scholarly journals Development of a person-centered interdisciplinary plan-of-care program for dialysis

2020 ◽  
Vol 35 (8) ◽  
pp. 1426-1435
Author(s):  
Adeline Dorough ◽  
Derek Forfang ◽  
Shannon L Murphy ◽  
James W Mold ◽  
Abhijit V Kshirsagar ◽  
...  
Keyword(s):  
Qualitative Interviews ◽  
Care Program ◽  
Care Planning ◽  
Care Providers ◽  
Planning Program ◽  
Concept Elicitation ◽  
Care Partners ◽  
Centered Care ◽  
Program Content ◽  
The Individual

Abstract Background Dialysis care often focuses on outcomes that are of lesser importance to patients than to clinicians. There is growing international interest in individualizing care based on patient priorities, but evidence-based approaches are lacking. The objective of this study was to develop a person-centered dialysis care planning program. To achieve this objective we performed qualitative interviews, responsively developed a novel care planning program and then assessed program content and burden. Methods We conducted 25 concept elicitation interviews with US hemodialysis patients, care partners and care providers, using thematic analysis to analyze transcripts. Interview findings and interdisciplinary stakeholder panel input informed the development of a new care planning program, My Dialysis Plan. We then conducted 19 cognitive debriefing interviews with patients, care partners and care providers to assess the program’s content and face validities, comprehensibility and burden. Results We identified five themes in concept elicitation interviews: feeling boxed in by the system, navigating dual lives, acknowledging an evolving identity, respecting the individual as a whole person and increasing individualization to enhance care. We then developed a person-centered care planning program and supporting materials that underwent 32 stakeholder-informed iterations. Data from subsequent cognitive interviews led to program revisions intended to improve contextualization and understanding, decrease burden and facilitate implementation. Conclusions My Dialysis Plan is a content-valid, person-centered dialysis care planning program that aims to promote care individualization. Investigation of the program’s capacity to improve patient experiences and outcomes is needed.

Abstract P847: Exploring the Perspective of Patient Recipients of a Provider and Systems-Level Intervention - A Mixed Methods Analysis From the Care Transitions and Hypertension Management (catch) Program for Ischemic Stroke Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jason J Sico ◽  
Laura Burrone ◽  
Brenda Fenton ◽  
Manali Phadke ◽  
Jan-Michael Ragunton ◽  
...  
Keyword(s):  
Patient Care ◽  
Clinical Pharmacy ◽  
Qualitative Interviews ◽  
Care Transitions ◽  
Care Program ◽  
Lean Six Sigma ◽  
Hypertension Management ◽  
Care Providers ◽  
Post Discharge ◽  
Project File

Introduction: The CAre Transitions and Hypertension management (CATcH) program was developed using Lean Six Sigma methodology and is a bundled, multi-faceted, provider- and healthcare systems-level pilot-intervention designed to enhance care coordination. Components of the intervention included: education delivered during the hospitalization, increased utilization of clinical pharmacy and home telehealth for blood pressure (BP) monitoring, and a patient care navigator. Hypothesis: Recipients of CATcH will find the program valuable though engaging with additional care providers may be deemed onerous. Methods: Twenty-eight semi-structured qualitative interviews were conducted between June 2018 and June 2019 among CATcH recipients. Interviews were audio-recorded, transcribed, and entered into an ATLAS.ti. project file. Thematic Content Analysis was used to analyze coded data, generate, and validate findings. Themes related to the overall impression of CATcH and its individual components were investigated across all patients and stratified by age, race, sex, and when they were discharged in relation to beginning of CATcH implementation. Results: A total of 108 Veterans were the recipients of CATcH. All patients received education, patient care navigator services, and offered both clinical pharmacy and telehealth services, with 52/108 (48.1%) attending clinical pharmacy appointments and 37/108 (34.3%) utilizing telehealth services within 6-months post-discharge. Subjects interviewed were on average 68.6±8.2 years of age, predominantly male (26/28; 92.9%) and equally distributed among black and non-black races. Themes were largely positive with patients expressing they were unaware that they were the recipients of an enhanced care program, and that CATcH. Patients who received CATcH in the second half of the program reported better care collaboration and more useful educational materials that those enrolled earlier in the project. Conclusions: Patients found the CATcH program and its component parts useful in the ongoing management of post-stroke BP control. Continuous self-evaluation and refinement of the program throughout the intervention period likely contributed to improvements in care collaboration and education.

scholarly journals Care Pathways in Persistent Orofacial Pain

2016 ◽  
Vol 2 (1) ◽  
pp. 48-57 ◽  
Author(s):  
M. Breckons ◽  
S.M. Bissett ◽  
C. Exley ◽  
V. Araujo-Soares ◽  
J. Durham
Keyword(s):  
Health Care Providers ◽  
Orofacial Pain ◽  
Care Pathway ◽  
Comparative Method ◽  
Qualitative Interviews ◽  
Care Pathways ◽  
Care Providers ◽  
Patient Centered ◽  
Centered Care ◽  
The Impact

Persistent orofacial pain is relatively common and known to have an adverse effect on quality of life. Previous studies suggest that the current care pathway may be problematic, but it is not well understood which health services patients access and what their experience is. The aim of this study was to explore care pathways and their impact from the perspective of patients. Qualitative interviews were conducted with a maximum variation sample of patients recruited from primary (community based) and secondary (specialist hospital based) care in the United Kingdom. Questions focused on the stages in their pathway and the impact of the care that they had received. Interviews were digitally recorded and transcribed verbatim, and analysis followed principles of the constant comparative method. NVivo 10 was used to help organize and analyze data. Twenty-two patients were interviewed at baseline, and 18 took part in a second interview at 12 mo. Three main themes emerged from the data: the “fluidity of the care pathway,” in which patients described moving among health care providers in attempts to have their pain diagnosed and managed, occurring alongside a “failure to progress,” where despite multiple appointments, patients described frustration at delays in obtaining a diagnosis and effective treatment for their pain. Throughout their care pathways, patients described the “effects of unmanaged pain,” where the longer the pain went unmanaged, the greater its potential to negatively affect their lives. Findings of this study suggest that the current care pathway is inefficient and fails to meet patient needs. Future work needs to focus on working with stakeholder groups to redesign patient-centered care pathways. Knowledge Transfer Statement: Data from qualitative interviews conducted with patients with persistent orofacial pain suggest significant problems with the existing care pathway, consisting of delays to diagnosis, treatment, and referral. Patients describing their struggle to progress through the current care pathway highlighted the difficulties occurring while living with orofacial pain. This study suggests a need for a revised care pathway, which better meets the needs of people with persistent orofacial pain.

Dementia Friendly Memory Institutions

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Lynne C Howarth
Keyword(s):  
Cultural Heritage ◽  
Health Care Providers ◽  
Life Experience ◽  
Severe Disease ◽  
Disease Process ◽  
Care Providers ◽  
Persons With Disabilities ◽  
People With Dementia ◽  
Centered Care ◽  
The Individual

On November 3, 1906, at the 37th Meeting of South-West German Psychiatrists, Dr. Alois Alzheimer, reported on “a peculiar severe disease process of the cerebral cortex”. The disease with which he is associated has continued to elude a cure and is forecast to afflict one in eighty-five persons globally by 2050. Health care providers, researchers, and governments are on notice to explore different ways of understanding and addressing Alzheimer’s Disease and Related Dementias (ADRD) as demands for resources and funding escalate. One of those approaches, person-centered care (PCC), puts a focus on the individual, not the disease, emphasizing ability and enablement, and recognizing people with dementia as having rights of choice, personal empowerment, and self-determination. We expand on the concept of “dementia friendly communities,” embodying PCC, to envision how spaces, programs, and services within cultural heritage institutions such as galleries, libraries, archives, and museums (GLAM), could be re-thought and designed to enhance the everyday life experience of persons with ADRD. Impetus for such initiatives is provided further through the articulation, acceptance, adoption, and promotion of the rights of those with dementia as the rights of persons with disabilities. This emphasis on rights is important as it has behind it the force of international agreement and legally-binding United Nations’ Convention on the Rights of Persons with Disabilities (2008). We argue that cultural heritage institutions have a responsibility and a rationale for servicing those who have been marginalized across time by what they have rather than who they are.

What gives your life meaning (WGYLM)? Strategies to encourage advanced care planning.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 8-8
Author(s):  
Catherina Anne Madani ◽  
Cassia Yi ◽  
Kyle Edmonds ◽  
Sharon Hamill
Keyword(s):  
Front Page ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Social Experiment ◽  
State University ◽  
Care Providers ◽  
Life Meaning ◽  
Loved One ◽  
San Marcos ◽  
Centered Care

8 Background: Conversations regarding healthcare decisions are central to patient-and-family-centered care. Early and regular advanced care planning (ACP) conversations benefit the patient, family, multidisciplinary team, and healthcare system. Initiatives targeting employee’s participation in their own ACP may extend to improvement in patients’ ACP utilization. Methods: A social experiment entitled, “What gives your life meaning” (WGYLM?) initially developed at California State University, San Marcos to increase student’s awareness of ACP was adapted to focus health system’s employees’ attention on ACP over the course of a 3-month campaign that culminated during National Healthcare Decisions week. Results: 55 volunteers were involved in the campaign. Over 10,000 workstation screensavers displayed campaign slogans. A system-wide newsletter with 12,500 subscribers included a campaign write-up. The local newspaper featured a front-page color article. Almost 1,700 post-its with comments of what gives their life meaning were collected. More than 1500 ACP packets with ACP resources were distributed with over 1200 people signing a pledge to have an ACP discussion with a loved one within 30 days. Of the 664-successful follow-up email sent to pledge participants: 77 (12%) of respondents responded to the survey; 44% were nurses, and 12% were physicians; 41% reported already having an AD in place, while 21% did not currently have a designated person to make healthcare decisions on their behalf; 66 (85%) reported talking with someone about what gives their own life meaning. Of these, 51% reported it was their spouse they spoke with and 34% reported it was a coworker; 5% created an AD, and 8% edited an AD since the campaign; 73% agreed it helped them think about ACP in a less scary way; 83% agreed it increased their interest in thinking about future healthcare preferences; and 79% agreed it motivated them to talk about healthcare they would want to receive at EOL with a loved one. Conclusions: ACP conversations can be used to prepare anyone regardless of age, sex, culture, or disease. Asking heath care providers, “What gives your life meaning” may familiarize them with the process of ACP and emboldened them to encourage patients to have these same crucial conversations.

scholarly journals Advance Care Planning Conversations in Primary Care: a Quality Improvement Project Using the Serious Illness Care Program

2021 ◽  
Author(s):  
Abe Hafid ◽  
Michelle Howard ◽  
Dale Guenter ◽  
Dawn Elston ◽  
Erin Gallagher ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Family Medicine ◽  
Care Program ◽  
Care Planning ◽  
Care Providers ◽  
Improvement Project ◽  
Serious Illness ◽  
Advance Care ◽  
Self Assessments

Abstract Background: Advance care planning (ACP) conversations are associated with improved end-of-life healthcare outcomes and patients want to engage in ACP with their healthcare providers. Despite this, ACP conversations rarely occur in primary care settings. Therefore, the objective of this study was to implement ACP through adapted Serious Illness Care Program (SICP) training sessions, and to understand primary care provider perceptions of implementing ACP into practice. Methods: We conducted a quality improvement project guided by the Normalization Process Theory (NPT). NPT is an explanatory model the delineates the processes by which organizations implement and integrate new work. The project was implemented in an interprofessional academic family medicine group in Hamilton, Ontario, Canada. Primary care providers (PCP), consisting of physicians, family medicine residents, and allied health care providers, completed Pre- and post-SICP training self-assessments, NoMAD surveys, and structured interviews. Results: 30 PCPs participated in SICP training and completed self-assessments, 14 completed NoMAD surveys, and 7 were interviewed. Training self-assessments reported improvements in ACP confidence and skills. NoMAD surveys reported mixed opinions towards ACP implementation into primary care, raising concerns with their colleagues’ abilities to conduct ACP and their patients’ abilities to participate in ACP conversations. Interviews identified barriers to successful implementation including busy clinical schedules, patient preparedness, and provider discomfort or lack of confidence in having ACP conversations. Allied health identified discussing prognosis, scope of practice limitations and identification of appropriate patients as barriers. Conclusions: Our findings complement existing literature regarding high PCP confidence and willingness to conduct ACP, but low participation which may be attributed to logistical challenges. Our findings identified areas of the SICP that were more difficult to implement (i.e., prognostication). Future iterations will require a more systematic process to support the implementation of ACP into regular practice and to address knowledge gaps identified with targeted training.

scholarly journals Advance care planning conversations in primary care: a quality improvement project using the Serious Illness Care Program

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Abe Hafid ◽  
Michelle Howard ◽  
Dale Guenter ◽  
Dawn Elston ◽  
Shireen Fikree ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Family Medicine ◽  
Qualitative Interviews ◽  
Care Program ◽  
Care Planning ◽  
Improvement Project ◽  
Serious Illness ◽  
Advance Care ◽  
Self Assessments

Abstract Background Advance care planning (ACP) conversations are associated with improved end-of-life healthcare outcomes and patients want to engage in ACP with their healthcare providers. Despite this, ACP conversations rarely occur in primary care settings. The objective of this study was to implement ACP through adapted Serious Illness Care Program (SICP) training sessions, and to understand primary care provider (PCP) perceptions of implementing ACP into practice. Methods We conducted a quality improvement project guided by the Normalization Process Theory (NPT), in an interprofessional academic family medicine group in Hamilton, Ontario, Canada. NPT is an explanatory model that delineates the processes by which organizations implement and integrate new work. PCPs (physicians, family medicine residents, and allied health care providers), completed pre- and post-SICP self-assessments evaluating training effectiveness, a survey evaluating program implementability and sustainability, and semi-structured qualitative interviews to elaborate on barriers, facilitators, and suggestions for successful implementation. Descriptive statistics and pre-post differences (Wilcoxon Sign-Rank test) were used to analyze surveys and thematic analysis was used to analyze qualitative interviews. Results 30 PCPs participated in SICP training and completed self-assessments, 14 completed NoMAD surveys, and 7 were interviewed. There were reported improvements in ACP confidence and skills. NoMAD surveys reported mixed opinions towards ACP implementation, specifically concerning colleagues’ abilities to conduct ACP and patients’ abilities to participate in ACP. Physicians discussed busy clinical schedules, lack of patient preparedness, and continued discomfort or lack of confidence in having ACP conversations. Allied health professionals discussed difficulty sharing patient prognosis and identification of appropriate patients as barriers. Conclusions Training in ACP conversations improved PCPs’ individual perceived abilities, but discomfort and other barriers were identified. Future iterations will require a more systematic process to support the implementation of ACP into regular practice, in addition to addressing knowledge and skill gaps.

scholarly journals Physical activities for older adults: Are local co-operations of sports clubs and care partners an option to increase access?

2021 ◽  
Vol 51 (4) ◽  
pp. 468-473 ◽  
Author(s):  
Veronique Wolter ◽  
Miriam Dohle ◽  
Lisa Sobo
Keyword(s):  
Older Adults ◽  
Qualitative Interviews ◽  
Added Value ◽  
Care Providers ◽  
Local Networks ◽  
Sports Clubs ◽  
Local Structures ◽  
Need Of Care ◽  
Care Partners ◽  
Exercise Programmes

AbstractGroup-based physical activity brings high and long-term added value for the participants. Especially for older adults in need of care, this development is dependent on interdisciplinary thinking and the networking of local structures. Studies underline the consideration of the communication and access options that are needed to be able to promote the target group’s health through exercise programmes. Sports clubs are repeatedly mentioned as competent partners in health promotion, but in municipal practice—possibly due to very different basic structures to the system of care—they receive less attention. The project Moving Nursing Homes and Care Providers (2019–2022) is coordinated by the State Sports Federation of North Rhine-Westphalia, Germany. Local sports clubs cooperate with providers of outpatient and inpatient care to start new sports programs for older adults in need of care. As part of the scientific evaluation, the perspectives involved are equally considered and their motives and needs are analysed. For this paper, four conducted qualitative interviews with representatives of sports clubs were analysed with the focus on opportunities and barriers for local partnerships between sports clubs and care. Results show structural and personal parameters that have to be looked at from the beginning. Local networks are essential for sports clubs to get in contact with potential partners and to reflect initiated processes. Although aspects of (financial) organisation is an often named topic, sports clubs have the opinion that they have the social responsibility to influence developments in their neighbourhood for all generations positively.

Hospice Care in the United States: The Process Begins

1983 ◽  
Vol 13 (2) ◽  
pp. 159-171 ◽  
Author(s):  
Robert W. Buckingham
Keyword(s):  
Home Care ◽  
Hospice Care ◽  
Care Facility ◽  
The United States ◽  
Considerable Change ◽  
Educational Institutions ◽  
Hospice Movement ◽  
Treatment Equipment ◽  
Centered Care ◽  
The Individual

The hospice concept represents a return to humanistic medicine, to care within the patient's community, for family-centered care, and the view of the patient as a person. Medical, governmental, and educational institutions have recognized the profound urgency for the advocacy of the hospice concept. As a result, a considerable change in policy and attitude has occurred. Society is re-examining its attitudes toward bodily deterioration, death, and decay. As the hospice movement grows, it does more than alter our treatment of the dying. Hospices and home care de-escalate the soaring costs of illness by reducing the individual and collective burdens borne by all health insurance policyholders. Because hospices and home care use no sophisticated, diagnostic treatment equipment, their overhead is basically for personal care and medication. Also, the patient is permitted to die with dignity. Studies indicated that the patient of a hospice program will not experience the anxiety, helplessness, inadequacy, and guilt as will an acute care facility patient. Consequently, a hospice program can relieve family members and loved ones of various psychological disorders.

scholarly journals Using the Age-Friendly 4Ms Framework to Redesign a Community Clinical Experience

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 9-9
Author(s):  
Margaret Avallone ◽  
Staci Pacetti
Keyword(s):  
Nursing Students ◽  
Social Workers ◽  
Clinical Experience ◽  
Affordable Housing ◽  
Fall Risk ◽  
Primary Care Providers ◽  
Care Providers ◽  
Undergraduate Nursing ◽  
Experience Teaching ◽  
The Individual

Abstract The Age-Friendly 4Ms Framework (IHI/Hartford Foundation) was used to redesign an existing undergraduate nursing community experience, teaching students how to evaluate what matters to the individual, medications, mentation, and mobility. As part of the NJ Geriatric Workforce Enhancement Program (NJGWEP), a 5-year grant supported by DHHS-HRSA, ten senior nursing students joined a team of bilingual social workers, APNs, and a PharmD in an affordable housing urban highrise. This paper will describe the implementation and evaluation of a redesigned clinical experience using the 4Ms framework. Students visited older residents with bilingual social workers, performed health assessments and developed person-centered plans of care. Students presented resident cases during weekly interprofessional conferences to promote team collaboration and planning. Residents who screened positive for dementia were referred to an interprofessional Memory Assessment Program. Medications were reviewed using the Beers criteria, reconciled, and referred to primary care providers if appropriate. Fall risk was assessed and managed using the STEADI toolkit (CDC). Students were evaluated on attainment of geriatric-specific competencies, including medication review, cognition and depression screening, and fall risk assessments, by direct observations and interview. Following the semester-long experience, students completed a retrospective pretest/posttest survey to evaluate achievement of objectives based on the 4Ms. Mean scores for achievement of learning objectives ranged from 4.7-4.9 on a Likert scale of 1-5. Students identified barriers that older diverse individuals face when managing chronic health problems in the community. Students also valued the partnership with the social workers, stating, “We learned from each other.”

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