scholarly journals M182. EFFECTIVENESS OF COORDINATED SPECIALTY CARE (CSC) DELIVERED VIA TELE-HEATH COMPARED TO THE STANDARD CSC CLINIC-BASED MODEL

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S205-S206
Author(s):  
Alan Breier ◽  
John Lurkins ◽  
Jennifer Vohs ◽  
Megan Gaunnac ◽  
Michael Francis
Keyword(s):  
Outcome Measures ◽  
Early Phase ◽  
Clinical Care ◽  
Social Function ◽  
Specialty Care ◽  
Assessment Instruments ◽  
Staffing Ratios ◽  
Team Meetings ◽  
Geographical Distances ◽  
School Function

Abstract Background There is a growing body of evidence suggesting that specialized early intervention (EI) programs deliver superior outcomes for individuals with early phase psychosis. Coordinated Specialty Care (CSC) is a recovery-oriented EI treatment program that employs multi-disciplinary team based care with high provider to patient staffing ratios and promotes shared decision making. CSC services are primarily provided in health care clinics. An alternative to “in clinic” service models is tele-health (TH) where clinical care and team interactions occur remotely through TH platforms. The advantages of this model may include reduced costs, bridging geographical distances, decreased stigma and increased flexibility for when and where therapeutic sessions occur. The purpose of this study is to compare the effectiveness of CSC delivered through TH (CSC-TH) versus the standard, clinic-based CSC model (CSC-Clinic). Methods A TH network was established in Indiana, USA to provide statewide CSC services. A “hub” team, comprised of a psychiatrist, therapist, team leader, nurse and data manger, was located in Indianapolis, IN and four “spoke” sites (Ft. Wayne, Anderson, Gary and Bloomington IN), were established across the State. All hub team services were delivered remotely through VIDYO, a leading, HIPPA compliant TH platform which was used on hand-held devices for care deliver in the subjects’ homes, as well as in local CMHCs. The standard clinical CSC program (CSC-Clinic), termed Prevention and Recovery Center (PARC), was located in Indianapolis, IN and all services were obtained through in-person clinic visits. Both the CSC-TH and CSC-Clinic programs employed identical inclusion criteria (16 – 30 years; within 3 years of psychosis onset; and non-substance induced psychotic disorder), assessment instruments, OnTrackNY training for all treatment staff, and outcome measures. Both programs conducted weekly team meetings where all patients were reviewed. Both programs were assessed for fidelity to the CSC model. All CSC patients were newly enrolled over the same treatment period. Data was collected at baseline, 3 months and 6 months. The outcome measures included engagement (drop outs), use of acute services (ER, hospitalization), illness severity (CGI-S), and MIRECC GAF symptoms, occupation/school function and social function. Ratings were independently determined through consensus of the respective treatment teams. Results Thirty-one early phase subjects were enrolled in the CSC-TH and 89 in the CSC-Clinic programs. Analyses demonstrates that CSC-TH was associated with significant and trend level superiority compared to CSC-Clinic for better engagement (3-month: X2=2.89, p=0.09; 6-month: X2=3.12, p=0.05); less use of acute services (3-month: X2= 6.62, p=0.01; 6-month: X2 =7.17, p=0.07); lower MIRECC GAF symptoms (3-month: t=3.2, p=0.002), improved occupation/school function (3-month: t=3.02, p=0.003) and social function (t=3.18, p=0.002). No group differences were found for CGI-S ratings. Discussion These results suggest that CSC-TH was associated with better outcomes compared to CSC-Clinic on key variables. Important caveats, including lack of randomization and blinded ratings, will be discussed. Future studies needed to further evaluate the role of TH in EI programs will be proposed.

Validated Outcome Measures and Postsurgical Scar Assessment Instruments in Auricular Surgery

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Sherman Chu ◽  
Diya Ramanathan ◽  
Jason E. Thuener ◽  
Bryan T. Carroll
Keyword(s):  
Outcome Measures ◽  
Assessment Instruments ◽  
Scar Assessment

scholarly journals Capturing PROMs in Oncology Through Consistent Nutrition Risk Identification: An Opportunity to Optimize Care by Embedding Patient Participation Facilitated by eHealth Tools

2021 ◽  
pp. 1-2
Author(s):  
Susana  Couto Irving 
Keyword(s):  
Outcome Measures ◽  
Patient Participation ◽  
Cancer Care ◽  
Clinical Care ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Risk Identification ◽  
Nutrition Status ◽  
Pancreatic Tumors ◽  
Patient Reported

Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study). <b>Background:</b> E-health based patient-reported outcome measures (PROMs) have the potential to automate early identification of both nutrition status and distress status in cancer patients while facilitating treatment and encouraging patient participation. This cross-sectional study assessed the acceptability, accuracy, and clinical utility of PROMs collected via E-Health tools among patients undergoing treatment for stomach, colorectal, and pancreatic tumors. <b>Results:</b> Eight-nine percent mostly, or completely, agreed that PROMs via tablets should be integrated in routine clinical care. Men were significantly more likely to require help completing the questionnaires than women (inv.OR = 0.51, 95% CI = (0.27, 0.95), p = 0.035). The level of help needed increased by 3% with each 1-year increase in age (inv. OR = 1.03, 95% CI = (1.01, 1.06), p = 0.013). On average, a patient tended to declare weight which was 0.84 kg inferior to their true weight (Bland and Altman 95 % CI = (–3.9, 5.6); SD: 2.41) and a height which was 0.95 cm superior to their true height (Bland and Altman 95 % CI = (−5, 3.1); SD 2.08). Patient-reported nutrition status was significantly associated with the professionally generated assessment (95% CI = (2.27, 4.15), p &#x3c; 0.001). As nutrition status declined, the distress score increased (95%CI = (0.88, 1.68), p &#x3c; 0.001). Of the patients, 48.8% who were both distressed and malnourished requested supportive care to address their problems. <b>Conclusion:</b> Patient-reported assessments utilizing E-health tools are an accurate and efficient method to encourage patient participation in cancer care while simultaneously ensuring that regular assessment of psycho-social and nutritional aspects of care are efficiently integrated in the daily clinical routine.

Validated Outcome Measures and Postsurgical Scar Assessment Instruments in Eyelid Surgery

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Diya Ramanathan ◽  
Sherman Chu ◽  
Mark Prendes ◽  
Bryan T. Carroll
Keyword(s):  
Outcome Measures ◽  
Assessment Instruments ◽  
Eyelid Surgery ◽  
Scar Assessment

Building an Integrative Health Program

2014 ◽  
pp. 56-67
Author(s):  
Mary Jo Kreitzer ◽  
Beth Somerville
Keyword(s):  
Patient Outcome ◽  
Program Evaluation ◽  
Outcome Measures ◽  
Iterative Process ◽  
Clinical Care ◽  
Successful Model ◽  
Integrative Health ◽  
Healthcare Environment ◽  
Strategic Goals ◽  
Patient Outcome Measures

In response to the changing healthcare environment, clinical care transformation can support the strategic goals of organizations. The creation of relevant and successful model(s) begins with a thorough assessment including the voices of all stakeholders. Program design is an iterative process that includes proto-typing, ongoing education and program evaluation. To ensure sustainability, patient outcome measures and employee feedback are an integral part of the new clinical care model.

scholarly journals Diagnosis and outcome measures in trials for neoplastic meningitis: a review of the literature and clinical experience

1998 ◽  
Vol 4 (6) ◽  
pp. E6 ◽  
Author(s):  
Michael J. Glantz ◽  
Marc C. Chamberlin ◽  
Beverly C. Walters
Keyword(s):  
Cerebrospinal Fluid ◽  
Outcome Measures ◽  
Primary Outcome ◽  
Randomized Clinical Trials ◽  
Outcome Measure ◽  
Clinical Care ◽  
Primary Outcome Measure ◽  
Neoplastic Meningitis ◽  
Review Of The Literature ◽  
Cytological Examination

Innovative approaches to the treatment of neoplastic meningitis are being widely tested. Unfortunately, research on diagnostic strategies and outcome measures on which any advances in treatment ultimately depend, has not been avidly pursued. A critical review of the literature on neoplastic meningitis published since 1978 was undertaken by using MEDLINE and other English language databases. All articles addressing the issues of diagnostic or response criteria were included. Randomized clinical trials (RCTs) were emphasized. Prospectively collected data from the authors' institution correlating the results of cerebrospinal fluid (CSF) cytological examinations with Karnofsky Performance Scale (KPS) score are also discussed. Twenty-six studies (representing 1208 patients) fulfilled search criteria. Only three were RCTs. Cerebrospinal fluid cytology was the sole diagnostic criterion in two-thirds of studies. The results of CSF cytological examination alone or in combination with other clinical or laboratory endpoints constituted the primary outcome measure in 85%. Few studies attempted to address known deficiencies in the reliability and validity of these measures, and correlation between measures was poor. Quality of life was never used as a primary outcome measure. All currently available measurements, including CSF cytology, biochemistry, immunological, and molecular markers, neuroimaging studies, clinical examination, and survival, suffer from poor sensitivity and/or specificity, and often correlate poorly with each other. Although CSF cytological examination, performed according to a rigorous, research-supported protocol, may be the optimum diagnostic and outcome measure at this time, additional research is a prerequisite for any further advances in the clinical care of patients with neoplastic meningitis.

Relevance of outcome measures in different cultural groups – does one size fit all?

2007 ◽  
Vol 19 (3) ◽  
pp. 457-466 ◽  
Author(s):  
Helen F. K. Chiu ◽  
Linda C. W. Lam
Keyword(s):  
Developing Countries ◽  
Outcome Measures ◽  
Developed Countries ◽  
Assessment Instruments ◽  
Cultural Groups ◽  
Methodological Issues ◽  
Treatment Benefits ◽  
Cultural Research ◽  
Cross Cultural Research

It is estimated that 24 million people currently have dementia and that two-thirds of them live in developing countries. However, most of the assessment instruments for dementia have originated in developed countries. This paper explores the relevance of outcome measures in clinical trials of dementia drugs in different cultural groups, particularly in developing countries. The challenges of assessing treatment benefits in dementia in such groups include linguistic and cultural diversity, as well as high illiteracy rates, lack of human resources and the time constraints in assessment of patients. This paper also highlights methodological issues in cross-cultural research of cognitive assessment. Improvement in neuropsychiatric outcomes may be of particular importance to people in non-Western cultures. Functional outcomes and global outcomes are potentially useful outcome measures, but more studies are required in various countries. The use of biological markers such as neuroimaging and cerebrospinal fluid studies may not be practical in developing countries due to their costs and acceptability respectively. More work is also needed in the area of quality of life measures in various countries.

scholarly journals The PROactive Cohort Study: Rationale, Design, and Study Procedures

2021 ◽  
Author(s):  
Merel. M Nap-van der Vlist ◽  
Johanna W. Hoefnagels ◽  
Geertje W. Dalmeijer ◽  
Neha Moopen ◽  
van der Cornelis K. Ent ◽  
...  
Keyword(s):  
Cohort Study ◽  
Outcome Measures ◽  
Chronic Condition ◽  
Daily Life ◽  
Longitudinal Design ◽  
Clinical Care ◽  
Psychosocial Problems ◽  
Well Being ◽  
Assessment Tools ◽  
Research Assessment

Abstract Children with a chronic condition face more obstacles than their healthy peers, which may impact their physical, social-emotional, and cognitive development. The PROactive cohort study identifies children with a chronic disease at high risk of debilitating fatigue, decreased daily life participation and psychosocial problems, as well as children who are resilient and thrive despite the challenges of growing up with a chronic condition. Both groups will teach us how we can best support children, adolescents and parents to adapt to and manage a disease, as well as tailor interventions to their specific needs. This cohort follows a continuous longitudinal design. It is based at the Wilhelmina Children's Hospital (WKZ) in the Netherlands and has been running since December 2016. Children with a chronic condition (e.g. cystic fibrosis, juvenile idiopathic arthritis, chronic kidney disease, or congenital heart disease) as well children with medically unexplained fatigue or pain in a broad age range (2-18 years) are included, as well as their parent(s). Data are collected from parents (of children between 2-18 years) and children (8-18 years), as well as data from their electronic health record (EHR). Primary outcome measures are fatigue, daily life participation, and psychosocial well-being, all assessed via patient- and proxy-reported outcome measures. Generic biological/lifestyle, psychological, and social factors were assessed using clinical assessment tools and questionnaires. In the PROactive cohort study the research assessment is an integrated part of clinical care. Children are included when they visit the outpatient clinic and are followed up annually.

Implementation and early adaptation of patient-reported outcome measures into an electronic health record: A technical report

2018 ◽  
Vol 26 (1) ◽  
pp. 129-140 ◽  
Author(s):  
Heather Taffet Gold ◽  
Raj J Karia ◽  
Alissa Link ◽  
Rachel Lebwohl ◽  
Joseph D Zuckerman ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Outcome Measures ◽  
Computerized Adaptive Testing ◽  
Clinical Care ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Measurement Information ◽  
Health Record ◽  
Patient Reported ◽  
Electronic Health

We integrated and optimized patient-reported outcome measures into the electronic health record to provide quantitative, objective data regarding patients’ health status, which is important for patient care, payer contracts, and research. With a multidisciplinary team from information technology, clinical informatics, population health, and physician champions, we used formal human–computer interaction techniques and user-centered design to integrate several technology platforms and computerized adaptive testing for the National Institutes of Health Patient-Reported Outcomes Measurement Information System. The patient-reported outcome measure system leverages software frequently used by health systems and provides data for research and clinical care via a mobile-responsive web application using Symfony, with REDCap for configuring assessments and de-identified data storage. The system incorporates Oracle databases and Epic flowsheets. Patients complete patient-reported outcome measures, with data viewable in MyChart and Epic Synopsis Reports. Researchers can access data portals. The highly usable, successful patient-reported outcome measures platform is acceptable to patients and clinicians and achieved 73 percent overall completion rates.

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