcomes, warranting future robust, quantitative studies of efficacy and effectiveness.

scholarly journals Development of a core outcome set for traumatic brachial plexus injuries (COMBINE): study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e030146 ◽  
Author(s):  
Caroline Miller ◽  
Jane Cross ◽  
Dominic M Power ◽  
Derek Kyte ◽  
Christina Jerosch-Herold
Keyword(s):  
Systematic Review ◽  
Brachial Plexus ◽  
Clinical Outcomes ◽  
Clinical Care ◽  
Core Outcome Set ◽  
Evidence Based ◽  
Core Outcome ◽  
Permanent Disability ◽  
Outcome Set ◽  
Patient Reported

IntroductionTraumatic brachial plexus injury (TBPI) involves major trauma to the large nerves of the arm which control the movement and sensation. Fifty per cent of injuries result in complete paralysis of the arm with many other individuals having little movement, sensation loss and unremitting pain. The injury often causes severe and permanent disability affecting work and social life, with an estimated cost to the National Health Service and the economy of £35 million per annum. Advances in microsurgery have resulted in an increase in interventions aimed at reconstructing these injuries. However, data to guide evidence-based decisions is lacking. Different outcomes are used across studies to assess the effectiveness of treatments. This has impeded our ability to synthesise results to determine which treatments work best. Studies frequently report short-term clinical outcomes but rarely report longer term outcomes and those focused on quality of life. This project aims to produce a core outcome set (COS) for surgical and conservative management of TBPI. The TBPI COS will contain a minimum set of outcomes to be reported and measured in effectiveness studies and collected through routine clinical care.Methods and analysisThis mixed-methods project will be conducted in two phases. In phase 1 a long list of patient-reported and clinical outcomes will be identified through a systematic review. Interviews will then explore outcomes important to patients. In phase 2, the outcomes identified across the systematic review, and the interviews will be included in a three-round online Delphi exercise aiming to reach consensus on the COS. The Delphi process will include patient and healthcare participants. A consensus meeting will be held to achieve the final COS.Ethics and disseminationThe use of a COS in TBPI will increase the relevance of research and clinical care to all stakeholders, facilitate evidence synthesis and evidence-based decision making. The study has ethical approval.Trial registration numbersCRD42018109843.

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